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 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
NORTHERN HEALTH PLAN
 
Employer identification number

20-1477015
Return Reference Explanation
FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR AND THE BOARD PRESIDENT FOR ACCURACY. UPON APPROVAL, THE 990 IS ALSO MADE AVAILABLE TO THE BOARD OF DIRECTORS IN ELECTRONIC FORMAT. AFTER ANY CONCERNS PRESENTED BY THE BOARD ARE ADDRESSED, THE EXECUTIVE DIRECTOR SIGNS AND FILES THE RETURN.
FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST STATEMENT IS GIVEN ANNUALLY TO BOARD MEMBERS WHO SIGN A WRITTEN STATEMENT ACKNOWLEDGING THAT THEY HAVE RECEIVED, UNDERSTAND AND AGREE TO ADHERE TO THE POLICY. THERE IS ALSO AN ETHICS COMMITTEE COMPRISED OF INDEPENDENT BOARD MEMBERS. BOARD MEMBERS AND CONTRACTED EMPLOYEES RECEIVE INFORMATION ON HOW TO REPORT POTENTIAL VIOLATIONS OF ETHICAL BEHAVIOR TO THIS COMMITTEE.
FORM 990, PART VI, SECTION C, LINE 19 ALL INFORMATION IS AVAILABLE UPON REQUEST. FORM 990 IS ALSO POSTED ANNUALLY ON GUIDESTAR'S WEBSITE. THE 990 IS PUBLIC INFORMATION THROUGH THE MICHIGAN ATTORNEY GENERAL'S OFFICE.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2015


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