2017-10-25T10:07:55-05:00 2016-12-31 KPMG LLP 60 South Street Boston MA 02111 990 2016-01-01 453416923 MAINE COMMUNITY HEALTH OPTIONS % CHARISSA KERR CONTROLLER MAIN 2074023330 150 MILL STREET THIRD FLOOR LEWISTON ME 04240 EDWARD VOZZO CFO 2073302390 2017-10-24 true THOMAS CYR P00651101 6179881000 2017-10-23 167.68.102.5 04502320172985000000 2017-10-25 P 97708A5330444EF9CD72BD4AB4D387C052E9A7C3 0CA5CB447FE18380BCC1C1015EE4A18F99FD79FD 2016 2021-01-29 14:40:06Z KEVIN LEWIS 150 mill street thrid floor lewiston ME 04240 435899856 false 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 WELL BEING. 16 16 201 16 0 0 0 0 403774436 435053351 248328 805406 0 704 404022764 435859461 0 0 440794415 411107879 10509761 13201640 0 0 0 27794573 26057170 479098749 450366689 -75075985 -14507228 185589711 106832733 261849068 197657711 -76259357 -90824978 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(SEE SCH O) false false 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. false false false false false false false false false true false false true true true true false false false false false false false false false false false false true false false false false false false false true false false false false false false false false true X 4273 0 true 201 true false false false false true true false false false false true 100000 100000 false X 16 16 false false true false true true true true true false false true true true true true true true true false ME NH X CHARISSA KERR CONTROLLER 2073302390 BATES MILL PO BOX 1121 LEWISTON ME 04243 JAMES DAVIS PRESIDENT 2.0 0.0 X 0 0 0 Frederic C Graigie Jr director 2.0 0.0 X 0 0 0 david shipman director 2.0 0.0 X 0 0 0 TRISH RILEY DIRECTOR 2.0 0.0 X 0 0 0 LAURA RONAN DIRECTOR 2.0 0.0 X 0 0 0 W DOUGLAS SMITH DIRECTOR 2.0 0.0 X 0 0 0 DOUGLAS WILSON DIRECTOR 2.0 0.0 X 0 0 0 MIKE WOODARD DIRECTOR 2.0 0.0 X 0 0 0 SARAH HINES DIRECTOR 2.0 0.0 X 0 0 0 DANA BALDWIN DIRECTOR 2.0 0.0 X 0 0 0 DAVID SHULTZ DIRECTOR 2.0 0.0 X 0 0 0 ROCELL MARCELLINO DIRECTOR 2.0 0.0 X 0 0 0 RONNIE WESTON DIRECTOR 2.0 0.0 X 0 0 0 TONUA FEDUSENKO DIRECTOR 2.0 0.0 X 0 0 0 FELICITY MYERS DIRECTOR 2.0 0.0 X 0 0 0 ANGELA BERRY DIRECTOR 2.0 0.0 X 0 0 0 KEVIN LEWIS CHIEF EXECUTIVE OFFICER 40.0 0.0 X 273505 0 11796 ROBERT HILLMAN CHIEF OPERATING OFFICER 40.0 0.0 X 239141 0 14505 EDWARD VOZZO CHIEF FINANCIAL OFFICER 40.0 0.0 X 183825 0 17001 JOYCE MCPHETRES CHIEF HUMAN RESOURCES OFFICER 40.0 0.0 X 151401 0 13187 JOHN YINDRA CHIEF MEDICAL OFFICER 40.0 0.0 X 204077 0 20816 WILLIAM KILBRETH CHIEF INFORMATION OFFICER 40.0 0.0 X 160898 0 15316 GREGORY MCCARTHY VP OPERATIONS 40.0 0.0 X 195886 0 15020 SHARON WARE DIR., BUSINESS DEVELOPMENT 40.0 0.0 X 122115 0 10460 MARGERET KELLEY AVP OF MEDICAL SERVICES 40.0 0.0 X 137289 0 11548 NANCY JOHNSON AVP COMPLIANCE & REG. AFFAIRS 40.0 0.0 X 130568 0 6651 JANE CARIELLO AVP SERVICE OPERATIONS 40.0 0.0 X 134521 0 11564 MICHAEL GENDREAU DIR. OUTREACH, EDUC. & COMM. 40.0 0.0 X 124877 0 7014 2058103 0 154878 17 false true false VALENCE HEALTH 540 W MADISON ST 1500 CHICAGO IL 60661 TPA SERVICES 8054352 DUBRASKI ASSOCIATES INS SERV LL 11622 EL CAMINO REAL STE 100 SAN DIEGO CA 92130 INSURANCE SERVICES 2391872 MPX 2301 CONGRESS ST PORTLAND ME 04104 PRINT SERVICES 1544066 MILLIMAN INC 80 LAMBERTON RD WINDSOR CT 06095 CONSULTING 1319034 FIRSTHEALTH GROUP CORP 23291 NETWORK PLACE CHICAGO IL 606731232 TPA SERVICES 1187602 14 0 PREMIUM REVENUE 435053351 435053351 435053351 845801 845801 0 0 0 0 0 0 0 40395 -40395 -40395 -40395 0 0 0 0 0 0 0 0 0 SPEAKING FEES 900099 704 704 704 435859461 435054055 805406 0 0 0 411107879 2575237 0 7901681 52988 1860342 811392 0 205342 360995 24252 0 147621 2128268 285644 894752 1976293 0 522813 87868 0 0 566021 0 1394088 333981 DUES,ASSOC. AND MEMBERSHIPS 15653 GOVERNMENT MANDATED FEES 17113579 450366689 16644697 8378551 59761266 11088409 11322816 9142301 5469188 4274286 0 0 0 0 0 0 0 0 1440007 1310089 5462484 3107226 2980730 2355258 41227974 45517792 0 0 0 0 0 0 46743033 24766047 185589711 106832733 9029087 10008184 0 0 0 0 0 0 0 0 0 0 133201147 133102081 0 0 119618834 54547446 261849068 197657711 X -76259357 -90824978 0 0 0 0 -76259357 -90824978 185589711 106832733 -14507228 -58393 X false true X true true true 1366686 1191985 174701 1162645 638545 524100 2933153 1276696 1656457 2355258 DEPOSITS 106642 INSURANCE RECEIVABLES 24487373 ACCRUED INTEREST RECEIVABLE 172032 24766047 0 UNEARNED PREMIUMS 3177520 CAPITAL LEASE OBLIGATIONS 412936 UNPAID CLAIMS AND LOSS 50956990 54547446 X 378045353 -66886 -4462945 -4529831 382575184 147621 53136656 53284277 435859461 392619467 -53136656 -53136656 445756123 147621 4462945 4610566 450366689 PART X LINE 2: EXPLANATION: 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 RECOGANIZED 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 REORGANIZED 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, 2011 THROUGH 2016. PART XI, LINE 2D CONTRA-PREMIUMS AND REINSURANCE PREMIUMS $(4,462,945) PART XI, LINE 4B OTHER REIMBURSEMENTS AND REBATES $53,136,656 PART XII, LINE 2D OTHER REIMBURSEMENTS AND REBATES $(53,136,656) PART XII, LINE 4B CONTRA-PREMIUMS AND REINSURANCE PREMIUMS $4,462,945 X X X false false false false false false false false false KEVIN LEWIS CHIEF EXECUTIVE OFFICER 273505 0 0 0 0 0 1749 0 10047 0 285301 0 0 0 ROBERT HILLMAN CHIEF OPERATING OFFICER 239141 0 0 0 0 0 1488 0 13017 0 253646 0 0 0 EDWARD VOZZO CHIEF FINANCIAL OFFICER 183825 0 0 0 0 0 1194 0 15807 0 200826 0 0 0 JOYCE MCPHETRES CHIEF HUMAN RESOURCES OFFICER 151401 0 0 0 0 0 987 0 12200 0 164588 0 0 0 JOHN YINDRA CHIEF MEDICAL OFFICER 204077 0 0 0 0 0 1298 0 19518 0 224893 0 0 0 WILLIAM KILBRETH CHIEF INFORMATION OFFICER 160898 0 0 0 0 0 1021 0 14295 0 176214 0 0 0 GREGORY MCCARTHY VP OPERATIONS 195886 0 0 0 0 0 914 0 14106 0 210906 0 0 0 DFD RUSSELL MEDICAL CENTER KEVIN LEWIS CEO OF MCHO 189630 CCT FEES AND CLAIMS PAID true DFD RUSSELL MEDICAL CENTER john yindra, cmo of MCHO SCHEDULE L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: DFD RUSSELL MEDICAL centeR (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: KEVIN LEWIS, CEO OF ORGANIZATION'S WIFE IS CEO OF DFD RUSSELL MEDICAL. john yindra, chief medical officer of the organization, is a service provider at dfd russell medical center. FORM 990, PART III, LINE 1: 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 NEW HAMPSHIRE AND EDUCATING THE PUBLIC ABOUT HEALTH, HEALTH CARE 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 4: EXPLANATION: SINCE THE PRIOR FORM 990 WAS FILED, MCHO HAS MADE SIGNIFICANT CHANGES TO ITS BYLAWS. PREVIOUSLY, MCHO DIRECTORS COULD ONLY BE ELECTED AND REMOVED BY MCHOS MEMBERS. THE BYLAWS WERE CHANGED SO THAT DIRECTORS MAY BE ELECTED BY THE MEMBERS OR APPOINTED BY THE BOARD OF DIRECTORS. HOWEVER, A MAJORITY OF DIRECTORS MUST BE ELECTED BY THE MEMBERS. ADDITIONALLY, DIRECTORS ELECTED BY THE MEMBERS MAY BE REMOVED BY THE MEMBERS AND DIRECTORS APPOINTED BY THE BOARD OF DIRECTORS MAY BE REMOVED BY THE MEMBERS OR THE BOARD OF DIRECTORS. THE BYLAWS ALSO NOW SET FORTH PROCEDURES FOR THE APPOINTMENT OF DIRECTORS BY THE BOARD OF DIRECTORS BY MAJORITY VOTE. FURTHERMORE, THE BYLAWS PREVIOUSLY PROHIBITED ANY MCHO DIRECTOR FROM BEING A REPRESENTATIVE OF ANY FEDERAL, STATE, OR LOCAL GOVERNMENT OR OF ANY POLITICAL SUBDIVISION OR INSTRUMENTALITY THEREOF. THE BYLAWS ALSO PREVIOUSLY PROHIBITED ANY MCHO DIRECTOR FROM BEING A REPRESENTATIVE OF A HEALTH INSURANCE ISSUER THAT WAS IN EXISTENCE AS OF JULY 16, 2009, A TRADE ORGANIZATION REPRESENTING SUCH ISSUERS, OR A RELATED PARTY OR PREDECESSOR OF EITHER. FINALLY, THE BYLAWS PREVIOUSLY STATED THAT IN THE EVENT OF ANY CIRCUMSTANCE WHICH THE BOARD OF DIRECTORS DETERMINES WILL CAUSE OR MAY REASONABLY CAUSE THE COMPOSITION OF THE BOARD TO NO LONGER COMPLY WITH THE REQUIREMENTS OF CO-OP STATUTES OR REGULATIONS, OTHER APPLICABLE STATUTES OR REGULATIONS, OR THE MCHO BYLAWS OF ARTICLES OF INCORPORATION, THE BOARD MAY DESIGNATE ONE OF MORE DIRECTORS TO BE NON-VOTING DIRECTORS UNTIL SUCH TIME AS DETERMINED BY THE BOARD. THE PROVISIONS SUMMARIZED IN THE PRIOR THREE SENTENCES WERE REMOVED AND NOW THE BYLAWS PROHIBIT ANY DIRECTOR FROM BEING AN INDIVIDUAL PROHIBITED FROM SERVING AS A DIRECTOR ON A BOARD OF A CO-OP AS PROVIDED UNDER FEDERAL STATUTES AND REGULATIONS GOVERNING CO-OPS. 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 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 STATEMENT INDICATING THAT THEY DO NOT HAVE ANY CONFLICTS OF INTEREST. THEY ARE THEN REQUIRED TO RECERTIFY ANNUALLY THAT THEY DO NOT HAVE ANY CONFLICTS OF INTEREST. 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 CEO'S 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. 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. 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 XII, LINE 2C: EXPLANATION: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.