| Return Reference | Explanation |
|---|---|
| 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 Form 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 Form 1099s issued to Providers. |
| Form 990, Part V, Line 2a, Number of Employees on W-3: | Hometown Health Plan 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 | Brian Erling, Anna Loomis, Ann Beck, Jamie Winter and Sean Hawthorne have a business relationship. Anna Loomis and Sean Hawthorne have a business relationship with Bethany Sexton. Bethany Sexton and Rebekah 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 an independent public accounting firm with support from the organization's tax department. The Form 990 is reviewed by the organization's current Corporate Controller and current Chief Financial Officer prior to the final version being sent to the Board. The Form 990, as filed with the IRS, is sent to each voting member of the Renown Health Board prior to filing. Along with the Form 990 and Schedules, the Renown Health Board is provided with a narrative that explains the contents of the various parts of the return. |
| Form 990, Part VI, Section B, line 12c | On an annual basis, 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 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. |
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