2022-05-12T19:23:46-05:00 2021-06-30 910189318 Moss Adams 2882 Prospect Park Dr Rancho Cordova CA 95670 990 2020-07-01 880231433 Hometown Health Plan Inc HOME 7759826488 1155 Mill St CO Tax Treasury Z-4 Reno NV 89502 Ann Beck Chief Financial Officer 7759826488 2022-05-11 1 Ann Beck 999009999 Tracy S Paglia P00366884 9165038100 2022-05-11 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z Thomas Graf 1155 Mill St C/O Tax Treasury Z-4 Reno NV 89502 277722660 0 X www.hometownhealth.com X 1987 NV An HMO health insurance company. 4 0 0 0 0 0 0 0 251970680 237233856 1124958 871435 156203 163219 253251841 238268510 0 0 0 0 22980367 8264847 0 0 0 222000586 233894336 244980953 242159183 8270888 -3890673 114791187 105254347 48157493 43118564 66633694 62135783 X Renown Health makes a genuine difference in the health and well-being of the people and communities we serve. 0 0 207607678 237233856 See Schedule OHometown Health Plan is part of the insurance division of Renown Health and is committed to providing high-quality health plans and great customer service. Hometown Health Plan operates a health maintenance organization and health insurance services to commercial enrollees and to those eligible for Medicare through its Medicare Advantage plan Senior Care Plus. Hometown Health Plan had 7,483 in its commercial HMO and 18,366 in its Senior Care Plus product as of June 30, 2021. Hometown Health Plan helps its members receive the most appropriate, financially responsible care based upon individual health needs. Hometown Health Plan operates community benefit programs such as: an annual influenza immunization campaign for the plan's members and the members of the community at large and a 24 hour health hotline, which is a free service for members of the community to call and receive medical advice and/or coordination of emergency medical services. For the fiscal year ending June 30, 2021, Hometown Health Plan, along with its parent, Renown Health and its subsidiaries, provided more than $198 million in benefit to the community (using community benefit numbers gathered by the Nevada Hospital Association using state-approved criteria to ensure consistency). For a full report on the benefit Renown Health provided to our community, as well as our community needs assessment and community benefit plan, go to https://www.renown.org/about/community-commitment. 207607678 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 X 1039 0 1 0 0 0 0 0 0 0 0 0 X 4 0 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X Ann Beck 7759826488 1155 Mill St Z-4 Reno NV 89502 X David Hansen - PresChair (Aug-Jun)/Chief Executive Officer 60.00 0.00 X X 258974 0 10899 Samuel King - Pres Jul Treasurer/Chief Financial Officer 60.00 0.00 X X 376414 0 35675 Jamie Winter - Secretary Senior Corporate Counsel 3.00 57.00 X X 0 218203 29950 Ty Windfeldt Director/COO 9.00 51.00 X 0 759571 117293 Anthony Slonim President/CEO 2.00 58.00 X 0 1573616 194408 Ann Beck Chief Financial Officer 2.00 58.00 X 0 601098 94641 Athan Roumanas Cardiothoracic CV Surgeon 60.00 0.00 X 1189050 0 27019 Robert Peters Physician - Nocturnist 60.00 0.00 X 901045 0 32425 Joseph Brandl Cardiothoracic CV Surgeon 60.00 0.00 X 893972 0 29618 Christos Galanopoulos VP & Chair of Dept of Surgery 60.00 0.00 X 886970 0 29237 Garrett Green Physician - Radiation Oncologist 60.00 0.00 X 885447 0 31416 Dawn Ahner - Former Officer RRMC COO Acute Care 0.00 60.00 X 0 936811 135647 Linda Ash-Jackson VP & CMO/Former Director 0.00 0.00 X 344323 0 2621 Ryan Mandell - Former Secr Interim General Counsel 0.00 60.00 X 0 244384 25911 5736195 4333683 796760 420 1 1 0 P3 Health Partners 2370 Corporate Circle Suite 300 Henderson NV 89074 Insurance Claims Processing 4935204 Delta Dental Insurance Company 1130 Sanctuary Parkway Alpharetta GA 30009 Insurance Claims Processing 2785730 Caremore Health Plan of Nevada PO Box 275 Artesia CA 90702 Insurance Claims Processing 1381845 Optuminsight Inc 2771 Momentum Pl Chicago IL 60689 Consulting Services 1003666 Eyemed Insurance Company 4000 Luxottica Place Mason OH 45040 Insurance Claims Processing 563895 12 Premium Revenue 524114 228898183 228898183 Administrative Fees 524298 8335673 8335673 237233856 536168 536168 186319 23100 163219 163219 163219 39766317 39430937 113 335380 -113 335267 335267 238268510 237233856 0 1034654 890531 890531 7374316 7374316 68638 68638 23285259 23285259 2216 2216 21820 21820 381351 381351 Medical Claims Expense 205449549 205449549 Cost Containment Exp 2134093 2134093 Premium Taxes 1369646 1369646 Regulatory license/fee 1124563 1124563 57201 57201 242159183 207607678 34551505 0 58758525 68640864 258915 140393 10790884 1882459 9289890 8908425 27139631 7607727 19344226 19956938 114791187 105254347 45545474 39939231 2612019 3179333 48157493 43118564 X 66633694 62135783 66633694 62135783 114791187 105254347 -3890673 -607238 0 X X 0 1 X 1 0 3189118 3189118 6574033 1305967 5268066 2618 2618 0 1025115 573874 451241 8908425 Cash Reserve Fund - Statutory 750000 Other Receivables 17310265 Affiliate Receivable 1896673 19956938 Due to Affiliates 2429333 Insolvency Reserve 750000 3179333 X Part X, Line 2: Hometown Health Plan, Inc. is organized as a Nevada nonprofit entity and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(4). This entity must annually file Returns of Organizations Exempt from Income Tax (Form 990) with the IRS. Hometown Health Plan, Inc. believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the combined financial statements. Hometown Health Plan, Inc. would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 1 0 0 0 0 0 0 0 David Hansen - PresChair (Aug-Jun)/Chief Executive Officer 237835 0 20000 0 1139 0 3846 0 7236 0 270056 0 0 0 Samuel King - Pres Jul Treasurer/Chief Financial Officer 300281 0 73281 0 2852 0 11082 0 24911 0 412407 0 0 0 Jamie Winter - Secretary Senior Corporate Counsel 0 189659 0 26819 0 1725 0 8925 0 21344 0 248472 0 0 Ty Windfeldt Director/COO 0 572400 0 181440 0 5731 0 95400 0 23380 0 878351 0 0 Anthony Slonim President/CEO 0 1104553 0 463028 0 6035 0 172174 0 22235 0 1768025 0 0 Ann Beck Chief Financial Officer 0 503371 0 92700 0 5027 0 78901 0 15739 0 695738 0 0 Athan Roumanas Cardiothoracic CV Surgeon 1096732 0 91084 0 1234 0 10046 0 17185 0 1216281 0 0 0 Robert Peters Physician - Nocturnist 355993 0 542756 0 2296 0 11400 0 21238 0 933683 0 0 0 Joseph Brandl Cardiothoracic CV Surgeon 869597 0 21125 0 3250 0 9945 0 19885 0 923802 0 0 0 Christos Galanopoulos VP & Chair of Dept of Surgery 842503 0 43750 0 717 0 11400 0 18155 0 916525 0 0 0 Garrett Green Physician - Radiation Oncologist 603455 0 280834 0 1158 0 11400 0 20228 0 917075 0 0 0 Dawn Ahner - Former Officer RRMC COO Acute Care 0 707966 0 222960 0 5885 0 114622 0 22512 0 1073945 0 0 Linda Ash-Jackson VP & CMO/Former Director 20618 0 0 0 323705 0 860 0 1899 0 347082 0 0 0 Ryan Mandell - Former Secr Interim General Counsel 0 202815 0 39226 0 2343 0 8406 0 17745 0 270535 0 0 Part I, Line 3 Hometown Health Plan, Inc. relies on Renown Health, a related organization, to establish compensation for officers and other key employees. Renown Health uses the identified methods to establish compensation. See Renown Health Schedule O, Form 990, Part VI, Section B, Line 15 for a description of the process utilized by Renown Health. Part I, Lines 4a-b Anthony Slonim, Ann Beck, Dawn Ahner, and Ty Windfeldt are parties to a supplemental nonqualified retirement plan. Contributions of $160,774 to Anthony Slonim, $67,501 to Ann Beck $103,222 to Dawn Ahner, and $84,000 to Ty Windfeldt were included in Schedule J, Part II, Column (C). Linda Ash-Jackson received a severance payment of $186,350. This payment is included in Schedule J, Part II, Column (B)(iii). 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, Ann Beck, Ty Windfeldt and Jamie Winter have a business relationship. Ty Windfeldt, Sam King and David Hansen 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 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. Renown Health 1155 Mill St Z-4 Reno NV 89502 942972845 Health Care NV 501(c)(3) Line 12c, III-FI N/A 0 Renown Regional Medical Center 1155 Mill St Z-4 Reno NV 89502 880213754 Hospital NV 501(c)(3) Line 3 Renown Health 0 Renown Health Foundation 1155 Mill St Z-4 Reno NV 89502 942972749 Foundation NV 501(c)(3) Line 7 Renown Health 0 Renown South Meadows Medical Center 1155 Mill St Z-4 Reno NV 89502 460517825 Hospital NV 501(c)(3) Line 3 Renown Health 0 Renown Transitional Care Services 1155 Mill St Z-4 Reno NV 89502 880231828 Pregnancy Center NV 501(c)(3) Line 3 Renown Health 0 Renown Businesses 1155 Mill St Z-4 Reno NV 89502 880228030 Health Care NV N/A C 0 Hometown Health Management Company 1155 Mill St Z-4 Reno NV 89502 880236758 Management Services NV N/A C 0 Hometown Health Providers Insurance Co 1155 Mill St Z-4 Reno NV 89502 880177026 Insurance NV N/A C 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 1 0 0