SCHEDULE O
(Form 990)

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.
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OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
UTMB HEALTH PLANS INC
 
Employer identification number

76-0480012
Return Reference Explanation
FORM 990 - ORGANIZATION'S MISSION UTMB HEALTH PLANS, INC. WAS ESTABLISHED TO HELP THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON FULFILL THE MISSION OF EDUCATION, RESEARCH, AND PATIENT CARE. FULFILLING THE MISSION OF PATIENT CARE INCLUDES MAINTENANCE OF A MEDICARE SELECT INSURANCE PROGRAM. MEDICARE SELECT IS A MEDICARE SUPPLEMENTAL POLICY AVAILABLE TO RESIDENTS OF GALVESTON COUNTY.
FORM 990, PAGE 6, PART VI, LINE 6 THE MEMBER OF UTMB HEALTH PLANS, INC. IS UTMB HEALTHCARE SYSTEMS, INC. WHOSE DESIGNATED REPRESENTATIVE TO ACT FOR THE MEMBER SHALL BE THE THEN- CURRENT CHIEF ADMINISTRATIVE OFFICER OF THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON. THE MEMBER HAS THE SOLE POWER TO DESIGNATE THE OFFICERS OF THE BOARD AND APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BODY.
FORM 990, PAGE 6, PART VI, LINE 7A UTMB HEALTHCARE SYSTEMS, INC. THROUGH ITS DESIGNATED REPRESENTATIVE, THE CHIEF ADMINISTRATIVE OFFICER OF THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON, HAS THE RIGHT TO DESIGNATE THE OFFICERS OF THE BOARD OF THE ORGANIZATION.
FORM 990, PAGE 6, PART VI, LINE 7B UTMB HEALTHCARE SYSTEMS, INC. THROUGH ITS DESIGNATED REPRESENTATIVE, THE CHIEF ADMINISTRATIVE OFFICER OF THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON, IS REQUIRED TO APPROVE THE FOLLOWING MATTERS OF THE ORGANIZATION: (A) THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; (B) MATERIAL (100,000.00) DEVIATIONS FROM ANNUAL OPERATING AND CAPITAL BUDGETS; (C) THE PURCHASE OR ACQUISITION OF ANY PROPERTY, REAL, PERSONAL, OR MIXED, BY THE CORPORATION EXCEEDING 100,000.00 OR THE LEASE OF ANY SUCH PROPERTY BY THE CORPORATION WHERE THE ANNUAL LEASE PAYMENT EXCEEDS 100,000.00; (D) THE SALE, GIFT, OR OTHER DISPOSITION OF ANY PROPERTY, REAL, PERSONAL, OR MIXED, OF THE CORPORATION EXCEEDING 100,000.00; (E) THE MORTGAGE OR OTHER ENCUMBRANCE OF ANY PROPERTY, REAL, PERSONAL, OR MIXED, OF THE CORPORATION IN EXCESS OF 100,000.00; (F) THE MERGER, DISSOLUTION, OR CONSOLIDATION OF THE CORPORATION; AND (G) THE CREATION OF OR INVESTMENT IN ANY SUBSIDIARY ENTITY.
FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S CEO PRIOR TO BEING FILED.
FORM 990, PAGE 6, PART VI, LINE 12C THE CORPORATE SECRETARY REVIEWS THE ANNUAL CONFLICTS OF INTEREST QUESTIONNAIRE RESPONSES. THE UTMB HEALTH PLANS, INC. BOARD OF DIRECTORS WILL MONITOR COMPLIANCE AND THE BOARD OF DIRECTORS WILL ADDRESS ANY CONFLICTS THAT ARISE. THE BOARD WILL DETERMINE IF A CONFLICT OF INTEREST EXISTS, AND IF SO, WILL APPLY DISCIPLINARY ACTION AND A CORRECTIVE ACTION PLAN. TO DATE THERE HAVE BEEN NO REPORTED CONFLICTS OF INTEREST.
FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST ONLY.
FORM 990, PART IX, LINE 11G ACTUARIAL SERVICES 28,340 0 0 CLAIM PAYMENT 61,575 0 0 CAPITATION PAYMENT 131,119 0 0 OTHER MEDICAL EXPENSE 6,170 0 0 CONSULTANT SERVICES-COMPUTER 6,137 0 0 FEES - OTHER 134 3 0 TOTAL 233,475 3 0
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


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