| 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 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, Dawn Ahner, and Hakeem Olanrewaju 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 B, line 15a |
Renown Health's executive compensation, including compensation for the CEO and certain executives, is reviewed and approved by the Renown Health Executive Committee. As a member of the executive committee, the CEO abstains from any decisions or discussions related to their own compensation. All decisions are submitted for final ratification at the next scheduled board meeting. The discussion is documented in the Executive Committee minutes and Board minutes. Total cash compensation for the organization's executives is targeted at competitive compensation levels, relative to market surveys of comparable healthcare organizations, based upon the level of performance required to achieve the targeted compensation levels. Base compensation and total cash compensation is reviewed at a minimum of every two years in comparison to the surveys for comparable businesses and responsibilities and adjusted as to maintain equity with the survey information. The Executive Committee undertook the process outlined above for the fiscal year 2018 executive compensation. |
| 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 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. |
Attach to Form 990 or 990-EZ.