While looking at the compensation of executives in Health Insurance "Not-for-Profit" corporations or Hospitals I have wondered about the governance of those organizations. It looked like the Board of Directors was omnipotent (most of the time). But how were the members of the Board chosen? It seems that in most cases the board members simply chose themselves: this is the system of the self-perpetuating board where all the power is concentrated within board members that are only accountable to themselves.
If you take organizations like Regence or Premera that "serve" millions of "members", they are ruled by a self-appointed board of directors without any elected representation from the millions of "members, without any accountability toward their "members" via an annual general assembly of any kind. The self-perpetuating board system effectively excludes the so called "members" from any say in the way the organization supposed to serve them operates. Those 'not-for-profit" structures are less accountable than for profit corporations that have to deal (at least) with their shareholders.