TIN:
SCHEDULE O
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Inspection
Name of the organization
Washington State Rural Hospital
Insurance Trust
Insurance Trust
Employer identification number
30-6135422
30-6135422
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section A, line 3 | The Trust has contracted with a third-party administrator (Vimly Benefit Solutions, Inc.) to provide bookkeeping and administrative services. |
| Form 990, Part VI, Section A, line 4 | The Trust Agreement was amended and restated effective April 10, 2020. |
| Form 990, Part VI, Section A, line 7a | The Board of Trustees comprises: a) five representatives of separate participating employer hospitals, as appointed by the Association of Washington Public Hospital Districts (Association); b) the Executive Director of the Association, who serves as Chair of the Board of Trustees (Chairperson), or may appoint a qualified individual to serve as Chairperson in his/her stead. If the appointed individual is not a seated trustee with voting capacity, the Executive Director will retain his/her voting capacity, and the appointed individual will have no authority to vote on any Board action or appoint individuals to either of the non-voting trustee positions described in c) or d) below; c) one appointment by the Chairperson of an individual whose position is Chief Financial Officer of one of the participating employers, who will serve as a non-voting trustee; and d) one appointment by the Chairperson of an individual whose position is Human Resources Manager of one of the participating employers, who will serve as a non-voting trustee. |
| Form 990, Part VI, Section B, line 11b | The Form 990 was prepared by the independent accounting firm SCHOEDEL & SCHOEDEL, Certified Public Accountants, PLLC. Draft copies of the Trust's financial statements and Form 990 were first provided to the Trust's consultants and advisors, who reviewed the Form 990 for accuracy and completeness. Any questions, concerns or issues raised by the consultants and advisors were addressed and any necessary revisions were made to the Form 990. The revised Form 990 was then provided to the Board of Trustees for its review and approval. Any additional questions, concerns or issues raised by the Board of Trustees were addressed and any necessary revisions were made to the Form 990. The final version of the Form 990 was reviewed and approved for filing by the Board of Trustees. |
| Form 990, Part VI, Section B, line 12c | All proposed relationships with service providers are reviewed by Trust counsel for compliance with prohibited transactions. All agreements between the Trust and service providers authorized to conduct transactions on behalf of the Trust are provided to Trust counsel for review before execution to ensure that, wherever possible, the agreement contains appropriate restrictions or other protections against prohibited transactions with parties in interest. In addition, all interested persons are required to disclose any actual or possible conflict of interest as soon as it becomes known or should have become known. An interested person is defined as any member of the Board of Trustees or other individual or organization which is delegated with fiduciary responsibility for the assets of the Trust, who has a direct or indirect financial interest, other than being a participant in the Trust. An interested person may make a presentation at the meeting of the Board of Trustees, but after the presentation, he/she must leave the meeting while the remaining Trustees deliberate and vote on the matter. The Chairperson of the Board of Trustees will, if appropriate, appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. After exercising due diligence, the Board of Trustees will determine whether the Trustees can obtain with reasonable efforts a more advantageous transaction or arrangement from a person or entity that would not give rise to a conflict of interest. If a more advantageous transaction or arrangement is not reasonably possible under circumstances not producing a conflict of interest, the Board of Trustees will determine by majority vote of the disinterested Trustees whether the transaction or arrangement is in the Trust's best interests, for its benefit, and whether it is fair and reasonable. In conformity with the above determination, it will make its decision as to whether to enter into the transaction or arrangement. The minutes of the meetings of the Board of Trustees and all committee meetings will contain: 1) the names of the persons who disclosed or otherwise were found to have a financial interest in connection with an actual or possible conflict of interest, the nature of the financial interest, any action taken to determine whether a conflict of interest was present, and the Trustees' decision as to whether a conflict of interest existed; and 2) the names of the persons who were present for discussions and votes relating to the transaction or arrangement, the content of the discussions, including any alternatives to the proposed transaction or arrangement, and a record of any votes taken in connection with the proceedings. |
| Form 990, Part VI, Section B, line 15 | There are no compensated management officials, officers or key employees of the organization. If the organization had such compensated individuals, policies and procedures would be developed to determine compensation. |
| Form 990, Part VI, Section C, line 19 | The Trust's governing documents, conflict of interest policy, financial statements and Form 990 are available to the general public upon written request sent to the Trust in care of Vimly Benefit Solutions, Inc. at: P.O. Box 6; Mukilteo, WA 98275. |
| Form 990, Part VII, Section A, Line 1A: | The Trust does not compensate any of the members of the Board of Trustees. One Trustee is the Executive Director of the Association of Washington Public Hospital Districts (the Association), the sponsor of the Trust. The other Trustees are administrators, chief executive officers, chief financial officers, chief operations officers, or other senior executives of participating employer hospitals. The Executive Director of the sponsor understands that, as part of his employment expectations for the Association, he must serve as the Trust's Chairperson of the Board. His regular compensation from the Association takes into consideration services performed by him in regard to the Trust. The remaining Trustees serve on a volunteer basis, and receive no known compensation from their employers or any other party for their services on the Board. The Trust does not readily have access to information related to compensation paid by other entities to the Trustees. |
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2019
Additional Data
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