2020-11-16T16:13:07-06:00 2019-12-31 KPMG LLP 60 South Street Boston MA 02111 990 2019-01-01 453416923 MAINE COMMUNITY HEALTH OPTIONS % JOANNE LAUTERBACH MAIN 2074023330 150 MILL STREET THIRD FLOOR LEWISTON ME 04240 JOANNE LAUTERBACH INTERIM CFO 2073302390 2020-11-16 true STEPHANIE LONCZAK P01880207 6179881000 2020-11-16 199.207.253.96 04502320203215000221 2020-11-16 P 9D555F16C7E89F93C59A72F8520745FF1D3DA448 9C37FB02EE77A6FF00EC66693955615721E3AD8A 2019 2021-04-22 16:20:28Z KEVIN LEWIS 150 MILL STREET THIRD FLOOR LEWISTON ME 04240 331190259 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. 17 17 207 17 19176 16218 0 0 422131585 314606284 2084065 3559190 0 0 424215650 318165474 0 500000 353702763 249484693 21422638 21532012 0 0 0 23803430 21461925 398928831 292978630 25286819 25186844 170659367 182400877 113325811 98211956 57333556 84188921 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 false false false true true true true false false false false false false false false false false true false true false false false false false false false true false false false false false false false false true X 2048 0 true 207 true true true false false false false false false false false true 100000 100000 false false false X 17 17 false false false false true true true true true false false true true true true true true true true false ME NH X JOANNE LAUTERBACH 2073302390 BATES MILL PO BOX 1121 LEWISTON ME 04243 KEVIN LEWIS CHIEF EXECUTIVE OFFICER 40.0 0.0 X 456585 0 19338 ROBERT HILLMAN CHIEF OPERATING OFFICER 40.0 0.0 X 387218 0 25220 EDWARD VOZZO CHIEF FINANCIAL OFFICER 40.0 0.0 X 299533 0 29991 EDWARD YOON CHIEF MEDICAL OFFICER 40.0 0.0 X 295170 0 24192 WILLIAM KILBRETH CHIEF INFORMATION OFFICER 40.0 0.0 X 272522 0 28856 NANCY JOHNSON AVP COMPLIANCE & REG. AFFAIRS 40.0 0.0 X 193897 0 22680 GRAYSON STUNTZ DIRECTOR OF INFO. TECHNOLOGY 40.0 0.0 X 179477 0 27295 MARGARET KELLEY AVP OF MEDICAL SERVICES 40.0 0.0 X 180856 0 22383 KIRK MIKLAVIC VP OF HUMAN RESOURCES 40.0 0.0 X 187020 0 14354 JANE CARIELLO AVP SERVICE OPERATIONS 40.0 0.0 X 174907 0 21764 W DOUGLAS SMITH PRESIDENT 2.0 0.0 X 0 0 0 MICHAEL DELORENZO DIRECTOR 2.0 0.0 X 0 0 0 FREDERIC C GRAIGIE JR DIRECTOR 2.0 0.0 X 0 0 0 JUDIANN FERRETTI SMITH DIRECTOR (AS OF 1/1/2019) 2.0 0.0 X 0 0 0 SARAH HINES DIRECTOR 2.0 0.0 X 0 0 0 HOLLY KORDA DIRECTOR (AS OF 1/1/2019) 2.0 0.0 X 0 0 0 ROBERT LORENZO DIRECTOR 2.0 0.0 X 0 0 0 HEIDI LUKAS DIRECTOR 2.0 0.0 X 0 0 0 ROCELL MARCELLINO DIRECTOR 2.0 0.0 X 0 0 0 JEFF NORRIS DIRECTOR 2.0 0.0 X 0 0 0 SHARON REISHUS DIRECTOR (AS OF 1/1/2019) 2.0 0.0 X 0 0 0 DAVID SHIPMAN DIRECTOR 2.0 0.0 X 0 0 0 DAVID SHULTZ DIRECTOR 2.0 0.0 X 0 0 0 MITCHELL STEIN DIRECTOR (AS OF 1/1/2019) 2.0 0.0 X 0 0 0 LISA TAPERT DIRECTOR 2.0 0.0 X 0 0 0 RONNIE WESTON DIRECTOR 2.0 0.0 X 0 0 0 DOUGLAS WILSON DIRECTOR 2.0 0.0 X 0 0 0 2627185 0 236073 27 false true false UST GLOBAL INC PO BOX 31001-1967 PASADENA CA 911101967 CLAIMS PLATFORM VEND 3996835 FREEPORT METRICS INC 15 FRANKLIN STREET 2ND FLOOR PORTLAND ME 04101 SOFTWARE DEVELOPMENT 1723182 EVICORE 400 BUCKWATER PLACE BLVD BLUFFTON SC 29910 UTILITZATION MGMT 1579922 MPX 2301 CONGRESS STREET PORTLAND ME 04102 PRINT/MAIL VENDOR 1064425 SUMMIT REINSURANCE SERVICES INC 7030 POINTE INVERNESS WAY STE 350 FORT WAYNE IN 46804 REINSURANCE PREM. 932218 36 0 PREMIUM REVENUE 314606284 314606284 314606284 3583975 19176 3564799 0 0 0 0 0 13000000 13024785 -24785 -24785 -24785 0 0 0 0 0 0 0 0 0 0 318165474 314606284 19176 3540014 500000 0 0 249484693 2863554 0 15007495 438520 2179708 1042735 0 164335 305510 50212 0 249169 4396999 561126 713281 3531119 0 465035 174682 0 0 33229 0 686505 325408 GOVERNMENT MANDATED FEES 9716584 DUES,ASSOC. AND MEMBERSHIPS 88731 292978630 19576556 10109643 77572555 103777257 7345920 4626942 53435 0 0 0 0 0 0 0 0 0 189085 0 6597588 6597588 755661 0 64177336 51384627 0 0 0 0 0 0 988819 12502408 170659367 182400877 60945266 68295297 0 0 0 0 0 0 0 0 0 0 569116 450565 0 0 51811429 29466094 113325811 98211956 X 57333556 84188921 0 0 57333556 84188921 170659367 182400877 X 25186844 1668521 X X false true X true true true INSURANCE RECEIVABLES 12145187 INVESTMENT INC. RECEIVABLE 357221 12502408 0 UNPAID CLAIMS AND LOSS 24849003 UNEARNED PREMIUMS 4617091 29466094 X 244415555 -21144422 -21144422 265559977 249169 52356328 52605497 318165474 219228711 -52356328 -52356328 271585039 249169 21144422 21393591 292978630 PART X LINE 2: EXPLANATION: MAINE COMMUNITY HEALTH OPTIONS HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(29) AND IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE CODE. ACCORDINGLY NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING FINANCIAL STATEMENTS. 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 RECOGNIZED 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 RECOGNIZED 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, 2016 THROUGH 2018. PART XI, LINE 2D CONTRA-PREMIUMS AND REINSURANCE PREMIUMS $(21,144,422) PART XI, LINE 4B OTHER REIMBURSEMENTS AND REBATES $52,356,328 PART XII, LINE 2D OTHER REIMBURSEMENTS AND REBATES $(52,356,328) PART XII, LINE 4B CONTRA-PREMIUMS AND REINSURANCE PREMIUMS $21,144,422 true MAINE COMMUNITY FOUNDATION 245 MAIN STREET ELSWORTH ME 046051613 010391479 501(C) (3) 500000 GENERAL SUPPORT 1 0 Schedule I, Line 2 THE ORGANIZATION ISSUED COMMUNITY BENEFIT GRANTS IN 2019. THERE WERE SPECIFIC CRITERIA TO BE MET BEFORE THE GRANTS WERE AWARDED. EACH GRANTEE MUST SUBMIT A FINAL REPORT DOCUMENTING THE USE AND IMPACT OF THE GRANT FUNDS. THESE REPORTS WILL BE SUBMITTED TO THE CHIEF EXECUTIVE OFFICER. X X X false false false false false false false false false KEVIN LEWIS CHIEF EXECUTIVE OFFICER 359918 0 96667 0 0 0 7293 0 12045 0 475923 0 0 0 ROBERT HILLMAN CHIEF OPERATING OFFICER 304859 0 82359 0 0 0 7801 0 17419 0 412438 0 0 0 EDWARD VOZZO CHIEF FINANCIAL OFFICER 235515 0 64018 0 0 0 8535 0 21456 0 329524 0 0 0 EDWARD YOON CHIEF MEDICAL OFFICER 239112 0 56058 0 0 0 8919 0 15273 0 319362 0 0 0 WILLIAM KILBRETH CHIEF INFORMATION OFFICER 215552 0 56970 0 0 0 7768 0 21088 0 301378 0 0 0 NANCY JOHNSON AVP COMPLIANCE & REG. AFFAIRS 163020 0 30877 0 0 0 6732 0 15948 0 216577 0 0 0 MARGARET KELLEY AVP OF MEDICAL SERVICES 176118 0 4738 0 0 0 7312 0 15071 0 203239 0 0 0 KIRK MIKLAVIC VP OF HUMAN RESOURCES 161138 0 25882 0 0 0 7506 0 6848 0 201374 0 0 0 GRAYSON STUNTZ DIRECTOR OF INFO. TECHNOLOGY 151178 0 28299 0 0 0 7204 0 20091 0 206772 0 0 0 JANE CARIELLO AVP SERVICE OPERATIONS 145744 0 29163 0 0 0 6775 0 14989 0 196671 0 0 0 DFD RUSSELL MEDICAL CENTER KEVIN LEWIS, CEO OF MCHO 61862 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 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 CEOS 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 XI, LINE 9: OTHER CHANGES IN NET ASSETS CHANGE IN NONADMITTED ASSETS $1,668,521 FORM 990, PART XII, LINE 1 MAINE COMMUNITY HEALTH OPTIONS PREPARED ITS 2019 AUDITED FINANCIAL STATEMENTS USING THE STATUTORY BASIS, WHICH IS A COMPREHENSIVE METHOD OTHER THAN U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). FORM 990, PART XII, LINE 2C: EXPLANATION: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.