2018-11-12T15:39:48-07:00 2017-12-31 990 2017-01-01 161580245 Fallon Health Weinberg Inc FALL 7168101867 2700 North Forest Road Getzville NY 14068 Kevin Grozio Chief Financial Officer 7168106920 2018-11-13 63.116.189.48 2017 2019-02-21 02:37:17Z David Przesiek 10 Chestnut Place Worcester MA 01608 31187883 0 X www.fallonweinberg.org X 1999 NY Fallon Health Weinberg consists of a managed long-term care program (MLTC), a Medicare Advantage Special Needs Program (DSNP) 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. 6 1 72 1 0 0 0 0 15261834 31187883 0 0 0 0 15261834 31187883 0 0 0 0 3073113 4188738 0 0 0 17700123 33885053 20773236 38073791 -5511402 -6885908 10162248 14387625 4684908 9454017 5477340 4933608 X Fallon Health Weinberg consists of a managed long-term care program (MLTC), a Medicare Advantage Special Needs Program (DSNP) 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 1 21120146 20157797 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 2017, Fallon Health Weinberg serviced over 800 members in the community through the managed long term care program. 4055670 0 3459452 The Fallon Health Weinberg DSNP Plan is a Medicare Advantage Special Needs Plan for individuals 21 years of age or older who have Medicare and Medicaid benefits and need additional coordination of primary and specialty medical care as well as long-term services and support. The goal of the plan is to help members stay healthy and continue living safely at home in the community through the coordination of care by a highly experienced Care Team. The Care Team is led by a Navigator, the single person of contact for the plan. The Navigator is in communication with the member's health care professionals in order to coordinate and monitor each members health and to ensure any post hospital care is in place to reduce hospital readmissions. The services provided by the Fallon Health Weinberg DSNP includes emergency and urgent care, outpatient health services, inpatient hospital care, primary and specialty care, behavioral health services, skilled nursing facility, outpatient surgery, home health services, and preventive care and screenings. This Program has been discontinued as of 12/31/2017 7910912 7570634 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 0 33086728 1 0 0 0 0 0 0 0 0 0 1 0 1 1 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 72 1 0 0 0 0 0 0 0 0 0 0 X 6 1 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 Michael Nickey Director - Board Chairman (Ended Feb 2017) 8 42 X X 0 219800 69005 Robert S Walker Director (Ended March 2017) 1 49 X 0 114464 11957 Thomas Ebert Director 2 48 X 0 403462 78040 David Dunkelman 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 4 46 X X 0 368255 184056 Kevin Grozio Director 1 49 X 0 364219 134047 Courtney Fasolino Executive Director 40 0 X 170397 0 15347 Keith Curtis Program Director 40 0 X 113718 0 3139 Kelly Voigt Finance Director 40 0 X 113410 0 6964 Laura Zulla Program Director 40 0 X 103087 0 2816 Charles Yates Medical Director 40 0 X 236970 0 3532 737582 1470200 508903 5 0 1 0 Schofield Home Health Services 2757 Elmwood Ave Kenmore NY 14217 Care Management Services 857983 CVS Caremark 2700 North Forest Road Getzville NY 14068 Pharmaceuticals 2306817 Willcare 346 Delaware Avenue Buffalo NY 14202 Aide Services 245230 3 0 Net Premium Revenue 524114 31187883 31187883 0 0 0 0 0 0 31187883 0 0 0 0 0 31187883 31187883 0 0 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3502447 1834894 1667553 125222 125222 344692 162881 181811 216377 103060 113317 1734562 1734562 85463 85463 49000 49000 0 30794601 30678079 116522 358576 358576 55749 55749 110295 110295 0 0 101966 101966 55520 55520 10190 10190 802 802 150328 150328 110051 110051 Dues and Subscriptions 21441 0 21441 0 Medical Surcharge 246509 0 246509 0 38073791 33086728 4987063 0 4240366 4118389 537077 2808906 62151 40964 3982964 557594 3575698 3425370 1605637 1590564 141319 2403432 10162248 14387625 4684908 9454017 4684908 9454017 X 5477340 4933608 0 0 0 0 5477340 4933608 10162248 14387625 X -6885908 -7824 0 0 0 6350000 X 0 1 X 1 0 X 0 0 0 0 0 0 4191150 4345306 6602588 15261834 31187883 61588761 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4191150 4345306 6602588 15261834 31187883 61588761 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 61588761 2216 648 635 0 0 3499 0 0 0 0 0 0 2216 648 635 0 0 3499 0 0 0 0 0 0 0 0 0 0 0 0 4193366 4345954 6603223 15261834 31187883 61592260 0.99994 0.99990 0.00006 0.00010 X 0 272979 272979 0 3577022 474523 3102499 0 0 0 0 0 132963 83071 49892 0 0 0 0 3425370 Escrow Balance 1590564 F 1590564 Due from Fallon Community Health Plan 2403432 2403432 37530060 -7823 0 0 6350000 6342177 31187883 0 0 0 31187883 38073791 0 0 0 0 0 38073791 0 0 0 38073791 Schedule D, Part XI, 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, an additional $6.35 million in capital contributions was required to meet regulatory capital requirements. X X X 0 0 0 0 0 0 0 0 1 1 David Przesiek Board Chairman 0 298052 0 37000 0 33203 0 156705 0 27352 0 552312 0 45818 Kevin Grozio Director 0 284701 0 58110 0 21408 0 106696 0 27352 0 498267 0 38110 Thomas Ebert Director 0 326612 0 31000 0 45850 0 53130 0 24910 0 481502 0 45727 Michael Nickey Director - Board Chairman (Ended Feb 2017) 0 197687 0 21573 0 540 0 46174 0 22831 0 288805 0 13540 Courtney Fasolino Executive Director 170397 0 0 0 0 0 2321 0 13026 0 185744 0 0 0 Charles Yates Medical Director 236970 0 0 0 0 0 2721 0 811 0 240502 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 III, Line 3 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. As a result, participants were notified of this decision on October 2, 2017 in accordance with regulations as outlined by the State of New York and the Centers of Medicare Services (CMS). The 2017 financial results reflect operating losses totaling $1,241,850 related to this discontinued product offering. 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 $30,678,079 Professional Services include independent contractors who provided support to clinical staff $78,636 Professional Services including independent contractors who provided support to Administration $33750 Physician services for employee physicals $1,250 Purchased Services for potential members to tour the facilities of the day center $2,886 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, an additional $6.35 million in capital contributions was required to meet regulatory capital requirements. 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 Due to technical issues with the software used to file the 2017 extension prior to deadline date, extension was unknowingly never finalized for submission to IRS. Fallon Health Weinberg has met all deadlines since inception and will continue to do so. The technical issue was discovered after the deadline date for the extension passed and has been resolved. We respectfully request that no late filing interest or penalties be assessed due to reasonable cause.