2024-04-30T16:09:18-05:00 2023-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2023-01-01 816073209 Montana Health Network Health Insurance Plan & Trust MONT 4062341420 519 Pleasant Street Miles City MT 59301 Bill Robinson Chair 4062341420 2024-04-30 1 Bill Robinson 999009999 1 Kim Hunwardsen CPA P00484560 6122536500 2024-04-30 2 AAL1 IAL1 2023 2023-04-26 12:10:37Z Bill Robinson 519 Pleasant Street Miles City MT 59301 27283937 0 X N/A X 1993 MT Multiple Employer Voluntary Employee Benefit Association 5 0 0 31 75393 0 0 0 22471415 27088158 -98901 75393 0 0 22372514 27163551 0 0 18819742 25562889 0 0 0 0 0 2662191 2004857 21481933 27567746 890581 -404195 17621039 18223766 1825933 2022803 15795106 16200963 None 0 0 Medical benefits paid for qualified medical claims of participants at 31 healthcare entities. Stop Loss insurance premiums paid to manage risk associated with being self-insured on ultimate benefit coverage. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 319 0 1 0 1 1 0 0 0 0 0 0 0 X 5 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X Montana Health Network Insurance Plan - Lori Backes 4062341420 519 Pleasant St Miles City MT 59301 X Bill Robinson Chair 1.00 40.00 X X 0 272580 20781 Greg Drapes Secretary 1.00 40.00 X X 0 0 0 Linda Mehlhoff Member 0.50 40.00 X 0 0 0 Jeri Chapman Member 0.50 40.00 X 0 0 0 Holly Wolff Member (Through Sept 2023) 0.50 40.00 X 0 0 0 Abby Lotz Member (From Oct 2023) 0.50 40.00 X 0 0 0 0 272580 20781 1 0 1 0 PacificSource Health Plans 555 International Way Springfield OR 97477 TPA 591534 Montana Health Network Inc 519 Pleasant Street Miles City MT 59301 Administrative Expenses 180395 2 Participating Employers' Contribu 525100 26992553 26992553 Limited continuation of coverage 525100 95605 95605 27088158 195779 195779 120386 -120386 -120386 -120386 27163551 27088158 75393 0 25562889 39218 38500 932684 40026 2492 Excess Loss Reinsurance 936714 Research Fee 10537 State of Montana Audit 2589 2097 27567746 7788289 6720949 1148588 1926543 189 209 7699573 8755065 984400 821000 17621039 18223766 1825933 2022803 1825933 2022803 X 0 0 0 0 15795106 16200963 15795106 16200963 17621039 18223766 -404195 810052 0 X 0 1 X 1 0 0 X 27973603 810052 810052 27163551 0 27163551 27567746 0 27567746 0 27567746 Part X, Line 2: Accounting principles generally accepted in the United States of America require Plan management to evaluate tax positions taken by the Plan and recognize a tax liability (or asset) if the Plan has taken an uncertain tax position that more likely than not would not be sustained upon examination by the Internal Revenue Service. The Plan is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. 0 0 0 Bill Robinson Chair 0 195235 0 77345 0 0 0 9284 0 12354 0 294218 0 0 Form 990, Part VI, Section A, line 1a The Board of Trustees consists of employees of the contributing employers and as such the board members are compensated by the contributing employers for the services they provide as employees of their respective employer. Due to this, they are not considered independent Trustees. Form 990, Part VI, Section A, line 1a The Plan shall be administered by an Executive Committee of at least five but no more than nine persons elected by representatives of each employer participating in the Plan. The Executive Committee will consist of officers, directors, or other full-time employees of one or more employers. The Executive Committee shall administer the Plan in accordance with its terms. Form 990, Part VI, Section A, line 6 The organization is made up of members representing all the employers that purchase health insurance through the trust. Form 990, Part VI, Section A, line 7a Each employer participating in the plan and trust has the right to appoint an individual to the Employer Committee. The Administrative Committee appoints a five to nine member Executive Committee, which serves as the governing body with voting rights. The Executive Committee meets on a regular basis to make decisions regarding the administration of the trust. Form 990, Part VI, Section A, line 7b Amendments to and termination of the Plan and Trust may be made by the Sponsor in consultation with the Executive Committee. Form 990, Part VI, Section A, line 8b There is no committee with authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b A copy of the Form 990 is e-mailed to all members of the Executive Committee (governing body) and a comment period is provided prior to filing. Form 990, Part VI, Section B, line 12c The non-voting members of the Administrative Committee elect the voting governing body, the Executive Committee. The 33 non-voting members are not required to sign the conflict of interest policy. Only the members of the Executive Committee and Plan Administrator are required to annually complete and sign a conflict of interest form to disclose any potential conflicts of interest. Any conflicts are reviewed by the Committee and the Plan Administrator and a decision is made about whether the member with the conflict should be excluded from discussion and/or vote. Form 990, Part VI, Section C, line 19 The organization makes its governing documents and financial statements available to the public upon request. Form 990, Part VII, Section A, Line 1A, Column (E) and (F): The compensation reported in columns E and F represents compensation paid by our member healthcare entities to their employee for services the employee provides to the Hospital as their employee. No portion of this compensation is provided for the services provided by our Trustees as a Trustee of the Montana Health Network Insurance Plan & Trust. Reasonable Effort to Obtain Compensation: The Trustees of the Montana Health Network Health Insurance Plan & Trust also are employed by the related contributing employers. A questionnaire was sent to the members of the Board of Trustees requesting the compensation and benefits paid by their employer for the services that the Trustee provides as an employee of their tax exempt employer. The organization was able to obtain compensation information from one Trustee. The Montana Heatlh Network Health Insurance Plan & Trust was unable to obtain the related organization compensation from the remaining four Trustees. Volunteer Exception to reporting compensation: The Board Secretary Greg Drapes is an employee of one of the related taxable participating employers. Montana Health Network Health Insurance Plan & Trust does not directly or indirectly own or control the related taxable employer. Additionally, no managment services are provided by the related taxable employer to Montana Health Network Health Insurance Plan & Trust. Due to this exception, the compensation paid to Greg Drapes, for his services as an employee of the related participating employer is not reportable in Part VII. Beartooth Billings Clinic (Memorial Hospital Association) Big Horn Hospital Association Central Montana Medical Center Colstrip Medical Center Dahl Memorial Healthcare Association Daniels Memorial Healthcare Center Eastern Montana Community Mental Health Center Frances Mahon Deaconess Hospital Glendive Medical Center Hot Springs County Hospital District Lone Tree Senior Living North Big Horn Hospital District Northeast Montana Health Services Northeast Montana STAT Air Ambulance Coop Phillips County Hospital Prairie County Hospital District Prairie Ridge Village Roosevelt Memorial Medical Center Rosebud Health Care Center Roundup Memorial Healthcare Sheridan Memorial Hospital Association Sidney Health Center South Big Horn Hospital District Sweet Memorial Nursing Home Valley View Nursing Home Wheatland Memorial Hospital Montana Health Network Inc 519 Pleasant Street Miles City MT 59301 810440728 Plan Sponsor MT N/A C 0 Advanced Imaging Community Medical Center Aye Family Dentistry Inc Big Sky Diagnostic Imaging Monida Healthcare Network 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 1