2018-11-16T14:28:09-06:00 2017-12-31 ERNST & YOUNG LLP 5 TIMES SQUARE NEW YORK NY 100366530 990 2017-01-01 113029569 Healthfirst Health Plan Inc % CRAIG BARATTIN-VP CONTROLLER HEAL 100 CHURCH ST FL 18 New York NY 100072601 JOHN BERMEL CFO 2128016000 2018-11-12 Laura Kielczewski P00740769 2127733000 2018-11-07 12.41.123.251 13966820183165000000 2018-11-12 P 48376AC60715834143EC7E8D06BB46C111BC8BCB E33A1571D2C37AC133723712033DBAF1EA8D7CD9 2017 2019-02-21 02:37:17Z PATRICIA J WANG 100 CHURCH ST FL 18 NEW YORK NY 100072601 2291139398 false X www.healthfirst.org X 1990 NY IMPROVE THE HEALTH AND WELL-BEING OF UN DERSERVED POPULATIONS BY PROVIDING AFFORDABLE QUALITY HEALTH PLANS TO ELIGIBLE MEDICARE,COMPLETECARE,FIDA&COMMERCIAL INSURANCE RECIPIENTS. 4 2 0 0 0 0 0 0 2237801213 2284126679 3993330 7012719 0 0 2241794543 2291139398 0 0 0 0 0 0 0 0 0 2235299601 2294732932 2235299601 2294732932 6494942 -3593534 831021649 778498574 529293275 468286175 301728374 310212399 IMPROVE THE HEALTH AND WELL-BEING OF UNDERSERVED POPULATIONS BY PROVIDING AFFORDABLE QUALITY HEALTH PLANS TO ELIGIBLE MEDICARE, COMPLETE CARE, FIDA & COMMERCIAL INSURANCE RECIPIENTS. false false 1777043380 1818689113 MEDICARE: HEALTHFIRST HEALTH PLAN, INC. (HFHP), IS INCORPORATED UNDER THE NOT-FOR-PROFIT LAW OF THE STATE OF NEW YORK AND IS LICENSED UNDER ARTICLE 44 OF THE PUBLIC HEALTH LAW OF THE STATE OF NEW YORK AS A HEALTH MAINTENANCE ORGANIZATION THAT PROVIDES ACCESS TO AFFORDABLE, QUALITY CARE THROUGH ITS NETWORK OF PARTICIPATING PROVIDERS AND HOSPITALS. HFHP PROVIDES HEALTH CARE SERVICES TO MEDICARE ADVANTAGE MEMBERS WHO ARE INDIGENT, AGED, DISABLED AND/OR MEDICALLY UNDERSERVED. IN 2017, THERE ARE APPROXIMATELY 86 PROVIDER ORGANIZATIONS WITH HFHP THAT SERVED 159,108 MEDICARE MEMBERS. 356952845 385460081 COMPLETECARE: HEALTHFIRST HEALTH PLAN, INC. (HFHP), IS INCORPORATED UNDER THE NOT-FOR-PROFIT LAW OF THE STATE OF NEW YORK AND IS LICENSED UNDER ARTICLE 44 OF THE PUBLIC HEALTH LAW OF THE STATE OF NEW YORK AS A HEALTH MAINTENANCE ORGANIZATION THAT PROVIDES ACCESS TO AFFORDABLE, QUALITY CARE THROUGH ITS NETWORK OF PARTICIPATING PROVIDERS AND HOSPITALS. HFHP PROVIDES HEALTH CARE SERVICES TO COMPLETE CARE MEMBERS. COMPLETECARE IS A MEDICAID ADVANTAGE PLUS SPECIAL NEEDS PLAN THAT COMBINES MEDICARE AND MEDICAID BENEFITS, WITH ADDED LONG-TERM CARE SERVICES FOR QUALIFIED DUAL-ELIGIBLE MEMBERS. IN 2017, THERE ARE APPROXIMATELY 59 PROVIDER ORGANIZATIONS WITH HFHP THAT SERVED 5,976 COMPLETE CARE MEMBERS. 74858824 79831922 Fully Integrated Duals Advantage Programs (FIDA): HEALTHFIRST HEALTH PLAN, INC. (HFHP), IS INCORPORATED UNDER THE NOT-FOR-PROFIT LAW OF THE STATE OF NEW YORK AND IS LICENSED UNDER ARTICLE 44 OF THE PUBLIC HEALTH LAW OF THE STATE OF NEW YORK AS A HEALTH MAINTENANCE ORGANIZATION THAT PROVIDES ACCESS TO AFFORDABLE, QUALITY CARE THROUGH ITS NETWORK OF PARTICIPATING PROVIDERS AND HOSPITALS. HFHP PROVIDES HEALTH CARE SERVICES TO FIDA MEMBERS, WHOSE BENEFIT CAN BE INTEGRATED AND CARE ACROSS THE MEDICARE AND MEDICAID PROGRAMS. IN 2017, THERE ARE APPROXIMATELY 57 PROVIDER ORGANIZATIONS WITH HFHP THAT SERVED 1,190 FIDA MEMBERS. HEALTHY NEW YORK : IN 2017 THERE ARE 36 HEALTHY NEW YORK MEMBERS AND APPROXIMATELY 10 PROVIDER ORGANIZATIONS. A PROGRAM OVERSEEN BY NY STATE DEPT. OF FINANCIAL SERVICES TO PROVIDE AFFORDABLE HEALTH CARE. 138845 145563 2208993894 false false false false false false false false false false false false true true false true true false false false false false false false false false false false true false false false false false false false false false false false false false true true true false true X 12657 0 false 0 false false false false false false X 4 2 false true false false false true true true true false false true true true true true true false false false NY X CRAIG BARATTIN-VP CONTROLLER 2128016000 100 CHURCH ST FL 18 NEW YORK NY 100072601 RICHARD MURCOTT - End 52517 BOARD DIRECOR-COMMUNITY REP. 1.0 0.0 X 0 0 0 JAY A SCHECHTMAN CHIEF MEDICAL OFFICER 1.0 40.0 X 0 1642737 126038 LINDA TIANO -BEG 2242017 CHIEF LEGAL OFFICER 1.0 40.0 X X 0 537294 90000 STEPHEN ROSENTHAL BOARD DIRECTOR 1.0 0.0 X 0 0 0 ERIC SCALETTAR BOARD DIRECTOR 1.0 0.0 X 0 0 0 PATRICIA J WANG CHIEF EXECUTIVE OFFICER 1.0 40.0 X 0 3105009 461430 DANIEL P MCCARTHY-END 63017 PRESIDENT & COO 1.0 40.0 X 0 2369180 200442 SEAN M NATARO SECRETARY 1.0 40.0 X 0 393329 33852 JOHN J BERMEL CHIEF FINANCIAL OFFICER 1.0 40.0 X 0 1157812 32944 PAUL E PORTSMORE JR SVP, GROWTH 1.0 40.0 X 0 739095 111900 REBECCA SCHWIETZ SVP CLINICAL SERVICES 1.0 40.0 X 0 596083 92197 GERALD T SWEENEY SVP CHIEF INFORMATION OFFICER 1.0 40.0 X 0 814400 140156 SEAN KANE CHIEF HR OFFICER 1.0 40.0 X 0 815602 106863 THOMAS E MEIXNER SVP Deliver System Engagement 1.0 40.0 X 0 542852 79190 ELIZABETH R ST CLAIR CHIEF LEGAL OFFICER 1.0 40.0 X 0 822455 278162 0 13535848 1753174 0 true true false CAREMARK LLC ONE CVS DRIVE WOONSOCKET RI 02895 PHARMACY 827881068 NEW YORK CITY HEALTH AND HOSPITAL C 125 WORTH STREET ROOM 514 NEW YORK NY 10013 MEDICAL/HOSPITAL 241070503 MONTEFIORE MEDICAL CENTER PO BOX 4296 CHURCH STREET STATION NEW YORK NY 10261 MEDICAL/HOSPITAL 157108011 NY PRESBYTERIAN HOSP-COLUMBIA PO BOX 6154 NEW YORK NY 10249 MEDICAL/HOSPITAL 85896225 MOUNT SINAI HOSPITAL 1 GUSTAVE L LEVY PLACE NEW YORK NY 10029 MEDICAL/HOSPITAL 67090679 1203 0 MEDICARE (INCLUDES PART D) 524114 1818689113 1818689113 COMPLETECARE (INCLUDES PART D) 524114 385460081 385460081 FIDA 524114 79831922 79831922 HEALTHY NY 524114 145563 145563 2284126679 7012719 7012719 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2291139398 2284126679 0 7012719 0 0 0 0 0 0 0 0 0 0 258500800 173195536 85305264 0 0 0 0 0 775692 419098 356594 6561484 6561484 306280 242567 64402 0 0 0 0 0 0 837598 824820 12778 0 0 0 HEALTHCARE SERVICE COSTS 1996296368 1996296368 MEDICAL ADMINISTRATIVE 31454710 31454021 689 2294732932 2208993894 85739038 0 0 0 221316525 136409460 0 0 63029438 61353164 0 0 0 0 0 0 0 0 0 0 0 0 346292166 435791051 0 0 0 0 0 0 200383520 144944899 831021649 778498574 466432598 382022489 0 0 0 8350627 0 0 0 0 0 0 0 0 0 0 62860677 77913059 529293275 468286175 X 301728374 310212399 0 0 0 0 301728374 310212399 831021649 778498574 X -3593534 -1204570 13282129 X X false true X true false INTEREST RECEIVABLE 2046947 PHARMACY REBATE RECEIVABLE 113047422 COVERAGE GAP DISCOUNT PROGRAM 3310129 MEDICARE NEGATIVE VENDOR BAL 5061136 MEDICARE D PLAN-TO-PLAN RECV 1386 OTHER CURRENT ASSETS/PREPAID 7122424 OTHER MEDICAL RECEIVABLE 3746077 SECURITY DEPOSIT - OTHER 147200 DUE FROM HEALTHFIRST OF NJ 23431 DUE FROM HFMS 638156 INVESTMENT IN AFFILIATE 9800591 144944899 0 DUE TO CMS 18454191 MEDICARE PART D DEPOSIT LIABIL 34274367 DUE TO 501(C)(3) AFFILIATE 4944440 NOTE PAYABLE TO RELATED PARTY 16623286 OTHER CURRENT LIABILITIES 3616775 77913059 2303216957 -1204570 13282129 12077559 2291139398 2291139398 2294732932 2294732932 2294732932 PART XI, LINE 2D - OTHER ADJUSTMENTS ADMINISTRATIVE CHARGES: $15,981,539. The health care services agreements with certain hospitals require that a portion of the premiums are retained as an administrative cost by Healthfirst Health Plan (HFHP), which represents the capital required for its statutory financial reserves. EQUITY LOSS FROM INVESTMENT IN AFFILIATE: ($2,699,410) represents 50% share of loss in Healthfirst Insurance Co. Inc. true true false false false false false false false JAY A SCHECHTMAN CHIEF MEDICAL OFFICER 446321 329148 867268 0 109860 0 16288 0 1768885 0 202731 LINDA TIANO -BEG 2242017 CHIEF LEGAL OFFICER 435865 95900 5529 0 90000 0 131 0 627425 0 0 PATRICIA J WANG CHIEF EXECUTIVE OFFICER 1243960 1005888 855161 0 456010 0 5532 0 3566551 0 389469 DANIEL P MCCARTHY-END 63017 PRESIDENT & COO 422404 965941 980835 0 195758 0 4836 0 2569774 0 461775 PAUL E PORTSMORE JR SVP, GROWTH 444537 239570 54988 0 111900 0 131 0 851126 0 54004 REBECCA SCHWIETZ SVP CLINICAL SERVICES 381493 198443 16147 0 73950 0 18378 0 688411 0 15207 GERALD T SWEENEY SVP CHIEF INFORMATION OFFICER 481668 304657 28075 0 122768 0 17528 0 954696 0 26564 SEAN KANE CHIEF HR OFFICER 427914 297433 90255 0 106863 0 138 0 922603 0 89271 SEAN M NATARO SECRETARY 304194 87446 1689 0 15605 0 18378 0 427312 0 0 JOHN J BERMEL CHIEF FINANCIAL OFFICER 611778 461625 84409 0 16200 0 16880 0 1190892 0 0 THOMAS E MEIXNER SVP Deliver System Engagement 361847 176118 4887 0 69821 0 9499 0 622172 0 0 ELIZABETH R ST CLAIR CHIEF LEGAL OFFICER 0 243212 579243 0 278162 0 151 0 1100768 0 0 SCHEDULE J, PART I, LINE 4A THE FOLLOWING INDIVIDUALS ENTERED INTO SEVERANCE AGREEMENTS AND/OR RECEIVED SEVERANCE PAYMENTS FROM HF MANAGEMENT SERVICES, LLC - AN AFFILIATE ORGANIZATION OF HEALTHFIRST. ELIZABETH ST. CLAIR - TOTAL SEVERANCE: $759,575, SEVERANCE PAID IN 2016: $107,120 SEVERANCE PAID IN 2017: $506,383 SEVERANCE DEFERRED: $146,072. DAN MCCARTHY - TOTAL SEVERANCE: $1,106,248, SEVERANCE PAID IN 2017: $340,384 SEVERANCE DEFERRED: $765,864 SCHEDULE J, PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE NON-QUALIFIED RETIREMENT PLAN PROVIDED BY HF MANAGEMENT SERVICES, LLC - A RELATED ORGANIZATION. THE AMOUNTS BELOW REPRESENT DISTRIBUTIONS FROM THE PLAN SPONSOR FOR 2017: PATRICIA J. WANG $850,820 DANIEL P. MCCARTHY $739,116 JAY A. SCHECHTMAN $865,756 GERALD T. SWEENEY $26,564 SEAN KANE $90,138 PAUL PORTSMORE $54,005 REBECCA SCHWIETZ $15,207 ELIZABETH R ST CLAIR $325,086. FORM 990, PART V, LINE 1c It has recently come to our attention that our processes for backup withholding were not fully effective. The Organization is currently making the necessary changes to those processes in order to ensure the proper backup withholding is taking place, when required. FORM 990, PART VI, SECTION A, LINE 3 HEALTHFIRST HEALTH PLAN INC. (HFHP), CONTRACTS WITH HF MANAGEMENT SERVICES, LLC (HFMS), A RELATED ORGANIZATION, TO PROVIDE ALL OF ITS MANAGEMENT AND ADMINISTRATIVE SERVICES. THE NOT-FOR-PROFIT ENTITY DOES NOT MAINTAIN ITS OWN STAFF OR OFFICE SPACE; THESE ARE PROVIDED BY HFMS. HFMS CHARGES A PERCENT OF PREMIUMS ON A PER MEMBER PER MONTH BASIS OR A FLAT FEE PER MEMBER PER MONTH. THE ARRANGEMENT IS APPROVED BY STATE REGULATORS. ALL OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES WERE PAID BY, AND WORKED FOR, HFMS A MANAGEMENT COMPANY WHICH PROVIDES MANAGEMENT SERVICES FOR MULTIPLE ENTITIES. NONE OF THE INDIVIDUALS LISTED EARNED ANY COMPENSATION FROM HFHP. FORM 990, PART VI, SECTION A, LINE 6 HEALTHFIRST HEALTH PLAN INC. HAS A SOLE CORPORATE MEMBER, WHICH IS HEALTHFIRST, INC. FORM 990, PART VI, SECTION A, LINE 7A HEALTHFIRST, INC., A RELATED NOT-FOR-PROFIT ORGANIZATION, HAS THE RIGHT TO APPOINT THE MEMBERS OF THE BOARD OF DIRECTORS OF HEALTHFIRST HEALTH PLAN, INC. FORM 990, PART VI, SECTION A, LINE 7B SOME DECISIONS OF THE GOVERNING BODY, SHOULD THEY OCCUR, ARE SUBJECT TO APPROVAL BY OTHER ENTITIES: * REPAYMENT OF THE ORGANIZATION'S DEBT OBLIGATIONS REQUIRES STATE REGULATORY APPROVAL * DISTRIBUTION OF THE ORGANIZATION'S NET ASSETS REQUIRES STATE REGULATORY APPROVAL * CERTAIN CHANGES TO PREMIUM RATES ARE SUBJECT TO FEDERAL OR STATE REGULATORY APPROVAL * EXPANSION TO OTHER MANAGED CARE BUSINESSES REQUIRES STATE LICENSURE * MANAGEMENT FEE RATE CHANGES REQUIRE APPROVAL FROM THE MANAGEMENT COMPANY AND STATE REGULATORS FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED BY THE HF MANAGEMENT SERVICES, LLC (HFMS) CORPORATE FINANCE DEPARTMENT STAFF AND THEN REVIEWED BY THE HFMS VICE PRESIDENT CONTROLLER AND TREASURER. SECONDARY REVIEWS ARE ALSO PERFORMED BY THE HFMS CHIEF LEGAL OFFICER AND CHIEF FINANCIAL OFFICER. THE DRAFT 990 IS THEN REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE DRAFT 990 IS THEN PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW. THE FINAL 990 IS SUBMITTED AFTER THE BOARD OF DIRECTORS REVIEWS IT. FORM 990, PART VI, SECTION B, LINE 12C A CONFLICT OF INTEREST DISCLOSURE STATEMENT IS COMPLETED ANNUALLY BY EACH BOARD MEMBER, OFFICER AND KEY EMPLOYEE. A NOMINATED BOARD MEMBER WHO DOES NOT COMPLETE THE STATEMENT WITHIN THE CALENDAR YEAR WILL NOT BE PERMITTED TO CARRY OUT DUTIES. THE SAME APPLIES TO AN OFFICER OR KEY EMPLOYEE WHO DOES NOT COMPLETE THE APPROPRIATE DISCLOSURES. ANY DISCLOSURE OF A CONFLICT OR POTENTIAL CONFLICT IS REVIEWED BY THE CHIEF COMPLIANCE OFFICER. CONFLICTS ARE ADDRESSED BY EXAMINING THE RELATIONSHIP OF THE INDIVIDUAL TO THE ORGANIZATION AND THE NATURE OF THE DISCLOSURE. A REPORT OF ANY CONFLICTS IS PREPARED FOR DISCUSSION WITH AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS OF HEALTHFIRST, INC., THE NOT FOR PROFIT CORPORATE PARENT, AS WELL AS THE FULL BOARD OF DIRECTORS OF HEALTHFIRST HEALTH PLAN, INC. AS APPROPRIATE. GUIDANCE IS PROVIDED TO THE NECESSARY PARTIES AND ACTION IS TAKEN, INCLUDING BUT NOT LIMITED TO DISCLOSURE AND RECUSAL FROM DECISION-MAKING, MODIFICATIONS TO BUSINESS AGREEMENTS, CHANGES IN VENDORS OR REPLACEMENT OF THE DIRECTOR, OFFICER OR KEY EMPLOYEE WITH A NON-CONFLICTED INDIVIDUAL. FORM 990, PART VI, SECTION B, LINE 15 BECAUSE THE REPORTING ORGANIZATION DID NOT COMPENSATE ANY OFFICERS OR EMPLOYEES, THE ORGANIZATION HAS RESPONDED "NO." HOWEVER, THE COMPENSATION OF THE CEO, OTHER OFFICERS AND KEY EMPLOYEES IS DETERMINED BY THE COMPENSATION COMMITTEE OF HF MANAGEMENT SERVICES, LLC, THE MANAGEMENT COMPANY THAT PROVIDES ALL SERVICES TO HFHP (A RELATED ORGANIZATION). THE COMMITTEE CONSISTS ONLY OF HFMS MEMBER HOSPITAL DIRECTORS (WHO ARE NOT EMPLOYED NOR COMPENSATED BY HFMS OR ANY OF ITS AFFILIATES). THE PROCESS FOR DETERMINING COMPENSATION IS DESCRIBED IN THE COMMITTEES CHARTER. THE PROCESS INCLUDES ENGAGEMENT OF AN OUTSIDE HUMAN RESOURCES CONSULTING FIRM TO CONDUCT A COMPARABILITY ANALYSIS. THE ANALYSIS INCLUDES COMPARABLE RANGES OF EXECUTIVE COMPENSATION USING THE COMPANY'S INDUSTRY CLASSIFICATION. THE COMMITTEE MEETS PRIOR TO IMPLEMENTATION OF ANY CHANGE IN COMPENSATION. CONTEMPORANEOUS MINUTES OF EACH MEETING ARE PREPARED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC BY PROVIDING COPIES ON REQUEST FOR INSPECTION AT ITS CORPORATE OFFICES. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS - ADMINISTRATIVE CHARGES: $15,981,539 and EQUITY LOSS IN INVESTMENT IN HEALTHFIRST INSURANCE CO. INC. - A 50% OWNED SUBSIDIARY : ($2,699,410). TOTAL OTHER CHANGES IN NET ASSETS -$13,282,129. FORM 990, PART XII, LINE 2C THE SELECTION OF THE INDEPENDENT AUDITOR IS ADMINISTERED BY THE AUDIT RISK AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS OF HEALTHFIRST, INC. (A RELATED ORGANIZATION). HEALTHFIRST PHSP INC 100 CHURCH ST FL 18 NEW YORK NY 10007 133783732 MANAGED CARE NY 501 (C)3 10 HEALTHFIRST true HEALTHFIRST INC 100 CHURCH ST FL 18 NEW YORK NY 10007 133714932 MANAGED CARE NY 501 (C)3 12 Type I N/A false HEALTHFIRST HEALTH PLAN OF NJ INC 1 WASHINGTON ST STE 1405 NEWARK NJ 07102 510609967 MANAGED CARE NJ 501 (C)4 HF MGMT SVCS true SENIOR HEALTH PARTNERS INC 100 CHURCH STREET 18FL NEW YORK NY 10007 134103882 MGD LT CARE NY 501 (C)3 10 HF MGMT SVCS true HF Managmt SCVSLLC 100 CHURCH ST FL 18 NEW YORK NY 100072601 134069806 3RD PTY ADM SCVS NY NA false 0 HF ADMINISTRATIVE SERVICES INC 100 CHURCH ST FL 18 NEW YORK NY 100072601 133873482 3RD PTY ADM SCVS NY HF MGMT SVCS C CORP true HEALTHFIRST INSURANCE COMPANY INC 100 CHURCH STREET FL 18 New York NY 100072601 464545744 Insur. Provider NY NA C corp false false false false false true false false false false false false false true false false false false true false HF MANAGEMENT SERVICES LLC E 16623286 CONTRACT-COST HF MANAGEMENT SERVICES LLC M 258500800 COST HEALTHFIRST PHSP INC R 50871137 ACTUAL AMOUNT FORM 990, SCHEDULE R, PART V, LINE 2 METHOD OF DETERMINING AMOUNT INVOLVED ITEM (1): THE AMOUNT REPRESENTS THE BALANCE OUTSTANDING, INCLUDING INTEREST ACCRUED AND UNPAID, AT DECEMBER 31, 2017. ITEM (2): THE AMOUNT REPRESENTS THE EXPENSES INCURRED AND PAID OR DUE TO THE RELATED ORGANIZATION FOR SERVICES RENDERED BASED ON CONTRACTED RATES APPROVED BY RESOLUTION OF THE BOARD OF DIRECTORS AND STATE REGULATORS. ITEM (3): In accordance with HFHPs contractual arrangements and upon approval by the Boards of Directors of HFHP, Healthfirst PHSP, Inc. ("PHSP"), an affiliated company, and Healthfirst, a Members risk-sharing contract balance in HFHP may be offset by or may be used to offset a percentage of that Members risk-sharing contract balance in PHSP through an intercompany transfer. The current policies permit the offsetting of any deficits that may accrue in the hospital risk-sharing contracts maintained by HFHP or PHSP on behalf of a Member hospital, including affiliate institutions, for surpluses from any line of business up to 50% of surpluses that may accrue, and would otherwise be distributed to a Member hospital or affiliate institution by either PHSP or HFHP.