2023-05-11T13:46:44-05:00 2022-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-01-01 816073209 Montana Health Network Health Insurance Plan & Trust MONT 4062341420 519 Pleasant Street Miles City MT 59301 Bill Robinson Chair 4062341420 2023-05-08 1 Bill Robinson 999009999 1 Kim Hunwardsen CPA P00484560 6122536500 2023-05-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Bill Robinson 519 Pleasant Street Miles City MT 59301 22666676 0 X N/A X 1993 MT Multiple Employer Voluntary Employee Benefit Association 5 0 0 29 -98901 0 0 0 23117146 22471415 154459 -98901 0 0 23271605 22372514 0 0 19522903 18819742 0 0 0 0 0 1530739 2662191 21053642 21481933 2217963 890581 15268844 17621039 10875 1825933 15257969 15795106 None 0 0 Medical benefits paid for qualified medical claims of participants at 29 healthcare entities. Stop loss insurance premiums paid to manage risk associated with being self-insured on ultimate benefit coverage. 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 3 0 1 0 1 1 0 0 0 0 0 0 0 X 5 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X Lori Backes 4062341420 519 Pleasant Street Miles City MT 59301 X Randy Holom Chair (Thru Sept 22) See Sch. O 1.00 40.00 X X 0 0 0 Bill Robinson Chair (Start Oct 22) See Sch. O 1.00 40.00 X X 0 264438 19847 Greg Drapes Secretary See Sch. O explanation 0.50 40.00 X X 0 0 0 Linda Mehlhoff Member See Sch. O explanatiion 0.50 40.00 X 0 0 0 Holly Wolff Member See Sch. O explanation 0.50 40.00 X 0 0 0 Jeri Chapman Member (Start Oct 22) See Sch. O 0.50 40.00 X 0 0 0 0 264438 19847 0 0 1 0 PacificSource Health Plans 2718 Montana Ave Suite 103 Billings MT 59101 TPA 359328 Allegiance Benefit Plan Management Inc PO Box 3018 Missoula MT 59806 TPA 169906 Montana Health Network Inc 519 Pleasant Street Miles City MT 59301 Administrative Expenses 136903 3 Participating Employers' Contribu 525100 22392426 22392426 Limited continuation of coverage 525100 78989 78989 22471415 195261 195261 294162 -294162 -294162 -294162 22372514 22471415 -98901 0 18819742 30967 27383 828556 35910 730 2356 Surcharge Reimbursement 986170 Premiums paid to insura 749619 500 21481933 5855070 7788289 839236 1148588 275 189 8410863 7699573 163400 984400 15268844 17621039 10875 1825933 10875 1825933 X 0 0 0 0 15257969 15795106 15257969 15795106 15268844 17621039 890581 -353444 0 X 0 1 X 1 0 0 Deposit - Navitus Health 163400 Deposit - PacificSource 821000 984400 X 22019070 -353444 -353444 22372514 0 22372514 21481933 0 21481933 0 21481933 Part X, Line 2: 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 tax position that more likely than not would not be sustained upon examination by the Internal Revenue Service. The Plan is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. 0 0 0 Bill Robinson Chair (Start Oct 22) See Sch. O 0 264438 0 0 0 0 0 9125 0 11577 0 285140 0 0 Form 990, Part VI, Section A, line 1a The Board of Trustees consists of employees of the contributing employers and as such the board members are compensated by the contributing employers for the services they provide as employees of their respective employer. Due to this, they are not considered independent Trustees. Form 990, Part VI, Section A, line 6 The organization is made up of members representing all the employers that purchase health insurance through the trust. Form 990, Part VI, Section A, line 7a Each employer participating in the plan and trust has the right to appoint an individual to the Administrative Committee, which is a non-voting committee. The Administrative Committee appoints a 5 member Executive Committee, which serves as the governing body with voting rights. The Executive Committee meets on a regular basis to make decisions regarding the administration of the trust. Form 990, Part VI, Section A, line 7b Amendments to and termination of the plan and trust are subject to the Administrative Committee's approval. Form 990, Part VI, Section A, line 8b There is no committee with authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b A copy of the Form 990 is e-mailed to all members of the Executive Committee (governing body) and a comment period is provided prior to filing. Form 990, Part VI, Section B, line 12c The non-voting members of the Administrative Committee elect the voting governing body, the Executive Committee. The 33 non-voting members are not required to sign the conflict of interest policy. Only the members of the Executive Committee and Plan Administrator are required to annually complete and sign a conflict of interest form to disclose any potential conflicts of interest. Any conflicts are reviewed by the Committee and the Plan Administrator and a decision is made about whether the member with the conflict should be excluded from discussion and/or vote. Form 990, Part VI, Section C, line 19 The organization makes its governing documents and financial statements available to the public upon request. Form 990, Part VII, Section A, Line 1A, Column (E) and (F): The compensation reported in columns E and F represent compensation paid by our member healthcare entities to their employee for services the employee provides to the Hospital as their employee. No portion of this compensation is provided for the services provided by our Trustees as a Trustee of the Montana Health Network Insurance Plan & Trust. Reasonable Effort to Obtain Compensation: The Trustees of the Montana Heatlh Network Health Insurance Plan & Trust also are employed by the related contributing employers. A questionnaire was sent to the members of the Board of Trustees requesting the compensation and benefits paid by their employer for the services that the Trustee provides as an employee of their tax exempt employer. The organization was able to obtain compensation information from one Trustee. The Montana Heatlh Network Health Insurance Plan & Trust was unable to obtain the related organization compensation from the remaining four Trustees. Volunteer Exception to reporting compensation: The Board Secretary Greg Drapes is an employee of one of the related taxable participating employer. Montana Health Network Health Insurance Plan & Trust does not directly or indirectly own or control the related taxable employer. Additionally, no managment services are provided by the related taxable employer to Montana Health Network Health Insurance Plan & Trust. Due to this exception, the compensation paid to Greg Drapes, for his services as an employee of the related participating employer is not reportable in Part VII and is correctly excluded. Big Horn Hospital Association Central Montana Medical Center Colstrip Medical Center Dahl Memorial Healthcare Association Daniels Memorial Healthcare Center Eastern Montana Community Mental Health Center Frances Mahon Deaconess Hospital Glendive Medical Center Hi-Line Retirement Center Lone Tree Senior Living Monida Healthcare Network Northeast Montana Health Services Northeast Montana STAT Air Ambulance Coop Phillips County Hospital Prairie County Hospital District Prairie Ridge Village LLP Roosevelt Memorial Medical Center Rosebud Health Care Center Roundup Memorial Healthcare Sheridan Memorial Hospital Association Sidney Health Center Sweet Memorial Nursing Home Valley View Nursing Home Wheatland Memorial Hospital Montana Health Network Inc 519 Pleasant Street Miles City MT 59301 810440728 Plan Sponsor MT N/A C 0 Advanced Imaging Community Medical Center Aye Family Dentistry Inc Big Sky Diagnostic Imaging Ravalli Orthopedics & Sports Medicine 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1