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 6 | THE ASSOCIATION IS COMPRISED OF ALL INSURANCE COMPANIES, NONPROFIT HEALTH CARE SERVICES PLANS, FRATERNAL BENEFIT SOCIETIES, HEALTH MAINTENANCE ORGANIZATIONS, ANY SELF-INSURANCE ARRANGEMENT COVERED BY THE EMPLOYEE RETIREMENT INCOME SECURITY ACT TO THE EXTENT CONSISTENT WITH FEDERAL LAW AND ANY OTHER ENTITY PROVIDING A PLAN OF HEALTH INSURANCE OR HEALTH BENEFITS SUBJECT TO STATE INSURANCE REGULATION, ANY HEALTH INSURANCE REINSURER IN MISSISSIPPI, AND THIRD PARTY ADMINISTRATORS PAYING OR PROCESSING HEALTH INSURANCE CLAIMS FOR ANY MISSISSIPPI RESIDENT. ALL SUCH ENTITIES, AS A CONDITION OF DOING BUSINESS, SHALL BE MEMBERS OF THE ASSOCIATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | PURSUANT TO MISSISSIPPI STATUTE THE MEMBERS OF THE ORGANIZATION ARE EVERY ENTITY AUTHORIZED TO WRITE HEALTH INSURANCE IN THE STATE OF MISSISSIPPI. THE MEMBERS OF THE ORGANIZATION APPOINT THREE (3) MEMBERS TO THE ORGANIZATION'S BOARD OF DIRECTORS (GOVERNING BODY). |
| FORM 990, PART VI, SECTION A, LINE 7B | PURSUANT TO MISSISSIPPI STATUTE CERTAIN DECISIONS OF THE ORGANIZATION'S GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE MISSISSIPPI COMMISSIONER OF INSURANCE. FOR EXAMPLE, ADOPTION OF THE ORGANIZATION'S ARTICLES, BYLAWS AND OPERATING RULES, ADOPTION OF THE ORGANIZATION'S MAJOR MEDICAL EXPENSE COVERAGE AND AMENDMENTS THERETO, RATES FOR COVERAGE ISSUED BY THE ORGANIZATION, RESIDENCY REQUIREMENTS IN CONNECTION WITH ELIGIBILITY FOR COVERAGE, AND ENTERING INTO CONTRACTS WITH SIMILAR ORGANIZATIONS OF OTHER STATES FOR THE JOINT PERFORMANCE OF COMMON ADMINISTRATIVE FUNCTIONS OR WITH PERSONS OR OTHER ORGANIZATIONS FOR THE PERFORMANCE OF ADMINISTRATIVE FUNCTIONS ARE SUBJECT TO THE APPROVAL OF THE MISSISSIPPI COMMISSIONER OF INSURANCE. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY THE ORGANIZATION'S INDEPENDENT CERTIFIED PUBLIC ACCOUNTANTS AND REVIEWED BY THE ORGANIZATION'S EXECUTIVE OFFICER(S) AND/OR COUNSEL. A COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES) IS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY. THE ORGANIZATION'S GOVERNING BODY REVIEWS THE FORM 990, APPROVES THE FORM 990 FOR FILING WITH THE INTERNAL REVENUE SERVICE, AND AUTHORIZES OFFICERS OF THE ORGANIZATION TO EXECUTE THE FORM 990 ON BEHALF OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH DIRECTOR, PRINCIPAL OFFICER, MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST AND BUSINESS ETHICS POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THE ORGANIZATION IS A TAX EXEMPT ORGANIZATION AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN ADDITION TO ANNUAL SIGNED STATEMENTS THE ORGANIZATION CONDUCTS PERIODIC REVIEWS TO ENSURE THE ORGANIZATION IS IN COMPLIANCE WITH ITS CONFLICT OF INTEREST AND BUSINESS ETHICS POLICY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XII, LINE 2C: | THE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT HAS NOT CHANGED FROM THE PRIOR YEAR. |
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