2017-10-31T14:46:41-05:00 2016-12-31 390859910 Baker Tilly Virchow Krause LLP 777 E Wisconsin Avenue 32nd Floor Milwaukee WI 53202 990 2016-01-01 453309488 Common Ground Healthcare Cooperative COMM 4144550500 120 Bishops Way No 150 Brookfield WI 53005 Cathy Mahaffey CEO 4144550500 2017-10-30 1 Troy Marine CPA P00187863 4147775500 2017-10-13 38.122.82.115 2017-10-30 16:55:51 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 FC291E00EDC6CE15C22AD045E9D90E0D24B72456 2016 2018-03-14 21:41:22Z Cathy Mahaffey 120 Bishops Way No 150 Brookfield WI 53005 97712128 0 X www.commongroundhealthcare.org X CO-OP 2011 WI PROVIDE AFFORDABLE HEALTH INSURANCE SOLUTIONS TO SMALL BUS., INDIVIDUALS & NON-PROFITS IN WI. 9 0 90 9 0 0 0 0 170167234 97708760 1545 3368 0 0 170168779 97712128 0 0 0 0 6805214 7234085 0 0 0 192677709 126508038 199482923 133742123 -29314144 -36029995 83794437 63700323 155673286 143220812 -71878849 -79520489 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 0 0 0 0 0 0 0 0 0 0 0 1 2598 0 1 90 1 0 0 0 0 0 1 24609086 13591985 0 X 9 0 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Brian Leben 4144550500 120 Bishops Way Suite 150 Brookfield WI 53005 Kristy Buus Secretary/Treasurer 1.00 X 2506 0 0 Suzanne Garrity Director 1.00 X 6014 0 0 Keisha Krumm Board Vice-Chair 1.00 X 6014 0 0 James Lazar Director 1.00 X 2506 0 0 John Magilo Director 1.00 X 6014 0 0 Amy Murphy Director 1.00 X 6014 0 0 Clifford Pukel Director 1.00 X 3508 0 0 Mary Rehberg Director 1.00 X 3508 0 0 Mary Rynders Director 1.00 X 6014 0 0 Terri Weber Director 1.00 X 3508 0 0 James Wesp Board Chair 6.00 X 6014 0 0 Cathy Mahaffey CEO 40.00 X 338158 0 38100 Shelly Johnson COO 40.00 X 221593 0 25288 Melissa Duffy CSO 40.00 X 215989 0 18597 Brian Leben CFO 40.00 X 184307 0 26748 Colleen Singh Director of Operations 40.00 X 144330 0 21746 Brenda Vechart Human ResourcesAdministrator 40.00 X 142827 0 28112 David Gemeinhardt VP, Information Technology 40.00 X 137382 0 15589 Gregory Lippe Director of Internal Audit & Financial Oversight 40.00 X 137310 0 35579 Thomas Lawless VP, Business Svcs & Data Analytics 40.00 X 122527 0 28628 1696043 0 238387 15 0 1 0 Affiliated Computer Services PO Box 201322 Dallas TX 753201322 Claims Processing Platform 1491738 Milliman Inc 15800 W Bluemound Rd Suite 100 Brookfield WI 53005 Actuarial 925411 Optum Health Care Solutions Inc 11000 Optum Circle MN101W400 Minneapolis MN 55344 Medical Management 827242 Equian LLC PO Box 641 BIN 141917 Indianapolis IN 462060641 Claims Repricing 687098 Verisk Health Inc Lockbox 5459 New York NY 100875459 Risk Adjustment and HEDIS vendor 541969 22 Premiums Earned 525100 97708760 97708760 97708760 3368 3368 97712128 97708760 0 3368 2164560 3437344 277326 914174 440681 100520 1530082 2794320 206186 2758403 173470 6763 210656 126619 378098 194790 99209 Claims Expense 117104403 CMS Exchange User Fee E 2821656 Commissions 1430985 Liscenses & Fees 731340 -4159462 133742123 13373857 6141103 10107927 37111290 1578232 443325 326743 183271 1053105 520975 657705 532130 57749973 19289204 83794437 63700323 4020298 3211879 3016461 4352393 107739354 107739354 40897173 27917186 155673286 143220812 X 0 0 0 30000000 -71878849 -109520489 -71878849 -79520489 83794437 63700323 X -36029995 -1611646 30000000 X 0 1 X 1 1 1 1053105 520975 532130 532130 accrued retrospective premiums 6171868 reinsurance recoverables 11658704 health care receivable 719078 advanced premium tax credit receivable 632662 cost sharing reduction receivable 106892 19289204 Interest Payable 828196 claims unpaid 24066339 risk adjustment transfer payable 2600000 insurance fees payable 414567 Accrued Lease Payable 8084 27917186 X 97712128 0 97712128 0 97712128 133742123 0 133742123 0 133742123 Part X, Line 2: The Organization received notification that it qualifies as a tax-exempt organization under Section 501(c)(29) of the U.S. Internal Revenue Code on August 19, 2013 and corresponding provisions of State law and, accordingly, is not subject to federal and state income taxes. X X 0 0 0 Cathy Mahaffey CEO 330958 0 0 0 7200 0 17940 0 20160 0 376258 0 0 0 Shelly Johnson COO 217593 0 0 0 4000 0 12693 0 12595 0 246881 0 0 0 Melissa Duffy CSO 215989 0 0 0 0 0 11119 0 7478 0 234586 0 0 0 Brian Leben CFO 184307 0 0 0 0 0 11259 0 15489 0 211055 0 0 0 Colleen Singh Director of Operations 144330 0 0 0 0 0 8894 0 12852 0 166076 0 0 0 Brenda Vechart Human ResourcesAdministrator 142827 0 0 0 0 0 8820 0 19292 0 170939 0 0 0 David Gemeinhardt VP, Information Technology 128826 0 0 0 8556 0 8317 0 7272 0 152971 0 0 0 Gregory Lippe Director of Internal Audit & Financi 137310 0 0 0 0 0 8585 0 26994 0 172889 0 0 0 Thomas Lawless VP, Business Svcs & Data Analytics 122527 0 0 0 0 0 7209 0 21419 0 151155 0 0 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, CSO, 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: Paid-In and Contributed Surplus 30,000,000.