TIN:
SCHEDULE O
(Form 990)
Department of the Treasury
Internal Revenue Service
(Form 990)
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
2021
Open to Public
Inspection
Inspection
Name of the organization
Hometown Health Plan Inc
Employer identification number
88-0231433
88-0231433
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 4a | Hometown Health Plan is part of the insurance division of Renown Health and is committed to providing high-quality health plans and great customer service. Hometown Health Plan operates a health maintenance organization and health insurance services to commercial enrollees and to those eligible for Medicare through its Medicare Advantage plan Senior Care Plus. Hometown Health Plan had 9,276 in its commercial product and 19,079 in its Senior Care Plus product as of June 30, 2022. Hometown Health Plan helps its members receive the most appropriate, financially responsible care based upon individual health needs. For the fiscal year ending June 30, 2022, Hometown Health Plan, 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: | Hometown Health Plan pays Providers directly resulting in the issuance of 1099s for these payments. However, Renown Health, the parent organization, pays other independent contractors directly. The actual expense of each independent contractor is directly charged to the assigned entity. The number reported on line 1a reflects the number of 1099s issued to Providers. |
| Form 990, Part V, Line 2a, Number of Employees on W-3: | Hometown Health Plan, Inc. 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 are reported on line 7 of Part IX. |
| 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 6 | Renown Health is the sole corporate member of Hometown Health Plan. |
| Form 990, Part VI, Section A, line 7a | Renown Health, acting through its Board of Directors, appoints the members of the Board of Governors of Hometown Health Plan. |
| Form 990, Part VI, Section A, line 7b | Renown Health must approve any merger, consolidation or dissolution of Hometown Health Plan, any borrowing in excess of $1 million in any fiscal year, and encumbrances of assets and certain other actions not in the 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 Hometown Health Plan 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 | Hometown Health Plan does not make its governing documents, conflict of interest policy, or financial statements available to the general public. |
| Form 990, Part VII and Part IX: | The salaries and benefits reported in Part VII are not directly reflected in Part IX, line 7, as the physicians salaries and benefits are directly allocated to the related entities where the work is being done and reported on those respective tax filings. |
| Form 990, Part XI, line 9: | Affiliation Adjustment 134,950. |
| Form 990, Part XII, Line 2b, Audit Committee: | 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. |
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021
Additional Data
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