2018-10-18T12:43:22-05:00 2017-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 777 E WISCONSIN AVENUE 32ND FLOOR MILWAUKEE WI 53202 990 2017-01-01 453309488 COMMON GROUND HEALTHCARE COOPERATIVE COMM 4144550500 120 BISHOPS WAY NO 150 BROOKFIELD WI 53005 CATHY MAHAFFEY CEO 4144550500 2018-10-12 1 TROY MARINE CPA P00187863 4147775500 2018-10-12 38.122.82.115 2018-10-12 15:04:23 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 793A1E00ACF041F16FD41A7A782950CAF62641F6 2017 2018-06-14 16:35:46Z CATHY MAHAFFEY 120 BISHOPS WAY NO 150 BROOKFIELD WI 53005 173686355 0 X WWW.COMMONGROUNDHEALTHCARE.ORG X CO-OP 2011 WI PROVIDE AFFORDABLE HEALTH INSURANCE SOLUTIONS TO SMALL BUS., INDIVIDUALS & NON-PROFITS IN WI. 9 0 109 0 0 0 0 0 97708760 173507725 3368 178630 0 0 97712128 173686355 0 0 0 0 7234085 7436682 0 0 0 126508038 177750387 133742123 185187069 -36029995 -11500714 63700323 105294302 143220812 196315505 -79520489 -91021203 COMMON GROUND HEALTHCARE COOPERATIVE ("CGHC") IS A NON-PROFIT MEMBER-GOVERNED HEALTH INSURANCE COMPANY DEDICATED TO PROVIDING AFFORDABLE, INNOVATIVE HEALTH INSURANCE SOLUTIONS TO SMALL BUSINESSES, NON-PROFITS, AND INDIVIDUALS IN WISCONSIN. 0 0 COMMON GROUND HEALTHCARE COOPERATIVE IS A NON-PROFIT MEMBER-GOVERNED HEALTH INSURANCE COOPERATIVE DEDICATED TO DELIVERING QUALITY, COMPREHENSIVE HEALTH INSURANCE TO SMALL BUSINESSES AND INDIVIDUALS IN WISCONSIN. 0 0 0 0 0 0 0 0 0 1 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 0 0 0 0 1 1039 0 1 109 1 0 0 0 0 0 1 24485484 17118820 0 X 9 0 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X TOM LAWLESS 4144550500 120 BISHOPS WAY SUITE 150 BROOKFIELD WI 53005 MARY REHBERG SECRETARY/TREASURER 1.00 X 8660 0 0 SUZANNE GARRITY DIRECTOR 1.00 X 8660 0 0 KEISHA KRUMM BOARD VICE-CHAIR 1.00 X 8660 0 0 JOHN MEURER SR DIRECTOR 1.00 X 3608 0 0 JOHN MAGILO DIRECTOR 1.00 X 8660 0 0 AMY MURPHY DIRECTOR 1.00 X 8660 0 0 CLIFFORD PUKEL DIRECTOR 1.00 X 8660 0 0 MARY RYNDERS DIRECTOR 1.00 X 4330 0 0 JOHN FARRELLY DIRECTOR 1.00 X 5052 0 0 TERRI WEBER DIRECTOR 1.00 X 7938 0 0 JAMES WESP BOARD CHAIR 6.00 X 8660 0 0 CATHY MAHAFFEY CEO 40.00 X 352037 0 44438 MELISSA DUFFY CSO 40.00 X 222618 0 20481 SHELLY JOHNSON COO 40.00 X 215940 0 25763 GREG LIPPE CFO 40.00 X 168844 0 37200 BRIAN LEBEN PAST CFO 40.00 X 189944 0 21082 SCOTT BERGMAN CONTROLLER 40.00 X 161049 0 32211 BRENDA VECHART EVP, HUMAN RESOURCES 40.00 X 147060 0 34084 TOM LAWLESS VP, INFORMATION SERVICES BUSINESS ANALYITICS 40.00 X 142246 0 39000 LINDA QUARTARO GENERAL COUNCIL 40.00 X 142408 0 20151 1823694 0 274410 14 0 1 0 OPTUM HEALTH CARE SOLUTIONS INC 11000 OPTUM CIRCLE MN101W400 MINNEAPOLIS MN 55344 MEDICAL MANAGEMENT 1172737 MILLIMAN INC 15800 W BLUEMOUND RD SUITE 100 BROOKFIELD WI 53005 ACTUARIAL 1049886 ONE TOUCH POINT MIDWEST PO BOX 88561 MILWAUKEE WI 53288 PRINTING 418636 VERISK HEALTH INC LOCKBOX 5459 NEW YORK NY 100875459 RISK ADJUSTMENT AND HEDIS VENDOR 415304 ALDERA HOLDINGS INC PO BOX 50505384 ST LOUIS MO 63150 CLAIMS PROCESSING PLATFORM 373868 17 PREMIUMS EARNED 525100 173507725 173507725 173507725 178630 178630 173686355 173507725 0 178630 1168871 4607296 269872 942151 448492 13899 1122956 2948226 142742 1459489 1159723 186506 52367 141875 480878 151001 112454 CLAIMS EXPENSE 161784716 CMS EXCHANGE USER FEE E 5193307 COMMISSIONS 1880268 LISCENSES & FEES 579925 340055 185187069 6141103 9998241 37111290 37289620 443325 9090988 183271 348844 1091713 671976 532130 419737 19289204 48146872 63700323 105294302 3211879 3803669 4352393 56578140 107739354 107739354 27917186 28194342 143220812 196315505 X 0 0 30000000 0 -109520489 -91021203 -79520489 -91021203 63700323 105294302 -11500714 0 X 0 1 X 1 1 1 1091713 671976 419737 419737 ACCRUED RETROSPECTIVE PREMIUMS 415978 REINSURANCE RECOVERABLES 2365590 HEALTH CARE RECEIVABLE 1885381 ADVANCED PREMIUM TAX CREDIT RECEIVABLE 43479923 48146872 INTEREST PAYABLE 1198581 CLAIMS UNPAID 26790671 INSURANCE FEES PAYABLE 203898 ACCRUED LEASE PAYABLE 1192 28194342 X 173686355 0 173686355 0 173686355 185187069 0 185187069 0 185187069 PART X, LINE 2: THE ORGANIZATION RECEIVED NOTIFICATION THAT IT QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(29) OF THE U.S. INTERNAL REVENUE CODE ON AUGUST 19, 2013 AND CORRESPONDING PROVISIONS OF STATE LAW AND, ACCORDINGLY, IS NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES. X X 0 0 0 CATHY MAHAFFEY CEO 344837 0 0 0 7200 0 18196 0 26242 0 396475 0 0 0 MELISSA DUFFY CSO 221418 0 0 0 1200 0 11263 0 9218 0 243099 0 0 0 SHELLY JOHNSON COO 211440 0 0 0 4500 0 11775 0 13988 0 241703 0 0 0 GREG LIPPE CFO 168844 0 0 0 0 0 9780 0 27420 0 206044 0 0 0 BRIAN LEBEN PAST CFO 189944 0 0 0 0 0 7709 0 13373 0 211026 0 0 0 SCOTT BERGMAN CONTROLLER 161049 0 0 0 0 0 9231 0 22980 0 193260 0 0 0 BRENDA VECHART EVP, HUMAN RESOURCES 147060 0 0 0 0 0 9074 0 25010 0 181144 0 0 0 TOM LAWLESS VP, INFORMATION SERVICES BUSINESS AN 142246 0 0 0 0 0 9023 0 29977 0 181246 0 0 0 LINDA QUARTARO GENERAL COUNCIL 142408 0 0 0 0 0 8899 0 11252 0 162559 0 0 0 FORM 990, PART V, LINE 13A WI FORM 990, PART VI, SECTION A, LINE 6 ON JANUARY 1, 2014 COMMON GROUND HEALTHCARE COOPERATIVE BEGAN ISSUING HEALTH INSURANCE TO INDIVIDUALS AND SMALL GROUPS. ANY ACTIVE POLICYHOLDER IS CONSIDERED A MEMBER OF THE COOPERATIVE. IN DECEMBER OF 2014 THERE WAS AN ELECTION FROM THE MEMBERS OF AN OPERATIONAL BOARD OF DIRECTORS REPLACING THE FORMATIVE BOARD OF DIRECTORS AT THAT TIME. FORM 990, PART VI, SECTION A, LINE 7A IN DECEMBER OF 2014 THERE WAS AN ELECTION FROM THE MEMBERS OF AN OPERATIONAL BOARD OF DIRECTORS REPLACING THE FORMATIVE BOARD OF DIRECTORS AT THAT TIME. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD MEMBERS ARE GIVEN A COPY OF THE RETURN BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY SETS FORTH CLEAR EXPECTATIONS AND GUIDANCE THAT IS TO BE FOLLOWED BY ALL DIRECTORS, OFFICERS, EMPLOYEES AND THIRD PARTY REPRESENTATIVES. THE COOPERATIVE WILL EVALUATE ITS ADHERENCE AND COMPLIANCE TO THIS POLICY BY REQUESTING FEEDBACK ON A REGULAR BASIS FROM OUR MEMBERS, EMPLOYEES, DIRECTORS AND THIRD PARTY REPRESENTATIVES. IF ANY INDIVIDUAL HAS QUESTIONS OR CONCERNS ABOUT COMPLIANCE WITH THE SUBJECTS DESCRIBED IN THIS POLICY, ARE UNSURE ABOUT WHAT IS THE "RIGHT THING" TO DO, OR REASONABLY BELIEVES THAT SOME POLICY, PRACTICE OR ACTIVITY OF THE COOPERATIVE IS IN VIOLATION OF THE ETHICS POLICY OR CODE, THIS INDIVIDUAL SHOULD SHARE THEIR QUESTIONS, CONCERNS, SUGGESTIONS OR COMPLAINTS WITH SOMEONE WHO CAN ADDRESS THEM PROPERLY. IN MOST CASES, AN INDIVIDUAL'S SUPERVISOR IS IN THE BEST POSITION TO ADDRESS AN AREA OF CONCERN. HOWEVER, IF THE INDIVIDUAL IS NOT COMFORTABLE SPEAKING WITH HIS OR HER SUPERVISOR OR IS NOT SATISFIED WITH THE SUPERVISOR'S RESPONSE, THE INDIVIDUAL IS ENCOURAGED TO SPEAK WITH THE COMPLIANCE OFFICER, OR ANYONE IN MANAGEMENT WHOM THE INDIVIDUAL IS COMFORTABLE IN APPROACHING. THE COOPERATIVE PROVIDES ALL INDIVIDUALS AN ADDITIONAL MECHANISM TO REPORT UNETHICAL CONDUCT WHICH IS DISCUSSED FURTHER IN THE EMPLOYEE PROTECTION AND NON-RETALIATION POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE EMPLOYMENT AGREEMENTS FOR THE CEO, COO, CSO, CMO AND CFO INCLUDING COMPENSATION, WERE REVIEWED AND APPROVED BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES IN ACCORDANCE WITH TERMS OF THE COOPERATIVE'S LOAN AGREEMENT. FORM 990, PART VI, SECTION C, LINE 19 THE DOCUMENTS ARE AVAILABLE UPON REQUEST.