SCHEDULE O
(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 to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
MILLCREEK HEALTH SYSTEM MEDICAL
PROFESSIONAL LIABILITY SELF-INS TRUST
Employer identification number

57-6204119
Identifier Return Reference Explanation
  FORM 990, PART VI, SECTION A, LINE 2 DR. JOHN M. FERRETTI, D.O. AND DR. ANTHONY J. FERRETTI, D.O. - FAMILY RELATIONSHIP
  FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING ITS FORM 990, THE ORGANIZATION PROVIDED ITS BOARD MEMBERS WITH ACCESS TO AN ELECTRONIC COPY OF THE TAX RETURN AND INVITED COMMENTS AND QUESTIONS FROM THE BOARD MEMBERS. PRIOR TO FILING FORM 990, MEMBERS OF THE ORGANIZATION'S FINANCIAL MANAGEMENT CONDUCTED A DETAILED REVIEW OF THE TAX FILING. THROUGHOUT THE REVIEW PROCESS, THERE WAS ONGOING DISCUSSION BETWEEN THE ORGANIZATION'S FINANCIAL MANAGEMENT AND THE TAX PREPARER.
  FORM 990, PART VI, SECTION B, LINE 12C EACH MEMBER OF THE BOARD OF TRUSTEES IS REQUIRED TO COMPLETE A STANDARDIZED CONFLICT OF INTEREST FORM ON AN ANNUAL BASIS. ANY POTENTIAL CONFLICTS OF INTEREST ARE ADDRESSED BY AN APPOINTED COMMITTEE WHOSE MEMBERS ARE INDEPENDENT WITH REGARD TO THE MATTER BEING EXAMINED. IF A POTENTIAL CONFLICT OF INTEREST ARISES, IT IS REVIEWED AND DOCUMENTED BY THE APPOINTED COMMITTEE, AND THEN THE APPOINTED COMMITTEE REPORTS THE RESULTS OF ITS REVIEW TO THE BOARD OF TRUSTEES.
  FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL AND CERTAIN MEMBERS OF ITS BOARD OF TRUSTEES ARE COMPENSATED EMPLOYEES OF RELATED ORGANIZATIONS. THE SALARIES OF THESE INDIVIDUALS ARE DETERMINED BY THE EMPLOYING ORGANIZATION'S FINANCE/BUDGET COMMITTEE, WHICH ACTS AS THE EMPLOYING ORGANIZATION'S COMPENSATION COMMITTEE.
  FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, BY-LAWS, AND FINANCIAL STATMENTS AVAILABLE TO THE GENERAL PUBLIC.
CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CONTRIBUTIONS PER TRUST AGREEMENT 123,000.
OVERSIGHT OF INDEPENDENT FINANCIAL STATEMENT AUDIT FORM 990, PART XI, LINES 2B AND 2C THE FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE ORGANIZATION'S INDEPENDENT FINANCIAL STATEMENT AUDIT. THE PROCESS ASSOCIATED WITH THE OVERSIGHT OF THE INDEPENDENT FINANCIAL STATEMENT AUDIT REMAINS CONSISTENT WITH THE PRIOR FISCAL YEAR. THE ORGANIZATION'S FINANCIAL STATEMENTS REFLECT THE ACTIVITY OF THE ACCOUNTS ESTABLISHED UNDER A TRUST AGREEMENT THAT COMPLIES WITH THE REGULATIONS OF THE INSURANCE DEPARTMENT OF THE COMMONWEALTH OF PENNSYLVANIA (IDCP). THE REGULATIONS OF THE IDCP DIFFER FROM ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA.
ESTIMATE OF AVERAGE HOURS PER WEEK DEVOTED TO A RELATED ORGANIZATION FORM 990, PART VII, SECTION A DR. JOHN M. FERRETTI, D.O.: MEDICAL ASSOCIATES OF ERIE - 5 HOURS PER WEEK MILLCREEK COMMUNITY HOSPITAL - 10 HOURS PER WEEK MILLCREEK MANOR - 5 HOURS PER WEEK MILLCREEK HEALTH SYSTEM - 1 HOUR PER WEEK LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE - 58 HOURS PER WEEK MARY L. ECKERT: MEDICAL ASSOCIATES OF ERIE - 1 HOUR PER WEEK MILLCREEK COMMUNITY HOSPITAL - 72 HOURS PER WEEK MILLCREEK MANOR - 1 HOUR PER WEEK MILLCREEK HEALTH SYSTEM - 1 HOUR PER WEEK LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE - 4 HOURS PER WEEK RICHARD P. OLINGER: MEDICAL ASSOCIATES OF ERIE - 1 HOUR PER WEEK MILLCREEK COMMUNITY HOSPITAL - 31 HOURS PER WEEK MILLCREEK MANOR - 1 HOUR PER WEEK MILLCREEK HEALTH SYSTEM - 1 HOUR PER WEEK LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE -30 HOURS PER WEEK DR. ANTHONY J. FERRETTI, D.O.: LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE - 40 HOURS PER WEEK MILLCREEK HEALTH SYSTEM - 1 HOUR PER WEEK DR. VINCENT S. FIERRO, D.O.: MILLCREEK COMMUNITY HOSPITAL - 3 HOURS PER WEEK LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE - 13 HOURS PER YEAR MILLCREEK MANOR - 1 HOUR PER WEEK MILLCREEK HEALTH SYSTEM - 1 HOUR PER WEEK
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version: