EXECUTIVE DIRECTOR

2013-06-07T07:22:47-05:00 2012-12-31 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 462400857 990 2012-01-01 311044774 INDIANA COMPREHENSIVE HEALTH INSURANCE ASSOCIATION INDI 3178775376 9465 COUNSELORS ROW NO 200 INDIANAPOLIS IN 46240 DOUGLAS STRATTON EXECUTIVE DIRECTOR 3178775376 2013-05-22 1 KEITH T GAMBREL P00150740 3175802000 2013-05-22 2012 2016-02-25 16:41:14Z DOUGLAS STRATTON 9465 COUNSELORS ROW SUITE 200 INDIANAPOLIS IN 46240 144782513 0 X WWW.ICHIA.ORG X 1981 IN TO PROVIDE HEALTHCARE INSURANCE FOR THE COMMERCIALLY UNINSURABLE. 9 9 1 0 0 0 1896103 2064614 133214543 142708229 1452 9670 0 0 135112098 144782513 0 0 129559528 144038788 227410 235070 0 0 0 4578166 4778816 134365104 149052674 746994 -4270161 14843872 13168409 29972721 32567419 -15128849 -19399010 PROVIDE HEALTH INSURANCE COVERAGE FOR THOSE UNABLE TO OBTAIN SUCH IN THE COMMERCIAL MARKET. 0 0 HIGH RISK HEALTH INSURANCE; AS OF DEC.31, 2012, THE ASSOCIATION HAD 7,193 ELIGIBLE PERSONS COVERED. 0 1 0 0 0 0 0 0 0 0 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 1 2006 0 1 1 1 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 1 1 0 IN X X DOUGLAS STRATTON 3178775376 9465 COUNSELORS ROW SUITE 200 INDIANAPOLIS IN 46240 DENNIS CASEY CHAIRMAN 0.30 X X 0 0 0 THOMAS LOCKE DIRECTOR 0.30 X 0 0 0 DAN KRAJNOVICH DIRECTOR 0.30 X 0 0 0 TOM ZURECK DIRECTOR 0.30 X 0 0 0 STEPHEN ROBERTSON DIRECTOR 0.30 X 0 0 0 ZACHARY JACKSON DIRECTOR 0.30 X 0 0 0 KATHLEEN SHOOK DIRECTOR 0.30 X 0 0 0 MICHELLE RICE DIRECTOR 0.30 X 0 0 0 LEAH SMITH DIRECTOR 0.30 X 0 0 0 DOUGLAS STRATTON EXECUTIVE DIRECTOR 50.00 X 204000 0 11000 204000 0 11000 1 0 1 0 ACS INC 4550 VICTORY LANE INDIANAPOLIS IN 46203 ADMINISTRATION 2086519 CQS 9779 S FRANKLIN DRIVE SUITE 300 FRANKLIN WI 53132 HEALTHCARE SERVICES 1149754 ANTHEM 44 S BROADWAY 1200 WHITE PLAINS NY 10601 NETWORK ACCESS FEE 571464 KEY BANK 127 PUBLIC SQUARE CLEVELAND OH 44114 FINANCIAL SERVICES 114767 4 2064614 2064614 ASSESSMENTS 525100 73992488 73992488 PREMIUMS EARNED 524298 68715741 68715741 142708229 9670 9670 144782513 142708229 0 9670 144038788 204000 11000 20070 9591 42370 1704 166012 10376 ADMINISTRATIVE EXPENSES 2357252 DISEASE MANAGEMENT FEES 1309676 PPN FEES 571464 ENHANCED CARE PROGRAM 114800 195571 149052674 10808070 4759722 1244025 400000 27821 446077 2763956 7562610 14843872 13168409 653745 1013001 29318976 31554418 29972721 32567419 X 0 0 0 0 -15128849 -19399010 -15128849 -19399010 14843872 13168409 -4270161 0 X X 0 1 X 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 PREMIUMS RECEIVABLE 7562610 7562610 PREMIUM AND LOSS RESERVES 31554418 31554418 X 144782513 0 144782513 0 144782513 149052674 0 149052674 0 149052674 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ASSOCIATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(26) OF THE INTERNAL REVENUE CODE. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. THERE WAS NO UNRELATED BUSINESS INCOME FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011. THE ASSOCIATION FILES U.S. FEDERAL AND STATE OF INDIANA TAX RETURNS. THE ASSOCIATION IS NO LONGER SUBJECT TO U.S. FEDERAL AND STATE TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2009. X X X 0 0 0 DOUGLAS STRATTON EXECUTIVE DIRECTOR 170000 0 34000 0 0 0 0 0 11000 0 215000 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 990 WILL BE REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C AT LEAST ONCE PER YEAR, ALL MEMBERS OF THE ASSOCIATION'S BOARD MUST COMPLETE THE DISCLOSURE FORM THAT ACCOMPANIES THE CONFLICT OF INTEREST POLICY. BOARD MEMBERS MUST ALSO UPDATE THE DISCLOSURE FORM DURING THE YEAR AS NECESSARY IF ANY NEW INTERESTS OR CHANGES IN PREVIOUSLY REPORTED INTERESTS DEVELOP. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR'S SALARY IS DETERMINED BY EXECUTIVE SESSION OF THE BOARD AND SET FORTH IN A THREE YEAR CONTRACT. THE BOARD ANNUALLY SETS GOALS FOR THE ORGANIZATION AND THE EXECUTIVE DIRECTOR'S BONUS IS DETERMINED BY ACCOMPLISHMENT OF GOALS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS AVAILABLE ON WEB SITE AND BY REQUEST. FORM 990: PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR.