2022-11-15T15:34:15-06:00 2021-12-31 135565207 KPMG LLP 60 SOUTH STREET TWO FINANCIAL CENTER BOSTON MA 02111 990 2021-01-01 453416923 MAINE COMMUNITY HEALTH OPTIONS MAIN 2074023330 150 MILL STREET THIRD FLOOR LEWISTON ME 04240 JOANNE LAUTERBACH CHIEF FINANCIAL OFFICER 2073302390 2022-11-15 1 JOANNE LAUTERBACH 999009999 STEPHANIE LONCZAK P01880207 6179881000 2022-11-15 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z KEVIN LEWIS 150 MILL STREET THIRD FLOOR LEWISTON ME 04240 187137640 0 X WWW.HEALTHOPTIONS.ORG X 2011 ME SEE SCHEDULE O 16 16 194 16 18251 14585 0 0 228677518 183385550 1857315 1752090 0 2000000 230534833 187137640 5000 0 126374419 174748658 19582760 19950059 0 0 0 28070189 12449867 174032368 207148584 56502465 -20010944 218975407 184016792 78835404 63626875 140140003 120389917 X ESTABLISHING AND OPERATING A CONSUMER OPERATED AND ORIENTED PLAN ("CO-OP") IN ACCORDANCE WITH THE PROVISIONS OF SECTION 1322 OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. AS A CONSUMER - GOVERNED NONPROFIT HEALTH INSURANCE ISSUER THAT WILL PROMOTE INTEGRATED MODELS OF CARE AND ENHANCE COMPETITION BY OFFERING ONE OR MORE QUALIFIED HEALTH PLANS IN THE AFFORDABLE INSURANCE EXCHANGES. CREATING AND DEVELOPING INNOVATIVE FORMS OF HEALTHCARE DELIVERY FOR THE PURPOSE OF CREATING BETTER HEALTHCARE VALUE THROUGH IMPROVED HEALTH OUTCOMES AT LOWER COSTS. PROMOTING THE HEALTH OF THE PEOPLE OF MAINE AND EDUCATING THE PUBLIC ABOUT HEALTH, HEALTH CARE AND RELATED TOPICS.FORM 990, PART V, LINE 13MCHO IS LICENSED TO ISSUE QUALIFIED HEALTH PLANS IN THE FOLLOWING STATES:ME, NHMCHO MAINTAINS AND REPORTS THE FULL AMOUNT OF RESERVES REQUIRED BY MAINE AND NEW HAMPSHIRE STATE LAW OF $100,000 AND $0, RESPECTIVELY. 0 0 ESTABLISHING AND OPERATING A CONSUMER OPERATED AND ORIENTED PLAN ("CO-OP") IN ACCORDANCE WITH THE PROVISIONS OF THE SECTION 1322 OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. AS A CONSUMER-GOVERNED NONPROFIT HEALTH INSURANCE ISSUER THAT WILL PROMOTE INTEGRATED MODELS OF CARE AND ENHANCE COMPETITION BY OFFERING ONE OR MORE QUALIFIED HEALTH PLANS IN THE AFFORDABLE INSURANCE EXCHANGES. PROMOTING THE HEALTH OF THE PEOPLE OF MAINE AND EDUCATING THE PUBLIC ABOUT HEALTH, HEALTH CARE AND RELATED TOPICS. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 X 2656 0 1 194 1 1 1 0 0 0 0 0 0 0 0 1 100000 100000 0 0 0 X 16 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 ME NH X JOANNE LAUTERBACH 2073302390 150 MILL STREET THIRD FLOOR LEWISTON ME 04240 REBECCA CONRAD DIRECTOR 2.00 X 0 0 0 FREDERIC C GRAIGIE JR DIRECTOR 2.00 X 0 0 0 SARAH HINES DIRECTOR 2.00 X 0 0 0 HOLLY KORDA DIRECTOR 2.00 X 0 0 0 ASHER KRAMER DIRECTOR 2.00 X 0 0 0 ROBERT LORENZO DIRECTOR 2.00 X 0 0 0 HEIDI LUKAS DIRECTOR 2.00 X 0 0 0 ROCELL MARCELLINO DIRECTOR 2.00 X 0 0 0 JEFF NORRIS CHAIRMAN OF THE BOARD 2.00 X 0 0 0 SHARON REISHUS DIRECTOR 2.00 X 0 0 0 DAVID SHIPMAN DIRECTOR 2.00 X 0 0 0 JUDIANN FERRETTI SMITH VICE CHAIR 2.00 X 0 0 0 MITCHELL STEIN DIRECTOR 2.00 X 0 0 0 RHONDA WESTON DIRECTOR 2.00 X 0 0 0 MICHELLE BETZ DIRECTOR (BEG 1/1/2021) 2.00 X 0 0 0 SARAH SULLIVAN DIRECTOR (BEG 1/1/2021) 2.00 X 0 0 0 KEVIN LEWIS CHIEF EXECUTIVE OFFICER 40.00 X 389156 0 30436 WILLIAM KILBRETH CHIEF INFORMATION OFFICER 40.00 X 234814 0 41480 ROBERT HILLMAN CHIEF OPERATING OFFICER 40.00 X 330056 0 41058 JOANNE LAUTERBACH CHIEF FINANCIAL OFFICER 40.00 X 230152 0 12487 MARGARET KELLEY AVP OF MEDICAL SERVICES 40.00 X 242128 0 36448 GRAYSON STUNTZ DIRECTOR OF INFO. TECHNOLO 40.00 X 165204 0 37413 MICHAEL TAKACH PHARMACY DIRECTOR 40.00 X 173007 0 10131 KIRK MIKLAVIC VP OF HUMAN RESOURCES 40.00 X 174823 0 31860 JENNIFER WILSON AVP PLAN MANAGEMENT 40.00 X 152121 0 31629 2091461 0 272942 35 0 1 0 UST HEALTHPROOF INC 5 POLARIS WAY ALISO VIEJO CA 92656 CLAIMS PLATFORM VEND 3344916 INOVALONINC 4321 COLLINGTON ROAD BOWIE MD 20716 SOFTWARE TECHNOLOGY 884096 MILLIMAN 80 LAMBERTON RD WINDSOR CT 06095 ACTUARIAL SERVICES 634558 TIERPOINT PO BOX 82670 LINCOLN NE 685012670 IT SOLUTIONS 604390 ETHOS MARKETING & DESIGN 17 ASH STREET WESTBROOK ME 04092 ADVERTISING 567729 47 PREMIUM REVENUE 900099 183385550 183385550 183385550 1752090 18251 1733839 MISCELLANEOUS 900099 2000000 2000000 2000000 187137640 185385550 18251 1733839 174748658 2735474 13991523 416758 1806623 999681 270005 340270 50200 294442 1735173 794660 742620 3088673 343179 9551 16759 220086 352094 GOVERNMENT MANDATED FEE 3999868 DUES, ASSOC. AND MEMBER 192287 207148584 61990275 -5403600 77646032 32410827 3892800 4824418 4700000 68950865 140171020 6495435 7314127 218975407 184016792 54115719 47069442 324702 191076 24394983 16366357 78835404 63626875 X 140140003 120389917 140140003 120389917 218975407 184016792 X -20010944 260858 X X 0 1 X 1 1 1 0 0 UNPAID CLAIMS AND LOSS 11579426 UNEARNED PREMIUMS 4786931 16366357 X 167309634 14215768 14215768 153093866 294442 33749332 34043774 187137640 187320578 -33749332 -33749332 221069910 294442 -14215768 -13921326 207148584 PART X, LINE 2: EXPLANATION: MAINE COMMUNITY HEALTH OPTIONS HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(29) AND IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE CODE. ACCORDINGLY NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE ORGANIZATION FOLLOWS THE PROVISIONS OF ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES AS PROVIDED FOR IN THE INCOME TAXES TOPIC OF THE FASB ACCOUNTING STANDARDS CODIFICATION, WHICH CLARIFIES THE CRITERIA THAT AN INDIVIDUAL TAX POSITION MUST BE RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. IT ALSO PRESCRIBES A RECOGNITION THRESHOLD OF MORE LIKELY THAN NOT, AND A MEASUREMENT ATTRIBUTE FOR ALL TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN, IN ORDER FOR THOSE TAX POSITIONS TO BE RECOGNIZED IN THE FINANCIAL STATEMENTS. THERE WAS NO CUMULATIVE EFFECT ON THE ORGANIZATION'S FINANCIAL STATEMENTS RELATED TO FOLLOWING THESE PROVISIONS, AND NO INTEREST OR PENALTIES RELATED TO UNCERTAIN TAX POSITIONS WERE ACCRUED. THE ORGANIZATION IS CURRENTLY OPEN TO AUDIT UNDER THE STATUTE OF LIMITATIONS BY THE INTERNAL REVENUE SERVICE AND STATE TAXING AUTHORITIES FOR THE YEARS ENDED DECEMBER 31, 2018 THROUGH 2020. PART XI, LINE 2D - OTHER ADJUSTMENTS: CONTRA-PREMIUMS AND REINSURANCE PREMIUMS PART XI, LINE 4B - OTHER ADJUSTMENTS: OTHER REIMBURSEMENTS AND REBATES PART XII, LINE 2D - OTHER ADJUSTMENTS: OTHER REIMBURSEMENTS AND REBATES PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRA-PREMIUMS AND REINSURANCE PREMIUMS X X X 0 0 0 0 0 0 0 1 0 KEVIN LEWIS CHIEF EXECUTIVE OFFICER 370462 0 18694 0 0 0 11600 0 18836 0 419592 0 0 0 ROBERT HILLMAN CHIEF OPERATING OFFICER 314022 0 16034 0 0 0 11600 0 29458 0 371114 0 0 0 MARGARET KELLEY AVP OF MEDICAL SERVICES 230283 0 11845 0 0 0 9486 0 26962 0 278576 0 0 0 WILLIAM KILBRETH CHIEF INFORMATION OFFICER 223466 0 11348 0 0 0 9088 0 32392 0 276294 0 0 0 JOANNE LAUTERBACH CHIEF FINANCIAL OFFICER 219202 0 10950 0 0 0 8760 0 3727 0 242639 0 0 0 KIRK MIKLAVIC VP OF HUMAN RESOURCES 166452 0 8371 0 0 0 6707 0 25153 0 206683 0 0 0 GRAYSON STUNTZ DIRECTOR OF INFO. TECHNOLO 157176 0 8028 0 0 0 6432 0 30981 0 202617 0 0 0 JENNIFER WILSON AVP PLAN MANAGEMENT 144509 0 7612 0 0 0 6090 0 25539 0 183750 0 0 0 MICHAEL TAKACH PHARMACY DIRECTOR 164882 0 8125 0 0 0 6510 0 3621 0 183138 0 0 0 PART I, LINE 7 CERTAIN INDIVIDUALS RECEIVED A NON-FIXED BONUS PAYMENT. THESE PAYMENTS WERE DISCRETIONARY AND REQUIRED BOARD APPROVAL. DFD RUSSELL MEDICAL CENTER KEVIN LEWIS, CEO OF MCHO 90052 CLAIMS PAID 1 SCHEDULE L, PART IV KEVIN LEWIS, CEO OF ORGANIZATION'S WIFE IS CEO OF DFD RUSSELL MEDICAL. FORM 990, PART I, LINE 1: TO PARTNER WITH MAINE PEOPLE, BUSINESSES AND HEALTH PROFESSIONALS TO PROVIDE AFFORDABLE, HIGH QUALITY BENEFITS THAT PROMOTE HEALTH AND WELL BEING. FORM 990, PART VI, SECTION A, LINE 6 EXPLANATION: THIS CORPORATION HAS ONE CLASS OF MEMBERS CONSISTING OF ALL INDIVIDUALS COVERED UNDER HEALTH INSURANCE POLICIES ISSUED BY THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A EXPLANATION: EACH MEMBER 18 YEARS AND OLDER SHALL HAVE A SINGLE VOTE. ALL DECISIONS OF THE MEMBERS SHALL BE BY A MAJORITY VOTE. THE MEMBERS SHALL BE LISTED ON A SCHEDULE THAT SHALL BE MAINTAINED WITH THIS CORPORATION'S OTHER BOOKS AND RECORDS. THE MEMBERS SHALL HAVE THE SOLE AND EXCLUSIVE POWER AND AUTHORITY: TO AMEND THIS CORPORATION'S ARTICLES OF INCORPORATION; TO ELECT OR REMOVE DIRECTORS OF THIS CORPORATION; AND TO APPROVE THE MERGER, CONSOLIDATION, DISSOLUTION, OR SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THIS CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B EXPLANATION: EACH MEMBER 18 YEARS AND OLDER SHALL HAVE A SINGLE VOTE. ALL DECISIONS OF THE MEMBERS SHALL BE BY A MAJORITY VOTE. THE MEMBERS SHALL BE LISTED ON A SCHEDULE THAT SHALL BE MAINTAINED WITH THIS CORPORATION'S OTHER BOOKS AND RECORDS. THE MEMBERS SHALL HAVE THE SOLE AND EXCLUSIVE POWER AND AUTHORITY: TO AMEND THIS CORPORATION'S ARTICLES OF INCORPORATION; TO ELECT OR REMOVE DIRECTORS OF THIS CORPORATION; AND TO APPROVE THE MERGER, CONSOLIDATION, DISSOLUTION, OR SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THIS CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B EXPLANATION: A COPY OF THE FORM 990 IS PROVIDED TO BOARD MEMBERS FOR REVIEW AND APPROVAL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EXPLANATION: WHEN OFFICERS AND BOARD MEMBERS START, THEY ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT AND REPORTING FORM INDICATING THAT THEY DO NOT HAVE ANY CONFLICTS OF INTEREST OR ANY POTENTIAL CONFLICTS OF INTEREST. ANY POTENTIAL CONFLICT OF INTEREST IS REVIEWED BY THE COMPLIANCE DEPARTMENT AND OUTSIDE COUNSEL, IF NECESSARY, TO DETERMINE IF SUCH CONFLICT WOULD PROHIBIT THE INDIVIDUAL FROM PERFORMING THEIR OFFICER OR BOARD DUTIES. THEY ARE THEN REQUIRED TO RECERTIFY ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 EXPLANATION: NUMEROUS LEVELS OF OVERSIGHT WERE INVOLVED IN SETTING BOTH CEO AND OFFICERS' COMPENSATION FOR MAINE COMMUNITY HEALTH OPTIONS. FIRST AND FOREMOST, THE FORMATION BOARD OF MCHO WAS CRITICALLY INVOLVED IN THE DECISION ABOUT THE COMPENSATION OF THE CEO. SALARIES OF CEOS OF OTHER NON-PROFIT INSURANCE ORGANIZATIONS WERE PROVIDED TO THE BOARD AND THE CEO SALARY WAS APPROVED. ONCE APPROVED BY THE BOARD, CMS REVIEWED THE SALARY FOR REASONABLENESS AND ADEQUATE COMPARABILITY PRIOR TO EXECUTION OF THE LETTER OF AGREEMENT. ON AN ANNUAL BASIS, COMPENSATION CHANGES FOR THE CEO ARE RECOMMENDED BY HUMAN RESOURCES UTILIZING VARIOUS MARKET COMPENSATION TOOLS. ANY COMPENSATION CHANGES ARE DISCUSSED AND ULTIMATELY APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. TO DETERMINE SALARIES FOR THE REMAINING OFFICERS OF MCHO, THE CEO AND THE CHRO UTILIZED THE 2011 ACAP SURVEY TO UNDERSTAND COMPARABLE SALARIES BASED ON WHAT WOULD BE PAID FOR SERVICES PERFORMED BY AN OFFICER FOR LIKE ENTERPRISES UNDER LIKE CIRCUMSTANCES. ONCE A SALARY WAS DETERMINED, THE CEO PROVIDED THE CONTRACT AND SALARY TO CMS TO ENSURE OVERSIGHT, COMPARABILITY AND REASONABLENESS. ONCE CMS APPROVED THE CONTRACT AND SALARY, THE CONTRACT WAS EXECUTED. IF AN OFFICER SUBSEQUENTLY LEAVES THEIR POSITION, THE SALARY OF THE NEWLY HIRED INDIVIDUAL IS DETERMINED BY HUMAN RESOURCES AND THE CEO UTILIZING VAROUS MARKET COMPENSATION TOOLS. ALL CONTRACTS ARE SENT TO CMS. ALL COMPENSATION DECISIONS ARE DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 EXPLANATION: MCHO WILL MAKE ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICIES AVAILABLE TO THE PUBLIC IN PRINT UPON REQUEST. MCHO'S FINANCIAL STATEMENTS ARE MADE PUBLIC WITH THE MAINE BUREAU OF INSURANCE AND THE NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS AS WELL AS THROUGH FORM 990. FORM 990, PART XI, LINE 9: CHANGE IN NONADMITTED ASSETS 260,858. FORM 990, PART XII, LINE 1 MAINE COMMUNITY HEALTH OPTIONS PREPARED ITS 2021 AUDITED FINANCIAL STATEMENTS USING THE STATUTORY BASIS, WHICH IS A COMPREHENSIVE METHOD OTHER THAN U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). FORM 990, PART XII, LINE 2C: EXPLANATION: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. COMMUNITY OPTIONS LLC PO BOX 1121 LEWISTON ME 04243 301244131 LICENSED RESIDENT PRODUCER AGENCY ME 40 15378 MAINE COMMUNITY HEALTH OPTIONS