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 B, line 11 | Executive management reviewed the draft form 990 and provided the final draft to the formation board of directors for review and approval prior to filing with the IRS. |
| Form 990, Part VI, Section B, line 12c | EACH BOARD MEMBER, OFFICER AND KEY EMPLOYEE OF THE ORGANIZATION IS REQUIRED TO COMPLETE AND SIGN THE CONFLICT OF INTEREST DISCLOSURE STATEMENT UPON APPOINTMENT OR HIRE AS WELL AS ANNUALLY AND WHENEVER NEW INFORMATION OR CHANGES ARISE THAT MY REQUIRE DIFFERENT RESPONSES IN CONNECTION WITH AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST. |
| Form 990, Part VI, Section B, line 15 | As part of the New Jersey Co-Op application process, the sponsoring organization conducted a market assessment of compensation for non-profit health plan executives. Based on the results of the market assessment, the compensation for the interim CEO was introduced in the budget submitted to the Centers for Medicare and Medicaid Services ("CMS") as part of the program application. At the time the interim CEO was hired, CMS again reviewed and approved the ceo position and compensation. The independent board of directors were briefed on the results of the market assessment and on the review and approval by CMS of the CEO position and compensation. |
| Form 990, Part VI, Section C, line 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| Form 990, Part XI, line 9: | Solvency Loan from CMS Disbursed 47,261,069. Change in Non-admitted assets -3,536,075. |
| Form 990, Part XII, Line 1: | THE STATUTORY BASIS FINANCIAL STATEMENTS HAVE BEEN PREPARED IN CONFORMITY WITH THE ACCOUNTING PRACTICES PRESCRIBED OR PERMITTED BY THE NEW JERSEY DEPARTMENT OF BANKING AND INSURANCE ("NJ DOBI"). |
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