2023-11-15T17:46:14-06:00 2022-12-31 135565207 KPMG LLP 301 MAIN STREET SUITE 2150 BATON ROUGE LA 70801 990 2022-01-01 472532880 COMMUNITYCARE GOVERNMENT PROGRAMS INC COMM 9185945295 TWO WEST SECOND STREET SUITE 100 TULSA OK 74103 JEFFREY BUTCHER CFO 9185945295 2023-11-14 1 JEFFREY BUTCHER 999009999 0 SHANNON KIRKPATRICK P00566467 2253444000 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ROBERT L BUSH TWO WEST SECOND STREET SUITE 100 TULSA OK 74103 397961202 0 X N/A X 2015 OK COMMUNITYCARE IS A HEALTH MAINTENANCE ORGANIZATION DEDICATED TO MEDICARE ADVANTAGE AND WITH THE GOAL OF IMPROVING THE HEALTH OF ITS MEMBERS. 10 9 0 0 0 0 0 0 358131218 395955351 114887 1107493 430461 0 358676566 397062844 0 0 320215038 352130827 0 0 0 0 0 36269131 41131341 356484169 393262168 2192397 3800676 89284308 84707844 44270348 35678675 45013960 49029169 X COMMUNITYCARE IS DEDICATED TO PROVIDING HIGH QUALITY, COST EFFECTIVE HEALTH CARE MANAGEMENT SERVICES IN THE COMMUNITIES IT SERVES. IN ACCOMPLISHING ITS MISSION COMMUNITYCARE ADHERES TO THESE PRINCIPLES IN ALL THAT WE DO: RESPECT, INTEGRITY, CONFIDENTIALITY, & ETHICS. 0 0 359136377 395955351 COMMUNITYCARE IS A HEALTH MAINTENANCE ORGANIZATION DEDICATED TO MEDICARE ADVANTAGE AND WITH THE GOAL OF IMPROVING THE HEALTH OF ITS MEMBERS. IN 2022, THE COMPANY HAD ENROLLED 31,001 MEMBERS AND HAD AN AVERAGE WEEKLY NUMBER OF CUSTOMER SERVICE CALLS OF 1,823 TO ASSIST AND COORDINATE MEMBERS' NEEDS. THE COMPANY PAID 914,430 MEDICAL CLAIMS WHICH TOTALED OVER $316 MILLION IN CLAIMS ON BEHALF OF THE MEMBERS. OUR MEDICARE ADVANTAGE PRESCRIPTION DRUG PROGRAM (MAPD) HAS RECEIVED THE HIGHEST CUSTOMER SATISFACTION RATING FOR MEDICARE ADVANTAGE PLANS IN THE STATE. COMMUNITYCARE PARTICIPATES IN THE STARS PROGRAM WHERE WE TRACK THE TYPES OF SERVICES OUR MEMBERS RECEIVE AND IDENTIFY AREAS THAT WE CAN DO OUTREACH TO MEMBERS TO ENSURE THEY ARE RECEIVING THE CARE THEY NEED. SOME OF THESE PROGRAMS INCLUDE THE FOLLOWING: 1) LIVE WELL IS A PROGRAM TO ENGAGE MEMBERS WITH UPLIFTING, RELATABLE CONTENT ON PHYSICAL AND MENTAL WELL-BEING TO IMPROVE THE MEMBERS' PERCEPTION OF THEIR PHYSICAL AND MENTAL HEALTH. 2) HEALTHY REWARDS IS A PROGRAM WHERE MEDICARE MEMBERS CAN EARN REWARDS FOR TAKING CARE OF THEIR HEALTH. COMMUNITYCARE MEMBERS EARN THESE REWARDS FOR COMPLETING HEALTH ACTIVITIES SUCH AS BREAST CANCER SCREENING, ANNUAL WELLNESS VISITS, COLON CANCER SCREENING, AND DIABETES SCREENINGS THAT ARE RECOMMENDED FOR THE MEMBER. 3) COMMUNITYCARE ALSO PERFORMS HOME ASSESSMENTS, PROVIDES EDUCATION AT ITS SENIOR CENTER, AND OPERATES A MEDICATION THERAPY MANAGEMENT PROGRAM. 359136377 0 0 0 0 0 0 0 0 0 0 1 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 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X NANCY HORSTMANN 9185945325 TWO WEST SECOND STREET SUITE 100 TULSA OK 74103 JEFF NOWLIN DIRECTOR 0.10 X 0 0 0 JAKE JEROME HENRY JR DIRECTOR 0.10 X 0 0 0 BARRY LEE STEICHEN DIRECTOR 0.10 X 0 0 0 THOMAS EDWARD RITCHIE DIRECTOR 0.10 X 0 24000 0 FRANK XAVIER HENKE IV DIRECTOR 0.10 X 0 16000 0 THEODORE RAYMOND MUNDT DIRECTOR 0.10 X 0 11000 0 ERIC EDWARD SCHICK DIRECTOR 0.10 X 0 0 0 TIMOTHY MOORHEAD DIRECTOR 0.10 X 0 0 0 TIMOTHY YOUNG MD DIRECTOR 0.10 X 0 0 0 ROBERT L BUSH PRESIDENT & CEO 40.00 X X 0 663525 109785 JEFFRETY A BUTCHER TREASURER, CFO 40.00 X 0 384156 82731 ANDREW G HILL CORPORATE SECRETARY 40.00 X 0 254827 60343 0 1353508 252859 0 0 1 0 COMMUNITYCARE HMO INC TWO WEST SECOND STREET SUITE 100 TULSA OK 74103 MANAGEMENT FEE 29861189 1 PREMIUM INCOME 524298 395593086 395593086 REINSURANCE RECOVERIES 524298 362265 362265 395955351 1126141 1126141 879710 898358 -18648 -18648 -18648 397062844 395955351 0 1107493 352130827 352130827 20634410 20634410 139383 139383 1453177 1453177 138220 138220 2363225 2363225 477298 477298 1448765 1448765 1397939 1397939 125913 125913 1430500 1430500 1196112 1196112 460692 460692 CLAIMS ADJUSTMENTS 7005550 7005550 COMMISSIONS 2184194 2184194 OTHER EXPENSE 399357 399357 BOARDS, BUREAUS AND ASS 158526 158526 118080 118080 393262168 359136377 34125791 0 36355957 47657894 42430649 26395895 10497702 10654055 89284308 84707844 44270348 35678675 44270348 35678675 X 0 0 46000000 46000000 -986040 3029169 45013960 49029169 89284308 84707844 X 3800676 -58159 272692 X 0 1 X 1 0 0 BONDS 10654055 C 10654055 CLAIMS UNPAID 29963500 UNPAID CLAIM ADJUSTMENT 805308 GENERAL EXPENSES DUE OR ACCRUED 4679909 PREMIUMS RECEIVED IN ADVANCE 229050 FEDERAL INCOME TAX PAYABLE 908 35678675 395131866 0 395131866 138220 1792758 1930978 397062844 391331190 0 391331190 138220 1792758 1930978 393262168 PART XI, LINE 4B - OTHER ADJUSTMENTS: REINSURANCE RECOVERIES RECLASS 362,265. INTEREST ON SURPLUS NOTE 1,430,493. PART XII, LINE 4B - OTHER ADJUSTMENTS: REINSURANCE RECOVERIES RECLASS 362,265. INTEREST ON SURPLUS NOTE 1,430,493. 0 1 0 0 0 0 0 0 0 ROBERT L BUSH PRESIDENT & CEO 0 481676 0 181125 0 724 0 73336 0 36449 0 773310 0 0 JEFFRETY A BUTCHER TREASURER, CFO 0 296269 0 86288 0 1599 0 54084 0 28647 0 466887 0 0 ANDREW G HILL CORPORATE SECRETARY 0 203893 0 50500 0 434 0 35065 0 25278 0 315170 0 0 PART I, LINE 4B THE OFFICERS ARE ENTITLED TO A SEVERANCE BENEFIT FROM A RELATED ORGANIZATION. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR A TERMINATION OF EMPLOYMENT WITHOUT CAUSE, FOR GOOD REASON, OR DUE TO CHANGE OF CONTROL. IF TRIGGERED, THE EXECUTIVE WOULD BE PAID HIS/HER BASE SALARY FOR A PERIOD OF 6 MONTHS NOT TO INCLUDE ANY INCENTIVE COMPENSATION, OR ANY OTHER PAID BENEFITS OUTSIDE OF COBRA. THE OFFICERS PARTICIPATE IN A RELATED ORGANIZATION'S SUPPLEMENTAL RETIREMENT PLAN WHICH MEETS THE REQUIREMENTS OF IRC SECTION 457 AND IRC SECTION 409A. THE PLAN PROVIDES FOR COMPENSATION TO BE DEFERRED AND PAID UPON THE OCCURRENCE OF CERTAIN EVENTS SUCH AS TERMINATION, DISABILITY, OR DEATH. PARTICIPATION IN THE PLAN IS LIMITED TO AND IS SUBJECT TO THE APPROVAL OF THE RELATED ORGANIZATION'S BOARD OF DIRECTORS. THE PLAN ALLOWS THE OFFICERS BOTH ELECTIVE AND NON-ELECTIVE DEFERRALS. THE RELATED ORGANIZATION MAKES ANNUAL NON-ELECTIVE CONTRIBUTIONS BETWEEN 5% AND 10% OF BASE SALARY DEPENDING ON THE EXECUTIVE'S LEVEL OF POSITION. FORM 990, PART VI, SECTION A, LINE 2 THE DIRECTORS OF COMMUNITYCARE HMO, INC., A RELATED TAXABLE CORPORATION, ARE ALSO THE DIRECTORS OF COMMUNITYCARE GOVERNMENT PROGRAM, INC. DUE TO THIS OVERLAPPING BOARD, THERE IS A BUSINESS RELATIONSHIP BETWEEN AND AMONG THE DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 SAINT FRANCIS HOSPITAL, INC. AND ST. JOHN HEALTH SYSTEM, INC. ARE THE MEMBERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A AS MEMBERS, SAINT FRANCIS HOSPITAL, INC. AND ST. JOHN HEALTH SYSTEM MAY APPOINT AND REMOVE ANY OR ALL OF ITS DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS DETERMINE THE NUMBER OF DIRECTORS. ANY PROPOSED LIQUIDATION OF THE CORPORATION MUST BE APPROVED IN WRITING BY THE MEMBERS. THE BYLAWS MAY BE AMENDED OR REPEALED ONLY BY UNANIMOUS CONSENT OF THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE COMPANY'S TAX ADVISORS, KPMG, PREPARED THE 990 FILING, THE COMPANY CFO REVIEWED THE FILING AND THE CFO WILL PROVIDE AN UPDATE TO THE BOARD AT THE NEXT BOARD MEETING AND WILL MAKE AVAILABLE THE FILING TO ANY MEMBER. FORM 990, PART VI, SECTION B, LINE 12C ALL COMMUNITYCARE WORKFORCE MEMBERS ATTEST ANNUALLY THAT THEY HAVE READ AND UNDERSTAND THE CODE OF EXCELLENCE, INCLUDING THE WRITTEN CONFLICT OF INTEREST POLICY. A SEPARATE ANNUAL ATTESTATION IS COMPLETED BY EVERY COMMUNITYCARE WORKFORCE MEMBER CONFIRMING THEY DO NOT HAVE ANY CONFLICTS OF INTEREST. ANY ACTUAL OR PERCEIVED CONFLICTS OF INTEREST MUST BE DISCLOSED ON THIS ATTESTATION AND ARE REVIEWED BY THE CHIEF COMPLIANCE & RISK OFFICER. APPROPRIATE ACTION, INCLUDING IMPLEMENTATION OF A MANAGEMENT PLAN TO ELIMINATE THE DISCLOSED CONFLICT OF INTEREST ARE PUT INTO PLACE BY THE CHIEF COMPLIANCE & RISK OFFICER. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC THROUGH THE NAIC WEBSITE. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CHANGE IN NONADMITTED ASSETS 272,692. COMMUNITYCARE HMO INC TWO WEST SECOND STREET SUITE 100 TULSA OK 74103 731433979 INSURANCE OK N/A C 0 COMMUNITYCARE MANAGED HEALTHCARE PLANS OF OKLAHOMA TWO WEST SECOND STREET SUITE 100 TULSA OK 74103 731513383 INSURANCE OK N/A C 0 COMMUNITYCARE LIFE & HEALTH INSURANCE CO TWO WEST SECOND STREET SUITE 100 TULSA OK 74103 731580741 INSURANCE OK N/A C 0 HOSPITAL CLAIMS INC TWO WEST SECOND STREET SUITE 100 TULSA OK 74103 363683174 INSURANCE DE N/A C 0 WORKNET INC TWO WEST SECOND STREET SUITE 100 TULSA OK 74103 731488665 INSURANCE OK N/A C 0 PREFERRED COMMUNITY CHOICE PPO INC TWO WEST SECOND STREET SUITE 100 TULSA OK 74103 731451360 INSURANCE OK N/A C 0 EXCELCARE INC TWO WEST SECOND STREET SUITE 100 TULSA OK 74103 363668948 INSURANCE DE N/A C 0 COMMUNITYCARE INSURANCE AGENCY TWO WEST SECOND STREET SUITE 100 TULSA OK 74103 461389531 INSURANCE OK N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0