2016-11-10T14:34:09-06:00 2015-12-31 KPMG LLP 60 South Street Boston MA 02111 990 2015-01-01 453416923 MAINE COMMUNITY HEALTH OPTIONS % CHARISSA KERR CONTROLLER MAIN 2074023330 150 MILL STREET THIRD FLOOR LEWISTON ME 04240 EDWARD VOZZO CFO 2073302390 2016-08-10 true DONALD ANDERSON MANAGER P00237591 6179881000 2016-08-10 2015 2017-02-10 21:41:12Z KEVIN LEWIS 150 mill street thrid floor lewiston ME 04240 404022764 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. 18 18 191 0 0 0 0 194146858 403774436 119594 248328 7925 0 194274377 404022764 500000 0 163704237 440794415 8473609 10509761 0 0 0 14236520 27794573 186914366 479098749 7360011 -75075985 89689782 185589711 90717159 261849068 -1027377 -76259357 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 467107645 403774436 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. 467107645 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 3670 0 true 191 true false false false false true true false false false false true 100000 100000 false X 18 18 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 maryagnes gillman secretary 2.0 0.0 X 0 0 0 linda riddell director 2.0 0.0 X 0 0 0 weston bonney treasurer 2.0 0.0 X 0 0 0 lani graham director 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 gregory wolf 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 KEVIN LEWIS CHIEF EXECUTIVE OFFICER 40.0 0.0 X 302708 0 31155 ROBERT HILLMAN CHIEF OPERATING OFFICER 40.0 0.0 X 263985 0 29704 EDWARD VOZZO CHIEF FINANCIAL OFFICER 40.0 0.0 X 203800 0 29809 JOYCE MCPHETRES CHIEF HUMAN RESOURCES OFFICER 40.0 0.0 X 167322 0 24277 JOHN YINDRA CHIEF MEDICAL OFFICER 40.0 0.0 X 224967 0 31117 WILLIAM KILBRETH CHIEF INFORMATION OFFICER 40.0 0.0 X 117922 0 28052 SHARON WARE DIR., BUSINESS DEVELOPMENT 50.0 0.0 X 121224 0 24713 MARGERET KELLEY DIRECTOR, CARE MGMT & QUALITY 40.0 0.0 X 129949 0 15257 MICHAEL GENDREAU DIR., OUTREACH, EDU. & COMM 40.0 0.0 X 123762 0 15539 BARBARA LOVEJOY DIRECTOR HR AND EDUCATION 40.0 0.0 X 117612 0 26968 JANE CARIELLO DIRECTOR OF SERVICE OPERATIONS 40.0 0.0 X 126137 0 23880 1899388 0 280471 11 false true false VALENCE HEALTH 600 West Jackson Boulevard 800 CHICAGO IL 60661 TPA SERVICES 10312813 firsthealth group corp 23291 Network Place CHICAGO IL 60673 tpa services 1755352 CRESCENDO CONSULTING GROUP 48 Free Street 206 PORTLAND ME 04101 MARKETING SERICES 1726342 mpx 2301 congress street PORTLAND ME 04104 print SERVICES 1312206 milliman inc 80 lamberton road WINDSOR CT 06095 consulting 873074 16 0 PREMIUM REVENUE 403774436 403774436 403774436 248328 248328 0 0 0 0 0 0 0 0 0 0 404022764 403774436 248328 0 0 0 440794415 440794415 2699113 1607397 1091716 0 5473860 4105395 1368465 0 1675129 1256347 418782 661659 496244 165415 0 188270 188270 186800 37360 149440 0 0 0 5553051 3538675 2014376 1704909 1704909 692907 692907 1496945 1496945 0 786743 786743 327019 327019 0 0 242751 242751 0 1118626 1118626 201988 201988 OUTREACH EXPENSE 180535 180535 DUES,ASSOC. AND MEMBERSHIPS 44544 22272 22272 GOVERNMENT MANDATED FEES 15053069 15053069 OTHER 15936 15936 480 480 479098749 467107645 11991104 19301239 16644697 8090113 59761266 3445598 11322816 0 5469188 0 0 0 0 0 0 0 0 1180436 1440007 4738195 1757465 3143123 2980730 23294528 41227974 0 0 0 0 0 0 31234745 46743033 89689782 185589711 5136305 9029087 0 0 0 0 0 0 0 0 0 0 43869994 133201147 0 0 41710860 119618834 90717159 261849068 X -1027377 -76259357 0 0 0 0 -1027377 -76259357 89689782 185589711 -75075985 -155995 X false true true true true 1366686 1054479 312207 1247367 439366 808001 2124142 263620 1860522 2980730 DEPOSITS 28181 INSURANCE RECEIVABLES 46565309 ACCRUED INTEREST RECEIVABLE 149543 46743033 0 UNEARNED PREMIUMS 7610274 CAPITAL LEASE OBLIGATIONS 590818 UNPAID CLAIMS AND LOSS 68345201 PREMIUM DEFICIENCY RESERVE 43072541 119618834 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 SATISFY FOR SOME OR ALL OF THE BENEFITS OF THAT POSITION TO 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 2014. X X X false false false false false false false false false KEVIN LEWIS CHIEF EXECUTIVE OFFICER 302708 0 0 0 0 0 9061 0 22094 0 333863 0 0 0 ROBERT HILLMAN CHIEF OPERATING OFFICER 263985 0 0 0 0 0 10598 0 19106 0 293689 0 0 EDWARD VOZZO CHIEF FINANCIAL OFFICER 203800 0 0 0 0 0 8718 0 21091 0 233609 0 0 0 JOYCE MCPHETRES CHIEF HUMAN RESOURCES OFFICER 167322 0 0 0 0 0 6970 0 17307 0 191599 0 0 JOHN YINDRA CHIEF MEDICAL OFFICER 224967 0 0 0 0 0 8178 0 22939 0 256084 0 0 JANE CARIELLO DIRECTOR OF SERVICE OPERATIONS 126137 0 0 5273 18607 150017 0 DFD RUSSELL MEDICAL CENTER KEVIN LEWIS CEO OF MCHO 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: ME,NH FORM 990, PART VI, SECTION A, LINE 4 The organization was directed by a Formation Board of Directors during its period of inception. The governing body of the organization is now an Operational Board of Directors. THE ORGANIZATION'S BYLAWS HAVE BEEN AMENDED TO REFLECT THIS CHANGE. 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; 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.