2020-05-15T09:25:28-05:00 2019-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2018-07-01 880231433 Hometown Health Plan Inc HOME 7759826488 1155 Mill St C/O Tax Treasury Z-4 Reno NV 89502 Ann Beck Chief Financial Officer 7759826488 2020-05-14 1 Kim Hunwardsen CPA P00484560 6122536500 2020-05-12 216.147.181.49 2020-05-14 16:18:33 CD P 159D60DA7C19331A7948BEBC6B1067FF5545FF60 EFC25E59FA7409AE560978A003AFB9E955B778C6 2018 2020-09-23 17:36:50Z Ann Beck 1155 Mill St C/O Tax Treasury Z-4 Reno NV 89502 289984021 0 X www.hometownhealth.com X 1987 NV An HMO health insurance company. 3 0 0 25 0 0 0 0 389146673 271523640 1564954 1263603 146503 147557 390858130 272934800 0 0 0 0 110258570 26037356 0 0 0 295419116 231519884 405677686 257557240 -14819556 15377560 124659740 115448901 93711596 57559255 30948144 57889646 X Renown Health makes a genuine difference in the health and well-being of the people and communities we serve. 0 0 209796341 271523640 See Schedule OHometown Health Plan is the insurance division of Renown Health and is committed to providing high-quality health plans and great customer service. Hometown Health 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 6,450 in its commercial HMO and 20,106 in its Senior Care Plus product as of June 30, 2019. 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, 2019, Hometown Health Plan, Inc., along with its parent, Renown Health and its subsidiaries, provided more than $158 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 www.renown.org/communitybenefit. 209796341 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 1172 0 1 0 0 0 0 0 0 0 0 0 0 0 X 3 0 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0 X Ann Beck 7759826488 1155 Mill St Z-4 Reno NV 89502 X Ty Windfeldt PresChair COO Health Services 60.00 0.00 X X 668154 0 113036 Lucius Layfield Secretary (Apr-Jun)/Chief Legal Officer 3.00 57.00 X X 0 590576 90276 Matthew Ladich Sec/Treas (Jul-Apr)/CGPO 60.00 0.00 X X 248602 0 24720 Samuel King Treasurer Apr-Jun Chief Financial Officer 60.00 0.00 X X 327826 0 35757 Linda Ash-Jackson Director (Jul-Apr)/VP & CMO Hometown Health 60.00 0.00 X 474297 0 31493 Anthony Slonim President/CEO 2.00 58.00 X 0 1560947 184005 Hakeem Olanrewaju Chief Financial Officer 2.00 58.00 X 0 366968 14776 David De La Santos Intensivist 60.00 0.00 X 1096111 0 25341 Joshua Jewell Intensivist 60.00 0.00 X 1072874 0 27180 David Smith Cardiologist 60.00 0.00 X 898987 0 33655 Michael Hardacre Section Chief Oncology 60.00 0.00 X 890493 0 34772 Abhinand Peddada Radiation Oncologist 60.00 0.00 X 888687 0 28093 Dawn Ahner - Former Officer Current COO Acute Services 0.00 60.00 X 0 896573 128435 6566031 3415064 771539 334 1 1 0 P3 Health Partners 2370 Corporate Circle Suite 300 Henderson NV 89074 Insurance Claims Processing 2765552 Eyemed Insurance Company 4000 Luxottica Place Mason OH 45040 Insurance Claims Processing 475534 Delta Dental Insurance Company 1130 Sanctuary Parkway Alpharetta GA 30009 Insurance Claims Processing 438650 Infocrossing Services West Inc PO Box 415697 Boston MA 02241 IT Services 431893 Change Healthcare Solutions LLC 3055 Lebanon Pike Suite 1000 Nashville TN 37214 Insurance Claims Processing 390005 7 Premium Revenue 524114 245463398 245463398 Physician Svcs Admin 524298 26060242 26060242 271523640 1344747 1344747 170508 22951 147557 147557 147557 16945126 17021452 4818 -76326 -4818 -81144 -81144 272934800 271523640 0 1411160 1718880 1718880 24318476 24318476 64663 64663 18784803 18784803 18825 18825 379660 379660 Healthcare Expense 206172786 206172786 Cost Containment Exp 3604730 3604730 Regulatory license/fee 1265475 1265475 Premium Taxes 1210342 1210342 18600 18600 257557240 209796341 47760899 0 59638224 56697245 372520 320397 1194385 0 10788102 1117752 10054828 9670350 24430643 25248753 28969140 23512156 124659740 115448901 83693560 53890858 10018036 3668397 93711596 57559255 X 30948144 57889646 30948144 57889646 124659740 115448901 X 15377560 563942 11000000 X X 0 1 X 1 0 3189118 3189118 6570942 827068 5743874 2618 2247 371 1025424 288437 736987 9670350 Cash Reserve Fund - Statutory 1000000 Other Receivables 20635456 Affiliate Receivable 1876700 23512156 Due to Affiliates 2425995 Insolvency Reserve 750000 Contractual Deposit 250000 Ceded Reinsurance Premiums Payable 242402 3668397 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. X X X X 0 1 0 0 0 0 0 0 0 Ty Windfeldt PresChair COO Health Services 475724 0 181384 0 11046 0 84395 0 30707 0 783256 0 0 0 Lucius Layfield Secretary (Apr-Jun)/Chief Legal Officer 0 424495 0 158659 0 7422 0 74097 0 18089 0 682762 0 0 Matthew Ladich Sec/Treas (Jul-Apr)/CGPO 210200 0 37448 0 954 0 8831 0 16332 0 273765 0 0 0 Samuel King Treasurer Apr-Jun Chief Financial Officer 274134 0 50986 0 2706 0 11000 0 25200 0 364026 0 0 0 Linda Ash-Jackson Director (Jul-Apr)/VP & CMO Hometown Health 363789 0 92094 0 18414 0 11000 0 22156 0 507453 0 0 0 Anthony Slonim President/CEO 0 1006488 0 550373 0 4086 0 162674 0 21332 0 1744953 0 0 Hakeem Olanrewaju Chief Financial Officer 0 315480 0 50000 0 1488 0 2077 0 12699 0 381744 0 0 David De La Santos Intensivist 351464 0 742865 0 1782 0 11000 0 14636 0 1121747 0 0 0 Joshua Jewell Intensivist 419231 0 652455 0 1188 0 11000 0 16475 0 1100349 0 0 0 David Smith Cardiologist 712753 0 185460 0 774 0 11000 0 22950 0 932937 0 0 0 Michael Hardacre Section Chief Oncology 662258 0 227965 0 270 0 11000 0 24067 0 925560 0 0 0 Abhinand Peddada Radiation Oncologist 517105 0 369295 0 2287 0 11000 0 17388 0 917075 0 0 0 Dawn Ahner - Former Officer Current COO Acute Services 0 645073 0 240658 0 10842 0 108380 0 22122 0 1027075 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 Schedule O, Form 990, Part VI, Section B, Line 15 for a description of the process utilized by Renown Health. Part I, Line 4b Anthony Slonim, Dawn Ahner, Lucius Layfield, and Ty Windfeldt are parties to a supplemental nonqualified retirement plan. Contributions of $151,674 to Anthony Slonim, $97,380 to Dawn Ahner, $64,200 to Lucius Layfield, and $73,395 to Ty Windfeldt were included in Schedule J, Part II, Column (C). 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, Hakeem Olanrewaju, and Lucius Layfield 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 VP of Finance 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 2019 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 VII and Part IX The current year salaries and benefits reported in Part VII are not directly reflected in Part IX, lines 7 and 9, 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. In the prior year the salaries and benefits reflected in Part IX, lines 7 and 9 reflected all the physician salary and benefits of the individuals employed by the filing entity. Form 990, Part XI, line 9: Capital contribution from related organization 11,000,000. 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) III-FI N/A 0 Renown Regional Medical Center 1155 Mill St Z-4 Reno NV 89502 880213754 Hospital NV 501(c)(3) 3 Renown Health 0 Renown Health Foundation 1155 Mill St Z-4 Reno NV 89502 942972749 Foundation NV 501(c)(3) 7 Renown Health 0 Renown South Meadows Medical Center 1155 Mill St Z-4 Reno NV 89502 460517825 Hospital NV 501(c)(3) 3 Renown Health 0 Renown Transitional Care Services 1155 Mill St Z-4 Reno NV 89502 880231828 Pregnancy Center NV 501(c)(3) 3 Renown Health 0 Renown Skilled Nursing 1155 Mill St Z-4 Reno NV 89502 201347269 Nursing Facility NV 501(c)(3) 10 Renown Health 0 Routt Dialysis LLC 1155 Mill St Z-4 Reno NV 89502 263558729 Kidney Dialysis NV N/A 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