2024-07-01T16:53:53-05:00 2023-08-31 760448495 HAM LANGSTON & BREZINA LLP 2200 MARKET ST STE 400 GALVESTON TX 77550 990 2022-09-01 760480012 UTMB HEALTH PLANS INC UTMB 4097664000 301 UNIVERSITY BOULEVARD RT 0109 GALVESTON TX 775550109 JENNIFER B SARPALIUS PRESIDENT AND CEO 4097664000 2024-07-01 1 JENNIFER SARPALIUS 999009999 0 JOHN R MC KENNA JR P00618649 4097659311 2024-07-01 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z JENNIFER B SARPALIUS 301 UNIVERSITY BLVD RT 0895 GALVESTON TX 775550895 446879 0 X HTTPS://WWW.UTMB.EDU/CHOICEONE-SELECT X 2000 TX SEE SCHEDULE O UTMB HEALTH PLANS, INC. WAS ESTABLISHED TO HELP THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON FULFILL THE MISSION OF EDUCATION, RESEARCH AND PATIENT CARE. FULFILLING THE MISSION OF PATIENT CARE INCLUDES MAINTENANCE OF A MEDICARE SELECT INSURANCE PROGRAM. MEDICARE SELECT IS A MEDICARE SUPPLEMENTAL POLICY AVAILABLE TO RESIDENTS OF GALVESTON COUNTY. 5 0 0 0 0 0 0 0 324786 256515 194642 190364 0 0 519428 446879 0 0 0 0 147628 120933 0 0 0 281676 200317 429304 321250 90124 125629 6472415 6652615 84124 60078 6388291 6592537 X SEE SCHEDULE O UTMB HEALTH PLANS, INC. WAS ESTABLISHED TO HELP THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON FULFILL THE MISSION OF EDUCATION, RESEARCH, AND PATIENT CARE. FULFILLING THE MISSION OF PATIENT CARE INCLUDES MAINTENANCE OF A MEDICARE SELECT INSURANCE PROGRAM. MEDICARE SELECT IS A MEDICARE SUPPLEMENTAL POLICY AVAILABLE TO RESIDENTS OF GALVESTON COUNTY. 0 0 274515 256515 HMO AND MANAGED CARE CONTRACTING FOR THE UNIVERSITY OF TEXAS MEDICAL BRANCH HOSPITALS AND CLINICS AND OTHER SUCH PROVIDERS AS MAY BE NECESSARY AND APPROPRIATE TO ENABLE UTMB TO FULFILL ITS MISSION. 274515 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 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 0 1 15 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 0 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X CHERYL HERROD 4097664045 301 UNIVERSITY BLVD RT 0985 GALVESTON TX 775550985 CHARLES MOUTON MD CHAIR, SOLE MEMBER 1.00 39.00 X 0 1500634 103929 DAVID C GRUENER PRESIDENT AND CEO 2.00 38.00 X 0 353584 6348 C AARON LEMAY CPA JD MSED TREASURER/DIRECTOR 1.00 39.00 X X 0 421432 59751 REBECCA KORENEK MBA MHA VICE CHAIR 1.00 39.00 X 0 850921 103726 MARIA L GONZALEZ SECETARY 13.00 27.00 X 0 87194 2660 BYRON PICKERING JD MA DIRECTOR 1.00 39.00 X 0 241661 6216 DUSTIN J THOMAS FORMER PRESIDENT AND CEO 0.00 X 0 405287 54397 BEN RAIMER MD FORMER CHAIR, SOLE MEMBER 0.00 X 0 927166 2622 CHERYL A SADRO FORMER TREASURER 0.00 X 0 306616 1709 ANISH BHARDWAJ MD FORMER VICE CHAIR 0.00 X 0 842509 4854 0 5937004 346212 0 1 1 0 0 MANAGED CARE 900099 256515 256515 256515 190364 190364 446879 256515 0 190364 X 11531 11531 109398 74308 35090 4 4 6 6 8963 8950 13 158495 158488 7 4 4 4788 4773 15 2 2 4 4 12 12 23467 23408 59 PREMIUM TAX AND FEES 3076 3076 PUBLICATIONS 1500 1500 321250 274515 46735 0 96977 55809 6348271 6568519 16595 17658 10572 10629 6472415 6652615 62623 44610 9469 6371 12032 9097 84124 60078 X 0 0 0 0 6388291 6592537 6388291 6592537 6472415 6652615 125629 78617 0 X 0 1 X 0 0 X X 1 UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON 746000949 6 1 234435 0 1 234435 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART IV, SECTION A, LINE 2 THE SUPPORTED ORGANIZATION IS NOT REQUIRED TO OBTAIN RECOGNITION OF ITS PUBLIC CHARITY STATUS SINCE IT IS A GOVERNMENTAL UNIT DESCRIBED IN IRC 170 (B)(1)(A)(V). 0 UTMB HEALTHCARE SYSTEMS, INC. EXPENSE REIMBURSEMENT 9097 9097 0 1 0 0 0 0 0 0 0 CHARLES MOUTON MD CHAIR, SOLE MEMBER 0 1351908 0 147286 0 1440 0 100000 0 3929 0 1604563 0 0 DAVID C GRUENER PRESIDENT AND CEO 0 319704 0 33760 0 120 0 0 0 6348 0 359932 0 0 C AARON LEMAY CPA JD MSED TREASURER/DIRECTOR 0 389102 0 31130 0 1200 0 50000 0 9751 0 481183 0 0 REBECCA KORENEK MBA MHA VICE CHAIR 0 741211 0 108750 0 960 0 100000 0 3726 0 954647 0 0 BYRON PICKERING JD MA DIRECTOR 0 209161 0 0 0 32500 0 0 0 6216 0 247877 0 0 DUSTIN J THOMAS FORMER PRESIDENT AND CEO 0 329489 0 39325 0 36473 0 50000 0 4397 0 459684 0 0 BEN RAIMER MD FORMER CHAIR, SOLE MEMBER 0 922533 0 0 0 4633 0 0 0 2622 0 929788 0 0 CHERYL A SADRO FORMER TREASURER 0 249498 0 56878 0 240 0 0 0 1709 0 308325 0 0 ANISH BHARDWAJ MD FORMER VICE CHAIR 0 646836 0 195507 0 167 0 0 0 4854 0 847364 0 0 PART I, LINE 3 THE CEO RECEIVES NO COMPENSATION FROM UTMB HEALTH PLANS, INC. HE IS COMPENSATED BY THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON. THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON USES LABOR MARKET SURVEY INFORMATION TO ESTABLISH THE COMPENSATION OF THE CEO. PART I, LINE 4 - SEVERANCE, NONQUALIFIED AND EQUITY-BASED PAYMENTS SEVERANCE NONQUALIFIED EQUITY-BASED CHARLES MOUTON, MD 0 100,000 0 C. AARON LEMAY 0 50,000 0 REBECCA B. KORENEK 0 100,000 0 DUSTIN THOMAS 0 50,000 0 FORM 990, PART VI, SECTION A, LINE 6 THE MEMBER OF UTMB HEALTH PLANS, INC. IS UTMB HEALTHCARE SYSTEMS, INC. WHOSE DESIGNATED REPRESENTATIVE TO ACT FOR THE MEMBER SHALL BE THE THEN-CURRENT CHIEF ADMINISTRATIVE OFFICER OF THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON. THE MEMBER HAS THE SOLE POWER TO DESIGNATE THE OFFICERS OF THE BOARD AND APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7A UTMB HEALTHCARE SYSTEMS, INC. THROUGH ITS DESIGNATED REPRESENTATIVE, THE CHIEF ADMINISTRATIVE OFFICER OF THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON, HAS THE RIGHT TO DESIGNATE THE OFFICERS OF THE BOARD OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B UTMB HEALTHCARE SYSTEMS, INC. THROUGH ITS DESIGNATED REPRESENTATIVE, THE CHIEF ADMINISTRATIVE OFFICER OF THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON, IS REQUIRED TO APPROVE THE FOLLOWING MATTERS OF THE ORGANIZATION: (A) THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; (B) MATERIAL ($100,000) DEVIATIONS FROM ANNUAL OPERATING AND CAPITAL BUDGETS; (C) THE PURCHASE OR ACQUISITION OF ANY PROPERTY, REAL, PERSONAL, OR MIXED, BY THE CORPORATION EXCEEDING $100,000 OR THE LEASE OF ANY SUCH PROPERTY BY THE CORPORATION WHERE THE ANNUAL LEASE PAYMENT EXCEEDS $100,000; (D) THE SALE, GIFT, OR OTHER DISPOSITION OF ANY PROPERTY, REAL, PERSONAL, OR MIXED, OF THE CORPORATION EXCEEDING $100,000; (E) THE MORTGAGE OR OTHER ENCUMBRANCE OF ANY PROPERTY, REAL, PERSONAL, OR MIXED, OF THE CORPORATION IN EXCESS OF $100,000; (F) THE MERGER, DISSOLUTION, OR CONSOLIDATION OF THE CORPORATION; AND (G) THE CREATION OF OR INVESTMENT IN ANY SUBSIDIARY ENTITY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S CEO PRIOR TO BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CORPORATE SECRETARY REVIEWS THE ANNUAL CONFLICTS OF INTEREST QUESTIONNAIRE RESPONSES. THE UTMB HEALTH PLANS, INC. BOARD OF DIRECTORS WILL MONITOR COMPLIANCE AND THE BOARD OF DIRECTORS WILL ADDRESS ANY CONFLICTS THAT ARISE. THE BOARD WILL DETERMINE IF A CONFLICT OF INTEREST EXISTS, AND IF SO, WILL APPLY DISCIPLINARY ACTION AND A CORRECTIVE ACTION PLAN. TO DATE THERE HAVE BEEN NO REPORTED CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST ONLY. FORM 990, PART IX, LINE 11G ACTUARIAL SERVICES: PROGRAM SERVICE EXPENSES 10,496. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,496. CONSULTANT SERVICES - COMPUTER: PROGRAM SERVICE EXPENSES 6,320. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,320. MISC FEES AND OTHER EXPENSES: PROGRAM SERVICE EXPENSES 199. MANAGEMENT AND GENERAL EXPENSES 7. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 206. CLAIM PAYMENT: PROGRAM SERVICE EXPENSES 24,656. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,656. CAPITATION PAYMENT: PROGRAM SERVICE EXPENSES 112,467. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 112,467. OTHER MEDICAL EXPENSE: PROGRAM SERVICE EXPENSES 4,350. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,350. UTMB HEALTHCARE SYSTEMS INC 301 UNIVERSITY BLVD RT 0109 GALVESTON TX 775550109 760682238 MANAGEMENT TX 501(C)(3) LINE 12A, I N/A 0 UTMB AT GALVESTON 301 UNIVERSITY BLVD GALVESTON TX 77555 746000949 HIGHER EDUCATION TX 170C1 N/A N/A 1 FHC FAMILY HEALTHCARE CENTERS INC 301 UNIVERSITY BLVD RT 0109 GALVESTON TX 775550109 760697230 INACTIVE TX N/A C 0 HSI HEALTHCARE SERVICES INC 301 UNIVERSITY BLVD RT 0109 GALVESTON TX 775550109 760632955 INACTIVE TX N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 UTMB HEALTHCARE SYSTEMS INC O 120934 % ALLOCATION UTMB AT GALVESTON M 112467 CAPITATION