2018-11-01T12:20:28-05:00 2017-12-31 KPMG LLP 1918 Eighth Avenue Suite 2900 Seattle WA 98101 990 2017-01-01 463264330 Health Plan of CareOregon Inc % TERESA KENNEDY LEARN CFO HEAL 5034164100 315 SW FIFTH AVE PORTLAND OR 97204 TERESA LEARN CFO 2018-10-04 true Sue Robison P00560072 2069134000 2018-10-30 167.68.102.5 91023620183055000003 2018-11-01 P 62F85D26A55D1544A8BAD7F3D5FA4E1FFB5CCFFE 827FF244BCAED97886C7B1CC1341CE2DAAA5086C 2017 2018-06-14 16:35:46Z X ERIC HUNTER 315 SW FIFTH AVE PORTLAND OR 97204 233789272 false X WWW.CAREOREGONADVANTAGE.ORG X 2005 OR HEALTH PLAN OF CAREOREGON'S MISSION IS BUILDING INDIVIDUAL WELL-BEING AND COMMUNITY HEALTH THROUGH SHARED LEARNING AND INNOVATION. 14 13 0 13 0 0 0 0 0 220604941 0 1376754 0 0 0 221981695 0 0 0 0 0 14829142 0 0 0 0 222709010 0 237538152 0 -15556457 0 69969006 0 35488811 0 34480195 X SEE SCHEDULE O false false 207133461 220604941 Medicare Plan 15899165 All Other 223032626 true false false false false false false false false false false false false false true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 1268 0 true 0 false false false false false false false false false false X 14 13 false false false false false false false true true false false true true true true true true true true false OR X TERESA KENNEDY LEARN CFO 5034161415 315 SW 5TH AVENUE Portland OR 97204 Glenn S Rodriquez Board Chairman 1.0 3.0 X X 0 0 0 Vickie S Gates Board Vice Chairman 1.0 3.0 X X 0 0 0 Susan M Hennessy Board of Director 1.0 3.0 X 0 0 0 Beth A deHamel Board of Director 1.0 3.0 X 0 0 0 Joanne Fuller Board of Director 1.0 3.0 X 0 0 0 Damien Richard Hall Board of Director 1.0 3.0 X 0 0 0 Brenda Irene Johnson Board of Director 1.0 3.0 X 0 0 0 Nathalie Johnson Board of Director 1.0 3.0 X 0 0 0 Hyosuk Rhee Board of Director 1.0 3.0 X 0 0 0 Robert C Stewart Board of Director 1.0 3.0 X 0 0 0 Erik W Thorsen Board of Director 1.0 3.0 X 0 0 0 Gina F Nikkel Board of Director 1.0 3.0 X 0 0 0 Woodruff J English II Board of Director 1.0 3.0 X 0 0 0 Eric C Hunter CEO, President & BOD 8.58 31.42 X X 0 440879 25078 Teresa K Learn CFO, Board Treasurer 8.58 31.42 X 0 351827 33497 Amit R Shah Chief Medical Officer 8.58 31.42 X 0 346588 20654 Katherine A Ellis COO, Board Secretary 8.58 31.42 X 0 325328 33242 Gregory P Morgan Chief Network Officer 8.58 31.42 X 0 147970 24668 Scott W Clement Integration & BDO 8.58 31.42 X 0 61409 19159 Nathan Corley Information Services Director 8.81 31.19 X 0 181361 22754 William J Kennedy Senior Medical Director 3.92 36.08 X 0 277801 44624 Douglas R Luther Senior Medical Director 7.55 32.45 X 0 293756 24806 Carl D Stevens Medical Director 7.55 32.45 X 0 250884 38639 Rebecca Ramsay Housecall Providers Director 4.97 35.03 X 0 212698 41274 Stephanie Cao Medicare Marketing Manager 40.0 0.0 X 0 193009 39206 0 3083510 367601 0 false true false CARRIE DUFFEY 2937 W 2ND ST WASHOUGAL WA 98671 Broker Commissions 440659 STEVEN PEARSE 14830 NW MARGUERITE LN PORTLAND OR 97229 Broker Commissions 173418 KPMG LLP PO BOX 120922 DEPT 0922 DALLAS TX 75312 Accounting and Tax 103288 LAKESHA JONES 8631 N FOWLER CT PORTLAND OR 97217 Broker Commissions 101907 4 0 PREMIUM REVENUE 524114 220604941 220604941 220604941 1338958 1338958 0 0 0 0 0 11845373 11807577 37796 37796 37796 0 0 0 0 0 0 0 0 0 0 221981695 220604941 1376754 0 0 0 0 437639 437639 0 11333882 7415288 3918594 909243 561450 347793 1254243 967902 286341 894135 570892 323243 0 510 510 99768 99768 0 0 145215 145215 5883555 1034216 4849339 19188 17925 1263 261800 260178 1622 159543 159543 0 0 21722 14779 6943 0 7205 3466 3739 1119 1119 0 0 0 PHYSICAL HEALTHCARE EXPENSE 208989540 208989540 ALL OTHER EXPENSES 7119845 3196990 3922855 237538152 223032626 14505526 0 0 0 0 4020031 0 0 0 7878477 0 0 0 0 0 0 0 0 0 77769 0 0 0 56087931 0 0 0 0 0 0 0 1904798 0 69969006 0 2392862 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33095949 0 35488811 X 0 34480195 0 0 0 0 0 34480195 0 69969006 -15556457 -115113 50151765 X false true X true false X 0 0 0 0 0 0 220604941 220604941 0 0 0 0 0 0 0 220604941 220604941 0 0 0 220604941 1338958 1338958 0 1338958 1338958 0 0 0 0 0 0 221943899 221943899 X 0.00000 false false 0 CLAIMS PAYABLE 23393301 ADVANCED PAYMENT 4447213 PREMIUM DEFICIENCY RESERVE 2886000 INTERCOMPANY LIABILITIES 2286261 PREMIUM RECOUPMENT PAYABLE 83174 33095949 X Part X, Line 2 On July 14, 2017, the internal revenue services (IRS) approved Health Plan of CareOregon's application for exemption from federal income tax under provisions of section 501 (c) (3) of the internal revenue code, effective December 31, 2016. X true true X X X X false false false false false false false false false Eric C Hunter CEO, President & BOD 405564 35000 315 18518 6560 465957 Teresa K Learn CFO, Board Treasurer 251995 25556 74276 18361 15136 385324 Amit R Shah Chief Medical Officer 315946 30042 600 18800 1854 367242 Katherine A Ellis COO, Board Secretary 267190 26351 31787 18204 15038 358570 Gregory P Morgan Chief Network Officer 147970 7687 16981 172638 William J Kennedy Senior Medical Director 267618 9163 1020 18630 25994 322425 Douglas R Luther Senior Medical Director 283187 9568 1001 18092 6714 318562 Carl D Stevens Medical Director 239142 11742 16770 21869 289523 Rebecca Ramsay Housecall Providers Director 205081 6702 915 15090 26184 253972 Stephanie Cao Medicare Marketing Manager 190779 1525 705 13310 25896 232215 Nathan Corley Information Services Director 181361 11357 11397 204115 Part I, Line 1a CareOregon reimbursed health club dues for Eric Hunter, CEO, Katherine Ellis, COO, William Kennedy, Sr. Medical Director, Douglas Luther, Senior Medical Director, Carl Stevens, Medical Director, Rebecca Ramsay, Housecall Providers Director, and Stephanie Cao, Medicare Marketing Manager in the amount of $315, $210, $420, $401, $105, $315 and $105 respectively. This reimbursement was included as taxable compensation to these parties. PART III, LINE 1 ORGANIZATION'S MISSION HEALTH PLAN OF CAREOREGON IS A HEALTHCARE SERVICE CONTRACTOR INCORPORATED AND DOMICILED IN THE STATE OF OREGON, AND IS REGULATED BY THE STATE OF OREGON DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, DIVISION OF FINANCIAL REGULATION. IT ORIGINATED AS A SPECIAL NEEDS MEDICARE ADVANTAGE PRESCRIPTION DRUG PLAN (SNP PLAN), ORGANIZED TO BENEFIT MEDICAID AND MEDICARE DUALLY ELIGIBLE MEMBERS IN OREGON. WE ALSO PROVIDES A COMMERCIAL MA PD PLAN, FOR MEMBERS WHO ARE NOT DUALLY ELIGIBLE, UNDER THECAREOREGON ADVANTAGE STAR PLAN (STAR PLAN). IN TOTAL, WE PROVIDE MANAGED CARE SERVICES TO APPROXIMATELY 10,500 MEMBERS IN THE SNP PLAN AND 2,500 MEMBERS IN THE STAR PLAN. WE PROVIDE HEALTH BENEFITS THROUGH OUR CONTRACTED NETWORK OF HOSPITALS, PARTICIPATING PHYSICIANS, AND OTHER HEALTHCARE ORGANIZATIONS AND OPERATE UNDER ANNUAL CONTRACTS WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS), WHICH PAYS A RISK ADJUSTED RATE PER MEMBER. OPERATIONS AS A MA PD PLAN COMMENCED JANUARY 1, 2006. ON JULY 14, 2017, THE INTERNAL REVENUE SERVICES ("IRS") APPROVED HEALTH PLAN OF CAREOREGON'S APPLICATION FOR EXEMPTION FROM FEDERAL INCOME TAX, EFFECTIVE DECEMBER 31, 2016. PART III, LINE 4a STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS HEALTH PLAN OF CAREOREGON ADMINISTERS A SNP PLAN, WHICH PROVIDES CONTINUITY OF COVERAGE FOR MEMBERS WHO ARE DUALLY ELIGIBLE FOR MEDICARE AND MEDICAID. THE CONTINUITY BENEFITS BOTH PATIENTS AND PROVIDERS BY ENSURING A COORDINATED AND CONVENIENT MEANS OF RECEIVING AND DELIVERING QUALITY CARE. WE ALSO ADMINISTER A STAR PLAN, A LOW-COST MEDICARE ADVANTAGE PLAN. COLLECTIVELY, IN 2017, THESE MEDICARE PLANS SERVED APPROXIMATELY 13,000 MEMBERS. IN 2017, WE CONTINUED TO PROVIDE COMMUNITY OUTREACH, SUPPORT AND CARE COORDINATION SERVICES TO HIGH-RISK MEMBERS IN MULTNOMAH, WASHINGTON AND CLACKAMAS COUNTIES THROUGH THE PARENT; IN JACKSON COUNTY THROUGH JACKSON CARE CONNECT; IN COLUMBIA, TILLAMOOK AND CLATSOP COUNTIES THROUGH COLUMBIA PACIFIC. WE ENCOURAGE CLINICS TO PROVIDE THE BEST PRIMARY CARE POSSIBLE THROUGH OUR VARIOUS IMPROVEMENT AND INCENTIVE-PAYMENT PROGRAMS. THE GOAL OF THESE PROGRAMS IS TO BUILD SYSTEMS AND PROCESSES FOR PROACTIVE PANEL MANAGEMENT; TEAM-BASED CARE; CASE MANAGEMENT; PATIENT EMPOWERMENT FOR SELF-MANAGEMENT; INTEGRATION OF PHYSICAL, MENTAL AND ORAL HEALTH CARE; IMMUNIZATION AND DISEASE-SPECIFIC PATIENT REGISTRIES; AND SAME-DAY AND EXTENDED-HOUR MEMBER ACCESS TO THE CARE TEAM. ALL THESE IMPROVEMENTS HAVE THE GOAL OF COST-EFFECTIVE, CONTINUOUS AND COORDINATED CARE. OUR PERSONALIZED HEALTH PROGRAMS FOCUS RESOURCES ON INDIVIDUAL NEEDS AND WELL-BEING. WE SUPPORT MEMBERS WHO ARE AT HIGH RISK AND/OR HAVE COMPLEX HEALTH CONDITIONS BY PROVIDING COORDINATED CARE THAT TAKES INTO CONSIDERATION PAST TRAUMAS. WE FOCUS ON EACH PERSON'S PSYCHOSOCIAL AND CARE MANAGEMENT NEEDS AND HELP MEMBERS TRANSITION FROM HOSPITAL TO HOME. WE PROVIDE HOME-BASED CARE SERVICES AND MEDICATION MANAGEMENT, AND DEVELOP SPECIALTY PRIMARY CARE TEAMS TO ADDRESS MEMBER NEEDS. THE FOLLOWING ARE SERVICES PROVIDED TO MEMBERS. HEALTH RESILIENCE TEAM - A TEAM OF SOCIAL WORKERS EXPERIENCED WITH MENTAL HEALTH AND SUBSTANCE USE DISORDER WHICH DEVELOPS PARTNERSHIPS BASED ON MUTUAL TRUST WITH MEMBERS WHO FACE THE GREATEST HEALTH CHALLENGES. THE TEAM ADDRESSES MEMBERS LIVING CONDITIONS AS WELL AS HEALTH CONDITIONS TO HELP MEMBERS TRANSITION TO OVERALL WELL-BEING. TRANSITIONS IN CARE TEAM - FOCUSES ON THE HOSPITALIZED DUAL-ELIGIBLE POPULATION, WORKING WITH THEM BEFORE THEY ARE DISCHARGED TO REDUCE THE RISK OF READMISSION. CARE COORDINATION - COORDINATION OF MULTI-DISCIPLINARY CARE FOR PATIENTS WITH COMPLEX MEDICAL ISSUES PALLIATIVE CARE - SUPPORT FOR CHRONICALLY ILL PATIENTS, REDUCING HOSPITAL AND EMERGENCY DEPARTMENT UTILIZATION RATES. PART IV, LINE 12/12A CONSOLIDATED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2017, AN AUDIT WAS PERFORMED BY AN INDEPENDENT AUDITOR FOR THE CONSOLIDATED ENTITY OF CAREOREGON, WHICH INCLUDES THE PARENT, HEALTH PLAN OF CAREOREGON,CARE ACCESS, COLUMBIA PACIFIC CCO, JACKSON CARE CONNECT, HOUSECALL PROVIDERS SERVICES, AND HOUSECALL PROVIDERS. IN ADDITION, HEALTH PLAN OF CAREOREGON HAD A STAND-ALONE STATUTORY AUDIT. PART VI, LINE 11A FORM 990 TO GOVERNING BODY HEALTH PLAN OF CAREOREGONS FORM 990 IS REVIEWED BY THE CFO, FINANCE COMMITTEE AND APPROVED BY THE BOARD OF DIRECTORS BEFORE IT IS FILED. THE FORM 990 IS REVIEWED AND DISCUSSED AT THE FINANCE COMMITTEE MEETING PRIOR TO FILING. ALL REVIEWERS ARE GIVEN TIME TO RESPOND WITH ANY REVISIONS. AFTER INCORPORATION OF ALL REVISIONS, THE FORM 990 IS REDISTRIBUTED TO THE REVIEWERS PRIOR TO FILING. PART VI, LINE 12C ENFORCEMENT OF CONFLICT OF INTEREST POLICY THE CONFLICT OF INTEREST POLICY OF THE PARENT AND ITS AFFILIATES, WHICH INCLUDES HEALTH PLAN OF CAREOREGON, IS DISTRIBUTED TO THE BOARD MEMBERS ANNUALLY. IT APPLIES TO DIRECTORS, OFFICERS AND KEY EMPLOYEES (ON THE BASIS OF TESTS SET FORTH IN IRS FORM 990), AND ANY OTHER INDIVIDUAL IN A POSITION TO EXERCISE SIGNIFICANT INFLUENCE OVER A DECISION HAVING MATERIAL ECONOMIC IMPACT FOR HEALTH PLAN OF CAREOREGON (COLLECTIVELY COVERED PERSONS). THE CONFLICT OF INTEREST POLICY IS REVIEWED AND APPROVED PERIODICALLY BY THE BOARD. AN ANNUAL CONFLICT OF INTEREST DECLARATION AND INDEPENDENCE QUESTIONNAIRE IS DISTRIBUTED TO ALL COVERED PERSONS FOR CAREOREGON THE PARENT AND ITS AFFILIATES. THROUGH THE DISTRIBUTED DOCUMENT, EACH COVERED PERSON SIGNS AND ACKNOWLEDGES THEIR COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY AND REPORTS FAMILY AND BUSINESS RELATIONSHIPS THAT ARE USED TO DETERMINE THE INDEPENDENCE OF A DIRECTOR PURSUANT TO THE DEFINITION AND TESTS SET FORTH IN IRS FORM 990. THE GOVERNANCE COMMITTEE REVIEWS THE RESPONSES TO THE ANNUAL QUESTIONNAIRES AND MAKES RECOMMENDATIONS TO THE FULL BOARD ON ANY RESOLUTIONS OR ACTIONS REQUIRED TO MITIGATE ANY CONFLICTS OF INTEREST. FOR 2017, THERE WERE NO CONFLICTS OF INTEREST REQUIRING RESOLUTION OR ACTIONS. AT THE BEGINNING OF EACH MEETING OF THE BOARD OF DIRECTORS, THE CHAIR ASKS ALL MEMBERS PRESENT TO DECLARE ANY CONFLICTS OF INTEREST SO THE BOARD IS UPDATED ON ANY NEW CONFLICTS THAT MAY HAVE ARISEN SINCE THE LAST ANNUAL QUESTIONNAIRE. ALL SIGNED CONFLICT OF INTEREST POLICY ACKNOWLEDGEMENTS AND INDEPENDENCE QUESTIONNAIRES ARE RETAINED AT THE PARENT'S OFFICE. IF FOR A SPECIFIC MATTER REQUIRING BOARD ACTION, A CONFLICT OF INTEREST EXISTS, AS DETERMINED BY THE BOARD, AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE MEETING, DISCLOSING THE EXISTENCE OF HIS OR HER INTEREST AND SHALL DISCLOSE ALL MATERIAL FACTS. FOLLOWING THE PERSON'S DISCLOSURES AND AFTER ANY DISCUSSION WITH THE BOARD, THE INDIVIDUAL LEAVES THE MEETING WHILE THE BOARD INDEPENDENTLY DISCUSSES THE MATTER BEFORE IT VOTES ON THE PROPOSED TRANSACTION OR ARRANGEMENT INVOLVING THE CONFLICT OF INTEREST. IF THERE IS REASONABLE QUESTION ABOUT THE APPROPRIATENESS OF THE PROPOSED TRANSACTION OR ARRANGEMENT, THE CHAIR SHALL APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTIONS OR ARRANGEMENTS. AFTER EXERCISING DUE DILIGENCE, THE BOARD SHALL EVALUATE THE RESULTING ALTERNATIVES PRESENTED BY THE APPOINTED PERSON OR COMMITTEE. IF AN APPROPRIATE CONFLICT- FREE ALTERNATIVE IS NOT REASONABLY ATTAINABLE, THE BOARD SHALL DETERMINE BY MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE ORIGINAL TRANSACTION OR ARRANGEMENT IS IN HEALTH PLAN OF CAREOREGON'S BEST INTERESTS, FOR HEALTH PLAN OF CAREOREGON'S OWN BENEFIT, WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO HEALTH PLAN OF CAREOREGON, AND WHETHER THE TRANSACTION IS IN COMPLIANCE WITH ALL APPLICABLE LAWS AND REGULATIONS. THE BOARD SHALL THEN VOTE WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH THE EVALUATION OF THE FOREGOING. PART VI, LINE 15A AND 15B PROCESS OF DETERMINING COMPENSATION MARKET DATA ON THE TOTAL COMPENSATION PACKAGE FOR EXECUTIVE POSITIONS (CEO, COO, CFO AND CMO) ARE PROVIDED ANNUALLY BY AN OUTSIDE INDEPENDENT COMPENSATION CONSULTANT USING COMPARABLE ORGANIZATIONS BY INDUSTRY, FOR-PROFIT AND NON-PROFIT STATUS AND REVENUE SIZE. THE COMPENSATION COMMITTEE, CONSISTING OF A MAJORITY OF INDEPENDENT BOARD MEMBERS, REVIEWS MARKET DATA, EVALUATES CEO PERFORMANCE AND REVIEWS CEO RECOMMENDATIONS FOR COMPENSATION FOR OTHER EXECUTIVE OFFICERS. THE COMMITTEE PRESENTS ITS RECOMMENDATIONS FOR CEO TO THE BOARD. DECISIONS ARE MADE IN A BOARD MEETING. THE BOARD REVIEWS THE COMPENSATION COMMITTEES RECOMMENDATION FOR THE COMPENSATION OF ALL OTHER EMPLOYEES AS PART OF THE BUDGET APPROVAL PROCESS. THE PROCESS OF DETERMINING THE COMPENSATION OF TOP MANAGEMENT OFFICIALS AND KEY OFFICERS INCLUDES A REVIEW OF AN INDEPENDENT CONSULTANT'S REPORT OF COMPARABLE SALARIES OF SIMILAR ORGANIZATIONS AND IS GUIDED BY WRITTEN COMPENSATION PRACTICES. WITH THE CEO AND ALL OTHER OFFICERS ABSENT FROM THE MEETINGS, THE BOARD APPROVES THE SALARY OF THE CEO. THIS COMPENSATION APPROVAL PROCESS WAS LAST UNDERTAKEN ON MARCH 30, 2017 FOR THE CEO, AND THE CEO'S RECOMMENDATIONS FOR OTHER OFFICERS. THERE IS CONTEMPORANEOUS DOCUMENTATION OF THIS PROCESS AND THE RESULTS. PART VI, LINE 18 AND 19 PUBLIC INSPECTION THE TAX RETURN INFORMATION IS AVAILABLE UPON REQUEST. WHILE NO REQUIREMENT TO MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC EXISTS, HEALTH PLAN OF CAREOREGON WILL CONSIDER ALL REQUESTS FOR THESE DOCUMENTS ON A CASE-BY-CASE BASIS. PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES IN 2017, THE PARENT TRANSFERRED $15,000,000 TO HEALTH PLAN OF CAREOREGON TO MEET RISK BASED CAPITAL (RBC) REQUIREMENTS IN LIGHT OF ANTICIPATED LOSSES IN 2018. BEGINNING NET ASSETS $35,151,765 EQUITY TRANSFER FROM PARENT $15,000,000 ______________ TOTAL $50,151,765 CareOregon Inc 315 SW Fifth Avenue Portland OR 97204 930933975 Management OR 501(c)(3) 10 N/A false Housecall Providers PC 315 SW Fifth Avenue Portland OR 97204 821663503 Clinical OR 501(c)(3) 10 CareOregon false false false false false false false false false false false false false true true true true false false true