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On Mar)17(c)1(h)1( )1(5)1(,)]TJ -3.93269 -1.4 TD [(2003, following a lengthy and turbulent r)18(eview pr)17(ocess, with)]TJ -0.0334 Tc 0.0278 Tw (highly visible public hearings, extensive newspaper coverage, and)' T* -0.033 Tc 0.028 Tw [(two legislative interventions along the way)92(,)1( )1(M)1(a)1(ryland Insurance)]TJ -0.0335 Tc 0.0278 Tw (Commissioner Steven Larsen publicly announced his denial of the)' T* -0.033 Tc 0.028 Tw [(p)1(r)18(oposed conversion and sale, r)18(eleasing a detailed r)18(eport)1( )1(o)1(f)1( )1(h)1(i)1(s)]TJ T* [(findings and conclusions. The r)18(eport was harsh in its criticisms of)]TJ T* [(the leadership of Car)18(eFirst and its consultants. That was only the)]TJ -0.0335 Tc 0.0278 Tw (beginning. Close on the heels of the denial came lawsuits,)' T* -0.033 Tc 0.028 Tw [(legislation to r)18(e)1(f)1(o)1(r)1(m)1( )1(C)1(a)1(r)18(eFirst, and a federal investigation.)]TJ 0 -1.94 TD [(In the following pages, I pr)18(esent the key lessons that can be)]TJ 0 -1.4 TD [(derived fr)18(om this inter)17(esting case study)92(. Clearly)92(,)1( )1(t)1(h)1(e)1( )1(m)1(e)1(r)1(i)1(t)1(s)1( )1(o)1(f)]TJ T* [(p)1(r)18(oposals by nonpr)18(ofit health car)18(e)1( )1(o)1(r)1(ganizations to convert)]TJ T* (and/or sell must be assessed on a case-by-case basis. Maryland)Tj T* [(has a unique political cultur)18(e and traditions r)18(elated to nonpr)17(o)1(f)1(i)1(t)]TJ 0 -1.40001 TD [(v)1(e)1(r)1(s)1(u)1(s)1( )1(f)1(o)1(r)56(-)1(p)1(r)18(ofit health car)18(e and to health car)18(e)1( )1(r)18(egulation.)]TJ 0 -1.4 TD -0.0334 Tc 0.0278 Tw (Nonetheless, the Car)Tj 8.25985 0 TD -0.0335 Tc (eFirst stor)Tj 3.76931 0 TD (y illustrates impor)Tj 6.91845 0 TD (tant lessons for)Tj -18.94761 -1.40001 TD (other states, as well as for all nonpr)Tj 14.07382 0 TD (ofit health car)Tj 5.4796 0 TD -0.033 Tc 0.027 Tw [(e)1( o)1(r)1(ganizations.)]TJ ET BT /F9 1 Tf 10 0 0 10 36 441.1 Tm /CS0 cs 1 scn -0.0335 Tc 0.0278 Tw (Lessons for Other States )Tj ET BT /F1 1 Tf 10 0 0 10 36 424.94 Tm -0.033 Tc 0.028 Tw [(1)1(.)1( )3(P)1(roposed Conversions Should Be Subjected to Robust )]TJ 1.0375 -1.4 TD -0.0335 Tc 0.0278 Tw (State Scr)Tj 3.44758 0 TD (utiny and Action)Tj ET BT /F2 1 Tf 10 0 0 10 36 387.94 Tm 0 0 0 1 k -0.033 Tc 0.028 Tw [(Nonpr)18(ofit health car)17(e)1( )1(o)1(r)1(ganizations, whether pr)18(ovider)92(,)1( )1(i)1(n)1(s)1(u)1(r)18(e)1(r)93(,)1( )1(o)1(r)]TJ 0 -1.4 TD [(b)1(o)1(t)1(h)1(,)1( )1(a)1(r)19(e typically significant public assets that exist under specific)]TJ T* [(c)1(h)1(a)1(r)1(ters and have special tax privileges; arguably)92(,)1( )1(t)1(h)1(e)1(y)1( )1(a)1(r)18(e the)]TJ T* [(p)1(r)18(ovider or insur)18(e)1(r)1( )1(o)1(f)1( )1(l)1(a)1(s)1(t)1( )1(r)19(esort in many situations. Accor)18(dingly)91(,)1( )]TJ -0.0335 Tc 0.0278 Tw (it makes both common sense and sound public policy for major)' -0.0337 Tc (pr)' 0.80414 0.00001 TD -0.0335 Tc (oposed conversions to be subjected to rigor)Tj 17.32581 0 TD -0.033 Tc 0.028 Tw [(ous state scru)1(t)1(i)1(n)1(y)]TJ -18.12995 -1.40001 TD [(and action, irr)18(espective of the mechanism used. )]TJ 0 -2.3 TD [(M)1(a)1(r)1(yland and about 30 other states have enacted conversion)]TJ 0 -1.4 TD [(laws to achieve r)18(obust state scrutiny and action, specifying a)]TJ T* [(r)18(eview pr)18(ocess and criteria and delegating the decision to an)]TJ T* [(independent state insurance commissioner or state attor)-18(ney)]TJ 0 -1.40001 TD [(general. In other states, elected leaders may pr)18(efer to keep such)]TJ 0 -1.4 TD [(decisions in their own hands, with the nonpr)18(ofit health car)18(e)]TJ -0.0337 Tc (or)' 0.82197 0.00001 TD -0.0335 Tc 0.0278 Tw (ganization having to seek special legislation to conver)Tj 21.19066 0.00001 TD (t. In still)Tj -22.01263 -1.40002 TD -0.033 Tc 0.028 Tw [(other states, a combination of state r)18(egulator and legislative)]TJ 0 -1.4 TD -0.0336 Tc (scr)Tj 1.06547 0.00001 TD -0.0335 Tc 0.0278 Tw (utiny may be pr)Tj 6.23028 0.00001 TD -0.034 Tc 0 Tw [(eferr)17(e)-1(d)-1(.)]TJ ET BT /F1 1 Tf 10 0 0 10 315 711.4999 Tm /CS0 cs 1 scn -0.0336 Tc 0.0278 Tw (2. )Tj 1.0375 0.00001 TD -0.033 Tc 0.028 Tw (States Should Promote and Require Due Diligence by)Tj 0 -1.4 TD [(Conversion Applicants, Placing the Burden of Pro)1(o)1(f)1( )1(o)1(f)]TJ -0.0335 Tc 0.0278 Tw (Justification on Them)' ET BT /F2 1 Tf 10 0 0 10 315 660.4999 Tm 0 0 0 1 k -0.033 Tc 0.028 Tw [(M)1(a)1(r)1(yland r)18(equir)17(es applicants to exer)18(cise due diligence in)]TJ 0 -1.4 TD [(demonstrating that the pr)18(oposed conversion is in the public)]TJ T* [(i)1(n)1(t)1(e)1(r)19(est. An applicant must: )]TJ 0.9 -2.3 TD -0.0335 Tc 0.0278 Tw (\245 Demonstrate the need for the conversion.)Tj 0 -1.4 TD -0.033 Tc 0.028 Tw [1( )2(Assess the impacts of the conversion on the organization\325)111(s)]TJ 0.7375 -1.4 TD [(mission, health car)18(e quality)91(, access, and af)18(f)1(o)1(r)19(dability)91(.)]TJ -0.7375 -1.4 TD [1( )2(Ensur)18(e the fair)-18(ness of the price/pr)18(oceeds of the )]TJ 0.7375 -1.4 TD -0.0335 Tc 0.0278 Tw (conversion or sale.)Tj -0.7375 -1.4 TD -0.033 Tc 0.028 Tw [1( )2(Ensur)18(e)1( )1(r)19(easonable terms in addition to the amount of )]TJ 0.7375 -1.4 TD [(t)1(h)1(e)1( )1(p)1(r)19(oceeds in the case of a sale.)]TJ -1.6375 -2.3 TD [(M)1(a)1(r)1(yland\325)111(s legislative action at the beginning of the pr)17(ocess to)]TJ 0 -1.4 TD -0.0335 Tc 0.0278 Tw (shift the bur)Tj 4.82535 0 TD -0.033 Tc 0.028 Tw [(den of pr)18(oof to the applicant sent a clear message)]TJ -4.82535 -1.4 TD [(that changing one\325)111(s nonpr)17(ofit health car)18(e ownership status and)]TJ T* [(mission can have a pr)18(ofound ef)17(fect on the public welfar)18(e, and)]TJ -0.0335 Tc 0.0278 Tw (that it is incumbent on the applicant to justify why and how it)' (has ar)' 2.38309 0 TD (rived at this decision and what the impacts will be on )Tj -2.38309 -1.4 TD -0.033 Tc 0.028 Tw (those served.)Tj ET BT /F1 1 Tf 10 0 0 10 315 395.5 Tm /CS0 cs 1 scn [(3)1(.)1( )3(States Should Prohibit Inappr)-1(opriate Compensation Incentives)]TJ 1.0375 -1.4 TD [(Linked to a Conversion to For)55(-)1(P)1(r)1(o)1(f)1(i)1(t)]TJ ET BT /F2 1 Tf 10 0 0 10 315 358.5 Tm 0 0 0 1 k -0.0335 Tc 0.0278 Tw (Whether or not one agr)Tj 9.52582 0 TD -0.033 Tc 0.028 Tw (ees with the Maryland insurance)Tj -9.52582 -1.4 TD [(commissioner that Car)18(e)1(F)1(i)1(r)1(s)1(t)1111(s)1( )1(e)1(f)19(f)1(o)1(r)1(t)1( )1(t)1(o)1( )1(c)1(o)1(n)1(v)1(e)1(r)1(t and sell was)]TJ T* [(\322driven by its executives driven by gr)18(eed,\323 that was a common)]TJ -0.0335 Tc (per)' 1.27079 0.00001 TD 0.0278 Tw (ception held by vir)Tj 7.28144 0.00001 TD -0.0334 Tc (tually all stakeholders. This was based on)Tj -8.55223 -1.40001 TD -0.033 Tc 0.028 Tw [(t)1(h)1(e)1( )1(p)1(r)19(oposal that substantial executive compensation bonuses)]TJ 0 -1.4 TD [(w)1(e)1(r)19(e to be paid by Car)17(eFirst and W)18(ellpoint. Accor)18(ding to Jay)]TJ T* [(Angof)18(f, a consultant to the commissioner and a former insurance)]TJ T* [(commissioner himself, \322The merger bonus cr)18(eates an incentive)]TJ T* [(for the executives to pr)18(efer the bid of a suitor who agr)17(eed to pay)]TJ -0.0335 Tc 0.0278 Tw (the bonuses over the bid of a suitor who would not pay them, )' T* -0.033 Tc 0.028 Tw [(or who insisted on r)18(educing them, and it cr)17(eates an incentive for)]TJ -0.0335 Tc 0.0278 Tw (executives to choose consummating a transaction\321any)' (transaction\321over not consummating a transaction at all, since)' (the executives r)' 6.11226 0.00001 TD (eceive a bonus for any transaction, but r)Tj 15.97327 0.00001 TD -0.0334 Tc (eceive no)Tj -22.08553 -1.40001 TD -0.0335 Tc (bonus for no transaction\323 (Salganik 2002 ). The compensation)Tj 0 -1.4 TD (issue undoubtedly negated any chance of a favorable decision,)Tj T* -0.033 Tc 0.028 Tw [(and spurr)18(ed the Maryland General Assembly to enact the drastic)]TJ T* [(r)18(e)1(f)1(o)1(r)1(ms described in my companion article. )]TJ ET 0 0 0 0 k 36 20.78 540 37.756 re f BT /F2 1 Tf 7 0 0 7 37 52.286 Tm 0 0 0 1 k -0.017 Tc [(Bruce McPherson, M.H.A., is executive dir)18(ector of the Alliance for Advancing Nonpr)17(ofit Health Car)18(e. Addr)18(ess corr)18(espondence to Mr)91(. McPherson at 3238 Spriggs Request W)37(ay)92(,)]TJ 0 -1.2857 TD [(Mitchellville, MD 20721. E-mail: mcphersonbruce@aol.com Publisher\325)111(s Note: Fr)17(om time to time, this section featur)18(es original papers or r)18(eprints of significant studies selected by )]TJ T* [(Inquiry\325)110(s publisher)92(.)]TJ ET 36 63.004 m 576 63.004 l S /GS0 gs Q endstream endobj 15 0 obj << /Length 8546 >> stream /GS0 gs 1 g 0 792 0 0 re f /GS2 gs q 1 w /CS0 CS 1 SCN 36 63 m 576 63 l S BT /F0 1 Tf 8 0 0 8 31.5527 21 Tm 0 0 0 1 k (3)Tj ET BT /F1 1 Tf 10 0 0 10 37 711.4999 Tm /CS0 cs 1 scn -0.0336 Tc 0.0278 Tw (4. )Tj 1.0375 0.00001 TD -0.033 Tc 0.028 Tw (States Should Provide Significant Opportunities in the Review)Tj 0 -1.4 TD [(P)1(r)1(ocess for Input by the General Public and a V)49(a)1(r)1(i)1(e)1(t)1(y)1( )1(o)1(f)]TJ -0.0334 Tc (Stakeholders)' ET BT /F2 1 Tf 10 0 0 10 37 660.4999 Tm 0 0 0 1 k -0.033 Tc [(M)1(a)1(r)1(yland involved many gr)18(oups and individuals ar)17(ound the state,)]TJ 0 -1.4 TD [(including but not limited to a variety of community)92(, consumer)]TJ T* [(and health car)18(e)1( )1(g)1(r)18(oups. Also, the state insurance commissioner)]TJ T* [(ensur)18(ed that all r)17(elevant documents associated with the)]TJ T* [(p)1(r)18(oceedings wer)18(e made available in a timely and r)18(eadily)]TJ T* [(accessible manner to all inter)18(ested parties. )]TJ ET BT /F1 1 Tf 10 0 0 10 37 567.4999 Tm /CS0 cs 1 scn [(5)1(.)1( )3(States Should Carefully Assess What the Pr)-1(oceeds of a)]TJ 1.0375 -1.4 TD [(P)1(r)1(oposed Conversion and/or Sale Can and Cannot Accomplish)]TJ T* (in Relationship to Opportunities Forgone)Tj ET BT /F2 1 Tf 10 0 0 10 37 516.4999 Tm 0 0 0 1 k [(On the surface, the pr)18(oceeds fr)17(om a conversion and sale of a)]TJ 0 -1.4 TD [(major health car)18(e)1( )1(o)1(r)1(ganization\321$1.37 billion in the case of)]TJ -0.0335 Tc (Car)' 1.38188 0 TD 0.0278 Tw (eFirst\321can appear to be a substantial \322windfall\323 that can be)Tj -1.38188 -1.4 TD -0.033 Tc 0.028 Tw (used in many ways to benefit the public. Certainly those)Tj T* [(p)1(r)18(oposing to convert will emphasize this point of view)55(, as will)]TJ -0.0335 Tc 0.0278 Tw (those or)' 3.26096 0 TD (ganizations or individuals who feel that they can become)Tj -3.26096 -1.4 TD -0.0336 Tc (dir)Tj 0.99272 0 TD -0.033 Tc 0.028 Tw [(ect or indir)18(e)1(c)1(t)1( )1(r)18(ecipients of such pr)18(oceeds. But as one of the)]TJ -0.99272 -1.4 TD [(M)1(a)1(r)1(yland insurance commissioner\325)111(s consultants concluded)]TJ T* [(following an extensive study)92(, conversion foundations have a)]TJ T* [(limited ability to make systemic changes or impr)18(ovements in)]TJ -0.0335 Tc 0.0278 Tw (health car)' 3.89738 0 TD (e access, quality)Tj 6.22808 0 TD -0.033 Tc 0.028 Tw [(, or costs. The ear)-18(n)1(i)1(n)1(g)1(s)1( )1(f)1(r)19(o)1(m)]TJ -10.12546 -1.40001 TD [(investment of the pr)18(oceeds of such conversions and sales pale in)]TJ 0 -1.4 TD [(comparison to the costs of pr)18(oviding coverage or car)17(e to the)]TJ -0.0335 Tc (uninsur)' 2.91595 0 TD 0.0278 Tw (ed and underinsur)Tj 7.25004 0 TD (ed in a state. Some politicians can be)Tj -10.16599 -1.40001 TD (tempted to embrace conversions as quick fixes to shor)Tj 21.56128 0 TD -0.0336 Tc (t-ter)Tj 1.66429 0 TD 0 Tc (m)Tj -23.22557 -1.40001 TD -0.0335 Tc (gover)Tj 2.23949 0 TD -0.033 Tc 0.028 Tw [(nmental budget pr)18(oblems. What then becomes lost is what)]TJ -2.23949 -1.4 TD [(the Maryland legislatur)18(e would not allow\321the demise of its)]TJ T* [(n)1(o)1(n)1(p)1(r)19(ofit health financing mechanism. As several people)]TJ T* [(i)1(n)1(t)1(e)1(r)1(viewed for the companion article pointed out, if Car)18(e)1(F)1(i)1(r)1(s)1(t)]TJ 0 -1.40001 TD [(had convert)1(e)1(d)1( )1(t)1(o)1( )1(f)1(o)1(r)56(-)1(p)1(r)18(ofit, it likely would have been only a)]TJ 0 -1.4 TD [(m)1(a)1(t)1(t)1(e)1(r)1( )1(o)1(f)1( )1(t)1(i)1(m)1(e)1( )1(b)1(e)1(f)1(o)1(r)19(e the legislatur)17(e sought to r)18(e)1(c)1(r)19(eate it in)]TJ -0.0335 Tc 0.0278 Tw (another or)' 4.19401 0.00001 TD (ganization to help meet the needs of poor)Tj 16.79066 0.00001 TD (, high-risk,)Tj -20.98467 -1.40002 TD -0.0334 Tc (and other vulnerable people.)Tj ET BT /F9 1 Tf 10 0 0 10 37 181.9 Tm /CS0 cs 1 scn -0.011 Tc 0.028 Tw [(Lessons for Nonpr)18(ofit Health Car)17(e Organizations )]TJ ET BT /F2 1 Tf 10 0 0 10 37 165.74 Tm 0 0 0 1 k -0.0112 Tc 0.0278 Tw (While ther)Tj 4.34172 0.00001 TD (e ar)Tj 1.57611 0.00001 TD (e undoubtedly some lessons that all nonpr)Tj 17.74996 0.00001 TD -0.0113 Tc (ofit)Tj -23.66779 -1.40002 TD -0.011 Tc 0.028 Tw [(health car)18(e executives can lear)-18(n fr)17(om the Car)18(eFirst case study)92(,)]TJ 0 -1.4 TD (the Maryland insurance commissioner and subsequently the)Tj T* (Maryland General Assembly focused the bulk of their)Tj T* [(attention and harsh criticism on Car)18(eFirst\325)110(s gover)-18(nance. This is)]TJ T* [(consistent with a national tr)18(end for the buck to stop at the)]TJ 27.8 61.576 TD -0.0113 Tc (boar)Tj 1.88231 0.00001 TD -0.011 Tc [(dr)17(oom rather than at the chief executive of)18(ficer\325)111(s desk.)]TJ -1.88231 -2.3 TD [(It is perhaps too easy to cast stones at the Car)18(eFirst boar)17(d)]TJ 0 -1.4 TD -0.0112 Tc 0.0278 Tw (members. Only they and the Car)Tj 13.67423 0.00001 TD (eFirst executives involved in)Tj -13.67423 -1.40001 TD -0.011 Tc 0.028 Tw [(all of the boar)18(d discussions starting a few years befor)17(e the)]TJ 0 -1.4 TD [(announced pr)18(oposal r)17(eally know what transpir)18(ed.)]TJ T* [(Abbr)18(eviated boar)17(d minutes might have masked a gr)18(eat deal)]TJ T* [(of the actual tone, br)18(eadth, and depth of discussions. Clearly)91(,)]TJ T* [(the boar)18(d tr)-1(usted and r)18(espected its CEO and his team,)]TJ T* [(c)1(r)18(editing them with bringing the organization fr)18(om)]TJ 0 -1.40001 TD [(thr)18(eatened insolvency to r)17(egional pr)18(ominence. Mor)18(eover)91(, the)]TJ 0 -1.4 TD [(commissioner noted that the boar)18(d had been told by its own)]TJ T* [(attor)-18(ney that the standar)18(d for due car)17(e was rather minimal,)]TJ 0 -1.40001 TD [(meaning that the boar)18(d generally could r)17(ely on the advice of)]TJ 0 -1.4 TD (its expert executives and consultants.)Tj 0 -2.3 TD [(Mor)18(eover)91(, the boar)18(d members wer)18(e most likely being shown)]TJ 0 -1.4 TD [(polished and convincing pr)18(esentations on how the wave of)]TJ T* [(Blue Cr)18(oss Blue Shield conversions and sales in the 1990s)]TJ 0 Tc (r)' 0.30383 0 TD -0.0113 Tc (epr)Tj 1.33751 0 TD -0.0112 Tc 0.0278 Tw (esented the \322new wisdom\323 of how to succeed in a highly)Tj -1.64134 -1.40001 TD (competitive market. During the 1980s and 1990s it was not)Tj 0 -1.4 TD -0.0113 Tc (uncommon for some nonpr)Tj 11.5878 0 TD -0.011 Tc 0.028 Tw [(ofit hospitals and insur)18(ers to)]TJ -11.5878 -1.4 TD [(emulate for)55(-pr)17(ofits\321setting up holding companies and)]TJ T* [(subsidiaries, adopting commer)18(cial language \(e.g.,)]TJ -0.0112 Tc 0.0278 Tw (\322corporations,\323 \322customers,\323 \322market shar)' 18.21885 0 TD (e\323\), and seeking)Tj -18.21885 -1.4 TD -0.011 Tc 0.028 Tw [(for)55(-pr)17(ofit compensation levels. The phrase \322no money)92(, no)]TJ T* (mission,\323 while absolutely true, was sometimes being)Tj -0.0113 Tc (distor)' 2.32151 0 TD -0.0112 Tc 0.0278 Tw (ted, intentionally or not, focusing all too nar)Tj 18.50356 0 TD 0 Tc (r)Tj 0.30384 0 TD -0.0113 Tc (owly on)Tj -21.1289 -1.40001 TD -0.0114 Tc (pr)Tj 0.84863 0 TD -0.0112 Tc (ofits at the expense of mission.)Tj -0.84863 -2.3 TD (Having said all that, however)Tj 12.02914 0 TD -0.011 Tc 0.028 Tw [(, the kind of yar)18(dstick that the)]TJ -12.02914 -1.4 TD [(Maryland insurance commissioner applied to the Car)18(eFirst)]TJ T* [(boar)18<64D5>110(s performance is symptomatic of br)18(oader demands )]TJ T* [(for gr)18(eater public accountability by all nonpr)17(ofit health car)18(e)]TJ 0 -1.40001 TD [(boar)18(ds. This pr)17(essur)18(e can be expected to gr)18(ow fr)17(om not only)]TJ 0 -1.4 TD [(state r)18(egulators and legislators but also the Inter)-18(nal Revenue)]TJ -0.0112 Tc (Ser)' 1.29943 0.00001 TD 0.0278 Tw (vice, donors, business par)Tj 10.68362 0.00001 TD (tners, companies pr)Tj 8.21432 0.00001 TD (oviding boar)Tj 5.21037 0.00001 TD 0 Tc (d)Tj -25.40774 -1.40003 TD -0.011 Tc 0.028 Tw [(liability insurance, voluntary accr)18(editation bodies, institutional)]TJ 0 -1.4 TD -0.0112 Tc 0.0278 Tw (associations and pr)Tj 7.93771 0.00001 TD (ofessional societies, the media, the general)Tj -7.93771 -1.4 TD (public, and cur)Tj 6.22215 0.00001 TD -0.011 Tc 0.028 Tw [(r)18(ent and pr)18(ospective boar)18(d members)]TJ -6.22215 -1.40001 TD -0.0112 Tc (themselves.)Tj 0 -2.3 TD -0.011 Tc [(The Car)18(eFirst story pr)17(ovides some enlightening examples of)]TJ 0 -1.4 TD [(the types of issues that nonpr)18(ofit boar)17(ds need to addr)18(ess)]TJ T* 0 Tw [(ef)18(fectively)91(.)]TJ /F4 1 Tf 1 0 0 1 -1000 1792 Tm 1 g 0 Tc ( )Tj ET Q endstream endobj 16 0 obj << /Length 8911 >> stream /GS0 gs 1 g 0 792 0 0 re f /GS2 gs q BT /F1 1 Tf 10 0 0 10 36 712.5 Tm /CS0 cs 1 scn -0.011 Tc 0.028 Tw [(1. )6(Nonprofit Health Care Boar)-1(ds Need to Be, and to)]TJ 1.1 -1.4 TD (Demonstrate That They Are, Fully Engaged and Acting)Tj -0.0112 Tc 0.0278 Tw (Independently of Management)' ET BT /F2 1 Tf 10 0 0 10 36 661.4999 Tm 0 0 0 1 k -0.011 Tc 0.028 Tw [(F)1(r)18(om Car)18(eFirst\325)111(s r)17(ecor)18(ds, it is impossible to discer)-18(n with )]TJ 0 -1.4 TD [(any degr)18(ee of certainty the level of engagement and)]TJ T* [(independence of its boar)18(d. At a very minimum, however)91(, this)]TJ T* [(experience should send a str)18(ong signal to all nonpr)17(ofit health)]TJ T* [(car)18(e or)-1(ganizations that minutes of boar)18(d discussions and)]TJ 0 -1.40001 TD -0.0112 Tc 0.0278 Tw (actions on major strategic issues should clearly document the)Tj 0 -1.4 TD -0.011 Tc 0.028 Tw [(diligence with which options ar)18(e being identified, analyzed,)]TJ T* [(and weighed in making decisions. Whether or not one agr)18(ees)]TJ 0 -1.40001 TD [(with the Maryland insurance commissioner\325)111(s position that the)]TJ 0 -1.4 TD [(boar)18(ds of nonpr)17(ofit health car)18(e organization should be)]TJ T* [(subjected to a higher standar)18(d of due car)17(e than the business)]TJ 0 -1.40001 TD (judgment rule \(a matter that is likely to be tested in the courts)Tj 0 -1.4 TD -0.0112 Tc 0.0278 Tw (over the next several years\), a \322best practice\323 appears to be)Tj -0.0113 Tc (emer)' 2.12108 0 TD -0.011 Tc 0.028 Tw [(ging for virtually all boar)18(ds, for)54(-pr)18(ofit and nonpr)18(ofit alike,)]TJ -2.12108 -1.40001 TD [(to establish and apply specific standar)18(ds that help to ensur)17(e)]TJ 0 -1.4 TD [(boar)18(d member independence and full engagement. As one )]TJ -0.0113 Tc 0.0278 Tw (of the inter)' 4.6986 0 TD -0.0112 Tc (viewees for the companion ar)Tj 12.46481 0 TD (ticle stated \(while)Tj -17.16341 -1.40001 TD 0 Tc (r)Tj 0.30383 0 TD -0.0112 Tc (equesting anonymity\), \322While much or all of what was)Tj -0.30383 -1.4 TD -0.011 Tc 0.028 Tw [(pr)17(esented to the Car)18(eFirst boar)18(d by management and)]TJ -0.0112 Tc 0.0278 Tw (consultants might have seemed rational and plausible, no one)' T* -0.022 Tc 0.028 Tw [(on the boar)18(d appear)17(ed to have ever stepped back and asked)]TJ -0.0223 Tc 0.0278 Tw (the simple question: \324How will this play in the )' ET BT /F1 1 Tf 10 0 0 10 224.4845 367.5 Tm -0.0224 Tc (Baltimor)Tj 3.3761 0 TD -0.0223 Tc (e Sun)Tj ET BT /F2 1 Tf 10 0 0 10 281.3082 367.5 Tm -0.0224 Tc <3FD5D320>Tj ET BT /F1 1 Tf 10 0 0 10 36 344.5 Tm /CS0 cs 1 scn -0.011 Tc 0.028 Tw [(2. )6(Nonprofit Boards Should Make the Or)-1(ganization\325)55(s Mission)]TJ 1.1 -1.4 TD -0.0112 Tc 0.0278 Tw (Paramount\321Guiding Strategic Decisions and Actions)Tj ET BT /F2 1 Tf 10 0 0 10 36 307.5 Tm 0 0 0 1 k (Ther)Tj 1.8264 0.00001 TD (e can be little if any doubt that ther)Tj 14.94555 0.00001 TD (e was a serious)Tj -16.77195 -1.40001 TD -0.011 Tc 0.028 Tw [(\322disconnect\323 between what the Car)18(eFirst boar)17(d and)]TJ 0 -1.4 TD -0.0112 Tc 0.0278 Tw (executives per)Tj 5.85196 0.00001 TD (ceived to be their mission and what various)Tj -5.85196 -1.40001 TD -0.011 Tc 0.028 Tw [(stakeholders believed. Had Car)18(eFirst been mor)17(e explicit and in)]TJ 0 -1.4 TD [(r)18(egular dialogue with its key stakeholders about its mission,)]TJ T* [(and the pr)18(ogr)17(ess and r)18(esults that the organization felt it was)]TJ -0.0112 Tc 0.0278 Tw (making to pursue that mission, the chasm of)' (misunderstanding might not have developed or been so)' -0.0114 Tc (pr)' 0.84863 0.00001 TD -0.0112 Tc (ofound. The Mar)Tj 7.11228 0.00001 TD (yland insurance commissioner and)Tj -7.96091 -1.40002 TD -0.011 Tc 0.028 Tw [(legislative leaders wer)18(e particularly critical of Car)17(eFirst\325)111(s)]TJ 0 -1.4 TD -0.0112 Tc 0.0278 Tw (unilateral decisions to withdraw fr)Tj 14.20124 0.00001 TD -0.0113 Tc (om par)Tj 3.01629 0.00001 TD -0.0112 Tc (ticipation in)Tj -17.21753 -1.40001 TD (Medicar)Tj 3.34776 0.00001 TD -0.011 Tc 0.028 Tw [(e and Medicaid managed car)18(e pr)17(ograms and to)]TJ -3.34776 -1.40001 TD -0.0112 Tc 0.0278 Tw (change under)Tj 5.78434 -0.00001 TD (writing practices for individuals and small)Tj -5.78434 -1.39999 TD -0.011 Tc 0.028 Tw [(gr)17(oups in ways that r)18(educed coverage. )]TJ 0 -2.3 TD [(Car)18(eFirst now has a new mission statement, consistent with)]TJ 0 -1.4 TD [(its legislative mandate. However)92(, for Car)17(eFirst\321or any)]TJ 27.9 62.40001 TD [(organization\321a mission statement is only a piece of paper)91(. T)111(o)]TJ 0 -1.4 TD [(become r)18(eal, it must be woven into the entir)17(e fabric of the)]TJ T* [(gover)-18(nance pr)18(ocess, including: )]TJ 0.9 -2.3 TD [8(Recruiting, selecting, and r)18(etaining only boar)18(d members)]TJ 0.775 -1.4 TD [(and executives who ar)18(e fully committed to the)]TJ T* [(organization\325)110(s mission and basic values;)]TJ -0.775 -1.4 TD [8(Ensuring that key stakeholders ar)18(e involved in identifying)]TJ 0.775 -1.4 TD [(community needs and priorities, and appr)18(oving plans and)]TJ 0 -1.40001 TD [(budgets for community benefit pr)18(ograms)]TJ 5 0 0 5 504.5399 597.0312 Tm 0 Tc (1)Tj 10 0 0 10 510.2089 591.4999 Tm -0.011 Tc [(that ar)18(e)]TJ -17.84589 -1.4 TD -0.0112 Tc 0.0278 Tw (consistent with those priorities and the overall mission;)Tj -0.775 -1.4 TD -0.011 Tc 0.028 Tw [8(Routinely monitoring pr)18(ogr)18(ess and r)17(esults of community)]TJ 0.775 -1.40001 TD [(benefit pr)18(ograms and explicitly linking them to CEO)]TJ 0 -1.4 TD (performance assessments and compensation adjustments,)Tj T* [(as well as to boar)18(d self-assessments;)]TJ -0.775 -1.40001 TD [8(Appr)18(oving r)18(egular r)17(eports to the public on pr)18(ogr)17(ess and)]TJ 0.775 -1.4 TD [(r)18(esults in achieving the mission.)]TJ ET BT /F1 1 Tf 10 0 0 10 315 470.5 Tm /CS0 cs 1 scn -0.0113 Tc 0.0278 Tw (3. )Tj 1.1 0 TD -0.011 Tc 0.028 Tw (Nonprofit Boards Should Establish and/or Reinforce)Tj 0 -1.4 TD -0.0112 Tc 0.0278 Tw (Standing Committees for Compensation, Audit,)Tj T* -0.011 Tc 0.028 Tw (Nominations, and Governance Performance)Tj ET BT /F2 1 Tf 10 0 0 10 315 419.5 Tm 0 0 0 1 k -0.0112 Tc 0.0278 Tw (As a r)Tj 2.41541 0 TD (esult of the Sarbanes-Oxley legislation and new stock)Tj -2.41541 -1.4 TD (exchange r)Tj 4.56486 0 TD -0.011 Tc 0.028 Tw [(equir)18(ements to pr)17(event futur)18(e abuses such as the)]TJ -4.56486 -1.4 TD -0.0113 Tc (Enr)Tj 1.33751 0 TD -0.0112 Tc 0.0278 Tw (on scandal, for)Tj 6.16722 0 TD -0.0114 Tc (-pr)Tj 1.17028 0 TD -0.0112 Tc (ofit companies ar)Tj 7.23582 0 TD -0.0113 Tc (e now r)Tj 3.23804 0 TD -0.0112 Tc (equir)Tj 2.09312 0 TD (ed to have)Tj -21.24199 -1.40002 TD (standing committees for auditing, compensation, and)Tj 0 -1.4 TD -0.011 Tc 0.028 Tw [(nominations and gover)-18(nance, composed solely of)]TJ -0.0112 Tc 0.0278 Tw (independent dir)' 6.62185 0 TD -0.011 Tc 0.028 Tw [(ectors with the authority to hir)18(e and fir)17(e)]TJ -6.62185 -1.40001 TD [(consultants if deemed necessary)92(. These r)18(equir)17(ements can be)]TJ 0 -1.4 TD -0.0112 Tc 0.0278 Tw (expected to become best practices for many types of)Tj -0.0113 Tc (nonpr)' 2.48302 0.00001 TD (ofit or)Tj 2.55986 0.00001 TD -0.0112 Tc (ganizations. While the Car)Tj 11.05301 0 TD -0.011 Tc 0.028 Tw (eFirst story did not)Tj -16.09589 -1.40002 TD -0.0112 Tc 0.0278 Tw (include any potential auditing issues, compensation was a)Tj 0 -1.4 TD (paramount issue. Also, Car)Tj 11.27688 0.00001 TD (eFirst might have benefited fr)Tj 12.31124 0.00001 TD -0.0113 Tc (om a)Tj -23.58812 -1.40002 TD -0.011 Tc 0.028 Tw (standing committee that was charged not only with)Tj 0 -1.4 TD [(nominations of new boar)18(d members but also with overall)]TJ T* [(gover)-18(nance performance: development, assessment, and)]TJ T* [(impr)18(ovement. Car)17(eFirst hir)18(ed a consultant in December 2003)]TJ T* [(to help it assess its \322boar)18(d structur)17(e.\323 This individual may)]TJ -0.0112 Tc 0.0278 Tw (have focused on some or all of these aspects of gover)' 22.59373 0.00001 TD (nance)Tj -22.59373 -1.40001 TD -0.011 Tc 0 Tw (performance. )Tj ET BT /F1 1 Tf 10 0 0 10 315 158.5 Tm /CS0 cs 1 scn -0.0113 Tc 0.0278 Tw (4. )Tj 1.1 0.00001 TD -0.0112 Tc (Nonpr)Tj 2.61192 0.00001 TD -0.011 Tc 0.028 Tw (ofit Boards Should Ensure That Executive)Tj -2.61192 -1.40001 TD -0.0112 Tc 0.0278 Tw (Compensation, and Any Boar)Tj 12.29568 0.00001 TD (d Compensation, )Tj -12.29568 -1.40001 TD (Is Reasonable, Both in Fact and Per)Tj 14.6113 -0.00001 TD (ception)Tj ET BT /F2 1 Tf 10 0 0 10 315 107.5 Tm 0 0 0 1 k (It appears that compensation would have played little if any)Tj 0 -1.4 TD -0.011 Tc 0.028 Tw [(r)18(ole in the failed Car)18(eFirst conversion had the Car)18(eFirst boar)17(d,)]TJ ET 1 w /CS0 CS 1 SCN 36 63 m 576 63 l S BT /F0 1 Tf 8 0 0 8 31.5527 21 Tm 0 Tc (4)Tj ET Q endstream endobj 17 0 obj << /Length 6917 >> stream /GS0 gs 1 g 0 792 0 0 re f /GS2 gs q 1 w /CS0 CS 1 SCN 36 63 m 576 63 l S BT /F0 1 Tf 8 0 0 8 31.5527 21 Tm 0 0 0 1 k (5)Tj ET BT /F2 1 Tf 10 0 0 10 37.6803 712.5 Tm -0.0112 Tc 0.0278 Tw (executives, their consultants, and major stakeholders been in)Tj 0 -1.4 TD -0.011 Tc 0.028 Tw [(agr)18(eement on r)17(easonable compensation for executives and)]TJ T* [(boar)18(d members, or at least on the yar)17(dsticks for determining)]TJ 0 Tc (r)' 0.30383 0.00001 TD -0.011 Tc [(easonable compensation. This can be a contr)18(oversial and)]TJ -0.30383 -1.4 TD [(complex issue that plays out dif)18(fer)17(ently depending on the)]TJ -0.0112 Tc 0.0278 Tw (locale, business sector)' 9.09591 0.00001 TD -0.011 Tc 0.028 Tw (, and organization. Defining and)Tj -9.09591 -1.4 TD [(analyzing the experience of compensation peer gr)18(oups may)]TJ T* [(be helpful in setting compensation ranges. 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Whether these potential conflicts)]TJ -0.0113 Tc (wer)' 1.55944 0 TD -0.011 Tc [(e r)18(eal or per)17(ceived, it seems r)18(easonable that such)]TJ -1.55944 -1.40001 TD -0.0112 Tc 0.0278 Tw (possibilities should at least have been disclosed, with their)Tj 0 -1.4 TD -0.011 Tc 0.028 Tw [(consideration and disposition by the boar)18(d well documented.)]TJ -0.0112 Tc 0.0278 Tw (While it is not known whether Car)' 14.5034 0.00001 TD -0.0113 Tc (eFirst is r)Tj 3.635 0.00001 TD -0.0112 Tc (eassessing its)Tj -18.1384 -1.40001 TD -0.011 Tc 0.028 Tw [(policies and pr)18(ocedur)17(es on a code of conduct in general, or)]TJ 0 -1.4 TD -0.0113 Tc 0.0278 Tw (conflict of inter)Tj 6.34544 0.00001 TD (est mor)Tj 3.15313 0.00001 TD -0.011 Tc 0.028 Tw [(e specifically)92(, this might well be one of)]TJ -9.49857 -1.40002 TD [(the ar)18(eas addr)17(essed by Car)18(eFirst\325)111(s gover)-18(nance consultant. )]TJ ET BT /F9 1 Tf 10 0 0 10 37.6803 238.9 Tm /CS0 cs 1 scn -0.0113 Tc (Conclusion)Tj ET BT /F2 1 Tf 10 0 0 10 37.6803 222.74 Tm 0 0 0 1 k -0.011 Tc [(The Car)18(eFirst story is in par)-1(t about conversions, and what)]TJ 0 -1.4 TD [(other states and nonpr)18(ofit health car)17(e organizations can lear)-18(n)]TJ T* [(f)1(r)18(om that experience. Mor)18(e fundamentally)92(, however)91(, it is)]TJ -0.0112 Tc 0.0278 Tw (about the failur)' 6.47007 0.00001 TD (e of gover)Tj 4.29504 0.00001 TD (nance, r)Tj 3.36517 0.00001 TD (eal or per)Tj 3.98156 0.00001 TD (ceived, and should)Tj -18.11184 -1.40003 TD -0.011 Tc 0.028 Tw [(send a str)18(ong signal to all nonpr)17(ofit health car)18(e organizations)]TJ 0 -1.4 TD -0.0113 Tc 0.0278 Tw (of wher)Tj 3.26519 0.00001 TD -0.0112 Tc (e gover)Tj 3.13409 0.00001 TD -0.0113 Tc (nment inter)Tj 4.90409 0.00001 TD -0.0112 Tc (vention can lead when the public)Tj -11.30337 -1.40002 TD -0.0113 Tc (loses tr)Tj 2.93792 0.00001 TD -0.0112 Tc (ust in the boar)Tj 6.12103 0.00001 TD -0.0114 Tc (d.)Tj ET BT /F9 1 Tf 10 0 0 10 315.8401 712.5 Tm /CS0 cs 1 scn -0.0113 Tc (Notes)Tj ET BT /F2 1 Tf 10 0 0 10 315.8401 696.34 Tm 0 0 0 1 k -0.011 Tc 0.028 Tw [(The Alliance for Advancing Nonpr)18(ofit Health Car)17(e is a new)]TJ 0 -1.4 TD -0.0112 Tc 0.0278 Tw (national gr)Tj 4.49858 0.00001 TD -0.011 Tc 0.028 Tw [(oup composed of a mix of nonpr)18(ofit health car)17(e)]TJ -4.49858 -1.4 TD [(pr)17(oviders, nonpr)18(ofit health insur)18(ers, nonpr)18(ofit integrated)]TJ T* [(health car)18(e financing and delivery or)-1(ganizations, and other)]TJ T* [(nonpr)18(ofit health car)17(e enterprises. It is dedicated to pr)18(eserving)]TJ T* [(the unique r)18(oles and r)17(esponsibilities of nonpr)18(ofit health car)18(e)]TJ T* [(organizations in the United States, while impr)17(oving their)]TJ T* [(performance. The views pr)17(esented ar)18(e the author\325)111(s and ar)18(e)]TJ -0.0112 Tc 0.0278 Tw (not positions taken by the Alliance. )' 5 0 0 5 315.8401 564.8713 Tm 0 Tc (1)Tj 10 0 0 10 321.5092 561.34 Tm -0.011 Tc 0.028 Tw [(Community benefits might include pr)18(ograms, activities,)]TJ -0.56691 -1.40001 TD [(and/or financial or in-kind contributions designed to pr)18(ovide)]TJ 0 -1.4 TD -0.017 Tc [(needed services, impr)18(ove access to needed ser)-1(vices, achieve a)]TJ T* [(single standar)18(d of car)17(e, and/or impr)18(ove health status or quality)]TJ 0 -1.40001 TD [(of life, particularly for the poor)91(, uninsur)18(ed, underinsur)18(ed, frail)]TJ 0 -1.4 TD [(elderly)92(, or other vulnerable population gr)17(oup. Additional)]TJ -0.0168 Tc 0.0278 Tw (community benefits include any subsidies for r)' 19.10029 0 TD (esear)Tj 2.12047 0 TD (ch and)Tj -21.22076 -1.40001 TD -0.017 Tc 0.028 Tw [(education pr)18(ograms benefiting society mor)17(e generally)92(.)]TJ ET BT /F9 1 Tf 10 0 0 10 315.8401 436.74 Tm /CS0 cs 1 scn -0.011 Tc 0 Tw [(Refer)18(ences)]TJ ET BT /F2 1 Tf 10 0 0 10 315.8401 420.58 Tm 0 0 0 1 k 0.028 Tw [(McPherson, B. 2004; The Failed Conversion of Car)18(eFirst)]TJ 0 -1.4 TD -0.0112 Tc (BlueCr)Tj 2.74901 0 TD 0.0278 Tw (oss BlueShield to For)Tj 8.57291 0 TD -0.0113 Tc (-Pr)Tj 1.11437 0 TD -0.0112 Tc (ofit Status: Par)Tj 6.09776 0 TD (t I, The Whole)Tj -18.53405 -1.40001 TD -0.0113 Tc (Stor)Tj 1.67699 0 TD (y: Inquir)Tj 3.37163 0 TD 0 Tc (y)Tj 0.34094 0 TD -0.0112 Tc (. 41:(3) 245\320254. )Tj -5.38956 -2.30001 TD -0.011 Tc 0.028 Tw [(Salganik, W)74(.M. 2002; Car)18(eFirst Action T)110(ests Limits on How)]TJ 0 -1.4 TD [(Far Boar)18(d Can Go: Baltimor)17(e Sun (November 24): 1C.)]TJ /F4 1 Tf 1 0 0 1 -1000 1792 Tm 1 g 0 Tc 0 Tw ( )Tj ET Q endstream endobj 18 0 obj << /Nums[0<>] >> endobj 19 0 obj << /Type/Encoding /BaseEncoding/MacRomanEncoding /Differences[32/space 44/comma 47/slash/zero/one/two/three/four/five 65/A/B/C 69/E/F 72/H/I 76/L/M/N/O/P/Q/R/S/T/U/V/W 89/Y] >> endobj 20 0 obj << /Length1 2127 /Subtype/Type1C /Length 2127 >> stream QYRZTH+Frutiger-Roman@=r|;   $ _4Copyright (c) 1988 Adobe Systems Incorporated. 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