2017-11-14T13:50:26-07:00 2016-12-31 870516083 LARSON & COMPANY PC 9065 SOUTH 1300 EAST SANDY UT 84094 990 2016-01-01 451294709 NEW MEXICO HEALTH CONNECTIONS NEWM 5056338020 2440 LOUISIANA BLVD NE SUITE 601 ALBUQUERQUE NM 87110 DR MARTIN HICKEY CEO 5056338020 2017-11-13 RICHARD SCORESBY CPA P00573067 8013131900 2017-11-13 FA3AD499A82CD574225E4F8B95847FBA20476762 D9F8ABBC4E7C92D3155C34040372F6D42BB4AEF3 2016 2021-01-29 14:40:06Z DR MARTIN HICKEY 2440 LOUISIANA BLVD NE SUITE 601 ALBUQUERQUE NM 87110 197170029 false X WWW.MYNMHC.ORG X 2011 NM TO ESTABLISH A CONSUMER OPERATED AND ORIENTED PLAN (COOP) CONSISTENT WITH THE PROVISIONS OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. NMHC WILL GENERATE FUNDING, ANALYSIS, AND SUSTAINABILITY CRITERIA FOR A NEW COOP HEALTH PLAN, INCLUDING AN ORGANIZATIONAL MODEL THAT ACCOMMODATES REGIONAL AND POPULATION-SPECIFIC PLANS FOR DELIVERING AFFORDABLE, COMMUNITY-SPECIFIC HEALTH CARE ACROSS THE STATE. 10 10 100 0 0 96217856 152982324 480807 841491 0 96698663 153823815 0 0 7457257 7839569 0 0 112241942 163865949 119699199 171705518 -23000536 -17881703 61014683 36849954 29631147 24736949 31383536 12113005 X TO ESTABLISH A CONSUMER OPERATED AND ORIENTED PLAN (COOP) CONSISTENT WITH THE PROVISIONS OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. NMHC WILL GENERATE FUNDING, ANALYSIS, AND SUSTAINABILITY CRITERIA FOR A NEW COOP HEALTH PLAN, INCLUDING AN ORGANIZATIONAL MODEL THAT ACCOMMODATES REGIONAL AND POPULATION-SPECIFIC PLANS FOR DELIVERING AFFORDABLE, COMMUNITY-SPECIFIC HEALTH CARE ACROSS THE STATE. false false NEW MEXICO HEALTH CONNECTIONS (THE "COMPANY") IS A PRIVATE, NONPROFIT COMPANY ESTABLISHED UNDER INTERNAL REVENUE CODE 501(C)(29) THAT WAS INCORPORATED IN THE STATE OF NEW MEXICO IN FEBRUARY 2011. ON FEBRUARY 17, 2012, THE COMPANY BECAME A QUALIFIED NONPROFIT HEALTH INSURANCE ISSUER UNDER THE CONSUMER-OPERATED AND ORIENTED PLAN (CO-OP) PROGRAM ESTABLISHED BY SECTION 1322 OF THE AFFORDABLE CARE ACT AND APPLICABLE REGULATIONS. UNDER THIS PROGRAM, THE COMPANY RECEIVES STARTUP AND SOLVENCY LOANS FROM THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES, CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS). THE COMPANY IS GOVERNED BY ITS BOARD OF DIRECTORS, WHICH HAVE THE AUTHORITY AND RESPONSIBILITY FOR MANAGEMENT, CONTROL, AND ADMINISTRATION OF THE COMPANY. THE COMPANY RECEIVED ITS CERTIFICATE OF AUTHORITY FROM THE STATE OF NEW MEXICO PUBLIC REGULATION COMMISSION, INSURANCE DIVISION IN FEBRUARY 2013. THE PRIMARY MISSION OF THE COMPANY IS TO PROVIDE AFFORDABLE COMMUNITY HEALTH CARE INSURANCE ACROSS THE STATE OF NEW MEXICO TO THE INDIVIDUAL AND SMALL GROUP MARKETS. THE COMPANY BEGAN OPEN ENROLLMENT IN OCTOBER 2013, FOR AN EFFECTIVE INSURANCE COVERAGE DATE OF JANUARY 1, 2014. THE COMPANY IS FOCUSED ON THE WELL-BEING OF PARTIES BY MAKING SURE THEIR HEALTH CARE IS COORDINATED AT EVERY LEVEL AND THAT A STRONG NETWORK OF PRIMARY-CARE PROVIDERS IS AVAILABLE TO ENSURE GOOD HEALTH OF OUR MEMBERS. THE COMPANY'S PRIORITY IS TO KEEP MEMBERS HEALTHY, LOWERING PREMIUM COSTS AND DELIVERING APPROPRIATE LEVELS OF CARE AT THE RIGHT TIME TO KEEP MEMBERS HOME AND OUT OF UNNECESSARY HOSPITAL STAYS. THIS WILL BE ACCOMPLISHED BY PROVIDING COMMUNITY-BASED CASE MANAGEMENT TO ENSURE THE MEMBERS ARE WELL CARED FOR. 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 false false false false false false false false false true 2335 0 100 true false false false false false false 8552188 12113004 false X 10 10 false false false false false false false true true false false true true true true true true true true false X NATHAN JOHNS 5056338023 2440 LOUISIANA BLVD NE STE 601 ALBUQUERQUE NM 87110 DIANE DENISH CHAIRWOMAN 3.00 X 5000 0 0 KEN CARSON DIRECTOR 3.00 X 2250 0 0 JOHN P ULRICH TREASURER 3.00 X 1500 0 0 JANE HAJOVSKY DIRECTOR 3.00 X 2750 0 0 DR BARBARA MCANENY DIRECTOR 3.00 X 1250 0 0 JAMES R DELGADO DIRECTOR 3.00 X 2750 0 0 JASON DESHAYES DIRECTOR 3.00 X 2500 0 0 ANTHONY ZANCANELLA SECRETARY 3.00 X 2000 0 0 SIMON ROSS GOLDFINE DIRECTOR 3.00 X 2500 0 0 CHRISTOPHER PAUL KRAHLING DIRECTOR 3.00 X 2750 0 0 DR MARTIN HICKEY CEO 40.00 X 415527 0 28276 DR MARK EPSTEIN CMO 40.00 X 392331 0 27348 NATHAN JOHNS CFO 40.00 X 232350 0 12121 ANNE SAPON COO 40.00 X 328037 0 21425 ANGELA VIGIL CCAO 40.00 X 210903 0 19236 RICHARD HILLIARD CIO 40.00 X 219968 0 19773 FRANCES TORRES SENIOR MEDIC 40.00 X 295427 0 22092 LINDA REITER SR DIRECT OF 40.00 X 207159 0 18006 JAN KOVACH MEDICAL DIRE 40.00 X 230700 0 16182 MARLENE MCCURDY SR DIRECT OF 40.00 X 167002 0 11113 PAULA HOSKINS SR DIRECT OF 40.00 X 146029 0 10242 MYJA PETERSON SR DIRECTO O 40.00 X 149815 0 17070 VIRGINIA WELTY CONTROLLER 40.00 X 130631 0 12670 EUTIMIO RIVERA SALES EXECUT 40.00 X 119489 0 4625 3270618 240179 19 false true false HUB INTERNATIONAL INSURANCE SERVICES 2375 E CAMELBACK RD STE 250 PHOENIX AZ 85016 BROKER 778643 MILLIMAN 1400 WEWATTA ST SUITE 300 DENVER CO 80202 ACTUARY 765315 LINTON & ASSOCIATES 1204 CENTRAL AVE SW ALBUQUERQUE NM 87102 BROKER 346803 PEPPER HAMILTON 3000 TWO LOGAN SQUARE PHILADELPHIA PA 19103 LEGAL 302895 BIANCHI & ASSOCIATES 4123 EUBANK BLVD NE ALBUQUERQUE NM 87111 BROKER 213914 16 NET PREMIUM INCOME 152982324 152982324 152982324 596645 596645 43589560 1500 43341233 4981 248327 -3481 244846 244846 153823815 152982324 841491 2920225 3584666 162271 763549 408858 381687 4150881 1048384 1552183 540837 350124 234173 9967 110402 208698 HOSPITAL/MEDICAL BENEFITS 136390692 CHANGE IN LAE EXPENSE 8598084 BROKER COMMISSIONS 6823950 PREMIUM TAXES 5339331 -1873444 171705518 0 0 0 2414819 354147 2560819 2910726 525000 260018 127295 73589 132723 49120669 20646883 6844787 12280475 61014683 36849954 3930875 5126569 4150941 2601183 21549331 17009197 29631147 24736949 X 77879748 77317782 -46496212 -65204777 31383536 12113005 61014683 36849954 -17881703 -1388828 X false true X true true true 260018 127295 132723 132723 ACCRUED RETROSPECTIVE PREMIUMS 6976000 AMOUNTS RECOVERABLE FROM REINSURERS 2577258 UNCOLLECTED PREMIUMS 1380658 ACCRUED REINSURANCE RECEIVABLE 1275701 INVESTMENT INCOME DUE AND ACCRUED 70858 12280475 CLAIMS UNPAID 16471702 UNPAID CLAIMS ADJUSTMENT EXPENSES 537495 17009197 X 153823815 153823815 153823815 171705518 171705518 171705518 SCHEDULE D, PAGE 3, PART X STATUTORY GUIDANCE EXISTS FOR HOW UNCERTAIN TAX POSITIONS SHOULD BE RECOGNIZED, MEASURED, DISCLOSED AND PRESENTED IN THE FINANCIAL STATEMENTS. THIS REQUIRES THE EVALUATION OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN THE COURSE OF PREPARING THE ENTITYS TAX RETURNS TO DETERMINE WHETHER THE TAX POSITIONS ARE MORE-LIKELY-THAN-NOT OR BEING SUSTAINED WHEN CHALLENGED OR WHEN EXAMINED BY THE APPLICABLE TAXING AUTHORITY. FOR 2016 AND 2015, MANAGEMENT HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN INCOME TAX POSITIONS. TAX YEARS THAT REMAIN SUBJECT TO EXAMINATIONS ARE YEARS 2013 AND FORWARD. X X false false false false false false false false false DR MARTIN HICKEY CEO 415527 16573 11703 443803 DR MARK EPSTEIN CMO 392331 15645 11703 419679 NATHAN JOHNS CFO 232350 5500 6621 244471 ANNE SAPON COO 328037 13074 8351 349462 ANGELA VIGIL CCAO 210903 8214 11022 230139 RICHARD HILLIARD CIO 219968 8751 11022 239741 FRANCES TORRES SENIOR MEDICAL DIREC 295427 11349 10743 317519 LINDA REITER SR DIRECT OF CLINICA 207159 7944 10062 225165 JAN KOVACH MEDICAL DIRECTOR 230700 6120 10062 246882 MARLENE MCCURDY SR DIRECT OF STRATEG 167002 6240 4873 178115 PAULA HOSKINS SR DIRECT OF PROVIDE 146029 5586 4656 156271 MYJA PETERSON SR DIRECTO OF HEALTH 149815 5732 11338 166885 FORM 990 - ORGANIZATION'S MISSION TO ESTABLISH A CONSUMER OPERATED AND ORIENTED PLAN (COOP) CONSISTENT WITH THE PROVISIONS OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. NMHC WILL GENERATE FUNDING, ANALYSIS, AND SUSTAINABILITY CRITERIA FOR A NEW COOP HEALTH PLAN, INCLUDING AN ORGANIZATIONAL MODEL THAT ACCOMMODATES REGIONAL AND POPULATION-SPECIFIC PLANS FOR DELIVERING AFFORDABLE, COMMUNITY-SPECIFIC HEALTH CARE ACROSS THE STATE. FORM 990, PAGE 2, PART III, LINE 4A CERTIFICATE OF AUTHORITY FROM THE STATE OF NEW MEXICO PUBLIC REGULATION COMMISSION, INSURANCE DIVISION IN FEBRUARY 2013. THE PRIMARY MISSION OF THE COMPANY IS TO PROVIDE AFFORDABLE COMMUNITY HEALTH CARE INSURANCE ACROSS THE STATE OF NEW MEXICO TO THE INDIVIDUAL AND SMALL GROUP MARKETS. THE COMPANY BEGAN OPEN ENROLLMENT IN OCTOBER 2013, FOR AN EFFECTIVE INSURANCE COVERAGE DATE OF JANUARY 1, 2014. THE COMPANY IS FOCUSED ON THE WELL-BEING OF PARTIES BY MAKING SURE THEIR HEALTH CARE IS COORDINATED AT EVERY LEVEL AND THAT A STRONG NETWORK OF PRIMARY-CARE PROVIDERS IS AVAILABLE TO ENSURE GOOD HEALTH OF OUR MEMBERS. THE COMPANY'S PRIORITY IS TO KEEP MEMBERS HEALTHY, LOWERING PREMIUM COSTS AND DELIVERING APPROPRIATE LEVELS OF CARE AT THE RIGHT TIME TO KEEP MEMBERS HOME AND OUT OF UNNECESSARY HOSPITAL STAYS. THIS WILL BE ACCOMPLISHED BY PROVIDING COMMUNITY-BASED CASE MANAGEMENT TO ENSURE THE MEMBERS ARE WELL CARED FOR. FORM 990, PAGE 6, PART VI, LINE 11B THE CFO AND CCAO REVIEW THE FORM 990 UPON COMPLETION. AFTER APPLICABLE CHANGES ARE MADE, IF ANY, THE UPDATED FORM 990 IS GIVEN TO THE FINANCE COMMITTEE FOR REVIEW. IF THERE ARE NO CHANGES, THE FORM 990 IS APPROVED FOR FILING. IF THE FINANCE COMMITTEE DOES REQUEST CHANGES TO THE FORM 990, THE CHANGES WILL BE MADE AND A NEW COPY WILL BE PROVIDED TO THE FINANCE COMMITTEE FOR REVIEW AND APPROVAL. THE FORM 990 IS ULTIMATELY APPROVED BY BOTH THE FINANCE COMMITTEE AND THE BOARD OF DIRECTORS. FORM 990, PAGE 6, PART VI, LINE 12C ALL BOARD MEMBERS AND KEY EMPLOYEES ARE REQUIRED TO SIGN A CONFLICT OF INTEREST POLICY UPON EMPLOYMENT OR POSITION ON THE BOARD. ON AN ANNUAL BASIS, ALL KEY EMPLOYEES AND BOARD MEMBERS ARE REQUIRED TO CERTIFY THAT NO CONFLICT OF INTEREST HAS ARISEN. IF A CONFLICT ARISES, THE PERSON WITH SUCH CONFLICT IS NOT ALLOWED TO VOTE ON THE TRANSACTION. THERE HAVE BEEN NO INCIDENCES OF CONFLICT DURING THE REPORTING YEAR. FORM 990, PAGE 6, PART VI, LINE 15A IN MAY 2014, MARTY KATZ OF FREDERICK W. COOK & COMPANY, INC. WAS RETAINED BY THE NEW MEXICO BOARD OF DIRECTORS TO PROVIDE ADVICE AND COUNSEL REGARDING ITS EXECUTIVE COMPENSATION POLICIES AND PRACTICES. THE PRIMARY ROLE OF MR. KATZ WAS TO PROVIDE OBJECTIVE, THIRD-PARTY ADVICE ON THE REASONABLENESS OF COMPENSATION FOR NEW MEXICO HEALTH CONNECTIONS' SENIOR EXECUTIVE TEAM AND BENEFIT LEVELS IN COMPARISON WITH THOSE OF OTHER SIMILARLY SITUATED ORGANIZATIONS, AND THE APPROPRIATENESS OF THE OVERALL COMPENSATION PROGRAM IN LIGHT OF THE ORGANIZATION'S PERFORMANCE AND OTHER RELEVANT FACTORS USED IN DETERMINING THE REASONABLENESS OF COMPENSATION. THE COMPENSATION REVIEW AND ULTIMATE RECOMMENDATIONS WERE SPECIFIC TO THE FOLLOWING SENIOR EXECUTIVE TEAM POSITIONS: 1.CHIEF EXECUTIVE OFFICER 2.CHIEF OPERATING OFFICER 3.CHIEF MEDICAL OFFICER 4.CHIEF FINANCIAL OFFICER 5.CHIEF COMPLIANCE AND ADMINISTRATIVE OFFICER 6.CHIEF INFORMATION OFFICER 7.CHIEF PROGRAM MANAGEMENT AND PLANNING OFFICER THE COMPENSATION FOR THE POSITIONS NOTED ABOVE WERE APPROVED BY THE COMPANY'S COMPENSATION COMMITTEE AND THE BOARD OF DIRECTORS, AS WELL AS THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. FORM 990, PAGE 6, PART VI, LINE 15B SEE STATEMENT FOR FORM 990, PART VI, LINE 15A - COMPENSATION PROCESS FOR TOP OFFICAL ABOVE. FORM 990, PAGE 6, PART VI, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THESE DOCUMENTS ARE ALSO FILED WITH THE OFFICE OF THE SECRETARY OF STATE AND ARE AVAILABLE FOR PUBLIC INSPECTION. FORM 990, PART XI, LINE 9 ROUNDING -1 CANGE IN UNASSIGNED SURPLUS -826,861 CHANGE IN SPECIAL SURPLUS -561,966 CHANGE IN NONADMITTED ASSETS 0 TOTAL -1,388,828