Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 1,881,920 | 352,050 | 350,000 | 1,225,000 | 2,291 | 3,811,261 |
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | 13,869,554 | 15,159,067 | 13,336,942 | 14,416,806 | 9,383,888 | 66,166,257 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | 15,751,474 | 15,511,117 | 13,686,942 | 15,641,806 | 9,386,179 | 69,977,518 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 69,977,518 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 15,751,474 | 15,511,117 | 13,686,942 | 15,641,806 | 9,386,179 | 69,977,518 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 104 | 104 | ||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 104 | 104 | ||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 667,638 | 2,501,436 | 3,169,074 | |||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 15,751,474 | 15,511,117 | 13,687,046 | 16,309,444 | 11,887,615 | 73,146,696 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2021 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part III, Line 12, Explanation of Other Income: | Forgiveness of Debt - 2020 Amount: $ 667,638. 2021 Amount: $ 2,501,436. |
| Software ID: | |
| Software Version: |
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 4a | Renown Medical School Associates North ("RMSAN") provides patient care services, medical education, and scientific research. RMSAN provides care to a diverse patient population while providing clinical educational experiences for medical students, residents, and fellows. RMSAN is comprised of seven clinical departments including Family Medicine, Internal Medicine, Pediatrics, Obstetrics/Gynecology, Psychiatry, Speech Pathology and Audiology and Pathology. In 2021, Renown Medical School Associates North entered into an Affiliation Agreement (the "Affiliation") by and among Renown Medical School Associates North, Renown Health ("Renown"), the Board of Regents of the Nevada System of Higher Education on behalf of the University of Nevada, Reno and its School of Medicine: The University of Nevada, Reno School of Medicine ("UNR Med") to more efficiently advance their shared clinical, research and educational purposes. The Affiliation resulted in the integration of medical education, clinical research and clinical practice activities between UNR Med and Renown. The Affiliation is a long-term commitment that establishes Nevada's first integrated health system to advance health and health care through world-class medical education, clinical research and patient care and transforms the delivery of healthcare services and creation of healthy communities throughout Nevada. The goal of the Affiliation is an integrated clinical, educational and research relationship with a shared vision, aligned governance, and unified leadership, through combined efforts working towards the unified vision of "A Healthy Nevada." The Affiliation has a mission of: improving quality patient care; increasing access to care for all, including creating new clinical specialty programs to serve the community; creating new clinical training experiences for residents and students; providing new patient access to clinical trials; expanding the research capabilities of all Parties; creating new residency specialties; increasing medical school student class sizes; and, recruiting physicians to grow clinical, educational and research programs. The Affiliation addresses the provider gap and increases access to care by developing new and innovative ways to train and retain the next generation of Nevada's health care professionals. For the fiscal year ending June 30, 2022, Renown Medical School Associates North, along with its parent, Renown Health and its subsidiaries, provided more than $260 million in benefit to the community (using community benefit numbers gathered by the Nevada Hospital Association using state-approved criteria to ensure consistency). For a full report on the benefit Renown Health provided to our community, as well as our community needs assessment and community benefit plan, go to https://www.renown.org/about/community-commitment. |
| Form 990, Part V, Line 1a, Number reported in Box 3 of Form 1096: | Renown Medical School Associates North has independent contractors, however, Renown Health, the parent organization, pays all the independent contractors directly. The actual expense of each independent contractor is directly charged to the assigned entity. The highest compensated independent contractors are reported on Part VII, Section B. |
| Form 990, Part V, Line 2a, Number of Employees on W-3: | Renown Medical School Associates North has its own employees, however, Renown Health, the parent organization, pays all compensation and employee benefit amounts under a common paymaster arrangement. The actual compensation of each employee is directly charged to their assigned entity. Salaries and benefits are reported on line 7 and 9 of Part IX, respectively. |
| Form 990, Part VI, Section A, line 2 | Anthony Slonim has a business relationship with Ann Beck, Sean Hawthorne, Jamie Winter and Ty Windfeldt. Thomas Graf, Josiah Johnson, Ann Beck, Sean Hawthorne, and Jamie Winter have a business relationship. |
| Form 990, Part VI, Section A, line 4 | The Organization's governing documents were restated from the original Articles of Incorporation from 1997 and the Bylaws from 2009 as a result of an Affiliation Agreement with Renown Health. The amendments for both documents include the following significant changes: 1. The name of the corporation was changed to Renown Medical School Associates North, Inc. (RMSAN). 2. The purpose was expanded to carry out the collaborative purposes described in the Affiliation Agreement by and among Renown Health. 3. The sole member of RMSAN was changed to Hometown Health Plan, Inc. (HHP), a controlled entity of Renown Health. The sole member acts in its capacity as the Board of Directors of RMSAN. Requests for other actions by the sole member may be made through the President and Chief Executive Officer or such other persons as the sole member may designate. 4. The Board of Directors of the sole member HHP serve as the Board of Directors for RMSAN. The Bylaws of the sole member govern the number of and qualifications for service, election, resignation, removal and other affairs regarding appointment and service for the RMSAN Board of Directors. 5. Compensation for Directors is outlined in the Renown Health Compensation for Governing Members policy. Members are not paid for their services on the RMSAN Board of Directors. 6. The Officers of RMSAN are identical to the Officers of the sole member, HHP and consist of a Chair, a Vice Chair, a Treasurer, a Secretary, and a Chief Executive Officer. The duties of the officers were updated to reflect the responsibilities of the sole member's officers. 7. A majority of the whole number of directors constitutes a quorum for transaction of business at all meetings of the Board of Directors. 8. Dissolution of RMSAN may be approved by the sole member or the Board of Directors of RMSAN. Distribution of the assets upon dissolution of RMSAN shall be distributed to Renown Health, or such other 501(c)(3) tax exempt organization(s) selected by Renown Health. 9. Amendments to the governing documents may be made either by the sole member or by the RMSAN Board of Directors. |
| Form 990, Part VI, Section A, line 6 | Hometown Health Plan, Inc. is the sole corporate member of Renown Medical School Associates North. |
| Form 990, Part VI, Section A, line 7a | Hometown Health Plan, Inc., acting through its board of directors, appoints the members of the Board of Governors of Renown Medical School Associates North, Inc. |
| Form 990, Part VI, Section A, line 7b | Hometown Health Plan, Inc. must approve: 1) any changes of a strategic plan 2) selection of independent auditors, employee benefit consultants, legal counsel, and investment advisors 3) insurance and risk management programs 4) annual operating or capital budgets 5) material changes to the budget 6) investment policies 7) contacts among Renown entities 8) changes to governing documents 9) encumbrances of assets in excess of $1 million or real property 10) any borrowing in excess of $1 million in any fiscal year 11) merger, purchase or acquisition of another organization 12) joint venture with any other organization, entity or persons 13) any other material action take outside of ordinary course of business |
| Form 990, Part VI, Section A, line 8b | There was no committee during the year that had the broad authority to act on behalf of the board. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is prepared by the organization's tax department with support from a certified tax preparer. The form is reviewed by the organization's current Controller and current Chief Financial Officer prior to the final Form 990 being sent to the board. The IRS Form 990, as filed with the IRS, is sent to each voting member of the Renown Health Board prior to filing. Along with the forms, the Renown Health board is provided with a narrative that explains the various parts of the Form and their content. |
| Form 990, Part VI, Section B, line 12c | On an annual basis at or prior to the first regular meeting following the election of new board members, the members of the Renown Medical School Associates North Board are given an Annual Disclosure Statement. They are expected to perform a reasonable investigation into their business, financial, family or significant personal relationships to disclose any actual or potential conflicts of interest. If, in connection with a proposed transaction or arrangement involving a Renown Health entity, a board member discovers that an actual or possible conflict of interest has arisen that was not disclosed on the Annual Statement, then the board member must disclose the existence and nature of his or her financial interests to the remaining directors that are considering the proposed transaction or arrangement in a timely manner. If a board member discloses an actual or possible conflict of interest, the board member shall leave the board or committee meeting while the remaining board members discuss the financial interest. The remaining board members shall vote upon and decide whether a conflict of interest actually exists. If the remaining board members determine that a conflict does exist, then appropriate measures are taken to ensure the issue is addressed. |
| Form 990, Part VI, Section C, line 19 | Renown Medical School Associates North does not make its governing documents, conflict of interest policy, or financial statements available to the general public. |
| Form 990, Part IX, line 11g | Professional Fees: Program service expenses 6,678,825. Management and general expenses 277,199. Fundraising expenses 0. Total expenses 6,956,024. Other Purchased Services: Program service expenses 312,689. Management and general expenses 504,648. Fundraising expenses 0. Total expenses 817,337. Cleaning Services: Program service expenses 185,960. Management and general expenses 0. Fundraising expenses 0. Total expenses 185,960. Consulting Services: Program service expenses 175,956. Management and general expenses 252,300. Fundraising expenses 0. Total expenses 428,256. Document Destruction: Program service expenses 0. Management and general expenses 1,046. Fundraising expenses 0. Total expenses 1,046. Garbage: Program service expenses 5,192. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,192. Medical Services (Non Physician): Program service expenses 50,265. Management and general expenses 0. Fundraising expenses 0. Total expenses 50,265. Medical Waste: Program service expenses 7,043. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,043. Other Service Contracts: Program service expenses 144,285. Management and general expenses 3,408. Fundraising expenses 0. Total expenses 147,693. Answering Service: Program service expenses 10,112. Management and general expenses 0. Fundraising expenses 0. Total expenses 10,112. Billing: Program service expenses 50,827. Management and general expenses 0. Fundraising expenses 0. Total expenses 50,827. Payroll Services: Program service expenses 10,129. Management and general expenses 0. Fundraising expenses 0. Total expenses 10,129. Laundry Expense: Program service expenses 984. Management and general expenses 0. Fundraising expenses 0. Total expenses 984. |
| Form 990, Part XI, line 9: | Interaffilate Transfers 18,008,767. Affiliate Adjustment 371,702. |
| Form 990, Part XII, Line 2b, Audit Committee: | The processes for oversight of the consolidated audit and selection of an independent accountant that audited the financial statements changed during the tax year as a result of the affiliation with Renown Health. Renown Health, the sole member of this entity has an audit committee that assumes responsibility for the consolidated audit and selection of the independent accountant. |
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