2025-10-03T13:38:45-05:00 2024-12-31 390859910 BAKER TILLY ADVISORY GROUP LP 790 N WATER ST SUITE 2000 MILWAUKEE WI 53202 990 2024-01-01 550585592 THE HEALTH PLAN OF WEST VIRGINIA INC HEAL 8006246961 1110 MAIN STREET WHEELING WV 26003 RYAN RALSTON CHIEF FINANCIAL OFFICER 8006246961 2025-09-30 1 1 SHELBY NETZ P01405265 4147775500 2025-09-26 2024 2025-03-06 01:10:19Z THE HEALTH PLAN JEFFREY M KNIGHT 1110 MAIN STREET WHEELING WV 26003 1071182420 0 X WWW.HEALTHPLAN.ORG X 1979 WV ESTABLISHED AS A COMMUNITY HEALTH ORGANIZATION, THE HEALTH PLAN DELIVERS A CLINICALLY-DRIVEN, TECHNOLOGY-ENHANCED, CUSTOMER-FOCUSED PLATFORM BY DEVELOPING AND IMPLEMENTING PRODUCTS AND SERVICES THAT MANAGE AND IMPROVE THE HEALTH AND WELL-BEING OF OUR MEMBERS. WE ACHIEVE THESE RESULTS THROUGH A TEAM OF HEALTHCARE PROFESSIONALS AND PARTNERS ACROSS OUR COMMUNITY. 9 9 623 0 0 0 0 0 778768443 747972277 14376241 22964459 72840 1739426 793217524 772676162 856558 532522 697332785 693128171 42840535 41327747 0 0 0 39744500 41306768 780774378 776295208 12443146 -3619046 452146751 461774997 145077868 169583887 307068883 292191110 X ESTABLISHED AS A COMMUNITY HEALTH ORGANIZATION, THE HEALTH PLAN DELIVERS A CLINICALLY-DRIVEN, TECHNOLOGY-ENHANCED, CUSTOMER-FOCUSED PLATFORM BY DEVELOPING AND IMPLEMENTING PRODUCTS AND SERVICES THAT MANAGE AND IMPROVE THE HEALTH AND WELL-BEING OF OUR MEMBERS. WE ACHIEVE THESE RESULTS THROUGH A TEAM OF HEALTHCARE PROFESSIONALS AND PARTNERS ACROSS OUR COMMUNITY. 0 0 124279965 532522 123811581 THE PRIMARY EXEMPT PURPOSE OF THE HEALTH PLAN OF WEST VIRGINA, INC. (THE HEALTH PLAN) IS TO OPERATE A STATE CERTIFIED, FEDERALLY QUALIFIED HEALTH MAINTENANCE ORGANIZATION (HMO) WHICH PROVIDES COMPREHENSIVE HEALTH CARE SERVICES ON A PREPAID BASIS. THE NUMBER OF COMMERCIAL HMO MEMBERS AT DECEMBER 31, 2024 WAS 18,696. 501019957 492163592 THE HEALTH PLAN OFFERS A MANAGED CARE PROGRAM FOR MOUNTAIN HEALTH TRUST (MHT), WEST VIRGINIA'S MEDICAID PROGRAM. AT DECEMBER 31, 2024, THE HEALTH PLAN'S MHT PLAN SERVICED 100,002 MEMBERS WITH 42,679 MEMBERS ENROLLED FROM THE EXPANSION POPULATION, 41,915 MEMBERS ENROLLED FOR THE TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) POPULATION, 9,911 MEMBERS ENROLLED FROM THE SUPPLEMENTAL SECURITY INCOME (SSI) POPULATION, AND 5,497 MEMBERS ENROLLED FROM THE WV CHILDREN'S HEALTH INSURANCE PROGRAM (WVCHIP). 136047351 133642487 THE HEALTH PLAN OFFERS A MEDICARE ADVANTAGE PROGRAM KNOWN AS SECURE CARE AND A PROGRAM FOR MEMBERS ELIGIBLE FOR BOTH MEDICARE AND MEDICAID KNOWN AS A MEDICARE DUAL SPECIAL NEEDS PLAN (DSNP). SECURE CARE ENABLES THE MEDICARE ELIGIBLE POPULATION TO SELECT MEDICARE COVERAGE AT A MUCH LOWER COST DUE TO THEIR AGREEMENT TO UTILIZE THE HEALTH PLAN NETWORK AND WITH PLAN OPTIONS FOR EXPANDED BENEFITS SUCH AS DENTAL, VISION, HEARING, TELEHEALTH, GYM MEMBERSHIPS, COVERAGE FOR "OVER-THE-COUNTER" ITEMS, IN-HOME MEAL DELIVERY AFTER HOSPITAL STAYS, AND ROUTINE TRANSPORTATION TO HEALTH-RELATED LOCATIONS. ENROLLMENT AT DECEMBER 31, 2024 FOR THESE PROGRAMS INCLUDED 8,218 MEMBERS. 761347273 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 1 3285 0 1 623 1 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X RYAN RALSTON CFO 7406996236 1110 MAIN STREET WHEELING WV 26003 DENISE D PENTINO CHAIR OF THE BOARD 1.00 1.00 X X 21000 0 0 WESLEY NICKELL VICE CHAIR OF THE BOARD 1.00 1.00 X X 20000 0 0 MARK LANCELLOTTI MEMBER 1.00 1.00 X 20000 0 0 SUSAN BUCHANAN CPA SECRETARY 1.00 1.00 X X 17500 0 0 LEA RIDENHOUR MEMBER 1.00 1.00 X 17500 0 0 DAVID COOK MEMBER 1.00 1.00 X 17500 0 0 JOSEPH G DONZELLA DO MEMBER 1.00 1.00 X 17500 0 0 WILLIAM D CRONIN MEMBER 1.00 1.00 X 17500 0 0 MANINDER SINGH BEDI MD MEMBER (THRU 11/2024) 1.00 1.00 X 2500 0 0 MARK VOELLINGER MD MEMBER 1.00 1.00 X 2500 0 0 JEFFREY KNIGHT PRESIDENT & CEO 40.00 5.00 X 690739 0 59639 RYAN RALSTON CHIEF FINANCIAL OFFICER 40.00 5.00 X 438346 0 79923 JAMIE LEARY CHIEF LEGAL COUNSEL 40.00 5.00 X 339859 0 25651 RYAN JEWELL SVP SALES & ACCOUNT MGMT 40.00 5.00 X 291573 0 52228 MUMTAZ IBRAHIM MD CHIEF MEDICAL OFFICER 40.00 5.00 X 296176 0 47117 KENNETH BRYAN CHIEF INFORMATION OFFICER 40.00 5.00 X 282353 0 58804 E DAVID MATHIEU SVP - UNDERWRITING & REGULATORY SERVICES 40.00 5.00 X 255891 0 57752 CHRISTINA DONOHUE SVP MHT 40.00 5.00 X 265513 0 39033 ANTOINETTE GEYER SVP PROVIDER DELIVERY SERVICES (THRU 09/2024) 40.00 5.00 X 219362 0 26698 EMILY KEANE DIRECTOR AUDIT & ADVISORY (THRU 04/2024) 40.00 5.00 X 224093 0 2664 ROBERT CROSS MEDICAL DIRECTOR 40.00 5.00 X 248483 0 55348 ROBERT J ROSET SVP - IT OPERATIONS & QUALITY 40.00 5.00 X 247602 0 52212 LARRY WELLING DIRECTOR - IT SOFTWARE 40.00 5.00 X 241296 0 49709 CHARLES F LUCAS VP, IT SOFTWARE DEVELOPMENT 40.00 5.00 X 241888 0 17347 4436674 0 624125 58 0 1 0 SCION DENTAL LLC 10201 NORTH PORT WASHINGTON RD MEQUON WI 53092 DENTAL CLAIMS PROCESSING AND ADMINISTRAT 24913415 HEALTHEDGE SOFTWARE INC 30 CORPORATE DRIVE BURLINGTON MA 01803 CLAIMS PAYMENT SOFTWARE 7299409 INCOMM HEALTHCARE & AFFINITY INC 250 WILLIAMS ST NW SUITE 500 ATLANTA GA 30303 MEMBER INCENTIVE CARDS FOR ACHIEVING HEA 7205049 EVICORE HEALTHCARE MSI LLC 400 BUCKWALTER PLACE BLVD BLUFFTON SC 29910 MEDICAL BENEFIT MANAGEMENT SERVICES 5172130 MILLIMAN INC 8500 NORMANDALE LAKE BLVD SUITE 18 BLOOMINGTON MN 55437 ACTUARIAL AND OTHER PROFESSIONAL SERVICE 4320138 80 MEDICAID 524114 492163592 492163592 MEDICARE 524114 133642487 133642487 COMMERCIAL HMO 524114 122083110 122083110 OTHER 524292 83088 83088 747972277 12230019 12230019 57560 0 57560 57560 57560 309240698 298506258 10734440 10734440 10734440 REINSURANCE RECOVERIES 900099 1645383 1645383 MISCELLANEOUS REVENUE 900099 36483 36483 1681866 772676162 749617660 0 23058502 288549 288549 243973 243973 693128171 693128171 3585158 1792579 1792579 17606830 13582728 4024102 2327369 1980971 346398 14993740 11775414 3218326 2814650 2430252 384398 1029357 772018 257339 3479703 2875250 604453 23035 23035 686339 686339 11261596 10678452 583144 3374976 2820577 554399 2050734 1609269 441465 8796095 8340076 456019 1139693 701034 438659 314677 266646 48031 294459 169618 124841 529100 396825 132275 1807520 1355640 451880 1411217 1007929 403288 MISCELLANEOUS EXPENSES 1857268 1857268 0 BROKER EXPENSE 1631606 1631606 NET REINSURANCE EXPENSE 1495036 1495036 PREMIUM TAX EXPENSE 124357 124357 776295208 761347273 14947935 0 28711967 19608573 36320258 84470089 15685699 8170587 7666187 7515112 320946651 294015739 56314738 54250760 2186950 1914724 452146751 461774997 133755638 155638335 1793752 981480 9528478 12964072 145077868 169583887 X 306568883 291691110 0 0 500000 500000 307068883 292191110 452146751 461774997 X -3619046 2061723 -13320450 X X 0 1 X 1 0 600000 600000 11588656 4939434 6649222 3497043 3231153 265890 7515112 INVESTMENT IN SUBSIDIARIES 54250760 C 54250760 POST RETIREMENT BENEFIT OBLIGATION 1332438 OTHER LIABILITIES 868211 DUE TO THP INSURANCE COMPANY 10763423 12964072 768341386 -2003054 -2003054 770344440 686339 1645383 2331722 772676162 777351641 -1645383 -1645383 778997024 686339 -3388155 -2701816 776295208 PART XI, LINE 2D - OTHER ADJUSTMENTS: REINSURANCE EXPENSE -1,495,036. DEPRECIATION -508,018. PART XI, LINE 4B - OTHER ADJUSTMENTS: REINSURANCE REVENUE 1,645,383. PART XII, LINE 2D - OTHER ADJUSTMENTS: REINSURANCE REVENUE -1,645,383. PART XII, LINE 4B - OTHER ADJUSTMENTS: REINSURANCE EXPENSE 1,495,036. CHANGE IN PREMIUM DEFICIENCY RESERVE -5,391,209. DEPRECIATION 508,018. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 EQUITY AND BOND INVESTMENTS 1061714 EAST ASIA AND THE PACIFIC - AUSTRALIA, BRUNEI, BURMA, CAMBODIA, 0 0 EQUITY AND BOND INVESTMENTS 1433989 EUROPE (INCLUDING ICELAND & GREENLAND) - ALBANIA, ANDORRA, AUSTRIA, BELGIUM 0 0 EQUITY AND BOND INVESTMENTS 5480192 NORTH AMERICA - CANADA AND MEXICO, BUT NOT THE UNITED STATES 0 0 EQUITY AND BOND INVESTMENTS 1024193 0 0 0 0 0 0 9000088 0 9000088 0 0 0 0 0 0 1 CAMPBELLS CREEK CHURCH 543 CAMPBELLS CREEK DRIVE CHARLESTON WV 25306 556066229 501C(3) 20000 0 FOOD PANTRY CATHOLIC CHARITIES WEST VIRGINIA INC 2000 MAIN STREET WHEELING WV 26003 550391262 501C(3) 20000 0 FOOD PANTRY CHRISTIAN HELP INC 219 WALNUT STREET MORGANTOWN WV 26505 550568989 501C(3) 20000 0 FOOD PANTRY EASTER SEALS 1305 NATIONAL ROAD WHEELING WV 26003 621266942 501C(3) 10000 0 REHABILITATION PROGRAM SUPPORT HOUSE OF THE CARPENTER LLC 200 SOUTH FRONT STREET WHEELING WV 26003 550751892 501C(3) 20000 0 FOOD PANTRY HUNTINGTON CITY MISSION 624 10TH ST P O BOX 3 HUNTINGTON WV 25701 550356991 501C(3) 20000 0 FOOD PANTRY MOUNTAINEER FOOD BANK INC 484 ENTERPRISE DRIVE GASSAWAY WV 26624 550611100 501C(3) 20000 0 FOOD PANTRY OLD MAN RIVERS MISSION 703 PIKE STREET PARKERSBURG WV 26101 550727794 501C(3) 20000 0 FOOD PANTRY SOUP KITCHEN OF GREATER WHEELING INC PO BOX 546 WHEELING WV 26003 550639285 501C(3) 20000 0 FOOD PANTRY ST JAMES EVANGELICAL LUTHERAN CHURCH 1409 CHAPLINE STREET WHEELING WV 26003 550361021 501C(3) 20000 0 FOOD PANTRY ST LUKES EPISCOPAL CHURCH 200 SOUTH PENN STREET WHEELING WV 26003 556000712 501C(3) 20000 0 FOOD PANTRY ST MATTHEWS EPISCOPAL CHURCH PO BOX 508 WHEELING WV 26003 550397070 501C(3) 20000 0 FOOD PANTRY UNION MISSION MINISTRIES INC PO BOX 112 CHARLESTON WV 25321 556000896 501C(3) 20000 0 FOOD PANTRY WOMENCARE INC DBA FAMILYCARE 97 GREAT TEAYS BLVD SUITE 6 SCOTT DEPOT WV 25560 550691297 501C(3) 38549 0 SUPPORT FOR HEALTHY FOOD INITIATIVE AND PROGRAM 14 0 MEDICAL AND NURSING STUDENT SCHOLARSHIPS 14 243973 PART I, LINE 2: THE HPWV MEDICAL STUDENT (DOCTORS/NURSES) SCHOLARSHIP PROGRAM BEGAN IN THE FALL OF 2009. MEDICAL STUDENTS SUBMIT SCHOLARSHIP APPLICATION TO A SUB-COMMITTEE OF THE BOARD. THESE APPLICATIONS ARE REVIEWED BY THE SUB-COMMITTEE BASED ON THE STUDENT'S FINANCIAL NEED. THE TUITION PAYMENTS ARE MADE DIRECTLY TO THE SCHOOL AND BOOK EXPENSES ARE REIMBURSED DIRECTLY TO THE STUDENTS. THE GRANT TERM IS OPEN UNTIL THE STUDENT GRADUATES. PRIOR TO MAKING A DONATION, THP REVIEWS AND CONSIDERS THE MISSION AND PURPOSE OF THE ORGANIZATION, ALONG WITH ITS TAX STATUS AND CONSIDERS THE IMPACT THAT THE ORGANIZATION CAN HAVE ON THE MISSION OF THP. THP CONSIDERS AND EVALUATES HOW THE FUNDS WILL USED BY THE ORGANIZATION. AFTER THE DONATION IS MADE, THP OFTEN COMMUNICATES WITH THE ORGANIZATION ON THE IMPACT OF THE DONATION ON THE COMMUNITIES IT SERVES. ADDITIONALLY, THP REPORTS ON A QUARTERLY BASIS TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS REGARDING DONATIONS THAT HAVE BEEN MADE OR ARE PROPOSED TO BE MADE; DONATIONS IN EXCESS OF $10,000 REQUIRE THE APPROVAL OF THE BOARD OF DIRECTORS. X X X X 1 0 0 0 0 0 0 0 0 JEFFREY KNIGHT PRESIDENT & CEO 565747 0 123750 0 1242 0 27600 0 32039 0 750378 0 0 0 RYAN RALSTON CHIEF FINANCIAL OFFICER 374979 0 62827 0 540 0 27600 0 52323 0 518269 0 0 0 JAMIE LEARY CHIEF LEGAL COUNSEL 299596 0 39021 0 1242 0 23968 0 1683 0 365510 0 0 0 RYAN JEWELL SVP SALES & ACCOUNT MGMT 268824 0 22209 0 540 0 20354 0 31874 0 343801 0 0 0 MUMTAZ IBRAHIM MD CHIEF MEDICAL OFFICER 293846 0 0 0 2330 0 4500 0 42617 0 343293 0 0 0 KENNETH BRYAN CHIEF INFORMATION OFFICER 256289 0 22500 0 3564 0 20615 0 38189 0 341157 0 0 0 E DAVID MATHIEU SVP - UNDERWRITING & REGULATORY SERVICES 230694 0 21006 0 4191 0 18672 0 39080 0 313643 0 0 0 CHRISTINA DONOHUE SVP MHT 233896 0 30375 0 1242 0 18924 0 20109 0 304546 0 0 0 ROBERT CROSS MEDICAL DIRECTOR 237656 0 7119 0 3708 0 17930 0 37418 0 303831 0 0 0 ROBERT J ROSET SVP - IT OPERATIONS & QUALITY 238758 0 7038 0 1806 0 19198 0 33014 0 299814 0 0 0 LARRY WELLING DIRECTOR - IT SOFTWARE 156661 0 84635 0 0 0 12645 0 37064 0 291005 0 0 0 CHARLES F LUCAS VP, IT SOFTWARE DEVELOPMENT 204046 0 37842 0 0 0 0 0 17347 0 259235 0 0 0 ANTOINETTE GEYER SVP PROVIDER DELIVERY SERVICES (THRU 09/2024) 178349 0 37312 0 3701 0 14141 0 12557 0 246060 0 0 0 EMILY KEANE DIRECTOR AUDIT & ADVISORY (THRU 04/2024) 51478 0 4795 0 167820 0 1931 0 733 0 226757 0 0 0 PART I, LINE 4A EMILY KEANE RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $167,371 IN 2024. PART I, LINE 7 BONUS PAYMENTS ARE BASED ON THE ACHIEVEMENT OF INDIVIDUAL AND STRATEGIC PLAN GOALS AND THE COMPANY'S (CONSOLIDATED) OVERALL FINANCIAL GOALS. THE AMOUNTS ARE DISCRETIONARY AND ARE NOT FIXED. MCKENZIE THOMAS DAUGHTER OF CHRISTINA DONOHUE, A KEY EMPLOYEE 36886 WAGES 0 FORM 990, PART VI, SECTION B, LINE 11B THE CFO AND CONTROLLER REVIEW THE FORM 990 FOR REASONABLENESS COMPARED TO THE INTERNAL FINANCIAL STATEMENTS. THE CFO PROVIDES COPIES TO THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES ARE DISTRIBUTED COMPANYWIDE AND TO THE BOARD OF DIRECTORS BY THE COMPLIANCE DEPARTMENT. ANY POTENTIAL CONFLICT WITH A BOARD MEMBER MIGHT RESULT IN THE BOARD MEMBER RECUSING IF THE CONFLICT IS RELATED TO A VOTING MATTER. IF THE CONFLICT ARISES AMONG EMPLOYEE(S), THE MATTER IS REVIEWED WITH HR AND THE EMPLOYEE COULD BE REASSIGNED OR OTHER CORRECTIVE ACTION MAY BE REQUIRED TO RESOLVE THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITEE OF THE BOARD OF DIRECTORS AND/OR IMMEDIATE SUPERVISOR REVIEWS PERFORMANCE ANNUALLY. THE COMPENSATION COMMITEE APPROVES COMPENSATION FOR THE CEO AND EXECUTIVE MANAGEMENT, AND THE CEO APPROVES ALL OTHERS' COMPENSATION. OUTSIDE COMPENSATION SURVEY TOOLS AND CONSULTATION WITH OUTSIDE COUNSEL/RESOURCES (WHERE NEEDED) ARE USED TO ESTABLISH APPROPRIATE COMPENSATION LEVELS WITHIN THE ORGANIZATION. THIS PROCESS WAS COMPLETED IN CY2024. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE FILED WITH THE DEPARTMENT OF INSURANCE AND ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN NONADMITTED ASSETS -7,929,241. CHANGE IN RESERVES -5,391,209. FORM 990, PART XII, LINE 2C: NO CHANGE TO THE OVERSIGHT PROCESS. PART IX, LINE 11D: $23,035 WAS PAID TO MEGAN ROSKOVENSKY FOR PROFESSIONAL SERVICES RELATED TO GOVERNMENT RELATIONS AND LOBBYING DURING 2024. THE FILING ORGANIZATION REPORTED THIS AMOUNT ON FORM 990, PART IX, LINE 11D. THP INSURANCE COMPANY 1110 MAIN STREET WHEELING WV 26003 550765726 INSURANCE AND THIRD PARTY ADMINISTRATOR WV THE HEALTH PLAN OF WEST VIRGINIA INC C 45056040 74985776 1.00000 1 HOMETOWN HHP SERVICES CORPORATION 1110 MAIN STREET WHEELING WV 26003 341588625 THIRD-PARTY ADMINISTRATOR OH THE HEALTH PLAN OF WEST VIRGINIA INC C -54425 4157779 1.00000 1 0 0 0 1 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 THP INSURANCE COMPANY L 14913015 ACTUAL ALLOC. - ADMIN. AGREEMENT THP INSURANCE COMPANY E 1805304 ACTUAL AMOUNT THP INSURANCE COMPANY D 6763422 ACTUAL AMOUNT HOMETOWN HHP SERVICES CORPORATION L 1101234 ACTUAL ALLOC. - ADMIN. AGREEMENT