Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | BUSINESS OR FAMILY RELATIONSHIPS: THERE ARE TWO DIRECTORS/BOARD MEMBERS THAT ARE RELATED BY COMMON EMPLOYMENT BY DENVER HEALTH AND HOSPITAL AUTHORITY (AUTHORITY): PEGGY BURNETTE AND DR. SIMON HAMBRIDGE ARE VOTING BOARD MEMBERS THAT ARE EMPLOYEES OF THE AUTHORITY. THE EXECUTIVE DIRECTOR/CEO, MEDICAL DIRECTOR, AND ASSOCIATE CFO OF THE PLAN ARE ALSO EMPLOYEES OF THE AUTHORITY. |
| FORM 990, PART VI, SECTION A, LINE 6 & 7a | DESCRIBE CIRCUMSTANCES FOR MEMBERS ELECTING GOVERNING BODY: THE SOLE MEMBER OF THE DENVER HEALTH MEDICAL PLAN (PLAN) IS THE DENVER HEALTH AND HOSPITAL AUTHORITY (AUTHORITY), A POLITICAL SUBDIVISION OF THE STATE OF COLORADO. THE BOARD OF THE AUTHORITY APPOINTS THE BOARD MEMBERS OF THE PLAN. THE PLAN WAS ORGANIZED FOR THE BENEFIT OF THE AUTHORITY, AND UPON DISSOLUTION, THE NET ASSETS MUST BE DISTRIBUTED TO THE AUTHORITY. |
| FORM 990, PART VI, SECTION B, LINE 11B | PROCESS TO REVIEW THE FORM 990: THE TAX RETURN IS REVIEWED BY EXECUTIVE MANAGEMENT PRIOR TO BEING FILED. AFTER FILING WITH THE IRS, MANAGEMENT THEN PROVIDES COPIES TO ALL MEMBERS OF THE GOVERNING BODY UPON REQUEST. |
| FORM 990, PART VI, SECTION B, LINE 12C | PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: THE ORGANIZATION'S CONFLICT OF INTEREST POLICY COVERS ALL EMPLOYEES AND BOARD MEMBERS. AN ANNUAL REVIEW AND QUESTIONNAIRE IS COMPLETED BY THE AUTHORITY'S OFFICE OF COMPLIANCE, WITH RESULTS REPORTED ANNUALLY TO THE PLAN'S BOARD OF DIRECTORS. THE POLICY ALSO GIVES THE PLAN'S COMPLIANCE COMMITTEE THE POWER TO DETERMINE IF THE PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AND DETERMINES THE APPROPRIATE CORRECTIVE ACTION. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC: THE PLAN MAINTAINS COPIES OF ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AT ITS COMPANY OFFICES IN DENVER, COLORADO, AND MAKES THEM AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART V, LINE 2A | EMPLOYEES FOR THE ORGANIZATION: Denver health medical plan (plan) has no employees. it pays Denver health hospital authority (authority), a political subdivision of the state of Colorado, for a portion of the time of certain authority employees that is spent on the plan's initiatives and operations. the total amount paid to the authority for employees in 2018 was $9,178,244. |
| FORM 990, PART VII, SECTION B, COLUMN B | DESCRIPTION OF SERVICES FOR DENVER HEALTH AND HOSPITAL AUTHORITY: MEDICAL & PHARMACY CLAIMS, CAPITATION PAYMENTS, ADMIN & LEGAL SERVICES, NURSE CALL LINE, SUBROGATION, AND LEASED EMPLOYEES. |
| FORM 990, PART XII, LINE 2B | FINANCIAL STATEMENTS & REPORTING: The Plan is a discretely presented component in the audited financial statements for the Authority which are prepared in accordance with generally accepted governmental accounting principles. in addition, the plan prepares statutory financial statements in accordance with generally accepted accounting practices prescribed by the division of insurance of the department of regulatory agencies of the state of Colorado. these statutory financial statements are separately audited. |
| FORM 990, PART XII, LINE 2C | ORGANIZATION'S OVERSIGHT PROCESS: The Denver Health and Hospital Authority Finance Committee assumes responsibility for the oversight of the audit and selection of the independent accountant. |
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