2025-11-17T08:34:50-06:00 2024-12-31 135565207 KPMG LLP 60 SOUTH STREET BOSTON MA 02111 990 2024-01-01 453416923 MAINE COMMUNITY HEALTH OPTIONS MAIN 2074023330 60 PINELAND DRIVE AUBURN HALL 301 NEW GLOUCESTER ME 04260 JOANNE LAUTERBACH CHIEF FINANCIAL OFFICER 2073302390 2025-11-13 1 0 STEPHANIE LONCZAK P01880207 6179881000 2025-11-11 2024 2025-03-06 01:10:19Z KEVIN LEWIS 60 PINELAND DRIVE AUBURN HALL 301 NEW GLOUCESTER ME 04260 303838628 0 X WWW.HEALTHOPTIONS.ORG X 2011 ME TO PARTNER WITH MAINE PEOPLE, BUSINESSES, AND HEALTH PROFESSIONALS TO PROVIDE AFFORDABLE, HIGH-QUALITY BENEFITS THAT PROMOTE HEALTH AND WELLBEING. 17 17 214 17 54007 45470 0 0 304268082 301937399 2030280 1900576 62625 0 306360987 303837975 0 0 289242539 295641854 24255467 23357500 0 0 0 17493897 18143119 330991903 337142473 -24630916 -33304498 157104410 124258026 66398006 78774314 90706404 45483712 X SEE SCHEDULE O 0 0 THE ORGANIZATION WAS ESTABLISHED AND OPERATES AS 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, THE ORGANIZATION: (1) PARTNERS WITH MEMBERS, BUSINESSES, AND HEALTH PROFESSIONALS TO PROVIDE AFFORDABLE, HIGH-QUALITY BENEFITS THAT PROMOTE HEALTH AND WELLBEING, (2) CREATES AND DEVELOPS INNOVATIVE FORMS OF HEALTHCARE DELIVERY FOR THE PURPOSE OF CREATING BETTER HEALTHCARE VALUE THROUGH IMPROVED HEALTH OUTCOMES AT LOWER COST, AND (3) PROMOTES THE HEALTH OF THE PEOPLE OF MAINE AND EDUCATES THE PUBLIC ABOUT HEALTH, HEALTHCARE, AND RELATED TOPICS. 0 0 0 0 0 0 0 0 0 0 0 0 1 1 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 0 1 0 0 0 1 1852 0 1 214 1 1 1 0 0 0 0 0 0 0 0 1 100000 100000 0 0 0 X 17 17 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 60 PINELAND DRIVE AUBURN HALL SUITE NEW GLOUCESTER ME 04260 JEFF NORRIS DIRECTOR 2.00 X 0 0 0 HOLLY KORDA CHAIR (THRU 12/2024) 2.00 X 0 0 0 REBECCA SWANSON CONRAD VICE CHAIR 2.00 X 0 0 0 ASHER KRAMER TREASURER 2.00 X 0 0 0 JUDIANN FERRETTI SMITH SECRETARY (THRU 12/2024) 2.00 X 0 0 0 PAUL ANDREWS DIRECTOR (THRU 12/2024) 2.00 X 0 0 0 LISA BARD LEVINE DIRECTOR (AS OF 1/2024) 2.00 X 0 0 0 LESLIE CLARK DIRECTOR (THRU 12/2024) 2.00 X 0 0 0 JEROD CRONKITE DIRECTOR (THRU 12/2024) 2.00 X 0 0 0 CHERYL GREANEY DIRECTOR 2.00 X 0 0 0 JIM HARRISON DIRECTOR 2.00 X 0 0 0 RALPH JOHNSON DIRECTOR 2.00 X 0 0 0 DR ROBERT LORENZO DIRECTOR 2.00 X 0 0 0 CORY MCKENNA DIRECTOR (THRU 12/2024) 2.00 X 0 0 0 LAURIE REED DIRECTOR (AS OF 1/2024) 2.00 X 0 0 0 SHARON REISHUS DIRECTOR (THRU 12/2024) 2.00 X 0 0 0 ANDY TOMLINSON DIRECTOR (AS OF 1/2024) 2.00 X 0 0 0 KEVIN LEWIS CHIEF EXECUTIVE OFFICER 40.00 X 420144 0 36512 LORI W TISHLER MD MPH CHIEF MEDICAL OFFICER 40.00 X 389066 0 57321 WILLIAM KILBRETH CHIEF INFORMATION OFFICER 40.00 X 277858 0 55053 JOANNE LAUTERBACH CHIEF FINANCIAL OFFICER 40.00 X 285377 0 18428 DAVID L STUART CHIEF OPERATING OFFICER (THRU 9/6/24) 40.00 X 219060 0 42832 HEATHER L BOUFFARD DIRECTOR MARKETING/COMMUNICATIONS 40.00 X 211518 0 38416 KIRK MIKLAVIC VP HUMAN RESOURCES 40.00 X 195434 0 42357 GRAYSON STUNTZ DIRECTOR INFO TECHNOLOGY 40.00 X 185996 0 12375 DEBORAH S YOLIN RALEY VP CLINICAL OPS (THRU 9/2/24) 40.00 X 174383 0 40063 JACQUELYN HEDLUND SENIOR MEDICAL DIRECTOR 40.00 X 172525 0 0 2531361 0 343357 46 0 1 0 UST HEALTHPROOF INC 5 POLARIS WAY ALISO VIEJO CA 92656 CLAIMS PLATFORM VENDOR 3202149 TIERPOINT 12444 POWERSCOURT DRIVE SUITE 450 ST LOUIS MO 63131 IT SOLUTIONS 997232 INOVALON INC 4321 COLLINGTON ROAD BOWIE MD 20716 SOFTWARE TECHNOLOGY 797299 SALESFORCECOM INC PO BOX 203141 DALLAS TX 753203141 SOFTWARE TECHNOLOGY 645325 HEALTHEDGE SOFTWARE INC 30 CORPORATE DRIVE BURLINGTON MA 01803 SOFTWARE TECHNOLOGY 628000 53 PREMIUM REVENUE 900099 301937399 301937399 301937399 1901229 54007 1847222 653 -653 -653 -653 303837975 301937399 54007 1846569 295641854 1591504 17444916 429388 2787024 1104668 635023 292051 60250 189946 1609703 1009186 950210 5092008 51474 73979 96634 521807 GOVERNMENT MANDATED FEE 7366109 DUES, ASSOC. AND MEMBER 194739 337142473 10677808 5574744 12255770 126002 6588869 9508610 111605737 100270907 15976226 8777763 157104410 124258026 39366091 41838204 27031915 36936110 66398006 78774314 X 90706404 45483712 90706404 45483712 157104410 124258026 X -33304498 -11918194 X X 0 1 X 1 1 1 0 INVESTMENT INCOME DUE AND ACCRUED 623351 AMOUNTS RECOVERABLE FROM REINSURERS 8154412 8777763 UNPAID CLAIMS AND CLAIM ADJUSTMENT EXPENSES 32989629 UNEARNED PREMIUMS 3946481 36936110 X 255656183 1050031 1050031 254606152 189946 49041877 49231823 303837975 299720906 -38281652 -38281652 338002558 189946 -1050031 -860085 337142473 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, 2020 THROUGH 2023. 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 INCREASE IN RESERVES FOR ACCIDENTS AND HEALTH INSURANCE CONTRACTS 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 420144 0 0 0 0 0 13800 0 22712 0 456656 0 0 0 LORI W TISHLER MD MPH CHIEF MEDICAL OFFICER 389066 0 0 0 0 0 13800 0 43521 0 446387 0 0 0 WILLIAM KILBRETH CHIEF INFORMATION OFFICER 277858 0 0 0 0 0 11343 0 43710 0 332911 0 0 0 JOANNE LAUTERBACH CHIEF FINANCIAL OFFICER 285377 0 0 0 0 0 11385 0 7043 0 303805 0 0 0 DAVID L STUART CHIEF OPERATING OFFICER (THRU 9/6/24 219060 0 0 0 0 0 9106 0 33726 0 261892 0 0 0 HEATHER L BOUFFARD DIRECTOR MARKETING/COMMUNICATIONS 210018 0 1500 0 0 0 8548 0 29868 0 249934 0 0 0 KIRK MIKLAVIC VP HUMAN RESOURCES 193934 0 1500 0 0 0 8124 0 34233 0 237791 0 0 0 DEBORAH S YOLIN RALEY VP CLINICAL OPS (THRU 9/2/24) 174383 0 0 0 0 0 6710 0 33353 0 214446 0 0 0 GRAYSON STUNTZ DIRECTOR INFO TECHNOLOGY 184496 0 1500 0 0 0 7425 0 4950 0 198371 0 0 0 JACQUELYN HEDLUND SENIOR MEDICAL DIRECTOR 171025 0 1500 0 0 0 0 0 0 0 172525 0 0 0 PART I, LINE 7 CERTAIN INDIVIDUALS RECEIVED A NON-FIXED BONUS PAYMENT. THESE PAYMENTS WERE DISCRETIONARY AND REQUIRED BOARD APPROVAL. FORM 990, PART III, LINE 1 THE ORGANIZATION WAS ESTABLISHED AND OPERATES AS 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, THE ORGANIZATION: (1) PARTNERS WITH MEMBERS, BUSINESSES, AND HEALTH PROFESSIONALS TO PROVIDE AFFORDABLE, HIGH-QUALITY BENEFITS THAT PROMOTE HEALTH AND WELLBEING, (2) CREATES AND DEVELOPS INNOVATIVE FORMS OF HEALTHCARE DELIVERY FOR THE PURPOSE OF CREATING BETTER HEALTHCARE VALUE THROUGH IMPROVED HEALTH OUTCOMES AT LOWER COST, AND (3) PROMOTES THE HEALTH OF THE PEOPLE OF MAINE AND EDUCATES THE PUBLIC ABOUT HEALTH, HEALTHCARE, AND RELATED TOPICS. FORM 990, PART V, LINE 13: MCHO IS LICENSED TO ISSUE QUALIFIED HEALTH PLANS IN THE FOLLOWING STATES: ME, NH MCHO MAINTAINS AND REPORTS THE FULL AMOUNT OF RESERVES REQUIRED BY MAINE AND NEW HAMPSHIRE STATE LAW OF $100,000 AND $0, RESPECTIVELY. 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 VICE PRESIDENT, HUMAN RESOURCES UTILIZED VARIOUS MARKET COMPENSATION TOOLS TO DETERMINE COMPARABLE SALARIES BASED ON WHAT WOULD BE PAID FOR SERVICES PERFORMED BY AN OFFICER FOR LIKE ENTERPRISES UNDER LIKE CIRCUMSTANCES. WHEN 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 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 -1,157,968. INCREASE IN RESERVES FOR ACCIDENTS/HEALTH CONTRACTS -10,760,226. FORM 990, PART XII, LINE 1: MAINE COMMUNITY HEALTH OPTIONS PREPARED ITS 2024 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 31655 98863 MAINE COMMUNITY HEALTH OPTIONS