2019-11-13T14:51:57-07:00 2018-12-31 990 2018-01-01 161580245 Fallon Health Weinberg Inc FALL 7168101867 2700 North Forest Road Getzville NY 14068 Todd Bailey Chief Financial Officer 5083686997 2019-11-13 63.116.189.48 2018 2020-04-17 16:48:07Z David Przesiek 10 Chestnut Place Worcester MA 01608 42433658 0 X www.fallonweinberg.org X 1999 NY Fallon Health Weinberg consists of a managed long-term care program (MLTC) and a Program of All-Inclusive Care for the Elderly (PACE). The mission of the Fallon Health Weinberg programs is to address the long-term care needs for those Medicaid or dually eligible (Medicare and Medicaid) individuals in the WNY community who are chronically ill or who have disabilities. The programs are designed to keep participants living safely and independently in the comfort of their own home as long as possible. Each participant's highly trained care team coordinates a plan of care that is personalized and developed to meet each participant's specific needs. The care team continually monitors participant's health status to update the care plan to ensure the participant is receiving the highest quality of care while remaining in the community. 5 2 69 2 0 0 0 0 31187883 42433658 0 0 0 0 31187883 42433658 0 0 0 0 4188738 3511583 0 0 0 33885053 35454815 38073791 38966398 -6885908 3467260 14387625 13789394 9454017 7590614 4933608 6198780 Fallon Health Weinberg consists of a managed long-term care program (MLTC) and a Program for All-Inclusive Care for the Elderly (PACE). The mission of the Fallon Health Weinberg programs is to address the long-term care needs for those Medicaid or dually eligible (Medicare and Medicaid) individuals in the WNY community who are chronically ill or who have disabilities. The programs are designed to keep participants living safely and independently in the comfort of their own home as long as possible. Each participant's highly trained care team coordinates a plan of care that is personalized and developed to meet each participant's specific needs. The care team continually monitors participant's health status to update the care plan to ensure the participant is receiving the highest quality of care while remaining in the community. 0 0 26003282 0 31442174 The MLTC program provides services to Medicaid eligible individuals in the WNY community who are chronically ill or who have disabilities. The Fallon Health Weinberg MLTC program is designed to keep participants living safely at their highest level of independence and in the comfort of their own home as long as possible. Through the coordination of personalized care plans, a participant has access to an array of health care services that they receive either in their home or in a day care setting. A majority of the services provided to participants are at no cost to the participant and are covered either by the program or by Medicare or Medicaid fee-for-service. The services provided by The Fallon Health Weinberg MLTC program include care management, nursing home care, private duty nursing, home health care, home care aide, physical, occupational, and speech therapy, home delivered meals, personal care, nutrition, audiology, dentistry, optometry, personal emergency response systems, and transportation. During 2018, Fallon Health Weinberg serviced over 988 members in Western New York through the managed long term care program. 9121634 0 10603275 The PACE program provides services to Medicaid, dually eligible (Medicare & Medicaid), and private pay individuals within Erie County who are chronically ill or who have disabilities. The Fallon Health Weinberg PACE program is designed to keep participants living safely at their highest level of independence and in the comfort of their own home as long as possible. Through the coordination of personalized care plans, a participant has access to an array of health care services that they receive either in their home or in a day care setting. A majority of the services provided to participants are at no cost to the participant and are covered either by the program or by Medicare or Medicaid fee-for-service. The services provided by The Fallon Health Weinberg PACE program include prescription drug coverage, care management, nursing home care, private duty nursing, home health care, home care aide, physical, occupational, and speech therapy, home delivered meals, personal care, nutrition, audiology, dentistry, optometry, personal emergency response systems, and transportation. 0 0 388209 As a result of unfavorable financial performance, the management of Fallon Health Weinberg, Inc. determined that it would not be feasible to continue to offer its Medicare Advantage Special Needs Program beyond the fiscal year ending December 31, 2017. The 2018 financial results reflect operating revenues totaling $388,209 related to 2017 Medicare Part D Settlement monies received in 2018. 0 0 388209 35124916 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 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 0 1 0 0 69 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 2 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X Kelly L Voigt 7168101867 461 John James Audubon Parkway Amherst NY 14228 Thomas Ebert - Ended March 2018 Director 2 48 X 0 285721 13199 David Dunkelman - Ended May 2018 Director 1 39 X 0 0 0 Robert T Mayer Director - Secretary 1 39 X X 0 0 0 Gregory Epstein Director 1 0 X 0 0 0 David Przesiek Board Chairman 2 47 X X 0 456942 144742 Kevin Grozio Director 1 49 X 0 428556 124181 Jill Lebow Director 2 48 X 0 319475 96792 Keith Curtis Program Director 40 0 X 112684 0 3700 Arunan Thurairajah Medical Director 40 0 X 214252 0 16836 Kelly Voigt Finance Director 40 0 X 111228 0 7776 438164 1490694 407226 3 0 1 0 Schofield Home Health Services 2757 Elmwood Ave Kenmore NY 14217 Care Management Services 696180 CVS Caremark 2700 North Forest Road Getzville NY 14068 Pharmaceuticals 717244 Schofield Residence 3333 Elmwood Avenue Buffalo NY 14217 Supervision Services 367840 3 0 Net Premium Revenue 524114 42433658 42433658 0 0 0 0 0 0 42433658 0 0 0 0 0 42433658 42433658 0 0 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3041126 1959366 1081760 0 -78080 0 -78080 0 340139 150679 189460 0 208398 105929 102469 0 1306090 0 1306090 0 84929 0 84929 0 158200 0 158200 0 0 0 0 0 0 0 0 0 0 0 32842684 32595029 247655 0 17383 0 17383 0 63327 0 63327 0 96527 0 96527 0 0 0 0 0 128159 128159 0 0 43867 43867 0 0 0 0 0 0 3727 0 3727 0 86 0 86 0 0 0 0 0 141887 141887 0 0 49327 0 49327 0 Medical Surcharge 185589 0 185589 0 Administration fees 15392 0 15392 0 Association Fees 58330 0 58330 0 259311 0 259311 0 38966398 35124916 3841482 0 4118389 5211165 0 0 0 0 2808906 3572699 0 0 0 0 0 0 0 0 40964 29436 3982964 699480 3425370 3283484 0 0 0 0 1590564 1586131 0 0 2403432 106479 14387625 13789394 9454017 7590614 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9454017 7590614 X 4933608 6198780 0 0 0 0 4933608 6198780 14387625 13789394 X 3467260 -2088 0 0 0 -2200000 X 0 1 X 1 0 X 0 0 0 0 0 4345306 6602588 15261834 31187883 42433658 99831269 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4345306 6602588 15261834 31187883 42433658 99831269 0 0 0 0 0 0 0 0 0 0 0 0 0 0 99831269 648 635 0 0 1283 0 0 0 0 0 648 635 0 0 0 1283 0 0 0 0 0 0 0 0 0 0 4345954 6603223 15261834 31187883 42433658 99832552 0.99999 0.99994 0.00001 0.00006 X 0 272979 272979 0 3577022 606137 2970885 0 0 0 0 0 132963 93343 39620 0 0 0 0 3283484 Escrow Balance 1586131 F 1586131 42431570 -2088 0 0 0 -2088 42433658 0 0 0 42433658 41166398 0 0 0 2200000 2200000 38966398 0 0 0 38966398 Schedule D, Part XII, Line 2d Per the Member Agreement between Fallon Community Health Plan and Menorah Campus, Inc. from time to time the Board may determine that the Company requires additional capital for purposes such as satisfying applicable regulatory capital requirements, funding capital expenditures approved by the Board, and funding working capital requirements to perform the business of the Company. During 2017, FCHP provided $6.35M in capital contributions of which $4.15M was transferred to FHW in 2017 in order to meet regulatory capital requirements. As a result of improved performance during 2018, the Board determined that the remaining balance of the $2.2M was not required to be transferred as Fallon Health Weinberg, Inc. was able to satisfy all regulatory and working capital requirements independently through operations. X X X 0 0 0 0 0 0 0 0 1 1 David Przesiek Board Chairman 0 308677 0 125372 0 22893 0 115931 0 28811 0 601684 0 135236 Kevin Grozio Director 0 331537 0 87701 0 9318 0 95370 0 28811 0 552737 0 89412 Jill Lebow Director 0 239855 0 62191 0 17429 0 72112 0 24680 0 416267 0 74154 Arunan Thurairajah Medical Director 214252 0 0 0 0 0 0 0 16836 0 231088 0 0 0 Schedule J, Part I, Line 3 To determine the compensation structure of management and key employees, the Board Members rely on compensation studies and comparisons. The Board of Directors then vote to approve the compensation for each member of the executive group. The executive group have written employment contracts that set their fixed salary per year. Schedule J, Part I, Line 8 All Directors, Officers and key employees of the company have agreed to receive a fixed salary each year through a written employment contract. To determine the compensation of the Directors, Officers and key employees the Board of Directors relied on compensation studies and comparisons and required the approval of the Board of Directors to determine compensation reasonableness. Form 990, Part VI, Section A, Line 6 According to the Member Agreement between Fallon Community Health Plan and Menorah Campus, Inc., Fallon Community Health Plan and Menorah Campus, Inc. shall be the only Members of Fallon Health Weinberg. The Members shall have the sole authority to elect the members of the Board of Directors, Fallon Community Health Plan is entitled to 4 voting members and Menorah Campus, Inc. is entitled to elect 2 voting members to the Company's Board of Directors. Form 990, Part VI, Section A, Line 7a According to the Member Agreement between Fallon Community Health Plan and Menorah Campus, Inc., Fallon Community Health Plan and Menorah Campus, Inc. shall be the only Members of Fallon Health Weinberg. The Members shall have the sole authority to elect the members of the Board of Directors, Fallon Community Health Plan is entitled to 4 voting members and Menorah Campus, Inc. is entitled to elect 2 voting members to the Company's Board of Directors. Form 990, Part VI, Section B, Line 11b A draft of the Form 990 was prepared internally using information from the organization including audited financial statements, compensation records, governing documents, and compliance policies. The draft was then reviewed by independent accounts for accuracy and completeness. The final Form 990 is prepared and then provided to each board member for his or her review before filing with the IRS. Form 990, Part VI, Section B, Line 12c A conflict of Interest Disclosure Statement is furnished to each Director, Officer, and Management employee annually. Fallon Health Weinberg has general conflict of interest policies that require reporting of potential conflicts and management approval of these transactions. These policies are enforced by executive management including the Chief Compliance Officer. Each new Director, Officer, and management employee is advised of this policy upon undertaking his or her perspective duties. Form 990, Part VI, Section B, Line 15 To determine the compensation structure of management and key employees, the Board Members rely on compensation studies and comparisons. The Board of Directors then vote to approve the compensation for each member of the executive group. The executive group have written employment contracts that set their fixed salary per year. Form 990, Part VI, Section C, Line 18 Fallon Health Weinberg's Form 990 and the audited Financial Statements are available to the general public on the website www.guidestar.org as well as upon request. Form 990, Part VI, Section C, Line 19 The organization makes its governing documents, Conflicts of Interest Policy, and its financial statements available to the public upon request. Form 990, Part IX, Line 11g Other Fee-for-Service expenses include Program Service Medical Expense payments made to independent contractors for medical services provided to members that include but not exclusive of clinical nursing, home health services, personal care aides, transportation, day care services, personal response services, podiatry, audiology, optometry, and meals. $32,595,029 represents professional services by independent contractors who provide support to the clinical staff. $200,705 represents professional services by independent contractors who provide support to the administration staff. $41,348 represents consulting services. $5,402 represents purchased services for potential members to tour the facilities of the day center. $200 represents Physician services for employee physicals. Form 990, Part XI, Line 9 Per the Member Agreement between Fallon Community Health Plan and Menorah Campus, Inc. from time to time the Board may determine that the Company requires additional capital for purposes such as satisfying applicable regulatory capital requirements, funding capital expenditures approved by the Board, and funding working capital requirements to perform the business of the Company. During 2017, FCHP provided $6.35M in capital contributions of which $4.15M was transferred to FHW in 2017 in order to meet regulatory capital requirements. As a result of improved performance during 2018, the Board determined that the remaining balance of the $2.2M was not required to be transferred as Fallon Health Weinberg, Inc. was able to satisfy all regulatory and working capital requirements independently through operations. Fallon Total Care Inc 10 Chestnut Place Worcester MA 01608 455591420 Healthcare MA 501(c)(3) 10 Fallon Community Health Plan Inc 0 Summit Living Inc 10 Chestnut Place Worcester MA 01608 261836279 Healthcare MA 501(c)(3) 10 Fallon Community Health Plan 0 Fallon Community Health Plan 10 Chestnut Place Worcester MA 01608 237442369 Healthcare MA 501(c)(3) 10 N/A 0 Fallon Health & Life Assurance Inc 10 Chestnut Place Worcester MA 01608 043169246 Health and Life MA N/A C 0 0 Ultrabenefits Inc 29 East Mountain Street worcester MA 01608 043525752 Healthcare MA N/A C 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0