Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| F990_P05_S00_L02a | Form 990, Part V, Line 2a | Concordia Health Plan (CHP) does not have any employees. Compensation to employees is paid by Concordia Plan Services (CPS), administrator for the plan and a related entity. CHP reimburses CPS through management fees. The salary and benefits allocated to CHP was approximately 40.46% of total salary and benefits. CPS has an agency relationship with The Lutheran Church-Missouri Synod who actually issues the Form W-2s to employees. CPS has 120 employees each who is partially allocated to the plan. |
| F990_P06_S0B_L11b | Form 990, Part VI, Section B, Line 11b | A copy of Form 990 was provided to the Board members prior to the September Board meeting. Board members were given the opportunity to comment and provide input prior to filing Form 990. The Chief Financial Officer reviewed Form 990 prior to filing. |
| F990_P06_S0B_L12c | Form 990, Part VI, Section B, Line 12c | The company requires each employee to review and sign a conflict of interest policy statement each year. |
| F990_P06_S0B_L15 | Form 990, Part VI, Section B, Line 15 | The review procedure for the President is as follows: The chairperson of the Board seeks input from all the board members with respect to performance of the President. With input from Board members, the chairperson completes a draft of the Performance Review Form and shares with the Governance Committee chair. The chairperson revises the form, if necessary, based upon input from the Governance Committee chair. The revised form is then presented to the Governance Committee for discussion. Based on discussion at this meeting, review is finalized for presentation to the full Board. The President and Board chair, and the Governance chair then meet to conduct the review process. The Governance Committee develops a recommendation for a salary increase and/or bonus for the President. These recommendations are presented to the Board for formal approval. Other officers are subject to an independent review prepared by the President and presented to the Governance Committee for approval along with suggested salary and bonus increases. |
| F990_P06_S0C_L19 | Form 990, Part VI, Section C, Line 19 | The annual report is published on the Concordia Plan Services website (www.concordiaplans.org). The conflict of interest policy, governing documents, and financial statements are available upon request. |
| F990_P09_S00_L05 | Form 990, Part IX, Line 5 | Concordia Plan Services (CPS) administers the benefit plans/trusts of The Lutheran Church-Missouri Synod. Concordia Health Plan (CHP) is one of the benefit plans/trusts administered by CPS. Workers are employed by Concordia Plan Services and expenses are allocated to the benefit plans/trusts. One hundred percent of the salaries for CHP are paid by CPS and CHP reimburses CPS through management fees. During 2011 the allocation was 40.46% with the remainder allocated to the other plans/trusts. |
| F990_P09_S00_L07 | Form 990, Part IX, Line 7 | See explanation for Form 990, Part IX, Line 5. |
| F990_P11_S00_L05 | Form 990, Part XI, Line 5 | The total of $110,047 consists of: Investment gain from Master Custody Agreement $3,117,047 and increase in actuarial reserve of ($3,007,000). |
| Software ID: | 11000129 |
| Software Version: | v1.00 |