2012-09-06T15:21:51-05:00 2011-12-31 310800053 CLARK SCHAEFER HACKETT AND CO ONE EAST FOURTH ST SUITE 1200 CINCINNATI OH 45202 990 2011-01-01 311151537 BUTLER HEALTH PLAN BUTL 5138962300 400 NORTH ERIE BLVD NO B HAMILTON OH 45011 STEPHANIE HEARN 5139426262 2012-08-23 1 KEVIN T DAVIS CPA P00039883 5132413111 2012-08-23 2011 2016-02-24 21:20:13Z STEPHANIE HEARN 1910 FAIRGROVE AVENUE SUITE C HAMILTON OH 45011 79859724 0 X WWW.BUTLERHEALTHPLAN.ORG X 1985 OH PROVIDE MEDICAL AND DENTAL BENEFITS FOR THE EXCLUSIVE BENEFIT OF ITS MEMBERS 7 7 2 0 600498 0 0 0 75070315 79259226 881623 600498 0 0 75951938 79859724 0 0 76310608 78601119 236973 250560 0 0 0 2854377 2908244 79401958 81759923 -3450020 -1900199 21063812 17271435 11046164 9206700 10017648 8064735 THE PLAN PROVIDES HEALTH (HOSPITAL, SURGICAL, MAJOR MEDICAL, AND PRESCRIPTION DRUG) AND DENTAL BENEFITS COVERING SUBSTANTIALLY ALL EMPLOYEES AND ELIGIBLE DEPENDENTS OF A CONSORTIUM OF SCHOOL DISTRICTS IN SOUTHWESTERN OHIO. 0 0 HEALTH CARE BENEFITS - PROVIDING HEALTH CARE COVERAGE TO PARTICIPATING SCHOOLS, SERVING APPROXIMATELY 6,400 INDIVIDUALS/FAMILIES. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 3 0 1 2 1 1 1 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 X STEPHANIE HEARN 5139426262 400 NORTH ERIE BLVD NO B HAMILTON OH 45011 BETH WEBER 1.00 X X 0 0 0 ROBIN WHITE 1.00 X 0 0 0 JAN KESSELRING 1.00 X X 0 0 0 RICHARD PACKERT 1.00 X X 0 0 0 NANCY LANE 1.00 X 0 0 0 CHRISTINE COOK-POETTER 1.00 X 0 0 0 MARSHA MUEGGENBERG 1.00 X 0 0 0 STEPHANIE HEARN 40.00 X 120000 0 21132 120000 0 21132 1 0 0 0 ALLIED BENEFIT SYSTEMS INC 208 SOUTH LASALLE ST STE 1300 CHICAGO IL 60604 ADMINISTRATION FEES 1201450 HEALTHSPAN 225 PICTORIA DRIVE SUITE 320 CINCINNATI OH 45246 ADMINISTRATION FEES 923141 MULTIPLAN 115 FIFTH AVENUE NEW YORK NY 10003 ADMINISTRATION FEES 122179 FIFTH THIRD BANK 5050 KINGSLEY DRIVE CINCINNATI OH 45263 BANKING & INVESTMENT SERVICES 116958 4 MEMBER CONTRIBUTIONS 525100 79259226 79259226 79259226 600498 600498 79859724 79259226 600498 0 78601119 135132 75000 9750 7395 23283 74558 26900 37326 150985 18051 1675 17731 7703 8637 130568 ADMINISTRATION FEES 2270106 BANK FEES 79632 WELLNESS & SUPPORT 42294 DUES & SUBSCRIPTIONS 24841 17237 81759923 1244602 1210594 941200 590606 18878010 15470235 21063812 17271435 2846164 1206700 8200000 8000000 11046164 9206700 X 0 0 0 0 10017648 8064735 10017648 8064735 21063812 17271435 X -1900199 -52714 X X 0 1 1 X 0 0 BENEFIT OBLIGATIONS - IBNR 8000000 8000000 79859724 81759923 -1900199 -52714 -52714 -1952913 79769684 -52714 -52714 79822398 37326 37326 79859724 81922597 200000 200000 81722597 37326 37326 81759923 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT, AS OF DECEMBER 31, 2011, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN ADMINISTRATOR BELIEVES THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS ENDED PRIOR TO DECEMBER 31, 2008. PART XIII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS - CLAIMS INCURRED BUT NOT REPORTED 200,000. FORM 990, PART IV, LINE 32: IN MARCH 2012, THE TRUSTEES APPROVED A MERGER OF THE PLAN, SUBJECT TO THE CONSENT OF THE MAJORITY OF THE MEMBER DISTRICTS. THE PLAN SUBSEQUENTLY RECEIVED CONSENTS FROM A SUFFICIENT NUMBER OF SCHOOL DISTRICTS TO PROCEED WITH THE MERGER. THE PLAN INTENDS TO JOIN OPTIMAL HEALTH INITIATIVES TO FORM A STATE-WIDE, JOINTLY ADMINISTERED ARRANGEMENT WITH NORTHERN BUCKEYE HEALTH PLAN AND SCIOTO HEALTH PLAN. THE THREE MERGING PLANS WILL OPERATE AS DIVISIONS, PROVIDING LOCAL SEPARATION OF ASSETS AND DECISION MAKING FOR ISSUES, SUCH AS PLAN DESIGN, RATES, RESERVE MANAGEMENT, ETC. THE PURPOSE FOR THE MERGER IS TO ENHANCE THE INDEPENDENT SURVIVABILITY OF THE PLAN FROM STATE AND FEDERAL CONTROL BY SIGNIFICANTLY INCREASING THE NUMBER OF MEMBERS SERVED ON A STATE-WIDE BASIS. THE ANTICIPATED EFFECTIVE DATE OF THE MERGER IS SEPTEMBER 1, 2012. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY GOVERNING COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS INITIALLY REVIEWED BY THE EXECUTIVE DIRECTOR WHO PROVIDES THE FORM TO THE BOARD BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, BOARD MEMBERS MUST STATE IF THERE ARE ANY POTENTIAL CONFLICTS. ADDITIONALLY, IF ANY CONFLICTS OCCUR DURING THE YEAR, THE AFFECTED BOARD MEMBER MUST BRING THE CONFLICT BEFORE THE BOARD. THE BOARD MEMBER WITH THE POTENTIAL CONFLICT IS NOT ALLOWED TO VOTE ON THE MATTER. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL PROVIDE PRINT COPIES OF ITS GOVERNING DOCUMENTS UPON WRITTEN REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -52,714. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS AN ANNUAL AUDIT OF THEIR FINANCIAL STATEMENTS AS REQUIRED BY THE DEPARTMENT OF LABOR. OVERSIGHT OF THE AUDIT IS PERFORMED BY MANAGEMENT AND THE BOARD OF TRUSTEES. THIS PROCESS IS CONSISTENT WITH THE PRIOR YEAR. FAIRFIELD CITY SCHOOL DISTRICT 211 DONALD DRIVE FAIRFIELD OH 45014 PUBLIC SCHOOLING OH 501(C)(1) 0 HAMILTON CITY SCHOOL DISTRICT 533 DAYTON STREET HAMILTON OH 45012 PUBLIC SCHOOLING OH 501(C)(1) 0 LAKOTA LOCAL SCHOOLS 5572 PRINCETON ROAD LIBERTY TOWNSHIP OH 45011 PUBLIC SCHOOLING OH 501(C)(1) 0 MIDDLETOWN CITY SCHOOLS 1515 GIRARD AVENUE MIDDLETOWN OH 45044 PUBLIC SCHOOLING OH 501(C)(1) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 FAIRFIELD CITY SCHOOL DISTRICT R 8935045 CASH HAMILTON CITY SCHOOL DISTRICT R 10057530 CASH LAKOTA LOCAL SCHOOLS R 17732963 CASH MIDDLETOWN CITY SCHOOLS R 7658316 CASH