2013-11-15T08:35:22-06:00 2012-12-31 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2012-01-01 450346132 Heart of America Health Plan HEAR 7017765848 810 South Main Rugby ND 58368 Mary Ann Jaeger 7017765848 2013-11-14 1 LISA CHAFFEE CPA P00193453 7012398500 2013-11-14 2012 2016-02-25 16:41:14Z Mary Ann Jaeger 810 South Main Rugby ND 58368 4409109 0 X www.hoahp.com X 1978 ND To coordinate effective and efficient delivery of high-quality health care in a cost effective manner. 9 9 8 9 0 0 0 0 4879140 4351974 55840 46830 0 10305 4934980 4409109 0 0 0 0 251845 226047 0 0 0 4793395 4482810 5045240 4708857 -110260 -299748 1778594 1461960 592676 608416 1185918 853544 X The Heart of America Health Plan is a rural, member-owned managed health care system. Our mission is to coordinate effective and efficient delivery of high-quality health care in a cost effective manner. Member service is our priority. We are committed to the development of personal responsibility for a healthy lifestyle. 0 0 4583790 0 4362279 Heart Of America Health Plan was incorporated for the purpose of providing comprehensive health care services on a prepaid basis and for the purpose of establishing and operating organized health maintenance and health care delivery systems.Heart Of America Health Plan (HAHP) served 410 Medicare members during 2012 and 743 commercial members. During 2012, the following community services were provided:A "Fun Walk" was open to anyone willing to walk a 3-mile course. T-shirts were given away to all walkers. Approximately 260 walkers joined the walk in 2012 to promote health and exercise. Total expenses -- $2,345.A "Turkey Trot" was also open to anyone willing to do a 5K walk/run to promote a healthy lifestyle. Total expenses -- $300. Pierce County's annual relay for life was held which is an all-night walk in support of cancer victims and survivors. The event is open to the public and participants of all ages. Total expenses -- $300.The annual Pierce County Fair was held in Rugby in early July. The fair provides free shows, contests, talent show, farm animals and exhibits and is open to the public. Total expenses - $400.Other miscellaneous items involved support of youth events including an Easter egg hunt, safe-after-prom parties, Imagination Library, along with support of the local Dollars for Scholars chapter and Rugby's Community Chest. Total expenses -- $395. 4583790 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 8 1 0 0 0 0 0 0 X 9 9 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 0 0 X Mary Ann Jaeger 7017765848 810 South Main Rugby ND 58368 Rob St Michel 0.50 X X 0 0 0 Rob Hovland 0.50 X X 0 0 0 Denise Myhre 1.00 X X 0 0 0 Cynthia Tastad 0.50 X 0 0 0 Wayne Judkins 0.50 X 0 0 0 Rod Wurgler 0.50 X 0 0 0 Philip Backstrom 0.50 X 0 0 0 Dr Teri Hurly 1.00 X 0 0 0 Tim McKay 0.50 X 0 0 0 Mary Ann Jaeger 40.00 X 68203 0 13780 68203 0 13780 0 0 0 0 0 Premiums 524114 2928736 2928736 Medicare Reimbursement 524114 1213247 1213247 Reinsurance Recoveries 524114 209991 209991 4351974 46830 46830 Credit for Small Emplo 900099 10305 10305 10305 4409109 4362279 0 46830 83439 83439 101229 101229 28039 28039 13340 7970 5370 1594 1594 14150 14150 26705 26705 7891 7891 21018 11132 9886 4290 4290 26737 26737 1843 1843 3169 2275 894 3684 3684 21961 21961 Claims 3292138 3292138 Capitation Services 990468 990468 Premium Tax 63082 63082 Community Services 3740 3740 340 340 4708857 4583790 125067 0 363380 273411 51724 40895 19025 18172 339 853 1221181 1003617 141970 143184 1778594 1461960 286692 413943 8179 3182 297805 191291 592676 608416 X 0 0 0 0 1185918 853544 1185918 853544 1778594 1461960 X -299748 30467 -63093 X X 0 1 X 0 0 19025 18172 853 853 Estimated Third Party Settlement 134730 Accrued Interest Receivable 8454 143184 Estimated Incomplete and Unreported Claims 169139 Unpaid Claims Adjustment 22152 191291 2985871 0 2985871 1423238 1423238 4409109 3285619 -1423238 -1423238 4708857 0 4708857 Part XI, Line 4b - Other Adjustments: Medicare Reimbursement 1,213,247. Reinsurance Recoveries Incurred 209,991. Part XII, Line 2d - Other Adjustments: Medicare Reimbursement -1,213,247. Reinsurance Recoveries Incurred -209,991. Form 990, Part VI, Section A, line 1 The total number of voting members including the board President is 9; however, the board President only votes if there is a tie. There is an Executive Committee made up of the President, Vice President, and Secretary. All members of the Executive Committee are on the full board. Executive Committee members have the authority to act on matters requiring immediate attention in the interim between board meetings. Form 990, Part VI, Section A, line 2 Rob Hovland and Rob St. Michel have a business relationship. Form 990, Part VI, Section B, line 11 The Executive Director will review the draft. The board is e-mailed a copy of the Form 990 prior to it being filed. Form 990, Part VI, Section B, line 12c Board Members, the Executive Director, and Assistant Medical Director sign disclosures annually. The Executive Director reviews the disclosures to determine if there is a conflict. Anyone with a conflict refrains from voting on the issue. Form 990, Part VI, Section B, line 15a Comparison with the North Dakota Job Service salary survey, north central region, was done for all positions during mid-year 2008, with revisions made to all positions based on the findings at that time. Compensation is also reviewed by the Executive Committee in October/November when working with the annual budget. Any cost of living increases proposed by the committee are then approved by HAHP's Board of Directors. Form 990, Part VI, Section B, Line 15b: There are no other officers or key employees at HAHP. Form 990, Part VI, Section C, line 19 Financial statements are provided at the annual meeting. Governing documents and the conflict of interest policy are available upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Change in Nonadmitted Assets -63,093. Form 990, Part XII, Line 2c: There is no separate audit committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant. This responsibility is performed by the entire board of directors.