2016-11-14T10:09:33-06:00 2015-12-31 910189318 Moss Adams LLP 805 SW Broadway Ste 1200 Portland OR 97205 990 2015-01-01 453261827 Health Republic Insurance Company HEAL 8889906635 2373 NW 185th Avenue No 701 Hillsboro OR 97124 DAWN BONDER CEO 8889906635 2016-11-07 1 Wendy Campos P00448102 5032421447 2016-11-07 2015 2017-02-10 21:41:12Z X Dawn Bonder 2373 NW 185th Avenue No 701 Hillsboro OR 97124 65498453 0 X www.healthrepublicinsurance.org X 2011 OR To create and operate consumer operated and oriented plan (co-op) as a qualified nonprofit health insurer under section 1322 of the Affordable Care Act. 6 6 61 5 0 0 0 0 25369573 46197492 58509 210101 24 0 25428106 46407593 0 0 0 0 3150658 7128159 0 0 0 35198211 68591985 38348869 75720144 -12920763 -29312551 38087371 21468523 26706637 17254781 11380734 4213742 X To 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. 0 1 Offered qualified health policies through the Oregon exchange and directly to consumers for coverage effective beginning January 1, 2014. 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 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 1 194 0 1 61 1 0 0 0 0 0 0 2500000 4213742 0 X 6 6 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X Janice Finley CFO 3606071247 2373 NW 185th Avenue 701 Hillsboro OR 97124 Tom Kuhn Chair 0.80 X X 0 0 0 Daniel Clay Secretary/Treasurer 0.80 X X 0 0 0 STEvEN UNGER Director 0.80 X 0 0 0 Robin Henderson Director 0.80 X 0 0 0 Kim Lamb Director 0.80 X 0 0 0 Arin Carmack Director 0.80 X 0 0 0 DAWN BONDER Chief Executive Officer 40.00 X 239327 0 14415 Janice Finley Chief Financial Officer 40.00 X 109577 0 4948 Meridith Johnson Chief Financial Officer 40.00 X 102912 0 6014 Linda Voelsch Chief Quality Officer 40.00 X 271375 0 9889 Susan Potter General Counsel 40.00 X 143846 0 10600 Cheryl Vandemore Chief Marketing Officer 40.00 X 124567 0 15894 Robin Ramsay Chief Technology Officer 40.00 X 145908 0 10484 Dana Franke Operations Manager 40.00 X 117462 0 12513 1254974 0 84757 19 0 1 0 Providence Health Plan 4400 NE Halsey Bldg 2 Ste 690 Portland OR 97213 Administrative 3494681 Milliman 15800 W Bluemound Rd Brookfield WI 53005 Actuarial 571135 Softheon Inc 1500 Stony Brook Rd Cewit R D Pa Stony Brook NY 11794 Member Portal 317289 Morneau Shepell Seven Parkway Center 857 Green Tre Pittsburg PA 15220 Member Portal 312168 Truven Health Analytics 1 N Dearborn Ste 1400 Chicago IL 60602 Consulting 115500 16 Net Premium Revenue 524114 46197492 46197492 46197492 211146 211146 19089815 19090860 -1045 -1045 -1045 46407593 46197492 0 210101 477193 5752375 98178 259108 541305 20206 135895 10368 42515 1061445 255006 260421 489512 156706 34373 116216 93132 Hospital and Medical 62133285 Claims Adjustment 2337755 Commissions 1864458 Health Contract Reserve -2975453 2556145 75720144 3401518 1471026 3465130 8398859 5190521 11290846 130021 74746 87585 55275 15633030 250181 7940 2336 10301647 0 38087371 21468523 1528313 856955 1370562 69820 10097005 0 13710757 16328006 26706637 17254781 X 0 0 0 0 11380734 4213742 11380734 4213742 38087371 21468523 X -29312551 22145559 X X 0 1 X 1 1 1 133018 68518 64500 -2997 6228 -9225 55275 Claims Unpaid 9829286 PREMIUM ADJUSTMENTS PAYABLE 5384657 Other Liabilities 1114063 16328006 46365079 0 46365079 42514 42514 46407593 75677630 0 75677630 42514 42514 75720144 X 1 0 0 DAWN BONDER Chief Executive Officer 239327 0 0 0 0 0 7180 0 7235 0 253742 0 0 0 Linda Voelsch Chief Quality Officer 124567 0 0 0 146808 0 3737 0 6152 0 281264 0 0 0 Susan Potter General Counsel 143846 0 0 0 0 0 4316 0 6284 0 154446 0 0 0 Robin Ramsay Chief Technology Officer 145908 0 0 0 0 0 3727 0 6757 0 156392 0 0 0 Part I, Line 4a Employees received payment under separation agreements in the amount of $155,399. Form 990, Part III, line 3 Effective 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 6 Members 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 7a Members 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 11 Executive 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 12c The 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 19 The 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") .