HEALTH REPULIC INSURANCE COMPANY: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
HEALTH REPULIC INSURANCE COMPANY (EIN 45-3261827)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-11-14
IRS object ID
201633199349303008
Schema version
2015v2.1
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)
Return2016-11-14T10:09:33-06:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt

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 Begin2015-01-01TaxPeriodBeginDt

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
Signature2016-11-07SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonWendy CamposPreparerPersonNm
PTINP00448102PTIN
Phone5032421447PhoneNum
Preparation2016-11-07PreparationDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeYes (X)AddressChangeInd
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$65,498,453GrossReceiptsAmt
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 Body6VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee61TotalEmployeeCnt
Total Volunteers5TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$25,369,573PYProgramServiceRevenueAmt
CY Program Service Revenue$46,197,492CYProgramServiceRevenueAmt
PY Investment Income$58,509PYInvestmentIncomeAmt
CY Investment Income$210,101CYInvestmentIncomeAmt
PY Other Revenue$24PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$25,428,106PYTotalRevenueAmt
CY Total Revenue$46,407,593CYTotalRevenueAmt
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$3,150,658PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$7,128,159CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$35,198,211PYOtherExpensesAmt
CY Other Expenses$68,591,985CYOtherExpensesAmt
PY Total Expenses$38,348,869PYTotalExpensesAmt
CY Total Expenses$75,720,144CYTotalExpensesAmt
PY Revenues Less Expenses-$12,920,763PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$29,312,551CYRevenuesLessExpensesAmt
Total Assets BOY$38,087,371TotalAssetsBOYAmt
Total Assets EOY$21,468,523TotalAssetsEOYAmt
Total Liabilities BOY$26,706,637TotalLiabilitiesBOYAmt
Total Liabilities EOY$17,254,781TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$11,380,734NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,213,742NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTo create and operate consumer operated and oriented plan (co-op) to provide healthcare coverage for individuals and small groups as a qualified nonprofit health insurer under section 1322 of the Affordable Care Act.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant ChangeYes (1)SignificantChangeInd
DescOffered qualified health policies through the Oregon exchange and directly to consumers for coverage effective beginning January 1, 2014.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 StmtYes (1)IndependentAuditFinclStmtInd
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 Document194IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee61EmployeeCnt
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$4,213,742ReservesMaintainedAmt
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members6GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
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)
Phone3606071247PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12373 NW 185th Avenue 701AddressLine1Txt
CityHillsboroCityNm
State AbbreviationORStateAbbreviationCd
ZIP97124ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
Tom Kuhn
Chair0.80Yes (X)Yes (X)$0$0$0
Daniel Clay
Secretary/Treasurer0.80Yes (X)Yes (X)$0$0$0
STEvEN UNGER
Director0.80Yes (X)$0$0$0
Robin Henderson
Director0.80Yes (X)$0$0$0
Kim Lamb
Director0.80Yes (X)$0$0$0
Arin Carmack
Director0.80Yes (X)$0$0$0
DAWN BONDER
Chief Executive Officer40.00Yes (X)$239,327$0$14,415
Janice Finley
Chief Financial Officer40.00Yes (X)$109,577$0$4,948
Meridith Johnson
Chief Financial Officer40.00Yes (X)$102,912$0$6,014
Linda Voelsch
Chief Quality Officer40.00$271,375$0$9,889Yes (X)
Susan Potter
General Counsel40.00$143,846$0$10,600Yes (X)
Cheryl Vandemore
Chief Marketing Officer40.00$124,567$0$15,894Yes (X)
Robin Ramsay
Chief Technology Officer40.00$145,908$0$10,484Yes (X)
Dana Franke
Operations Manager40.00$117,462$0$12,513Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,254,974TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$84,757TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K19IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Providence Health Plan
4400 NE Halsey Bldg 2 Ste 690PortlandOR97213Administrative$3,494,681
Milliman
15800 W Bluemound RdBrookfieldWI53005Actuarial$571,135
Softheon Inc
1500 Stony Brook Rd Cewit R D PaStony BrookNY11794Member Portal$317,289
Morneau Shepell
Seven Parkway Center 857 Green TrePittsburgPA15220Member Portal$312,168
Truven Health Analytics
1 N Dearborn Ste 1400ChicagoIL60602Consulting$115,500
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K16CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescNet Premium RevenueDesc
Business524114BusinessCd
Total Revenue Column$46,197,492TotalRevenueColumnAmt
Related Or Exempt Func Income$46,197,492RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$46,197,492TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$211,146TotalRevenueColumnAmt
Exclusion$211,146ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$19,089,815SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$19,090,860SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities-$1,045SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$1,045TotalRevenueColumnAmt
Exclusion-$1,045ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$46,407,593TotalRevenueColumnAmt
Related Or Exempt Func Income$46,197,492RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$210,101ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$477,193TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$5,752,375TotalAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$98,178TotalAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$259,108TotalAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$541,305TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$20,206TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$135,895TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$10,368TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$42,515TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,061,445TotalAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$255,006TotalAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$260,421TotalAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$489,512TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$156,706TotalAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$34,373TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$116,216TotalAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$93,132TotalAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmt
Hospital and Medical$62,133,285
Claims Adjustment$2,337,755
Commissions$1,864,458
Health Contract Reserve-$2,975,453

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$2,556,145TotalAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$75,720,144TotalAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$3,401,518BOYAmt
EOY$1,471,026EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$3,465,130BOYAmt
EOY$8,398,859EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$5,190,521BOYAmt
EOY$11,290,846EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$130,021LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$74,746LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$87,585BOYAmt
EOY$55,275EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$15,633,030BOYAmt
EOY$250,181EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$7,940BOYAmt
EOY$2,336EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$10,301,647BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$38,087,371BOYAmt
EOY$21,468,523EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,528,313BOYAmt
EOY$856,955EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$1,370,562BOYAmt
EOY$69,820EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$10,097,005BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$13,710,757BOYAmt
EOY$16,328,006EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$26,706,637BOYAmt
EOY$17,254,781EOYAmt
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$11,380,734BOYAmt
EOY$4,213,742EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$11,380,734BOYAmt
EOY$4,213,742EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$38,087,371BOYAmt
EOY$21,468,523EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$29,312,551ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$22,145,559OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting OtherYes (X)MethodOfAccountingOtherInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule D IRS990ScheduleD

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$133,018OtherCostOrOtherBasisAmt
Depreciation$68,518DepreciationAmt
Book Value$64,500BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis-$2,997OtherCostOrOtherBasisAmt
Depreciation$6,228DepreciationAmt
Book Value-$9,225BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$55,275TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
Claims Unpaid$9,829,286
PREMIUM ADJUSTMENTS PAYABLE$5,384,657
Other Liabilities$1,114,063
FieldValueIRS element (for citing)
Total Liability$16,328,006TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$46,365,079TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$46,365,079RevenueSubtotalAmt
Investment Expenses Not Incld$42,514InvestmentExpensesNotIncldAmt
Revenue Not Reported Fincl Stmt$42,514RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$46,407,593TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$75,677,630TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$75,677,630ExpensesSubtotalAmt
Investment Expenses Not Incld2$42,514InvestmentExpensesNotIncld2Amt
Expenses Not Rpt Fincl Stmt$42,514ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$75,720,144TotalExpensesPerForm990Amt

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 (4 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$239,327$0$0$0$0$0$7,180$0$7,235$0$253,742$0$0$0
Linda Voelsch
Chief Quality Officer$124,567$0$0$0$146,808$0$3,737$0$6,152$0$281,264$0$0$0
Susan Potter
General Counsel$143,846$0$0$0$0$0$4,316$0$6,284$0$154,446$0$0$0
Robin Ramsay
Chief Technology Officer$145,908$0$0$0$0$0$3,727$0$6,757$0$156,392$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 4aFormAndLineReferenceDesc
ExplanationEmployees received payment under separation agreements in the amount of $155,399.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part III, line 3Effective December 31, 2015, Health Republic Insurance Company withdrew from the individual and group markets, ceasing operations for 2016.
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.
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 11Executive 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 2015 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 XI, line 9:change in solvency loan 18,605,615. Change in Non-Admitted Assets 3,539,944.
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") .

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