Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | INCLUDES OFFICERS WITH A TOTAL OF NINE LABOR TRUSTEES AND NINE MANAGEMENT TRUSTEES. |
| FORM 990, PART VI, SECTION B, LINE 11 | FORM 990 IS REVIEWED BY ADMINISTRATIVE STAFF AND PRESENTED TO THE HEALTH BOARD OF TRUSTEES FOR APPROVAL PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE TRUSTEES ARE REQUIRED TO COMPLETE AN ANNUAL QUESTIONNAIRE REGARDING ANY POSSIBLE CONFLICTS OF INTEREST. ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST MUST BE DISCLOSED TO THE APPROPRIATE BOARD OR COMMITTEE AND THEY WILL DETERMINE IF A CONFLICT EXISTS AND IF THEY CAN OBTAIN A MORE ADVANTAGEOUS ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT. IF NOT, THE BOARD OR COMMITTEE WILL DETERMINE BY A MAJORITY VOTE OF DISINTERESTED TRUSTEES WHETHER THE TRANSACTION IS IN THE FUNDS BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE AND WILL DECIDE WHETHER TO ENTER INTO THE TRANSACTION ON THAT BASIS. IF THE BOARD OR COMMITTEE BELIEVES THAT A TRUSTEE HAS FAILED TO DISCLOSE, IT WILL GIVE THE TRUSTEE AN OPPORTUNITY TO EXPLAIN. IF THE BOARD OR COMMITTEE DETERMINES THE TRUSTEE HAS FAILED TO DISCLOSE, IT WILL TAKE DISCIPLINARY AND CORRECTIVE ACTION. THE TRUSTEE WITH A CONFLICT MUST LEAVE THE MEETING WHILE THE BOARD OR COMMITTEE MAKES THE DECISION WHETHER A CONFLICT EXISTS. |
| FORM 990, PART VI, SECTION B, LINE 15A | ADMINISTRATIVE MANAGER WAGES ARE DETERMINED BY THE EXECUTIVE COMMITTEE AND APPROVED BY THE FULL BOARD. BALANCE OF FUND OFFICE STAFF ARE RECOMMENDED BY THE ADMINISTRATIVE MANAGER, REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE AND PRESENT TO THE FULL BOARD FOR APPROVAL AT EACH QUARTERLY MEETING. THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2013. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | BANK CHARGES 21,809. AIM COLLECTION FEES 6,138. INPATIENT NOTIFICATION - CMS 78,236. CLAIMS REVIEW - CMS 204,463. PAYROLL AUDIT FEES - BPA 50,690. CONSULTANT FEES 57,750. MISC EXPENSE 16. |
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