2023-11-11T10:14:38-06:00 2022-12-31 861065722 DELOITTE TAX LLP 50 SOUT SIXTH STREET MINNEAPOLIS MN 55402 990 2022-01-01 872944493 SCAN HEALTH PLAN TEXAS INC SCAN 5629895100 3800 KILROY AIRPORT WAY 100 LONG BEACH CA 90806 KAREN SCHULTE PRESIDENT 5629895100 2023-11-11 1 KAREN SCHULTE 999009999 0 ANNA KOLAKALURI P01275237 6123974000 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z X KAREN SCHULTE 3800 KILROY AIRPORT WAY 100 LONG BEACH CA 90806 4502172 0 X WWW.SCANHEALTHPLAN.COM X 2021 TX KEEP SENIORS HEALTHY AND INDEPENDENT. 3 0 0 0 0 0 1600000 4500000 0 0 0 2172 0 0 1600000 4502172 0 75000 0 0 0 119489 0 0 0 0 3503765 0 3698254 1600000 803918 1600000 3686143 0 1286043 1600000 2400100 KEEP SENIORS HEALTHY AND INDEPENDENT. 0 0 3519538 75000 0 TO SERVE AND IMPROVE THE LIVES OF THE FRAIL, ELDERLY AND DISABLED RESIDENTS OF TEXAS BY PROVIDING MEDICAL AND PHARMACY SERVICES, COORDINATED CARE, SOCIAL SERVICES AND OTHER SERVICES TO A GERIATRIC POPULATION THAT IS UNDERSERVED AND AT RISK. 3519538 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 5 0 1 0 0 0 0 0 0 0 0 0 X 3 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 TX X VIRGINIA HAVAI 5629895100 3800 KILROY AIRPORT WAY LONG BEACH CA 908065616 JAIN MD SACHIN H DIRECTOR & CEO 1.00 39.00 X X 0 3006034 2020160 PLUMB MICHAEL DIRECTOR & CFO 1.00 39.00 X X 0 943395 618386 KROEKER KEVIN B SECRETARY 0.50 39.50 X X 0 785900 525156 MONK NANCY J CHIEF OPERATIONS OFFICER 1.00 39.00 X 0 1743764 611810 STANISLAW SHERRY GENERAL MANAGER OFFICER (START 4/22) 1.00 39.00 X 0 743473 381530 SELBY JILL V SVP PRODUCT DEV & MKT EXP 0.50 39.50 X 0 551752 283727 0 7774318 4440769 0 0 1 0 MILNER BUTCHER MEDIA GROUP LLC 11150 W OLYMPIC BLVD SUITE 835 LOS ANGELES CA 90064 TV & RADIO SERVICES IN HOUSTON AND SAN A 479452 1 4500000 4500000 2172 2172 4502172 0 0 2172 X 75000 75000 187461 108727 78734 -70081 -29046 -41035 2109 1822 287 17241 13679 3562 11125 11125 1306794 1205893 100901 2122206 2117296 4910 2036 983 1053 323 205 118 7871 4913 2958 31275 17132 14143 1222 974 248 3672 1960 1712 3698254 3519538 178716 0 1600000 -25500 3597637 572 9493 0 103941 1600000 3686143 1286043 0 1286043 X 1600000 2400100 1600000 2400100 1600000 3686143 803918 -3818 0 X 0 1 X 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 X PART X, LINE 2: UNDER FASB ASC 740, INCOME TAXES, THE COMPANY IS REQUIRED TO RECOGNIZE A LIABILITY FOR EACH UNCERTAIN TAX POSITION AT THE AMOUNT ESTIMATED TO BE REQUIRED TO SETTLE THE ISSUES. AS OF DECEMBER 31, 2022, THERE WERE NO LIABILITIES RECORDED FOR UNCERTAIN TAX POSITIONS. 1 INTERFAITH MINISTRIES FOR GREATER HOUSTON 3303 MAIN STREET HOUSTON TX 77002 741488102 501(C)(3) 25000 0 SCAN WILL SUPPORT THE INCREASED DEMAND FOR THE MEALS ON WHEELS PROGRAM BY FUNDING PROGRAM MEAL COSTS AND DELIVERY TO LOW-INCOME DISABLED OLDER ADULTS IDENTIFIED AS FOOD INSECURE LIVING IN HARRIS COUNTY. THE $25,000 SCAN GRANT WILL SUPPORT THE EQUIVALENT OF 2,640 MEALS TO 12 SENIORS AND PROVIDE SUPPORT TO 24 FAMILY CAREGIVERS OVER A ONE-YEAR PERIOD. MEALS ON WHEELS SAN ANTONIO 4306 NW LOOP 410 SAN ANTONIO TX 78229 741948646 501(C)(3) 20000 0 SCAN FUNDING WILL SUPPORT 2,800 MEALS TO 380 OLDER ADULT CLIENTS AGES 55+ THAT MEALS ON WHEELS SAN ANTONIO IS NOT ABLE TO OTHERWISE SERVE THROUGH CURRENT FEDERAL FUNDING AND OTHER GRANT ALLOCATIONS. SAN ANTONIO FOOD BANK 5200 ENRIQUE M BARRERA PKWY SAN ANTONIO TX 78227 742122979 501(C)(3) 20000 0 SCAN WILL SUPPORT THE DISTRIBUTION OF 2,667 FRESH PRODUCE BAGS DELIVERED TO 100 SENIORS OVER A ONE-YEAR PERIOD. THE FRESH PRODUCE HOME DELIVERY PROGRAM HELPS TO REDUCE BARRIERS TO FOOD ACCESS FOR MANY VULNERABLE SENIORS THAT LIVE ALONE, HAVE MOBILITY ISSUES, ETC. THE 12 MONTHS OF FRESH PRODUCE ACCESS THROUGH THE SCAN GRANT WILL DIMINISH SHORT-TERM FOOD BARRIERS AND ALLOW FOOD BANK STAFF TO SCREEN AND CONNECT SENIOR CLIENTS TO BENEFITS SUCH AS SNAP, PROVIDE UTILITY PROGRAMS AND HOUSING ASSISTANCE REFERRALS, AND ALSO HELP PARTICIPANTS IDENTIFY NEARBY DISTRIBUTION PARTNERS FOR LONG-TERM FOOD ACCESS PARTICIPATION. HOUSTON FOOD BANK 535 PORTWALL STREET HOUSTON TX 77029 742181456 501(C)(3) 10000 0 SUPPORT CULTURALLY RESPONSIVE FOOD FOR SENIORS PROGRAM. FUNDING WILL ALLOW HOUSTON FOOD BANK TO EXPAND THE SENIOR BOX PROGRAM TO INCLUDE CULTURALLY RESPONSIVE FOOD ITEMS TO 1,500 PARTICIPANTS. CULTURALLY RESPONSIVE FOOD IS DEFINED AS FOODS THAT ARE CULTURALLY TIED TO POPULATIONS THROUGH TRADITIONS, RELIGION, AND CUSTOMS. 4 PART I, LINE 2: ALL GRANTEES SUBMIT IMPACT REPORTS DOCUMENTING METRICS AND PERFORMANCE YEAR-TO-DATE THROUGHOUT THE DURATION OF THE FUNDING, COMMUNITY GIVING STAFF, TRACK AND REVIEW THE REPORTS TO ENSURE COMPLIANCE. COMMUNITY GIVING STAFF ADDRESSES ANY IDENTIFIED ISSUES WITH THE GRANTEE TO DETERMINE CAUSES AND ANY REMEDIATION REQUIRED. ISSUES WITH COMPLIANCE ARE RAISED TO DIRECTOR, COMMUNITY GIVING, WHO WILL ASSIST WITH REMEDIATION OR ELEVATE TO THE COMMUNITY GIVING COMMITTEE (CGC) FOR ADVISEMENT AND/OR APPROVAL IF A CHANGE TO THE GRANTEE'S SCOPE OF WORK IS REQUIRED. 0 1 0 0 0 0 0 0 0 JAIN MD SACHIN H DIRECTOR & CEO 0 976619 0 2022492 0 6923 0 2006845 0 13315 0 5026194 0 1425000 MONK NANCY J CHIEF OPERATIONS OFFICER 0 502765 0 434611 0 806388 0 572454 0 39356 0 2355574 0 1214855 PLUMB MICHAEL DIRECTOR & CFO 0 496761 0 424202 0 22432 0 590423 0 27963 0 1561781 0 424202 KROEKER KEVIN B SECRETARY 0 519406 0 189337 0 77157 0 498755 0 26401 0 1311056 0 240451 STANISLAW SHERRY GENERAL MANAGER OFFICER (START 4/22) 0 380811 0 280125 0 82537 0 362051 0 19479 0 1125003 0 331500 SELBY JILL V SVP PRODUCT DEV & MKT EXP 0 341030 0 186931 0 23791 0 264558 0 19169 0 835479 0 186831 PART I, LINE 3 COMPENSATION FOR SHERRY STANISLAW (GENERAL MANAGER-SCAN HEALTH PLAN TEXAS) WAS ESTABLISHED BY A RELATED ORGANIZATION, SCAN GROUP, AND PAID BY SCAN HEALTH PLAN. SCAN GROUP USED THE FOLLOWING TO ESTABLISH THE PRESIDENT'S COMPENSATION: 1) COMPENSATION COMMITTEE; 2) INDEPENDENT COMPENSATION CONSULTANT; 3) COMPENSATION SURVEY OR STUDY; 4) APPROVAL BY THE SCAN HEALTH PLAN CEO AND SCAN GROUP BOARD OF DIRECTORS. PART I, LINE 4B SCAN GROUP AND SCAN HEALTH PLAN PROVIDE A SUPPLEMENTAL NON QUALIFIED RETIREMENT PLAN TO OFFICERS AND SENIOR VICE PRESIDENTS VIA ITS SECTION 457(F) PLAN. FOR CONTRIBUTIONS MADE PRIOR TO DECEMBER 31, 2017, A PARTICIPANT BECOMES VESTED IN THE 457(F) PLAN UPON COMPLETION OF ONE OF THE CHOSEN VESTING OPTIONS: 1) FIVE YEARS OF SERVICE AND 62 YEARS OF AGE OR 2) CONTRIBUTIONS MADE ON OR AFTER THAT DATE, A PARTICIPANT BECOMES VESTED IN NON-QUALIFIED PLAN PAYMENTS WERE MADE DURING THE YEAR TO THE FOLLOWING 10 YEARS OF SERVICE. ON JANUARY 1, 2018, A NEW PLAN WAS ADOPTED, FOR THE 457(F) PLAN FOLLOWING A 4 YEAR CLASS VESTING CYCLE. SUPPLEMENTAL LISTED PERSONS IN PART VII: NANCY MONK - $ 780,345 KEVIN KROEKER - $ 51,114 SHERRY STANISLAW - $ 51,375 DEFERRED COMPENSATION FOR 2022, REPORTED ON SCHEDULE J, PART 11, COLUMN B AND COLUMN C CONSISTS OF THE FOLLOWING: 1) 457(F) EMPLOYER CONTRIBUTIONS ARE SUBJECT TO VESTING TERMS AND CONDITIONS AS NOTED THE PLAN DOCUMENTS. BASED ON THESE VESTING TERMS AND CONDITIONS, THERE IS SUBSTANTIAL RISK OF FORFEITURE. 2) 457(B) IS A DEFERRED COMPENSATION PLAN THAT THE EMPLOYER AND EMPLOYEE CONTRIBUTE TO, UP TO THE SCAN GROUP AND SCAN HEALTH PLAN DEFINED AND IRS ANNUAL LIMITS. 3) 401(K) QUALIFIED RETIREMENT PLAN CONTRIBUTIONS (EMPLOYER MATCH AND SAFE HARBOR) UP TO THE IRS ANNUAL LIMITS. 4) SCAN GROUP AND SCAN HEALTH PLAN PROVIDE AN INCENTIVE PLAN TO VICE PRESIDENTS AND ABOVE. THE INCENTIVE PLAN IS BASED ON ORGANIZATION AND INDIVIDUAL PERFORMANCE METRICS. PAYMENTS ARE MADE ON OR AROUND APRIL 1 OF THE SUBSEQUENT CALENDAR YEAR. EFFECTIVE JULY 1, 2020, A NEW STRATEGIC INCENTIVE PLAN WAS DEVELOPED FOR THE CEO AND PAYMENTS ARE PAID ANNUALLY IN DECEMBER. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS SCAN GROUP, A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE ACCOUNTING FIRM OF DELOITTE TAX, LLP WORKING IN CONJUNCTION WITH SCAN'S FINANCE DEPARTMENT. SCAN HEALTH PLAN'S DIRECTOR OF ACCOUNTING HAS DIRECT RESPONSIBILITY FOR THIS EFFORT, SUBJECT TO SUPERVISION BY THE VICE PRESIDENT AND CONTROLLER OF SCAN HEALTH PLAN. AFTER AN INITIAL DRAFT OF THE FORM 990 IS PREPARED, IT IS CIRCULATED FOR REVIEW AND COMMENT BY RELEVANT MEMBERS OF THE EXECUTIVE TEAM WHO HAVE RESPONSIBILITY FOR AND/OR KNOWLEDGE REGARDING THE VARIOUS MATTERS DISCLOSED AND/OR DESCRIBED IN THE FORM. THE GENERAL COUNSEL, IN PARTICULAR, REVIEWS THE FORM 990 FOR ACCURACY AND COMPLETENESS. THE FORM 990 IS PROVIDED TO THE SCAN HEALTH PLAN TEXAS BOARD FOR REVIEW AFTER IT IS PREPARED, BUT PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION FOR SHERRY STANISLAW (GENERAL MANAGER-SCAN HEALTH PLAN TEXAS), OFFICERS AND SENIOR VICE PRESIDENT OF SCAN DESERT HEALTH PLAN IS CONDUCTED BY THE HUMAN RESOURCES DEPARTMENT OF SCAN GROUP AND CHIEF EXECUTIVE OFFICER (CEO) OF SCAN HEALTH PLAN, WITH THE APPROVAL OF THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF SCAN GROUP. ALL OF THE VOTING MEMBERS OF THE COMPENSATION COMMITTEE ARE INDEPENDENT DIRECTORS. IN DETERMINING EACH EMPLOYEE'S COMPENSATION, THE HUMAN RESOURCES DEPARTMENT AND COMPENSATION COMMITTEE WORK WITH AND RELY UPON THE COUNSEL AND EXPERTISE OF AN OUTSIDE COMPENSATION CONSULTANT WITH WELL-ESTABLISHED EXPERIENCE AND EXPERTISE IN THE AREA OF NONPROFIT HEALTH CARE ORGANIZATIONS, EXECUTIVE COMPENSATION, AND COMPLIANCE WITH THE INTERMEDIATE SANCTIONS REQUIREMENTS APPLICABLE TO SUCH COMPENSATION. THE COMPENSATION CONSULTANT PROVIDES AN EXECUTIVE COMPENSATION REPORT TO THE HUMAN RESOURCES DEPARTMENT EACH YEAR WHICH FURNISHES THE BASIS FOR THE DETERMINATION OF EACH EMPLOYEE'S COMPENSATION PACKAGE DURING THE FOLLOWING YEAR. THE EXECUTIVE COMPENSATION REPORT IS BASED ON A REVIEW OF THE EXECUTIVE COMPENSATION PRACTICES OF A VARIETY OF ORGANIZATIONS CONSIDERED COMPARABLE TO SCAN HEALTH PLAN BASED ON VARIOUS METRICS. THE CHIEF EXECUTIVE OFFICER (CEO) MAKES A RECOMMENDATION TO THE COMPENSATION COMMITTEE WITH RESPECT TO EACH EMPLOYEE'S COMPENSATION PACKAGE IN LIGHT OF THE EXECUTIVE COMPENSATION REPORT. AT THE COMPENSATION COMMITTEE MEETING ADDRESSING SUCH MATTERS, QUESTIONS ARE ASKED OF, AND ANSWERED BY, THE COMPENSATION CONSULTANT, REGARDING THEIR REPORT AND OTHER MATTERS RELEVANT TO THE COMPENSATION PACKAGE; PURSUANT TO THEIR DELIBERATIONS, THE COMPENSATION COMMITTEE MAKES A DECISION REGARDING THE COMPENSATION PACKAGE FOR SUCH EMPLOYEES FOR THE FOLLOWING YEAR. THE MINUTES OF THE COMPENSATION COMMITTEE FOR THIS MEETING ARE PREPARED SUBSTANTIALLY CONTEMPORANEOUSLY AND SUBSTANTIATE SUCH DELIBERATION AND DECISIONS. THE OUTSIDE COMPENSATION CONSULTANT PROVIDING THE EXECUTIVE COMPENSATION REPORT AND GUIDANCE RELATED TO THE 2022 SALARY PACKAGE WAS SULLIVAN COTTER. FORM 990, PART VI, SECTION C, LINE 19 SCAN HEALTH PLAN TEXAS, INC'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY WERE NOT MADE AVAILABLE TO THE PUBLIC. SCAN HEALTH PLAN TEXAS, INC WAS NOT REQUIRED TO FILE 2022 AUDITED STATUTORY-BASIS FINANCIAL STATEMENTS WITH THE TEXAS DEPARTMENT OF INSURANCE (TDI). SCAN HEALTH PLAN TEXAS, INC'S TAX RETURNS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PREMIUM DEFICIENCY RESERVE: PROGRAM SERVICE EXPENSES 983,367. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 983,367. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 222,526. MANAGEMENT AND GENERAL EXPENSES 100,901. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 323,427. SCAN GROUP 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 953826037 ADMIN SUPPORT CA 501(C)(3) 12B, II N/A 0 THE SCAN FOUNDATION 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 450552845 GRANT MAKING CA 501(C)(3) 12B, II SCAN GROUP 1 SCAN HEALTH PLAN 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 953858259 MEDICARE ADVANTAGE CA 501(C)(3) 10 SCAN GROUP 1 SCAN HEALTH PLAN NEVADA INC 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 854288083 MEDICARE ADVANTAGE NV 501(C)(4) SCAN GROUP 1 SCAN DESERT HEALTH PLAN INC 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 854275186 MEDICARE ADVANTAGE AZ 501(C)(4) SCAN GROUP 1 SCAN HEALTH PLAN NEW MEXICO INC 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 920651838 MEDICARE ADVANTAGE NM 501(C)(4) SCAN GROUP 1 HEALTHCARE IN ACTION INC 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 871858798 MEDICARE ADVANTAGE CA 501(C)(3) 10 SCAN GROUP 1 SCAN HEALTHCHECK ASSESSMENT CENTERS INC 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 462962358 HEALTHCARE CA N/A C 1 ALIVE VENTURES INC 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 852381694 VENTURE STUDIO CA N/A C 1 HEALTHCARE IN ACTION MEDICAL GROUP 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 871942811 HEALTHCARE CA N/A C 1 PROSPER SERVICES LLC 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 872979343 HEALTHCARE CA N/A C 1 SCAN CALIFORNIA MANAGEMENT COMPANY 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 462951831 MANAGEMENT CA N/A C 1 WELCOME HEALTH INC 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 863730275 HEALTHCARE CA N/A C 1 WELCOME HEALTH MEDICAL GROUP 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 872705807 HEALTHCARE CA N/A C 1 WELCOME HEALTH OF CALIFORNIA INC 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 920363899 HEALTHCARE CA N/A C 1 PREVENT TRG HOLDINGS INC 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 880965994 HEALTHCARE CA N/A C 1 THE RESIDENTIALIST GROUP INC 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 330969912 HEALTHCARE CA N/A C 1 HOUSECALLS DOCTORS MEDICAL GROUP INC 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 043644245 HEALTHCARE CA N/A C 1 RESIDENTIALIST HOUSECALL MEDICAL GROUP PC 4190 CITY AVE SUITE 528 PHILADELPHIA PA 19131 474053626 HEALTHCARE PA N/A C 1 MYPLACE GREATER LA PACE INC 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 881512241 HEALTHCARE CA N/A C 1 MYPLACE SOUTH LA PACE INC 3800 KILROY AIRPORT WAY SUITE 100 LONG BEACH CA 90806 923486437 HEALTHCARE CA N/A C 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 SCAN GROUP C 4500000 BOOK VALUE SCAN GROUP P 64206 BOOK VALUE SCAN HEALTH PLAN P 518677 BOOK VALUE