HEALTH REPULIC INSURANCE COMPANY: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
HEALTH REPULIC INSURANCE COMPANY (EIN 45-3261827)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-05-12
IRS object ID
201711329349304441
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2017-05-12T13:34:18-05:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN910189318PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1MOSS ADAMS LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1805 SW BROADWAY STE 1200AddressLine1Txt
CityPORTLANDCityNm
State AbbreviationORStateAbbreviationCd
ZIP97205ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN453261827EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HEALTH REPUBLIC INSURANCE COMPANYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlHEALBusinessNameControlTxt
Phone8889906635PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12373 NW 185TH AVENUE NO 701AddressLine1Txt
CityHILLSBOROCityNm
State AbbreviationORStateAbbreviationCd
ZIP97124ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDAWN BONDERPersonNm
Person TitleCEOPersonTitleTxt
Phone8889906635PhoneNum
Signature2017-05-12SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonWENDY CAMPOSPreparerPersonNm
PTINP00448102PTIN
Phone5032421447PhoneNum
Preparation2017-05-12PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address12.129.7.100IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-05-12IPDt
IP Tm12:15:29IPTm
IP TimezonePDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdDA39A3EE5E6B4B0D3255BFEF95601890AFD80709AtSubmissionCreationDeviceId
At Submission Filing Device Id1133A14FFAB8169331CEB935F8079429E4018A44AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDAWN BONDERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12373 NW 185TH AVENUE NO 701AddressLine1Txt
CityHILLSBOROCityNm
State AbbreviationORStateAbbreviationCd
ZIP97124ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$23,578GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressWWW.HEALTHREPUBLICINSURANCE.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2011FormationYr
Legal Domicile StateORLegalDomicileStateCd
Activity Or MissionTO CREATE AND OPERATE CONSUMER OPERATED AND ORIENTED PLAN (CO-OP) AS A QUALIFIED NONPROFIT HEALTH INSURER UNDER SECTION 1322 OF THE AFFORDABLE CARE ACT.ActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent5VotingMembersIndependentCnt
Total Employee21TotalEmployeeCnt
Total Volunteers5TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$46,197,492PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$210,101PYInvestmentIncomeAmt
CY Investment Income-$29,226CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$46,407,593PYTotalRevenueAmt
CY Total Revenue-$29,226CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$7,128,159PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$461,485CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$68,591,985PYOtherExpensesAmt
CY Other Expenses-$49,733CYOtherExpensesAmt
PY Total Expenses$75,720,144PYTotalExpensesAmt
CY Total Expenses$411,752CYTotalExpensesAmt
PY Revenues Less Expenses-$29,312,551PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$440,978CYRevenuesLessExpensesAmt
Total Assets BOY$21,468,523TotalAssetsBOYAmt
Total Assets EOY$6,104,746TotalAssetsEOYAmt
Total Liabilities BOY$17,254,781TotalLiabilitiesBOYAmt
Total Liabilities EOY$2,319,321TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$4,213,742NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$3,785,425NetAssetsOrFundBalancesEOYAmt
MissionTO CREATE AND OPERATE CONSUMER OPERATED AND ORIENTED PLAN (CO-OP) TO PROVIDE HEALTHCARE COVERAGE FOR INDIVIDUALS AND SMALL GROUPS AS QUALIFIED NONPROFIT HEALTH INSURER UNDER SECTION 1322 OF THE AFFORDABLE CARE ACT.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
DescOFFERED QUALIFIED HEALTH POLICIES THROUGH THE OREGON EXCHANGE AND DIRECTLY TO CONSUMERS FOR COVERAGE EFFECTIVE BEGINNING JANUARY 1, 2014, BUT TERMINATED ALL COVERAGE AS OF DECEMBER 31, 2015. HAVE BEEN MANAGING THE RUN OUT OF OPERATIONS SINCE THAT TIME.Desc
Described In Section501c30DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document11IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee21EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Licensed More Than One State0LicensedMoreThanOneStateInd
State Required Reserves$2,500,000StateRequiredReservesAmt
Reserves Maintained$3,785,427ReservesMaintainedAmt
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members5GoverningBodyVotingMembersCnt
Independent Voting Member5IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JANICE FINLEY CFOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9712321247PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12373 NW 185TH AVENUE 701AddressLine1Txt
CityHILLSBOROCityNm
State AbbreviationORStateAbbreviationCd
ZIP97124ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
TOM KUHN
FORMER CHAIR0.30Yes (X)Yes (X)$0$0$0
DANIEL CLAY
CHAIR/TREASURER0.10Yes (X)Yes (X)$0$0$0
STEVEN UNGER
DIRECTOR0.10Yes (X)$0$0$0
ROBIN HENDERSON
DIRECTOR0.10Yes (X)$0$0$0
KIM LAMB
DIRECTOR0.10Yes (X)$0$0$0
ARIN CARMACK
DIRECTOR0.10Yes (X)$0$0$0
DAWN BONDER
CHIEF EXECUTIVE OFFICER16.00Yes (X)$374,991$0$3,543
JANICE FINLEY
CHIEF FINANCIAL OFFICER35.00Yes (X)$283,443$0$4,128
BRETT MONELLO
CHIEF OPERATING OFFICER8.00$297,781$0$1,558Yes (X)
SUSAN POTTER
GENERAL COUNSEL14.00$211,506$0$1,691Yes (X)
CHERYL VANDEMORE
CHIEF MARKETING OFFICER26.00$173,385$0$418Yes (X)
ROBIN RAMSEY
CHIEF INFORMATION OFFICER6.00$206,708$0$826Yes (X)
VICKI INGLIS
CONTROLLER21.00$105,819$0$1,620Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,653,633TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$13,784TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K7IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PROVIDENCE HEALTH PLANBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line14400 NE HALSEY BLDG 2 STE 690AddressLine1Txt
CityPORTLANDCityNm
State AbbreviationORStateAbbreviationCd
ZIP97213ZIPCd
FieldValueIRS element (for citing)
ServicesADMINISTRATIVE AND CUSTOMER SERVICEServicesDesc
Compensation$400,000CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,820TotalRevenueColumnAmt
Exclusion$2,820ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$20,758OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$52,804OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$32,046OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$32,046TotalRevenueColumnAmt
Exclusion-$32,046ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column-$29,226TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion-$29,226ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$263,416TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$173,131TotalAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$5,377TotalAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$19,561TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total-$3,206TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$20,245TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$834TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$18,565TotalAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$18,630TotalAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$114,536TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$24,827TotalAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$25TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$94,463TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$31,031TotalAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$98,831TotalAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmt
RISK ADJUSTMENT PREMIUM$538,274
EXCHANGE/ADMIN FEES$89,198
STATE TAXES/FEES$41,054
HOSPITAL AND MEDICAL-$1,202,993

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$65,953TotalAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$411,752TotalAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,471,026BOYAmt
EOY$2,951,769EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$8,398,859BOYAmt
EOY$1,274,842EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$11,290,846BOYAmt
EOY$1,628,090EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$12,650LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$12,650LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$55,275BOYAmt
EOY$0EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$250,181BOYAmt
EOY$250,045EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$2,336BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$21,468,523BOYAmt
EOY$6,104,746EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$856,955BOYAmt
EOY$36,649EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$69,820BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$16,328,006BOYAmt
EOY$2,282,672EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$17,254,781BOYAmt
EOY$2,319,321EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$4,213,742BOYAmt
EOY$3,785,425EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,213,742BOYAmt
EOY$3,785,425EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$21,468,523BOYAmt
EOY$6,104,746EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$440,978ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$12,661OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting OtherYes (X)MethodOfAccountingOtherInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS Audited0FSAuditedInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule D IRS990ScheduleD

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$12,650OtherCostOrOtherBasisAmt
Depreciation$12,650DepreciationAmt
Book Value$0BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
CLAIMS UNPAID$253,127
PREMIUM ADJUSTMENTS PAYABLE$1,649,265
OTHER LIABILITIES$380,280
FieldValueIRS element (for citing)
Total Liability$2,282,672TotalLiabilityAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentYes (1)SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DAWN BONDER
CHIEF EXECUTIVE OFFICER$118,112$0$0$0$256,879$0$3,543$0$0$0$378,534$0$0$0
JANICE FINLEY
CHIEF FINANCIAL OFFICER$137,633$0$0$0$145,810$0$4,128$0$0$0$287,571$0$0$0
BRETT MONELLO
CHIEF OPERATING OFFICER$51,923$0$0$0$245,858$0$1,558$0$0$0$299,339$0$0$0
SUSAN POTTER
GENERAL COUNSEL$56,398$0$0$0$155,108$0$1,691$0$0$0$213,197$0$0$0
CHERYL VANDEMORE
CHIEF MARKETING OFFICER$13,927$0$0$0$159,458$0$418$0$0$0$173,803$0$0$0
ROBIN RAMSEY
CHIEF INFORMATION OFFICER$27,990$0$0$0$178,718$0$826$0$0$0$207,534$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 4AFormAndLineReferenceDesc
ExplanationALL EMPLOYEES WERE PLACED ON PART TIME TEMPORARY STATUS AS OF 1/1/16 AND RECEIVED $1,193,646 IN TOTAL SEVERANCE PAYMENTS AS SPECIFIED IN THE CORPORATE SEVERANCE POLICY. THESE SEVERANCE PAYMENTS WERE ACCRUED AS OF THE END OF THE PRIOR TAX YEAR (2015) BUT PAID OUT AND INCLUDED IN W-2 COMPENSATION IN THE CURRENT TAX YEAR (2016).ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6MEMBERS OF THE CORPORATION ARE THOSE INDIVIDUALS AGE EIGHTEEN OR OVER COVERED UNDER THE CORPORATION'S HEALTH INSURANCE POLICIES. THE CORPORATION CURRENTLY HAS NO ACTIVE POLICIES AND NO MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7AMEMBERS WHO HAVE PURCHASED HEALTH INSURANCE CAN PARTICIPATE IN ELECTION OF BOARD POSITIONS AND CAN BE ELECTED TO BOARD POSITIONS.
FORM 990, PART VI, SECTION B, LINE 11BEXECUTIVE MANAGEMENT REVIEWS THE DRAFT FORM 990 AND PROVIDES THE FINAL REPORT TO THE BOARD OF DIRECTORS FOR APPROVAL AFTER FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION'S WRITTEN CONFLICT OF INTEREST POLICY STATEMENTS WERE OBTAINED FOR ALL OFFICERS AND DIRECTORS IN 2016 AND ARE REQUIRED TO BE UPDATED ANNUALLY AS WELL AS UPON APPOINTMENT TO THE BOARD OR HIRE DATE. THE POLICY IS ADMINISTERED BY THE BOARD OF DIRECTORS OR ANY APPLICABLE COMMITTEE, WHICH IS RESPONSIBLE FOR REVIEWING REPORTS REGARDING CONFLICT OF INTEREST DISCLOSURE STATEMENTS, RECEIVING DISCLOSURES OF PROPOSED COVERED TRANSACTIONS, REVIEWING PROPOSED COVERED TRANSACTIONS AND MAINTAINING MINUTES OR OTHER SUCH DOCUMENTATION TO DOCUMENT THE REVIEW OF THE COVERED TRANSACTIONS.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 24EMEMBER PORTAL COSTS 35,875. ALL OTHER EXPENSES 30,078.
FORM 990, PART XI, LINE 9:CHANGE IN NON-ADMITTED ASSETS 12,661.
FORM 990, PART XII, LINE 1:THE STATUTORY BASIS FINANCIAL STATEMENTS HAVE BEEN PREPARED IN CONFORMITY WITH THE ACCOUNTING PRACTICES PRESCRIBED OR PERMITTED BY THE OREGON INSURANCE DIVISION ("OID").
FORM 990, PART XII, LINE 2B:FINANCIAL STATEMENTS WERE NOT AUDITED FOR THE 2016 YEAR BECAUSE THE ORGANIZATION RECEIVED AN EXEMPTION FROM THE STATE OF OREGON.

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