2019-11-15T13:17:43-06:00 2018-12-31 KPMG LLP 60 South Street Boston MA 02111 990 2018-01-01 453416923 MAINE COMMUNITY HEALTH OPTIONS % JOANNE LAUTERBACH MAIN 2074023330 150 MILL STREET THIRD FLOOR LEWISTON ME 04240 EDWARD VOZZO CFO 2073302390 2019-11-15 true MARY HANINK P01244578 6179881000 2019-11-14 167.68.102.5 04502320193195000109 2019-11-15 P 312FA2736B9E4A89DBAAD0AC879D6B749DE8B5F7 072F242B0F8FA55BC44C4BBFD6D81B3F0B7E1C92 2018 2020-04-17 16:48:07Z KEVIN LEWIS 150 MILL STREET THIRD FLOOR LEWISTON ME 04240 437605741 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. 14 14 200 15 0 71958 0 0 286395880 422131585 454489 2084065 40 0 286850409 424215650 0 0 260347453 353702763 16249924 21422638 0 0 0 16504071 23803430 293101448 398928831 -6251039 25286819 75519544 170659367 172560155 113325811 -97040611 57333556 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 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 true false false false 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 2340 0 true 200 true true true false false false false false false false false true 100000 100000 false false false X 14 14 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 W DOUGLAS SMITH PRESIDENT 2.0 0.0 X 0 0 0 MICHAEL DELORENZO DIRECTOR (AS OF 7/19/18) 2.0 0.0 X 0 0 0 FREDERIC C GRAIGIE JR DIRECTOR 2.0 0.0 X 0 0 0 TONUA FEDUSENKO DIRECTOR 2.0 0.0 X 0 0 0 SARAH HINES DIRECTOR 2.0 0.0 X 0 0 0 JOEL KALLICH DIRECTOR (UNTIL 2/13/18) 2.0 0.0 X 0 0 0 ROBERT LORENZO DIRECTOR (AS OF 1/1/18) 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 FELICITY MYERS DIRECTOR (Until 4/17/18) 2.0 0.0 X 0 0 0 JEFF NORRIS DIRECTOR (as of 1/1/18) 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 LISA TAPERT DIRECTOR (AS OF 1/1/18) 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 KEVIN LEWIS CHIEF EXECUTIVE OFFICER 40.0 0.0 X 342598 0 22786 ROBERT HILLMAN CHIEF OPERATING OFFICER 40.0 0.0 X 290398 0 27624 EDWARD VOZZO CHIEF FINANCIAL OFFICER 40.0 0.0 X 220381 0 28328 JOYCE MCPHETRES CHIEF HUMAN RESOURCES OFFICER 40.0 0.0 X 121411 0 19014 JOHN YINDRA Chf Medical Officer (U 3/2/18) 40.0 0.0 X 94888 0 0 WILLIAM KILBRETH CHIEF INFORMATION OFFICER 40.0 0.0 X 200774 0 26992 EDWARD YOON Chf Medical Off (as of 3/2/18) 40.0 0.0 X 221193 0 25044 SHARON WARE DIR., BUSINESS DEVELOPMENT 40.0 0.0 X 153204 0 17472 MARGARET KELLEY AVP OF MEDICAL SERVICES 40.0 0.0 X 169997 0 18894 NANCY JOHNSON AVP COMPLIANCE & REG. AFFAIRS 40.0 0.0 X 170979 0 20262 JANE CARIELLO AVP SERVICE OPERATIONS 40.0 0.0 X 159665 0 19366 CHRISTOPHER KENNEDY Dir. Provider Network & Ops 40.0 0.0 X 155058 0 18815 2300546 0 244597 19 false true false UST GLOBAL INC 5 POLARIS WAY ALISO VIEJO CA 92656 CLAIMS PLATFORM VEND 5844706 EVICORE 400 BUCKWATER PLACE BLVD BLUFFTON SC 29910 UTILITZATION MGMT 4182960 SUMMIT REINSURANCE SERVICES INC 7030 POINTE INVERNESS WAY STE 350 FORT WAYNE IN 46804 CEDED REINS. PREM. 2059696 MILLIMAN INC 80 LAMBERTON RD WINDSOR CT 06095 ACTUARIAL SERVICES 1034318 MAINEHEALTH ACCOUNTABLE CARE ORG 110 FREE STREET PORTLAND ME 04104 MHNP 1000456 17 0 PREMIUM REVENUE 422131585 422131585 422131585 2074156 0 2074156 0 0 0 0 0 13400000 13390091 9909 9909 9909 0 0 0 0 0 0 0 0 0 0 424215650 422131585 0 2084065 0 0 0 353702763 2793961 0 15789362 303475 1683105 852735 0 314295 334961 25139 0 177544 1694929 591391 736970 3089267 0 449343 157170 0 0 45537 0 722971 303250 DUES,ASSOC. AND MEMBERSHIPS 104684 GOVERNMENT MANDATED FEES 15055979 398928831 12460101 19576557 11658332 77572555 4863651 7345920 203354 53435 0 0 0 0 0 0 0 0 2248575 189085 3897182 3141521 1501333 755661 38394538 64177336 0 0 0 0 0 0 4189660 988818 75519544 170659367 5576895 60945266 0 0 0 0 0 0 0 0 0 0 132996904 569116 0 0 33986356 51811429 172560155 113325811 X -97040611 57333556 0 0 0 0 -97040611 57333556 75519544 170659367 X 25286819 129087348 X X false true X true true true 0 0 0 0 0 0 0 0 0 3897182 3141521 755661 755661 0 UNEARNED PREMIUMS 5488975 CAPITAL LEASE OBLIGATIONS 89855 UNPAID CLAIMS AND LOSS 46232599 51811429 X 380596171 -29673832 -29673832 410270003 45537 13900110 13945647 424215650 355309352 -13900110 -13900110 369209462 45537 29673832 29719369 398928831 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, 2011 THROUGH THE CURRENT YEAR. PART XI, LINE 2D CONTRA-PREMIUMS AND REINSURANCE PREMIUMS $(30,548,981) UNCOLLECTABLE PREMIUM $ 432,303 INVESTMENT EXPENSES $ 443,292 ROUNDING $ (446) TOTAL $(29,673,832) PART XI, LINE 4B OTHER REIMBURSEMENTS AND REBATES $ 13,900,110 PART XII, LINE 2D OTHER REIMBURSEMENTS AND REBATES $(13,990,110) PART XII, LINE 4B CONTRA-PREMIUMS AND REINSURANCE PREMIUMS $ 30,548,981 UNCOLLECTABLE PREMIUM $ (432,303) INVESTMENT EXPENSES $ (443,292) ROUNDING $ 446 TOTAL $ 29,673,832 X X X false false false false false false false false false KEVIN LEWIS CHIEF EXECUTIVE OFFICER 342598 9409 13377 365384 0 ROBERT HILLMAN CHIEF OPERATING OFFICER 290398 9557 18067 318022 0 EDWARD VOZZO CHIEF FINANCIAL OFFICER 220381 7407 20921 248709 0 WILLIAM KILBRETH CHIEF INFORMATION OFFICER 200774 6622 20370 227766 0 EDWARD YOON Chf Medical Off (as of 3/2/18) 221193 4892 20152 246237 0 SHARON WARE DIR., BUSINESS DEVELOPMENT 153204 4330 13142 170676 0 MARGARET KELLEY AVP OF MEDICAL SERVICES 169997 4111 14783 188891 0 NANCY JOHNSON AVP COMPLIANCE & REG. AFFAIRS 170979 4669 15593 191241 0 JANE CARIELLO AVP SERVICE OPERATIONS 159665 4494 14872 179031 0 CHRISTOPHER KENNEDY Dir. Provider Network & Ops 155058 0 18815 173873 0 DFD RUSSELL MEDICAL CENTER KEVIN LEWIS, CEO OF MCHO 118682 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 NON-ADMITTED ASSETS $ 1,688,057 GAAP TO STATUTORY ADJUSTMENT $ 127,399,291 TOTAL $ 129,087,348 FORM 990, PART XII, LINE 1: FOR THE CALENDAR YEAR ENDING DECEMBER 31, 2018 MAINE COMMUNITY HEALTH DID NOT ISSUE GAAP FINANCIAL STATEMENTS AND ISSUED ONLY STATUTORY FINANCIAL STATEMENTS. IN ORDER TO BETTER ALIGN WITH THE PRESENTATION OF ITS AUDITED FINANCIAL STATEMENTS MAINE COMMUNITY HEALTH OPTIONS HAS CHANGED THE ACCOUNTING METHOD USED TO PREPARE THE FORM 990 TO THE STATUTORY BASIS OF ACCOUNTING. THE CHANGE IN PRESENTATION OF NET ASSETS IS FOUND IN PART XI, LINE 9. FORM 990, PART XII, LINE 2C: EXPLANATION: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.