2023-11-13T09:54:15-06:00 2022-12-31 910189318 Moss Adams 2882 Prospect Park Dr Rancho Cordova CA 95670 990 2022-07-01 880231433 Hometown Health Plan Inc HOME 7759826488 1155 Mill St CO Tax Treasury Z-4 Reno NV 89502 Ann Beck Chief Financial Officer 7759826488 2023-11-10 1 Ann Beck 999009999 0 Tracy S Paglia P00366884 9165038100 2023-11-10 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z Brian Erling 1155 Mill St C/O Tax Treasury Z-4 Reno NV 89502 147845152 0 X www.hometownhealth.com X 1987 NV An HMO health insurance company. 3 0 0 0 0 0 0 0 269537057 139900012 -386754 768981 167538 73498 269317841 140742491 0 0 0 0 12157621 7196183 0 0 0 282622552 157154739 294780173 164350922 -25462332 -23608431 95684117 79859894 64966658 74822307 30717459 5037587 X Renown Health makes a genuine difference in the health and well-being of the people and communities we serve. 0 0 135656736 139900012 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 8,920 in its commercial product and 18,969 in its Senior Care Plus product as of December 31, 2022. Hometown Health Plan helps its members receive the most appropriate, financially responsible care based upon individual health needs. For the six-month period ended December 31, 2022, Hometown Health Plan, along with its parent, Renown Health and its subsidiaries, provided approximately $99 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. 135656736 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 1 1 0 1 X 1220 0 1 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 0 0 0 X Ann Beck 7759826488 1155 Mill St Z-4 Reno NV 89502 X Matthew Cain Physician - Cardiologist 60.00 0.00 X 1450716 0 28431 Josiah Johnson - President (Jul-Nov)/Chief of Staff 2.00 58.00 X X 0 923348 150427 Athan Roumanas Cardiothoracic CV Surgeon 60.00 0.00 X 1097759 0 29285 Abhilash Akinapelli Physician - Cardiologist 60.00 0.00 X 1013938 0 35342 David Hansen - President and Chair/CEO Hometown Health (Jul-Oct) 57.00 3.00 X X 992940 0 30086 Vlad Radulescu Physician - Cardiologist 60.00 0.00 X 972433 0 26221 Shining Sun Physician - Cardiologist 60.00 0.00 X 934191 0 20496 Thomas Graf - CEO Jul-Nov Chief Clinical & Quality Officer 2.00 58.00 X 0 713325 119311 Ann Beck Chief Financial Officer 2.00 58.00 X 0 669952 109755 Bethany Sexton - President and Chair/CEO (Oct-Dec) 57.00 3.00 X X 192773 266210 87283 Sean Hawthorne - Treasurer (Jul-Oct)/VP of Finance 3.00 57.00 X X 0 377951 35232 Ty Windfeldt Former Officer 0.00 0.00 X 0 305986 8352 Jamie Winter - Secretary /Senior Corporate Counsel 3.00 57.00 X X 0 238655 29733 Samuel King - Former Officer Chief Financial Officer (Jul-Sep) 57.00 3.00 X 260514 0 16699 Anthony Slonim Former Officer 0.00 0.00 X 0 232791 13044 Brian Erling President/CEO (Nov-Dec) 2.00 58.00 X 0 183417 0 Bill Coffin - Treasurer (Oct-Dec)/CFO (Oct-Dec) 3.00 57.00 X X 0 111831 5182 6915264 4023466 744879 497 1 1 0 Delta Dental Insurance Company 1130 Sanctuary Parkway Alpharetta GA 30009 Insurance Claims Processing 5452580 P3 Health Partners 2370 Corporate Circle Suite 300 Henderson NV 89074 Insurance Claims Processing 4326578 Caremore Health Plan of Nevada PO Box 275 Artesia CA 90702 Insurance Claims Processing 2032306 AON Benfield Inc 5600 West 83rd Street 8200 Tower Minneapolis MN 55437 Reinsurance Services 1681708 Extend Insurance Services LLC 10975 Sterling View Drive South Jordan UT 84095 Insurance Broker Services 626979 10 Premium Revenue 524114 132659442 132659442 Administrative Fees 524298 7240570 7240570 139900012 730262 730262 85808 12310 73498 73498 73498 7129070 7090301 50 38769 -50 38719 38719 140742491 139900012 0 842479 X 959843 959843 6236340 6236340 104268 104268 19191325 19191325 366701 1803 364898 12500 12500 225573 225573 220938 220938 Medical Claims Expense 133903900 133903900 Cost Containment Exp 1525460 1525460 Premium Taxes 837165 837165 Regulatory license/fee 310983 310983 455926 455926 164350922 135656736 28694186 0 13030459 2627805 262840 338968 10789909 2449876 8529459 8340033 49277457 48275734 24583902 20277354 95684117 79859894 59904868 52072777 5061790 22749530 64966658 74822307 X 30717459 5037587 30717459 5037587 95684117 79859894 -23608431 -2071441 0 X X 0 1 X 1 0 3189118 3189118 6574033 1665314 4908719 2618 2618 0 1024140 781944 242196 8340033 Cash Reserve Fund - Statutory 750000 Other Receivables 18975825 Affiliate Receivable 551529 20277354 Due to Affiliates 21999530 Insolvency Reserve 750000 22749530 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 Matthew Cain Physician - Cardiologist 918596 0 531958 0 162 0 12200 0 16440 0 1479356 0 0 0 Josiah Johnson - President (Jul-Nov)/Chief of Staff 0 781371 0 139454 0 2523 0 126298 0 25590 0 1075236 0 0 Athan Roumanas Cardiothoracic CV Surgeon 1059297 0 37274 0 1188 0 10577 0 18917 0 1127253 0 0 0 Abhilash Akinapelli Physician - Cardiologist 572787 0 440847 0 304 0 12200 0 23351 0 1049489 0 0 0 David Hansen - President and Chair/CEO Hometown Health (Jul-Oct) 411007 0 90005 0 491928 0 10801 0 20503 0 1024244 0 0 0 Vlad Radulescu Physician - Cardiologist 695493 0 276778 0 162 0 12200 0 14229 0 998862 0 0 0 Shining Sun Physician - Cardiologist 478695 0 455334 0 162 0 12200 0 8505 0 954896 0 0 0 Thomas Graf - CEO Jul-Nov Chief Clinical & Quality Officer 0 709455 0 0 0 3870 0 94702 0 24608 0 832635 0 0 Ann Beck Chief Financial Officer 0 559973 0 98876 0 11103 0 95400 0 15817 0 781169 0 0 Bethany Sexton - President and Chair/CEO (Oct-Dec) 157140 217003 35000 48333 633 874 25784 35607 11378 15712 229935 317529 0 0 Sean Hawthorne - Treasurer (Jul-Oct)/VP of Finance 0 376413 0 0 0 1538 0 10410 0 25136 0 413497 0 0 Ty Windfeldt Former Officer 0 0 0 0 0 305986 0 0 0 8352 0 314338 0 0 Jamie Winter - Secretary /Senior Corporate Counsel 0 237866 0 0 0 789 0 6591 0 23456 0 268702 0 0 Samuel King - Former Officer Chief Financial Officer (Jul-Sep) 214327 0 0 0 46187 0 4669 0 12162 0 277345 0 0 0 Anthony Slonim Former Officer 0 231898 0 0 0 893 0 7012 0 6032 0 245835 0 0 Brian Erling President/CEO (Nov-Dec) 0 146310 0 30000 0 7107 0 0 0 0 0 183417 0 0 Part I, Line 3 Hometown Health Plan, Inc. relied on Renown Health, a related organization to establish compensation for its top management official. Renown Health used the following methods to establish compensation: compensation committee, independent compensation consultant, compensation survey or study, and approval by the board or compensation committee. See Renown Health's Form 990, Schedule O, narrative for Part VI, Section B, Line 15 for a description of the process utilized by Renown Health. Part I, Lines 4a-b David Hansen and Ty Windfeldt received severance payments. Payments of $486,034 to David Hansen and $172,308 to Ty Windfeldt were included in Schedule J, Part II, Column (B)(iii). Thomas Graf, Josiah Johnson, Ann Beck, and Bethany Sexton are parties to a supplemental nonqualified retirement plan. Contributions of $82,502 to Thomas Graf, $114,098 to Josiah Johnson, $84,752 to Ann Beck, $52,092 to Bethany Sexton 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 Brian Erling has a business relationship with Ann Beck, Bill Coffin, and Jamie Winter. Thomas Graf, Josiah Johnson, Ann Beck, Sean Hawthorne, and Jamie Winter have a business relationship. Bill Coffin has a business relationship with Thomas Graf, Josiah Johnson, Ann Beck, and Jamie Winter. Bethany Sexton, Josiah Johnson, and Jamie Winter have a business relationship. Ann Beck has a business relationship with Bethany Sexton. 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 VII, Section A Bethany Sexton was paid by Renown Health for her position as Chief Transformation Officer. As of September 5, 2022, her position changed to CEO Hometown Health. Her wages changed from being paid by Renown Health to Hometown Health Plan at that time. Form 990, Part IX, line 11g Broker Commission Expense: Program service expenses 0. Management and general expenses 2,100,634. Fundraising expenses 0. Total expenses 2,100,634. Outsourced Purchased Services: Program service expenses 0. Management and general expenses 578,210. Fundraising expenses 0. Total expenses 578,210. Purchased Service Overhead Allocation: Program service expenses 0. Management and general expenses 16,222,205. Fundraising expenses 0. Total expenses 16,222,205. Consulting Fees: Program service expenses 0. Management and general expenses 44,227. Fundraising expenses 0. Total expenses 44,227. Medical Services: Program service expenses 0. Management and general expenses 246,049. Fundraising expenses 0. Total expenses 246,049. 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 Medical School Associates North 1155 Mill St Z-4 Reno NV 89502 860881749 Patient Care NV 501(c)(3) Line 10 Hometown Health Plan 1 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 1 1 0 0 0 0 0 0 1 1 0 1 0 1 1 0 0 0 Renown Medical School Associates North M 177605 General Ledger