Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 3 Significant changes in program services | During 2017, the Company elected to exit the Indiana Health Insurance Exchange ('Exchange") and covered members were notified of the decision to withdraw from the Exchange. The election by the Company was announced on June 21, 2017 and resulted in the discontinuation of coverage for existing members of the Company beginning in 2018 and significantly alters the ongoing operations of the Company. The Company's decision was influenced by uncertainty over the future of the federally subsidized exchange. In 2018 and going forward, the Company intends to discontinue operations after all obligations to policyholders have been satisfied. |
| Form 990, Part VI, Line 15a Compensation Practices- Pt VI, Section B, Lines 15a & 15b | No has been answered to lines 15a & 15 b, as the filing organization does not compensate its officers but rather they are paid by a related organization. |
| Form 990, Part VI, Line 13 Whistleblower Policy | The filing organization maintains a joint policy with MDwise, Inc. |
| Form 990, Part VI, Line 14 Document Retention and Destruction Policy | The filing organization maintains a joint policy with MDwise, Inc. |
| Form 990, Part VI, Line 4 Significant changes to organizational documents | The organization filed with the Indiana Secretary of State effective November 15, 2018 for dissolution after-which additional activities necessary or appropriate to wind up and liquidate the organization's affairs. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | Indiana University Health ("IU Health") shall appoint three members of the board of directors and The Health and Hospital Corporation of Marion County ("HHC") shall appoint two members of the board. In accordance with the organization's governance agreement, if HHC does not make certain additional capital contributions, the number of directors HHC is entitled to appoint may be reduced and the number IUH can appoint may be increased. |
| Form 990, Part VI, Line 8b Documentation of meetings held by committees of governing body | This question was marked 'no' as there are no other committees with authority to act on behalf of the board |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | The President of MDWise Marketplace, Inc. reviewed a final draft of the form 990 prior to filing with the IRS. A final copy of the form 990 was sent to every member of the governing body after it was filed with the IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | The organization REQUIRES THAT ALL BOARD MEMBERS and OFFICERS SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. THE COMPLIANCE OFFICER OF MDWISE, INC. REVIEWS EACH COMPLETED STATEMENT AND IS PRESENT(OR IS REPRESENTED BY A DESIGNEE) AT ALL BOARD MEETINGS TO ENFORCE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. IF AN ISSUE WITH A POTENTIAL CONFLICT IS BROUGHT TO THE TABLE AT A BOARD MEETING, THE PERSON WITH THE POTENTIAL CONFLICT ABSTAINS FROM VOTING ON THE ISSUES. |
| Form 990, Part VI, Line 19 Required documents available to the public | All required documents will be made available upon authorized request. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Loss on discountined operations - -1207762; |
| Form 990, Part XII, Line 2c Change of oversight process or selection process | In 2018, the members of the filing organizations, Indiana University Health ("IU Health") and The Health and Hospital Corporation of Marion County ("HHC"), served as the audit committee for the filing organization. The filing organization in liquidation no longer has its own separate audit committee. |
| Software ID: | 18007697 |
| Software Version: | 2018v3.1 |