2022-11-14T20:22:26-06:00 2021-12-31 390859910 BAKER TILLY US LLP 777 E WISCONSIN AVENUE 32ND FLOOR MILWAUKEE WI 53202 990 2021-01-01 453309488 COMMON GROUND HEALTHCARE COOPERATIVE COMM 4144550500 120 BISHOPS WAY 150 BROOKFIELD WI 53005 CATHY MAHAFFEY CEO 4144550500 2022-11-14 1 CATHY MAHAFFEY 999009999 TROY MARINE CPA P00187863 4147775500 2022-11-09 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z CATHY MAHAFFEY 120 BISHOPS WAY 150 BROOKFIELD WI 53005 365900087 0 X WWW.COMMONGROUNDHEALTHCARE.ORG X CO-OP 2011 WI PROVIDE AFFORDABLE HEALTH INSURANCE SOLUTIONS TO SMALL BUS., INDIVIDUALS & NON-PROFITS IN WI. 9 9 136 0 0 0 0 0 478995791 326829843 3543388 2694519 0 0 482539179 329524362 0 0 0 0 11832359 11766922 0 0 0 432485672 344924762 444318031 356691684 38221148 -27167322 366280384 311102675 237111559 211369790 129168825 99732885 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 0 0 0 1 1537 0 1 136 1 0 0 0 0 0 0 64516356 183102772 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 BRIAN GARTNER 4144550500 120 BISHOPS WAY SUITE 150 BROOKFIELD WI 53005 AMY MURPHY BOARD CHAIR 6.00 X 6537 0 0 TERESA PISZCOR BOARD VICE-CHAIR 1.00 X 6537 0 0 MARY REHBERG SECRETARY/TREASURER 1.00 X 6537 0 0 WILLIAM KORT DIRECTOR 1.00 X 6537 0 0 RACHAEL BUSH DIRECTOR 1.00 X 6537 0 0 JAMES WESP NON-VOTING DIRECTOR 1.00 X 6537 0 0 JOHN MAGLIO NON-VOTING DIRECTOR 1.00 X 6537 0 0 ROBERT CONNOLLY NON-VOTING DIRECTOR 1.00 X 6537 0 0 BRETT REMINGTON DIRECTOR 1.00 X 5992 0 0 ERIN KENNEKE DIRECTOR 1.00 X 5448 0 0 CHRISTOPHER MARTIN BOARD CHAIR-PRIOR 6.00 X 3269 0 0 KEVIN GILLIGAN DIRECTOR 1.00 X 3269 0 0 TONNI LARSON DIRECTOR 1.00 X 3269 0 0 CATHY MAHAFFEY CEO 40.00 X 613590 0 45023 SCOTT ANDERSON CMO - CHIEF MEDICAL OFFICER 40.00 X 385157 0 50085 BRIAN MCDONALD CHIEF BUS DEV OFFICER 40.00 X 381586 0 43790 TOM LAWLESS CFO 40.00 X 333276 0 49125 MELISSA HENDERSON COO 40.00 X 329849 0 18202 ROBERT PLESHA CHIEF ACTUARY 40.00 X 309210 0 42177 SHELLY JOHNSON VP OF NETWORK OPTIMIZATION 40.00 X 226010 0 33313 JESSICA KOTTWITZ VP OF OPERATIONS 40.00 X 229941 0 27721 AARON JACKSON VP PROVIDER CONTRACTING & 40.00 X 218373 0 37727 SCOTT BERGMAN SR FINANCIAL ADVISOR 40.00 X 196224 0 40510 3296759 0 387673 20 0 1 0 OPTUM HEALTH CARE SOLUTIONS INC 11000 OPTUM CIRCLE MN101W400 MINNEAPOLIS MN 55344 MEDICAL MANAGEMENT 1401189 HUMANA WISCONSIN HEALTH ORG INSURANCE CO PO BOX 4616 CAROL SREAM IL 60197 HEALTH INSURANCE 1161144 SECURITY HEALTH PLAN OF WISCONSIN INC 1515 SAINT JOSEPH AVENUE MARSHFIELD WI 54449 MEDICAL MANAGEMENT 975409 MILLIMAN INC 15800 W BLUEMOUND ROAD SUITE 100 BROOKFIELD WI 53005 ACTUARIAL 926065 MPX 2301 CONGRESS STREET PORTLAND ME 04102 PRINTING AND POSTAGE 667736 38 PREMIUMS EARNED 525100 326829843 326829843 326829843 2686015 2686015 36384229 36375725 8504 8504 8504 329524362 326829843 0 2694519 2323225 6990461 438434 1374214 640588 179082 2851306 48658 3475113 603277 1504274 1658837 261059 38346 89377 453028 217241 232685 CLAIMS EXPENSE 317996955 CMS EXCHANGE USER FEE E 9160369 COMMISSIONS 3310997 BANK CHARGES 1433062 1411096 356691684 84990660 20997101 200608332 185735791 4093167 9750017 356358 231913 1997875 1483326 731790 514549 75500077 93873304 366280384 311102675 5457522 4374726 44770544 54269636 97893003 91429763 88990490 61295665 237111559 211369790 X 0 0 0 0 129168825 99732885 129168825 99732885 366280384 311102675 X -27167322 132176 -2400794 X X 0 1 X 1 1 1 356298 307611 48687 1049939 878213 171726 591638 297502 294136 514549 REINSURANCE RECOVERABLES 53808002 HEALTH CARE RECEIVABLE 10096998 ADVANCED PREMIUM TAX CREDIT RECEIVABLE 29266834 PROVIDER RECEIVABLE 701470 93873304 UNEARNED PREMIUM 37017914 MLR PAYABLE TO MEMBERS 349 PREMIUM DEFICIENCY 10008966 INSURANCE FEE PAYABLE 14268436 61295665 X 329524362 0 329524362 0 329524362 356691684 0 356691684 0 356691684 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 0 0 0 0 0 1 0 0 0 CATHY MAHAFFEY CEO 486918 0 118250 0 8422 0 13512 0 31511 0 658613 0 0 0 SCOTT ANDERSON CMO - CHIEF MEDICAL OFFICER 300180 0 77625 0 7352 0 15071 0 35014 0 435242 0 0 0 BRIAN MCDONALD CHIEF BUS DEV OFFICER 299222 0 74360 0 8004 0 15169 0 28621 0 425376 0 0 0 TOM LAWLESS CFO 265053 0 67600 0 623 0 15372 0 33753 0 382401 0 0 0 ROBERT PLESHA CHIEF ACTUARY 242996 0 60000 0 6214 0 13515 0 28662 0 351387 0 0 0 MELISSA HENDERSON COO 265651 0 63600 0 598 0 15492 0 2710 0 348051 0 0 0 SHELLY JOHNSON VP OF NETWORK OPTIMIZATION 180314 0 45250 0 446 0 12424 0 20889 0 259323 0 0 0 JESSICA KOTTWITZ VP OF OPERATIONS 183611 0 45950 0 380 0 12640 0 15081 0 257662 0 0 0 AARON JACKSON VP PROVIDER CONTRACTING & 174248 0 44000 0 125 0 6719 0 31008 0 256100 0 0 0 SCOTT BERGMAN SR FINANCIAL ADVISOR 195813 0 0 0 411 0 11944 0 28566 0 236734 0 0 0 PART I, LINE 1A COMMON GROUND MADE REIMBURSMENTS OF INCOME FOR GROUP TERM LIFE OVER $50,000 INCLUDED IN WAGES. PART I, LINE 6 LEADERSHIP INCENTIVE BONUSES ARE ACCRUED DURING THE PREVIOUS YEAR BASED ON A SERIES OF METRICS, ONE OF THE METRICS BEING THE COOPERATIVE MUST BE PROFITABLE FOR THE PREVIOUS YEAR. MELISSA DUFFY FORMER OFFICER 223200 INDEPENDENT CONTRACTOR 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, CBDO, 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. FORM 990, PART XI, LINE 9: REDUCTION IN PRIOR YEAR NET UNREALIZED LOSS IN INVESTMENT -2,583,345. UNCLAIMED PROPERTY 182,551. PART XII, LINE 2C THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR.