2013-03-25T14:56:18-05:00 2012-09-30 310800053 CLARK SCHAEFER HACKETT AND CO ONE EAST FOURTH ST SUITE 1200 CINCINNATI OH 45202 990 2012-01-01 311151537 BUTLER HEALTH PLAN BUTL 5132732520 400 NORTH ERIE BLVD STE B HAMILTON OH 45011 STEPHANIE HEARN 5139426262 2013-03-14 1 KEVIN T DAVIS CPA P00039883 5132413111 2013-03-14 2012 2016-02-25 16:41:14Z X STEPHANIE HEARN 400 NORTH ERIE BLVD STE B HAMILTON OH 45011 48129923 0 X WWW.BUTLERHEALTHPLAN.ORG X 1985 OH PROVIDE MEDICAL AND DENTAL BENEFITS FOR THE EXCLUSIVE BENEFIT OF ITS MEMBERS 7 7 2 0 388126 0 0 0 79259226 47741797 600498 388126 0 0 79859724 48129923 0 0 78601119 50677410 250560 205600 0 0 0 2908244 1758192 81759923 52641202 -1900199 -4511279 17271435 0 9206700 0 8064735 0 X THE PLAN PROVIDES HEALTH (HOSPITAL, SURGICAL, MAJOR MEDICAL, AND PRESCRIPTION DRUG) AND DENTAL BENEFITS COVERING SUBSTANTIALLY ALL EMPLOYEES AND ELIGIBLE DEPENDENTS OF A CONSORTIUM OF SCHOOL DISTRICTS IN SOUTHWESTERN OHIO. 0 1 HEALTH CARE BENEFITS - PROVIDING HEALTH CARE COVERAGE TO PARTICIPANTS EMPLOYED BY 14 LOCAL SCHOOL DISTRICTS AND RELATED EDUCATIONAL INSTITUTIONS 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 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 3 0 1 2 1 1 1 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 X STEPHANIE HEARN 5139426262 400 NORTH ERIE BLVD STE B HAMILTON OH 45011 BETH WEBER 1.00 X 0 0 0 ROBIN WHITE 1.00 X X 0 0 0 JAN KESSELRING 1.00 X 0 0 0 RICHARD PACKERT 1.00 X 0 0 0 NANCY LANE 1.00 X 0 0 0 CHRISTINE COOK-POETTER 1.00 X 0 0 0 MIKE DAVIS 1.00 X 0 0 0 PATTY SPATH-MEYER 1.00 X 0 0 0 STEPHANIE HEARN 40.00 X 92769 0 15422 92769 0 15422 0 0 0 0 ALLIED BENEFIT SYSTEMS INC 208 SOUTH LASALLE ST STE 1300 CHICAGO IL 60604 ADMINISTRATION FEES 742960 HEALTHSPAN 225 PICTORIA DRIVE SUITE 320 CINCINNATI OH 45246 ADMINISTRATION FEES 566358 MULTIPLAN 115 FIFTH AVENUE NEW YORK NY 10003 ADMINISTRATION FEES 106546 3 MEMBER CONTRIBUTIONS 525100 47741797 47741797 47741797 388126 388126 48129923 47741797 388126 0 50677410 108191 72115 3606 945 20743 40664 33300 21192 54311 4332 1500 9978 6253 3568 72182 ADMINISTRATION FEES 1418472 BANK FEES 46823 WELLNESS & SUPPORT 41348 DUES & SUBSCRIPTIONS 2445 1824 52641202 0 1210594 0 0 590606 0 0 0 0 0 0 0 15470235 0 0 0 0 0 17271435 0 1206700 8000000 0 9206700 0 X 0 0 0 0 8064735 0 8064735 0 17271435 0 X -4511279 -184818 -3368638 X X 0 1 X 1 0 0 X 47923913 -184818 -184818 48108731 21192 21192 48129923 52620010 0 52620010 21192 21192 52641202 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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 POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT, AS OF SEPTEMBER 1, 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN 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. THE PLAN ADMINISTRATOR BELIEVES THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS ENDED PRIOR TO DECEMBER 31, 2009. CASH 2012-09-01 480431 BOOK VALUE OPTIMAL HEALTH INITIATIVES CONSORTIUM 10999 REED HARTMAN HIGHWAY SUITE 3 CINCINNATI OH 45242 ACCOUNTS RECEIVABLE 2012-09-01 275097 BOOK VALUE OPTIMAL HEALTH INITIATIVES CONSORTIUM 10999 REED HARTMAN HIGHWAY SUITE 3 CINCINNATI OH 45242 INVESTMENTS 2012-09-01 12723766 FMV IS READILY AVAILABLE FOR PUBLICLY TRADED ASSETS OPTIMAL HEALTH INITIATIVES CONSORTIUM 10999 REED HARTMAN HIGHWAY SUITE 3 CINCINNATI OH 45242 ALLIED CLAIM ACCOUNT 2012-09-01 -2104985 BOOK VALUE OPTIMAL HEALTH INITIATIVES CONSORTIUM 10999 REED HARTMAN HIGHWAY SUITE 3 CINCINNATI OH 45242 BENEFIT OBLIGATIONS - IBNR 2012-09-01 -8500000 BOOK VALUE OPTIMAL HEALTH INITIATIVES CONSORTIUM 10999 REED HARTMAN HIGHWAY SUITE 3 CINCINNATI OH 45242 ACCOUNTS PAYABLE 2012-09-01 -5671 BOOK VALUE OPTIMAL HEALTH INITIATIVES CONSORTIUM 10999 REED HARTMAN HIGHWAY SUITE 3 CINCINNATI OH 45242 1 1 0 0 1 1 1 1 0 0 PART I, LINE 2E: STEPHANIE HEARN, BETH WEBER, ROBIN WHITE, RICHARD PACKERT, NANCY LANE, CHRISTINE COOK-POETTER, MIKE DAVIS & PATTY SPATH-MEYER PART I, LINE 2E: THE EXISTING BOARD OF DIRECTORS CONTINUES TO DIRECT THE OPERATIONS OF BUTLER HEALTH PLAN, AS A DIVISION OF OPTIMAL HEALTH INITIATIVES. STEPHANIE HEARN CONTINUES TO FUNCTION AS EXECUTIVE DIRECTOR OF THE PLAN, BUT IS NOW AN EMPLOYEE OF SHAFELY PLAN MANAGEMENT. CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 IN MARCH 2012, THE TRUSTEES APPROVED A MERGER OF THE PLAN, SUBJECT TO THE CONSENT OF THE MAJORITY OF THE MEMBER DISTRICTS. THE PLAN SUBSEQUENTLY RECEIVED CONSENTS FROM A SUFFICIENT NUMBER OF SCHOOL DISTRICTS TO PROCEED WITH THE MERGER. EFFECTIVE SEPTEMBER 1, 2012, THE PLAN JOINED OPTIMAL HEALTH INITIATIVES TO FORM A STATE-WIDE, JOINTLY ADMINISTERED ARRANGEMENT WITH NORTHERN BUCKEYE HEALTH PLAN AND SCIOTO HEALTH PLAN. THE THREE MERGING PLANS WILL OPERATE AS DIVISIONS, PROVIDING LOCAL SEPARATION OF ASSETS AND DECISION MAKING FOR ISSUES, SUCH AS PLAN DESIGN, RATES, RESERVE MANAGEMENT, ETC. THE PURPOSE FOR THE MERGER IS TO ENHANCE THE INDEPENDENT SURVIVABILITY OF THE PLAN FROM STATE AND FEDERAL CONTROL BY SIGNIFICANTLY INCREASING THE NUMBER OF MEMBERS SERVED ON A STATE-WIDE BASIS. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY GOVERNING COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS INITIALLY REVIEWED BY THE EXECUTIVE DIRECTOR WHO PROVIDES THE FORM TO THE BOARD BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, BOARD MEMBERS MUST STATE IF THERE ARE ANY POTENTIAL CONFLICTS. ADDITIONALLY, IF ANY CONFLICTS OCCUR DURING THE YEAR, THE AFFECTED BOARD MEMBER MUST BRING THE CONFLICT BEFORE THE BOARD. THE BOARD MEMBER WITH THE POTENTIAL CONFLICT IS NOT ALLOWED TO VOTE ON THE MATTER. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL PROVIDE PRINT COPIES OF ITS GOVERNING DOCUMENTS UPON WRITTEN REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN BENEFIT OBLIGATIONS - CLAIMS INCURRED BUT NOT REPORTED -500,000. TRANSFER OF ASSETS OUT TO OHI -2,868,638. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS AN ANNUAL AUDIT OF THEIR FINANCIAL STATEMENTS AS REQUIRED BY THE DEPARTMENT OF LABOR. OVERSIGHT OF THE AUDIT IS PERFORMED BY MANAGEMENT AND THE BOARD OF TRUSTEES. THIS PROCESS IS CONSISTENT WITH THE PRIOR YEAR. FAIRFIELD CITY SCHOOL DISTRICT 211 DONALD DRIVE FAIRFIELD OH 45014 PUBLIC SCHOOLING OH 501(C)(1) 0 HAMILTON CITY SCHOOL DISTRICT 533 DAYTON STREET HAMILTON OH 45012 PUBLIC SCHOOLING OH 501(C)(1) 0 LAKOTA LOCAL SCHOOLS 5572 PRINCETON ROAD LIBERTY TOWNSHIP OH 45011 PUBLIC SCHOOLING OH 501(C)(1) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 FAIRFIELD CITY SCHOOL DISTRICT S 5901978 CASH HAMILTON CITY SCHOOL DISTRICT S 6673033 CASH LAKOTA LOCAL SCHOOLS S 11132468 CASH