2025-11-11T12:47:12-06:00 2024-12-31 990 2024-01-01 311471229 MOUNT CARMEL HEALTH PLAN INC MOUN 6145464000 3100 EASTON SQUARE PL 300 COLUMBUS OH 432196290 BRIAN ZIMMERMAN VP FINANCE AND CFO 6145464000 2025-11-11 1 2024 2025-03-06 01:10:19Z SEE SCHEDULE O FOR LIST JACK RANDOLPH 3100 EASTON SQUARE PL 300 COLUMBUS OH 432196290 598543717 0 X WWW.THPMEDICARE.ORG X 1996 OH TO OPERATE A MEDICARE HMO FOR SENIORS 9 6 0 6 0 0 0 0 559569201 571992372 10695071 18730538 13459624 7820807 583723896 598543717 0 0 0 0 22356847 25025520 0 0 0 526837759 545992717 549194606 571018237 34529290 27525480 489379422 501777966 89284053 82525095 400095369 419252871 X WE, MOUNT CARMEL AND TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES.MOUNT CARMEL HEALTH PLAN IS A MEMBER OF MOUNT CARMEL AND TRINITY HEALTH. 0 0 537816562 0 579813179 MOUNT CARMEL HEALTH PLAN WAS FORMED IN 1996 FOR THE PURPOSE OF PROVIDING COMPREHENSIVE HEALTH CARE COVERAGE TO SENIORS IN CENTRAL OHIO AS A WHOLLY OWNED SUBSIDIARY OF MOUNT CARMEL HEALTH SYSTEM, A TAX-EXEMPT HEALTH CARE SYSTEM UNDER IRC SECTION 501(C)(3). THE SERVICE AREA WAS EXPANDED TO COVER PARTS OF IOWA IN 2021. MOUNT CARMEL HEALTH PLAN IS A NONPROFIT ORGANIZATION THAT OFFERS BENEFITS THROUGH A MEDICARE ADVANTAGE PLAN (MEDIGOLD) APPROVED BY THE CENTERS OF MEDICARE AND MEDICAID SERVICES (CMS) THAT REPLACES TRADITIONAL MEDICARE COVERAGE. MEDIGOLD SERVES SENIORS AND OTHER MEDICARE BENEFICIARIES IN 62 OHIO COUNTIES AND 58 IOWA COUNTIES.MOUNT CARMEL HEALTH PLAN ENTERED INTO A CONTRACT WITH CMS IN 1996 AS PART OF A DEMONSTRATION PROGRAM TO DETERMINE THE EFFECTIVENESS OF HEALTH CARE PROVIDERS IN PROVIDING MEDICARE COVERAGE TO SENIORS. MEDIGOLD MEMBERS ELECT TO HAVE MOUNT CARMEL HEALTH PLAN (INSTEAD OF THE FEDERAL GOVERNMENT) ADMINISTER THE BENEFITS OF MEDICARE PART A AND PART B, AND MEDIGOLD ALSO OFFERS PHARMACEUTICAL COVERAGE UNDER MEDICARE PART D. MOUNT CARMEL HEALTH PLAN IS REQUIRED TO PROVIDE COVERAGE FOR EVERYTHING THAT THE FEDERAL MEDICARE PROGRAM COVERS, PLUS MEDIGOLD ALSO COVERS ADDITIONAL ITEMS SUCH AS: UNLIMITED INPATIENT HOSPITAL DAYS COVERED AT 100% WITH NO DEDUCTIBLE; OUTPATIENT SURGERY FOR A SMALL CO-PAYMENT; DIAGNOSTIC AND TESTING SERVICES FOR A SMALL CO-PAYMENT; HOME HEALTH CARE AND SKILLED NURSING CARE COVERAGE WHEN NECESSARY; PRESCRIPTION DRUG BENEFITS; PHYSICIAN OFFICE VISITS WITH FIXED CO-PAYMENTS; AND UNLIMITED GENERIC DRUG COVERAGE.MOUNT CARMEL HEALTH PLAN HAS BEEN RECOGNIZED FREQUENTLY AS THE PLAN THAT PROVIDES THE "BEST VALUE TO SENIORS" IN THE CENTRAL OHIO MARKET AS MEASURED BY INDEPENDENT SOURCES ALONG WITH CONSISTENTLY RECEIVING THE HIGHEST MARKS FOR CUSTOMER SATISFACTION AND SERVICE IN THE STATE OF OHIO AS MEASURED BY THE CMS CAHPS SURVEYS. AS AN INTEGRAL PART OF MOUNT CARMEL HEALTH SYSTEM, MOUNT CARMEL HEALTH PLAN IS A COMMUNITY-BASED MANAGED HEALTH CARE ORGANIZATION THAT WORKS IN COLLABORATION WITH EMPLOYERS, INDIVIDUAL MEMBERS, PHYSICIANS, HEALTH CARE PROVIDERS, AND COMMUNITY AND GOVERNMENTAL AGENCIES TO CONTINUALLY IMPROVE THE HEALTH OF ITS MEMBERS BY PROVIDING EXCEPTIONAL COVERAGE AND ACCESS TO HIGH QUALITY AND COST-EFFECTIVE CARE. PLEASE VISIT OUR WEBSITE FOR ADDITIONAL INFORMATION: WWW.THPMEDICARE.ORG/MOUNT-CARMEL 537816562 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 1 616 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X DAVID VIS 8009644525 3100 EASTON SQUARE PLACE COLUMBUS OH 432196232 LORRAINE LUTTON DIRECTOR & MOUNT CARMEL CEO THR 6/24 2.00 53.00 X X 0 1593270 310232 JACK RANDOLPH DIRECTOR; PRESIDENT & CEO 45.00 10.00 X X 0 922877 198404 TAUANA MCDONALD DIRECTOR & MOUNT CARMEL CEO AT 7/24 2.00 53.00 X 0 842723 66881 ANDY PRIDAY MOUNT CARMEL CFO 2.00 48.00 X 0 549581 35089 DANIEL WENDORFF MD FRMR OFF;PRES,MC HLTH PTNRS THR11/24 0.00 50.00 X 0 503479 51714 GREG WISE MD MEDICAL DIRECTOR MCHP 42.00 10.00 X 0 434319 32473 DAVID VIS ASST TREASURER;VP FINANCE OPERATIONS 40.00 10.00 X 0 399687 44341 PETER CONSTANT CHIEF STRATEGIC GROWTH OFFICER MCHP 50.00 0.00 X 0 364540 62126 CARLOS ALVARADO CHIEF ADMINISTRATIVE OFFICER MCHP 40.00 10.00 X 0 332745 54963 PATRICK MCMAHON VP, NETWORK DEVELOPMENT MCHP 50.00 0.00 X 0 320362 40423 MEREDITH MUCHA DIR AT 3/24; MCHS DIR MEDICAL EDUC 2.00 48.00 X 0 329622 22330 TRAVIS DUES DIRECTOR, SALES MCHP 50.00 0.00 X 0 274998 49781 ANGELA THOMAS VICE PRESIDENT, HEALTH SERVICES MCHP 50.00 0.00 X 0 229553 35249 TRISHA WHETSTONE ASST SECRETARY; MCHS ASSOC COUNSEL 2.00 48.00 X 0 219465 44947 PATRICIA SUFFERN CHIEF COMPLIANCE OFFICER MCHP 50.00 0.00 X 0 226201 30917 STEVE LUNDREGAN DIRECTOR; CHAIR 2.00 2.00 X X 0 0 0 JOSEPH PATRICK JR DIRECTOR; TREASURER; SECRETARY 2.00 2.00 X X 0 0 0 CATHY EDDY DIRECTOR 2.00 2.00 X 0 0 0 TODD FOX DIRECTOR 2.00 2.00 X 0 0 0 CHARLES HICKEY DIRECTOR AS OF 3/24 2.00 2.00 X 0 0 0 JILL PHLEGAR DIRECTOR 2.00 2.00 X 0 0 0 0 7543422 1079870 0 1 1 0 ARTHUR JAMES CANCER INSTITUTE 4019 W DUBLIN GRANVILLE ROAD DUBLIN OH 43017 HEALTH CARE SERVICES 19300497 FAIRFIELD MEDICAL CENTER 401 N EWING LANCASTER OH 43130 HEALTH CARE SERVICES 17452007 ZANGMEISTER CANCER CENTER 3100 PLAZA PROPERTIES BLVD COLUMBUS OH 43219 HEALTH CARE SERVICES 13324341 THE OHIO STATE UNIVERSITY HOSPITAL 410 W 10TH AVE COLUMBUS OH 43210 HEALTH CARE SERVICES 12012690 ADENA REGIONAL MEDICAL CENTER 272 HOSPITAL ROAD CHILLICOTHE OH 45601 HEALTH CARE SERVICES 9918800 388 MEDICARE PAYMENTS 524114 547912351 547912351 MEMBER PREMIUMS 524114 24080021 24080021 571992372 13800880 13800880 4929658 0 4929658 4929658 4929658 INTERCOMPANY MANAGEMENT FEES 551114 4168088 4168088 RISK ADJUSTMENT 524114 3652719 3652719 7820807 598543717 579813179 0 18730538 X 2278765 2278765 18985700 18985700 2295131 2295131 1465924 1465924 94 94 286162 286162 428222 428222 526849072 526849072 4967927 4967927 3082459 3082459 5895850 5895850 80515 80515 33243 33243 209185 209185 20797 20797 CORPORATE ALLOCATION 2901503 2901503 TAXES AND LICENSES 1043200 1043200 SUBSCRIPTIONS AND DUES 73567 73567 BAD DEBT EXPENSE 34609 34609 86312 69104 17208 571018237 537816562 33201675 0 38272251 6849715 22344161 26993433 3582678 5155359 4671923 1008203 1081869 3663720 391099871 419419445 32998592 39696294 489379422 501777966 9204206 14239623 249603 255294 79830244 68030178 89284053 82525095 X 400095369 419252871 400095369 419252871 489379422 501777966 X 27525480 9632022 -18000000 X X 0 1 X 1 0 114039 57022 57017 1453653 951181 502472 3104231 3104231 3663720 MISCELLANEOUS RECEIVABLES 84670 INVESTMENT IN SUBSIDIARY 29095519 INTERCOMPANY RECEIVABLES 10516105 39696294 ACCRUED IBNR 43790348 INTERCOMPANY ACCOUNTS PAYABLE 3924861 CMS OVERPAYMENT LIABILITY 16082435 OTHER ACCRUED LIABLITIES 1578759 OTHER LONG TERM LIABILITIES 2653775 68030178 X 587726587 9632022 9632022 578094565 20449152 20449152 598543717 569609951 0 569609951 1408286 1408286 571018237 PART X, LINE 2: ON JANUARY 23, 2007, THE COMPANY WAS RECOGNIZED BY THE IRS, UNDER IRC SECTION 501(C)(4), AS AN ORGANIZATION EXEMPT FROM TAX UNDER SECTION 501(A). THE COMPANY IS ALSO EXEMPT FROM STATE OF OHIO INCOME TAXES. THERE WERE NO DEFERRED INCOME TAX ASSETS, DEFERRED INCOME TAX LIABILITIES, INVESTMENT TAX CREDITS, OR LOSS CARRYFORWARDS AS OF DECEMBER 31, 2024 OR 2023. THE COMPANY DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2024 OR 2023. PART XI, LINE 4B - OTHER ADJUSTMENTS: DIFFERENCE IN REVENUES REPORTED ON STATUTORY BASIS OF ACCOUNTING FOR AUDITED FINANCIAL STATEMENTS(NON-GAAP) BUT REPORTED ON FORM 990 IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES 20,449,152. PART XII, LINE 4B - OTHER ADJUSTMENTS: DIFFERENCE IN EXPENSES AND LOSSES REPORTED ON STATUTORY BASIS OF ACCOUNTING FOR AUDITED FINANCIAL STATEMENTS(NON-GAAP) BUT REPORTED ON FORM 990 IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES 1,408,286. 1 1 0 0 0 0 0 0 0 LORRAINE LUTTON DIRECTOR & MOUNT CARMEL CEO THR 6/24 0 465919 0 469126 0 658225 0 274781 0 35451 0 1903502 0 185719 JACK RANDOLPH DIRECTOR; PRESIDENT & CEO 0 559663 0 223555 0 139659 0 161469 0 36935 0 1121281 0 108601 TAUANA MCDONALD DIRECTOR & MOUNT CARMEL CEO AT 7/24 0 561756 0 187275 0 93692 0 20425 0 46456 0 909604 0 0 ANDY PRIDAY MOUNT CARMEL CFO 0 440144 0 102135 0 7302 0 16675 0 18414 0 584670 0 0 DANIEL WENDORFF MD FRMR OFF;PRES,MC HLTH PTNRS THR11/24 0 418155 0 79458 0 5866 0 20425 0 31289 0 555193 0 0 GREG WISE MD MEDICAL DIRECTOR MCHP 0 369583 0 62217 0 2519 0 8749 0 23724 0 466792 0 0 DAVID VIS ASST TREASURER;VP FINANCE OPERATIONS 0 337085 0 58124 0 4478 0 20425 0 23916 0 444028 0 0 PETER CONSTANT CHIEF STRATEGIC GROWTH OFFICER MCHP 0 308026 0 55087 0 1427 0 20425 0 41701 0 426666 0 0 CARLOS ALVARADO CHIEF ADMINISTRATIVE OFFICER MCHP 0 281330 0 50154 0 1261 0 20398 0 34565 0 387708 0 0 PATRICK MCMAHON VP, NETWORK DEVELOPMENT MCHP 0 271881 0 47293 0 1188 0 20138 0 20285 0 360785 0 0 MEREDITH MUCHA DIR AT 3/24; MCHS DIR MEDICAL EDUC 0 328996 0 0 0 626 0 20185 0 2145 0 351952 0 0 TRAVIS DUES DIRECTOR, SALES MCHP 0 256570 0 18228 0 200 0 13868 0 35913 0 324779 0 0 ANGELA THOMAS VICE PRESIDENT, HEALTH SERVICES MCHP 0 195176 0 34194 0 183 0 15043 0 20206 0 264802 0 0 TRISHA WHETSTONE ASST SECRETARY; MCHS ASSOC COUNSEL 0 193664 0 25633 0 168 0 14918 0 30029 0 264412 0 0 PATRICIA SUFFERN CHIEF COMPLIANCE OFFICER MCHP 0 191611 0 33415 0 1175 0 15003 0 15914 0 257118 0 0 PART I, LINE 3 MOUNT CARMEL HEALTH PLAN IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. MOUNT CARMEL HEALTH PLAN'S CEO IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF MOUNT CARMEL HEALTH PLAN'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINES 4A-B THE FOLLOWING INDIVIDUAL RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2024. THIS AMOUNT IS INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: LORRAINE LUTTON - $441,590 IN ADDITION, COLUMN C OF SCHEDULE J, PART II INCLUDES THE FOLLOWING SEVERANCE AMOUNT, WHICH WAS UNPAID AS OF 12/31/24: LORRAINE LUTTON - $254,356 (PAID IN 2025) THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2024. THE PLAN PROVIDES RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. PARTICIPANTS' VESTED BENEFITS WERE PAID OUT IN 2024, AND THEIR NON-VESTED BENEFITS FOR 2024 WERE ACCRUED. THE FOLLOWING PAYOUTS FOR 2024 FOR THE PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: LORRAINE LUTTON - $194,247 TAUANA MCDONALD - $75,808 ANDY PRIDAY - $0 JACK RANDOLPH - $113,587 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING ACCRUAL FOR 2024 IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: JACK RANDOLPH - $141,044 THE FOLLOWING IS A PARTICIPANT IN A TRINITY HEALTH RESTORATION PLAN. THE RESTORATION PLAN PROVIDES RETIREMENT BENEFITS FOR CERTAIN TRINITY HEALTH SYSTEM OFFICE EXECUTIVES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($345,000 FOR 2024). THE FOLLOWING PAYOUT FOR 2024 FOR THIS PLAN IS INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: ANDY PRIDAY - $5,301 GREG A WISE MD INC KEY EMPLOYEE GREG WISE IS THE OWNER OF GREG A. WISE MD, INC. 199237 HEALTH CARE SERVICES 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF MOUNT CARMEL HEALTH PLAN IS MOUNT CARMEL HEALTH SYSTEM (MCHS). SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A MCHS IS THE SOLE MEMBER OF MOUNT CARMEL HEALTH PLAN. MCHS HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF MOUNT CARMEL HEALTH PLAN. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, MCHS MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. MCHS MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, AND MODIFICATIONS TO GOVERNING DOCUMENTS. AS THE PARENT OF THE NATIONAL TRINITY HEALTH SYSTEM, CERTAIN POWERS ARE RESERVED TO TRINITY HEALTH CORPORATION. THESE INCLUDE THE AUTHORITY TO ADOPT OR MODIFY THE ORGANIZATION'S GOVERNING DOCUMENTS, TO APPROVE MAJOR CHANGES SUCH AS A MERGER OR DISSOLUTION, AND TO APPROVE SIGNIFICANT FINANCE MATTERS IN EXCESS OF CERTAIN LIMITS ESTABLISHED BY TRINITY HEALTH CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING, THE FORM 990 FOR MOUNT CARMEL HEALTH PLAN IS REVIEWED BY MANAGEMENT. EACH MEMBER OF THE BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C MOUNT CARMEL HEALTH PLAN HAS ADOPTED TRINITY HEALTH'S GOVERNANCE POLICY NO. 1, WHICH SETS FORTH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND PROCESSES. IT APPLIES TO ALL "INTERESTED PERSONS" OF MOUNT CARMEL HEALTH PLAN, WHICH INCLUDES DIRECTORS, PRINCIPAL OFFICERS, KEY EMPLOYEES, AND MEMBERS OF COMMITTEES WITH BOARD-DELEGATED POWERS. INTERESTED PERSONS ARE EXPECTED TO DISCHARGE THEIR DUTIES IN A MANNER THE PERSON REASONABLY BELIEVES TO BE IN THE BEST INTERESTS OF MOUNT CARMEL HEALTH PLAN AND TO AVOID SITUATIONS INVOLVING A CONFLICT OF INTEREST. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE PROVIDED TO THE INTEGRITY AND COMPLIANCE OFFICER WHO COLLABORATES WITH INTERNAL LEGAL COUNSEL TO ASSESS THE CONFLICT AND IDENTIFY A CONFLICT MANAGEMENT PLAN WHEN NECESSARY. ADDITIONALLY, THE INTEGRITY AND COMPLIANCE OFFICER ALONG WITH LEGAL COUNSEL PREPARES A REPORT FOR THE BOARD CHAIR AND CEO. A SUMMARY OF POTENTIAL CONFLICTS IS REVIEWED WITH THE BOARD OF DIRECTORS OF MOUNT CARMEL HEALTH PLAN (OR A DELEGATED COMMITTEE OF THE BOARD) ON A YEARLY BASIS. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO MOUNT CARMEL HEALTH PLAN OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF MOUNT CARMEL HEALTH PLAN (OR A DELEGATED COMMITTEE OF THE BOARD) IS RESPONSIBLE FOR THE REVIEW OF TRANSACTIONS TO DETERMINE WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS. IN THE EVENT OF AN ACTUAL CONFLICT, THE BOARD (OR A DELEGATED COMMITTEE OF THE BOARD) WILL EITHER AVOID THE CONFLICT OR APPROPRIATELY SCRUTINIZE THE TRANSACTION TO ENSURE IT IS IN THE BEST INTERESTS OF MOUNT CARMEL HEALTH PLAN. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE POLICY FURTHER ADDRESSES THE PROPER DOCUMENTATION OF THE PROCEEDINGS AND POTENTIAL DISCIPLINARY AND CORRECTIVE ACTION FOR VIOLATIONS OF THE POLICY. THE POLICY IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 15 QUESTIONS 15A AND 15B ARE ANSWERED "NO" BECAUSE THE COMPENSATION FOR CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF MOUNT CARMEL HEALTH PLAN IS ESTABLISHED BY TRINITY HEALTH, A RELATED ORGANIZATION. IN ESTABLISHING CEO AND CFO COMPENSATION, TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF THE CEO AND CFO OF MOUNT CARMEL HEALTH PLAN ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. FOR OTHER EXECUTIVES WHO ARE NOT PART OF THE REBUTTABLE PRESUMPTION PROCESS, TRINITY HEALTH USES A MARKET ANALYSIS TO DETERMINE THE APPROPRIATENESS OF THE EXECUTIVE'S COMPENSATION. THE COMPENSATION FOR CERTAIN OTHER KEY MANAGEMENT OFFICIALS IS ESTABLISHED AND PAID BY MOUNT CARMEL HEALTH SYSTEM. MOUNT CARMEL HEALTH SYSTEM UTILIZES COMPARABLE MARKET DATA PROVIDED BY THE HUMAN RESOURCES DEPARTMENT IN ITS EVALUATION AND DETERMINATION OF COMPENSATION. THIS PROCESS IS PERFORMED ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 MOUNT CARMEL HEALTH PLAN IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE ANNUAL REPORT (WHICH INCLUDES COMMUNITY BENEFIT MINISTRY INFORMATION) AND CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. MOUNT CARMEL HEALTH PLAN'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G MEDICAL SPECIALIST FEES: PROGRAM SERVICE EXPENSES 154,342,962. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 154,342,962. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 356,287,041. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 356,287,041. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 3,356,583. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,356,583. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 12,862,486. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,862,486. FORM 990, PART IX, LINES 5 - 9: INDIVIDUALS WHO WORK AT MOUNT CARMEL HEALTH PLAN ARE ON THE PAYROLL OF A RELATED ORGANIZATION. THESE INDIVIDUALS' SALARIES AND BENEFITS ARE ALLOCATED TO MOUNT CARMEL HEALTH PLAN AND ARE REPORTED ON PART IX, LINES 5 THROUGH 9. FORM 990, PART XI, LINE 9: CASH DISTRIBUTION TO SOLE MEMBER, MOUNT CARMEL HEALTH SYSTEM -18,000,000. FORM 990, PART XII, LINE 2: MOUNT CARMEL HEALTH PLAN'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY25 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. MOUNT CARMEL HEALTH PLAN ALSO HAS STATUTORY-BASIS STATEMENTS PREPARED FOR THE PURPOSE OF FILING WITH THE OHIO DEPARTMENT OF INSURANCE. THESE STATUTORY-BASIS STATEMENTS ARE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM. FORM 990, PAGE 1, DOING BUSINESS AS NAMES: MEDIGOLD MERCYONE HEALTH PLAN MOUNT CARMEL MEDIGOLD ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 200 JEFFERSON AVE SE GRAND RAPIDS MI 49503 272491974 HEALTH CARE SERVICES MI 501(C)(3) LINE 10 TRINITY HEALTH-MICHIGAN 1 ALLEGANY FRANCISCAN MINISTRIES INC 33920 US HIGHWAY 19 NORTH SUITE 269 PALM HARBOR FL 34684 581492325 GRANT MAKING FL 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION 1 ASYLUM HILL FAMILY MEDICINE CENTER INC 114 WOODLAND STREET HARTFORD CT 06105 061450170 HEALTH CARE SERVICES CT 501(C)(3) LINE 3 TRINITY HEALTH OF NEW ENGLAND CORP INC 1 BAUM HARMON MERCY HOSPITAL 801 5TH STREET SIOUX CITY IA 51101 421500277 HEALTH CARE AND HOSPITAL SERVICES IA 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP 1 BAUM HARMON MERCY HOSPITAL AND CLINICS FOUNDATION 801 5TH STREET SIOUX CITY IA 51101 262973307 FOUNDATION IA 501(C)(3) LINE 12A, I BAUM HARMON MERCY HOSPITAL 1 BEECHWOOD INC 2212 BURDETT AVE TROY NY 12180 141651563 TITLE HOLDING COMPANY NY 501(C)(2) N/A LTC (EDDY) INC 1 BETHLEHEM HAVEN OF PITTSBURGH 905 WATSON STREET PITTSBURGH PA 15219 251436685 HOMELESS SHELTER PA 501(C)(3) LINE 7 PITTSBURGH MERCY HEALTH SYSTEM INC 1 BEVERWYCK INC 40 AUTUMN DRIVE SLINGERLANDS NY 12159 141717028 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 BRIGHTSIDE INC 114 WOODLAND STREET HARTFORD CT 06105 042182395 HEALTH CARE SERVICES MA 501(C)(3) LINE 10 THE MERCY HOSPITAL INC 1 CAPITAL REGION GERIATRIC CENTER INC 421 WEST COLUMBIA STREET COHOES NY 12047 141701597 LONG TERM CARE NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 CATHERINE MCAULEY HEALTH SERVICES CORP 5315 ELLIOTT DR 102 YPSILANTI MI 48197 382507173 HEALTH CARE SERVICES MI 501(C)(3) LINE 3 TRINITY HEALTH-MICHIGAN 1 CATHOLIC HEALTH INITIATIVES - IOWA CORP 1111 6TH AVENUE DES MOINES IA 50314 420680448 HEALTH CARE AND HOSPITAL SERVICES IA 501(C)(3) LINE 3 MERCY HEALTH NETWORK INC 1 CATHOLIC HEALTH MINISTRIES 20555 VICTOR PARKWAY LIVONIA MI 48152 GOVERNANCE AND MANAGEMENT OF TRINITY 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