2023-04-06T11:22:31-05:00 2022-12-31 910189318 MOSS ADAMS LLP 6565 AMERICAS PARKWAY NE STE 600 ALBUQUERQUE NM 87110 990 2022-01-01 270093845 OSMA HEALTH - HEALTH PLAN OSMA 4058439571 313 NE 50TH OKLAHOMA CITY OK 73105 JACK J BELLER MD PRESIDENT 4058439571 2023-04-05 1 JACK BELLER MD 999009999 0 PAMELA ALEXANDERSON P01218925 5058787200 2023-04-05 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JACK J BELLER MD 313 NE 50TH OKLAHOMA CITY OK 73105 14551429 0 X N/A X 2004 OK THE CORPORATION'S SPECIFIC PURPOSES ARE TO (1) ACT AS A SPONSOR OF A HEALTH BENEFIT PROGRAM AND ANY OTHER WELFARE BENEFIT PROGRAMS AS DIRECTED BY THE OSMA HOUSE OF DELEGATES AND/OR BOARD OF TRUSTEES; AND (2) ESTABLISH A TRUST(S) THROUGH WHICH THE HEALTH AND WELFARE BENEFIT PLANS WILL BE OFFERED. 15 13 0 3 315432 274408 0 0 13067897 14235997 294540 315432 0 0 13362437 14551429 0 0 10888690 11268808 49945 82358 0 0 0 2697900 3203015 13636535 14554181 -274098 -2752 12168080 11959151 2019385 2134033 10148695 9825118 X THE CORPORATION'S SPECIFIC PURPOSES ARE TO (1) ACT AS A SPONSOR OF A HEALTH BENEFIT PROGRAM AND ANY OTHER WELFARE BENEFIT PROGRAMS AS DIRECTED BY THE OSMA HOUSE OF DELEGATES AND/OR BOARD OF TRUSTEES; AND (2) ESTABLISH A TRUST(S) THROUGH WHICH THE HEALTH AND WELFARE BENEFIT PLANS WILL BE OFFERED. 0 0 THE CORPORATION'S SPECIFIC PURPOSES ARE TO (1) ACT AS A SPONSOR OF A HEALTH BENEFIT PROGRAM AND ANY OTHER WELFARE BENEFIT PROGRAMS AS DIRECTED BY THE OSMA HOUSE OF DELEGATES AND/OR BOARD OF TRUSTEES; AND (2) ESTABLISH A TRUST(S) THROUGH WHICH THE HEALTH AND WELFARE BENEFIT PLANS WILL BE OFFERED. 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 1 48 0 1 0 1 1 0 0 0 0 0 0 0 X 15 13 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 0 0 0 OK X RICK FRANKLIN 4052905744 13439 BROADWAY EXT SUITE 110 OKLAHOMA CITY OK 73114 JACK BELLER PRESIDENT 15.00 X X 25124 0 0 MICHAEL HAUGH VICE PRESIDENT 2.00 X X 1025 0 0 JOHN ROBINSON TREASURER 2.00 X X 5636 0 0 MARY CLARKE DIRECTOR (THROUGH APRIL 2022) 2.00 X 0 0 0 WES GLINSMANN DIRECTOR 2.00 X 0 0 0 AUDRA HARDIN-LINCK DIRECTOR 2.00 X 3700 0 0 BASEL HASSOUN DIRECTOR 2.00 X 2400 0 0 DIANE HEATON DIRECTOR 2.00 X 4100 0 0 DALE NEIKIRK DIRECTOR 2.00 X 14908 0 0 WILLIAM OEHLERT DIRECTOR 2.00 X 6396 0 0 LEE SCHOEFFLER DIRECTOR 2.00 X 5731 0 0 DAVID SIEGLER DIRECTOR 2.00 X 800 0 0 DANA STONE DIRECTOR 2.00 X 2662 0 0 DARYLE VOSS DIRECTOR 2.00 X 6577 0 0 GREG RATLIFF DIRECTOR 2.00 X 3300 0 0 DAVID HOLDEN DIRECTOR 2.00 X 0 0 0 82359 0 0 0 0 0 0 ASSURED BENEFITS ADMINISTRATORS 8150 N CENTRAL EXPRESSWAY STE 1700 DALLAS TX 75206 BENEFIT ADMINISTRATION 1112977 MAXCARE 3000 E MEMORIAL ROAD EDMOND OK 73013 PHARMACY BENEFIT MANAGER 280515 PAYER COMPASS 5800 GRANITE PARKWAY STE 450 PLANO TX 75024 HOSPITAL CLAIMS PRICING 169792 3 PLAN CONTRIBUTIONS 900099 14235997 14235997 14235997 315432 315432 14551429 14235997 315432 0 11268808 82358 1112977 10530 32100 23327 234295 17344 2680 152624 14553 459767 ADMINISTRATIVE FEES 987951 TRANSITIONAL REINSURANC 81520 INCOME TAX EXPENSE - UB 73347 14554181 320668 375748 6323509 6373370 136417 175819 5352377 4992117 35109 42097 12168080 11959151 18789 351039 39658 103179 1960938 1679815 2019385 2134033 X 0 0 0 0 10148695 9825118 10148695 9825118 12168080 11959151 X -2752 -621854 301029 X 0 1 X 1 0 0 41293 BENEFITS CLAIMS LIABILITIES 1638522 1679815 X 13929575 -621854 -621854 14551429 0 14551429 14554181 0 14554181 0 14554181 PART X, LINE 2: THE PLAN IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C) (9) OF THE INTERNAL REVENUE CODE (IRC) AND IS, THEREFORE, NOT SUBJECT TO FEDERAL INCOME TAXES UNDER PRESENT INCOME TAX LAWS. THE PLAN HAS BEEN APPROVED BY THE INTERNAL REVENUE SERVICE (IRS) FOR TAX-EXEMPT STATUS. HOWEVER, PER CODE SECTION 512(A)(3)(E)(I), TO THE EXTENT THAT A SET-ASIDE FOR ANY GIVEN YEAR CAUSES THE PLAN ASSETS AT YEAR END, TO EXCEED THE ACCOUNT LIMIT AS DESCRIBED BY CODE SECTION 419A, THE EXCESS AMOUNT IS CONSIDERED TO BE UNRELATED BUSINESS TAXABLE INCOME (TO THE EXTENT OF INVESTMENT INCOME). THE PLAN INCURRED INCOME TAX EXPENSE OF $73,347 AND $71,095 DURING THE YEARS ENDED DECEMBER 31, 2022 AND 2021, RESPECTIVELY. IN ACCORDANCE WITH GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, MANAGEMENT EVALUATED THE PLAN'S TAX POSITIONS AND DOES NOT BELIEVE THE PLAN HAS ANY UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO 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. FORM 990, PART VI, SECTION B, LINE 11B THE PRESIDENT OF THE ORGANIZATION PERFORMS A DETAILED REVIEW OF THE FORM 990 BEFORE IT IS SUBMITTED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO FORMALLY ACKNOWLEDGE THEIR COMPLIANCE WITH THE CONFLICT-OF-INTEREST POLICY ON AN ANNUAL BASIS. IF A CONFLICT ARISES, THE BOARD MEMBER CANNOT TAKE PART IN THE DISCUSSION OR VOTE ON THE ISSUE. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: ESTIMATED LIABILITY FOR CLAIMS INCURRED BUT NOT PAID 301,029. OKLAHOMA STATE MEDICAL ASSOCIATION 313 NE 50TH STREET OKLAHOMA CITY OK 73105 730384245 TRADE ASSOCIATION OK 501(C)(6) N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0