2023-11-01T10:02:26-05:00 2022-12-31 390859910 BAKER TILLY US LLP 790 N WATER ST SUITE 2000 MILWAUKEE WI 53202 990 2022-01-01 453309488 COMMON GROUND HEALTHCARE COOPERATIVE COMM 4144550500 120 BISHOPS WAY 150 BROOKFIELD WI 53005 TODD HUTCHISON CFO 4144550500 2023-10-31 1 TODD HUTCHISON XXX-XX-XXXX 0 TROY MARINE CPA P00187863 4147775500 2023-10-31 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z CATHY MAHAFFEY 120 BISHOPS WAY 150 BROOKFIELD WI 53005 441087838 0 X WWW.COMMONGROUNDHEALTHCARE.ORG X CO-OP 2011 WI PROVIDE AFFORDABLE HEALTH INSURANCE SOLUTIONS TO SMALL BUS., INDIVIDUALS & NON-PROFITS IN WI. 9 9 170 0 0 0 0 0 326829843 418236478 2694519 3307273 0 0 329524362 421543751 0 491 0 0 11766922 12498811 0 0 0 344924762 427003054 356691684 439502356 -27167322 -17958605 311102675 304410600 211369790 232786613 99732885 71623987 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 1 0 0 0 0 0 0 0 1 0 0 1 1554 0 1 170 1 0 0 0 0 0 0 75240978 153669975 0 0 0 X 9 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X TODD HUTCHISON 4144550500 120 BISHOPS WAY SUITE 150 BROOKFIELD WI 53005 AMY MURPHY BOARD CHAIR 6.00 X 10023 0 0 TONNI LARSON BOARD VICE-CHAIR 1.00 X 8913 0 0 KEVIN GILLIGAN SECRETARY/TREASURER 1.00 X 7803 0 0 WILLIAM KORT DIRECTOR 1.00 X 7803 0 0 RACHAEL BUSH DIRECTOR 1.00 X 7803 0 0 JAMES WESP NON-VOTING DIRECTOR 1.00 X 7803 0 0 JOHN MAGLIO NON-VOTING DIRECTOR 1.00 X 7803 0 0 ROBERT CONNOLLY NON-VOTING DIRECTOR 1.00 X 7803 0 0 DAVID STRAM DIRECTOR 1.00 X 5001 0 0 DEAN SCHADRIE DIRECTOR 1.00 X 5001 0 0 MICHAEL WINKLER DIRECTOR 1.00 X 5001 0 0 BECKY TUCHSCHERER DIRECTOR 1.00 X 4440 0 0 TERESA PISZCOR BOARD VICE-CHAIR-PRIOR 1.00 X 2803 0 0 LAUREN WARD DIRECTOR 1.00 X 2642 0 0 CATHY MAHAFFEY CEO 40.00 X 583997 0 49294 TOM LAWLESS TERM 102022 EX- CFO 40.00 X 323794 0 50228 SCOTT ANDERSON CMO - CHIEF MEDICAL OFFICER 40.00 X 315413 0 55954 MELISSA HENDERSON CCO - CHIEF COMPLIANCE OFFICER 40.00 X 275482 0 19241 BRIAN MCDONALD TERM 082022 EX - CHIEF BUS DEV OFFICER 40.00 X 255419 0 38560 BRIAN GARTNER CHIEF OF STAFF 40.00 X 159658 0 13877 JESSICA KOTTWITZ VP OF OPERATIONS 40.00 X 210305 0 29198 ROBET PLESHA TERM 022022 EX - CHIEF ACTUARY 40.00 X 209392 0 9766 SHELLY JOHNSON HEALTH PLAN QUALITY ADMINISTRATOR 40.00 X 189758 0 24485 JENNIFER WALKOWIAK VP OF BUSINESS DEVELOPMENT 40.00 X 187389 0 22816 AARON JACKSON VP PROVIDER CONTRACTING & STRATEGY 40.00 X 196948 0 10996 SCOTT BERGMAN SR. FINANCIAL ADVISOR 40.00 X 158810 0 41239 3157007 0 365654 28 1 1 0 SECURITY HEALTH PLAN OF WISCONSIN INC 1515 SAINT JOSEPH AVENUE MARSHFIELD WI 54449 MEDICAL MANAGEMENT 1284944 HUMANA WISCONSIN HEALTH ORG INSURANCE CO PO BOX 4616 CAROL SREAM IL 60197 HEALTH INSURANCE 1188608 OPTUM HEALTH CARE SOLUTIONS INC PO BOX 84019 CHICAGO IL 50689 MEDICAL MANAGEMENT 1149443 MILLIMAN INC 17335 GOLF PARKWAY STE 100 BROOKFIELD WI 53045 ACTUARIAL 1137691 WENDIGO ADVISORS 2817 PROMONOTORY LOOP BROOMFIELD CO 80023 CONSULTING 1135357 56 PREMIUMS EARNED 525100 418236478 418236478 418236478 3290999 3290999 19560361 19544087 16274 16274 16274 421543751 418236478 0 3307273 491 2431607 7659623 479304 1206219 722058 163113 3826780 44640 4253203 369152 1716345 2147240 273565 106350 177741 400345 187864 285288 CLAIMS EXPENSE 391199094 CMS EXCHANGE USER FEE E 10757310 COMMISSIONS 7686665 BANK CHARGES 1691076 1717283 439502356 20997101 41731277 185735791 150588074 9750017 5735780 231913 613396 2046878 1671190 514549 375688 93873304 105366385 311102675 304410600 4374726 5160270 54269636 81026950 91429763 80302872 61295665 66296521 211369790 232786613 X 0 0 0 0 99732885 71623987 99732885 71623987 311102675 304410600 X -17958605 -10069463 -80830 X X 0 1 X 1 1 1 405301 328294 77007 1049939 946271 103668 591638 396625 195013 375688 REINSURANCE RECOVERABLES 62692022 HEALTH CARE RECEIVABLE 12563794 ADVANCED PREMIUM TAX CREDIT RECEIVABLE 29364504 PROVIDER RECEIVABLE 746065 105366385 UNEARNED PREMIUM 39590255 MLR PAYABLE TO MEMBERS -2452 INSURANCE FEE PAYABLE 26585846 INTEREST PAYABLE 122872 66296521 X 421543751 0 421543751 0 421543751 439502356 0 439502356 0 439502356 PART X, LINE 2: THE ACA ESTABLISHED SECTION 501(C) (29) OF THE INTERNAL REVENUE CODE AS A NEW TAX-EXEMPT CATEGORY SPECIFICALLY FOR QUALIFIED NON-PROFIT HEALTH INSURANCE ISSUERS THAT HAVE RECEIVED A LOAN OR GRANT UNDER THE CMS CO-OP PROGRAM FOR PERIODS THAT THEY MEET BOTH THE REQUIREMENTS OF SECTION 1322 OF THE ACA AND ANY LOAN AGREEMENT WITH CMS. THE COMPANY RECEIVED AN APPROVAL LETTER FROM THE INTERNAL REVENUE SERVICE STATING THAT THEY ARE EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS AN ORGANIZATION DESCRIBED IN SECTION 501(C) (29). X 1 1 X X 1 0 0 0 0 0 0 0 0 CATHY MAHAFFEY CEO 513185 0 1496 0 69316 0 17314 0 31980 0 633291 0 0 0 TOM LAWLESS TERM 102022 EX- CFO 245121 0 1538 0 77135 0 18237 0 31991 0 374022 0 0 0 SCOTT ANDERSON CMO - CHIEF MEDICAL OFFICER 305524 0 1490 0 8399 0 17733 0 38221 0 371367 0 0 0 MELISSA HENDERSON CCO - CHIEF COMPLIANCE OFFICER 273350 0 1494 0 638 0 16484 0 2757 0 294723 0 0 0 BRIAN MCDONALD TERM 082022 EX - CHIEF BUS DEV OFFICER 207358 0 1496 0 46565 0 14094 0 24466 0 293979 0 0 0 JESSICA KOTTWITZ VP OF OPERATIONS 208359 0 1498 0 448 0 12812 0 16386 0 239503 0 0 0 ROBET PLESHA TERM 022022 EX - CHIEF ACTUARY 35912 0 0 0 173480 0 4806 0 4960 0 219158 0 0 0 SHELLY JOHNSON HEALTH PLAN QUALITY ADMINISTRATOR 185872 0 1498 0 2388 0 11467 0 13018 0 214243 0 0 0 JENNIFER WALKOWIAK VP OF BUSINESS DEVELOPMENT 185545 0 1505 0 339 0 8856 0 13960 0 210205 0 0 0 AARON JACKSON VP PROVIDER CONTRACTING & STRATEGY 195302 0 1494 0 152 0 5924 0 5072 0 207944 0 0 0 SCOTT BERGMAN SR. FINANCIAL ADVISOR 148645 0 0 0 10165 0 9751 0 31488 0 200049 0 0 0 BRIAN GARTNER CHIEF OF STAFF 159566 0 0 0 92 0 6073 0 7804 0 173535 0 0 0 PART I, LINE 1A COMMON GROUND MADE REIMBURSMENTS OF INCOME FOR GROUP TERM LIFE OVER $50,000 INCLUDED IN WAGES. COMMON GROUND MADE GROSS-UP PAYMENTS FOR EMPLOYMENT COVENANT AGREEMENTS WITH CERTAIN LEADERSHIP EMPLOYEES. PART I, LINE 4A ROB PLESHA RECEIVED $124,800.00 IN SEVERANCE PAY IN 2022. MELISSA DUFFY FORMER OFFICER 223200 INDEPENDENT CONTRACTOR 0 FORM 990, PART V, LINE 13A WI FORM 990, PART VI, SECTION A, LINE 6 COMMON GROUND HEALTHCARE COOPERATIVE BEGAN ISSUING HEALTH INSURANCE POLICIES IN 2014. WE OPERATE AS A HEALTH INSURANCE COMPANY SERVING BOTH INDIVIDUALS AND SMALL BUSINESSES. ALL ACTIVE POLICYHOLDERS ARE ALSO CONSIDERED MEMBERS OF THE COOPERATIVE. THIS STRUCTURE FOSTERS A SENSE OF COMMUNITY AND SHARED PURPOSE AMONG ITS MEMBERS, AS WE COLLECTIVELY STRIVE TO ACHIEVE THE COMMON GOAL OF PROMOTING AND MAINTAINING GOOD HEALTH WHILE KEEPING HEALTHCARE COSTS AS AFFORDABLE AS POSSIBLE. FORM 990, PART VI, SECTION A, LINE 7A COMMON GROUND HEALTHCARE COOPERATIVE IS GOVERNED BY A BOARD OF DIRECTORS, AND ALL VOTING DIRECTORS ARE ACTIVE MEMBERS WHO HAVE BEEN NOMINATED AND ELECTED BY THEIR FELLOW MEMBERS. THIS PROCESS ENSURES THAT THE VOICES AND PERSPECTIVES OF THE POLICYHOLDERS/MEMBERS ARE REPRESENTED IN THE COOPERATIVE'S DECISION-MAKING PROCESSES. THE COOPERATIVE'S MISSION OF "PUTTING MEMBERS FIRST. PURSUING BETTER HEALTHCARE" UNDERSCORES ITS COMMITMENT TO PRIORITIZING THE WELL-BEING OF ITS MEMBERS AND CONTINUALLY STRIVING TO IMPROVE THE QUALITY AND ACCESSIBILITY OF HEALTHCARE SERVICES. FORM 990, PART VI, SECTION B, LINE 11B FINANCE MANAGEMENT PRESENTS FORM 990 TO COMMON GROUND HEALTHCARE COOPERATIVE'S AUDIT & FINANCE COMMITTEE, AFTER WHICH A MOTION IS MADE, AND VOTE TAKEN TO APPROVE AND PRESENT TO THE FULL BOARD. THE BOARD IS LIKEWISE SUBSEQUENTLY PROVIDED THE FORM 990, AND AFTER REVIEW, IS ASKED FOR A MOTION AND ULTIMATELY APPROVAL OF FORM 990. ONCE APPROVAL IS GIVEN, THE FORM 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 COMPLIANCE COMMUNICATION, REPORTING, AND INVESTIGATION POLICY. FORM 990, PART VI, SECTION B, LINE 15 CGHC'S MEMBER-ELECTED BOARD OF DIRECTORS' REVIEWS AND APPROVES CEO COMPENSATION ANNUALLY. CGHC RECOGNIZES THAT EMPLOYEES ARE KEY TO FULFILLING ITS MISSION; THEREFORE, CGHC ENGAGES WITH A 3RD PARTY CONSULTANT TO EVALUATE INTERNAL PAY PRACTICES AND CONDUCT MARKET ANALYSIS TO ENSURE CGHC APPROPRIATELY ATTRACTS AND RETAINS EMPLOYEES, INCLUDING THOSE OF THE EXECUTIVE LEADERSHIP TEAM. FORM 990, PART VI, SECTION C, LINE 19 THE DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: NET REDUCTION IN PRIOR YEAR UNREALIZED LOSS AND CHANGE IN BOARD FUNDS -80,830. FORM 990, PART XII, LINE 2C: THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. COMMON GROUND HEALTHCARE FOUNDATION INC 120 BISHOPS WAY STE 150 BROOKFIELD WI 53005 883360460 PROVIDE FUNDING WI 501 (C )(3) PF COMMON GROUND HEALTH COOPERATIVE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0