2018-06-25T11:16:21-05:00 2017-12-31 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2017-01-01 113153422 NEW YORK STATE CATHOLIC HEALTH PLAN INC NEWY 7183936403 95-25 QUEENS BOULEVARD REGO PARK NY 113744510 PATRICK J FRAWLEY CHIEF EXECUTIVE OFFICER 7183936403 2018-06-08 1 CHRISTINE KAWECKI P00743140 5169187000 2018-06-06 2017 2022-09-23 18:48:47Z FIDELIS CARE NEW YORK PATRICK J FRAWLEY 95-25 QUEENS BOULEVARD REGO PARK NY 113744510 10901776524 0 X WWW.FIDELISCARE.ORG X 1993 NY SEE SCHEDULE O. 18 18 4468 0 0 0 896865 415749 8407238664 9692298442 15301767 55522502 14901768 25519534 8438339064 9773756227 4937087 5184210 7694782844 8893847473 263733378 342970670 0 0 0 163804432 219978558 8127257741 9461980911 311081323 311775316 3370300258 4275726392 1600301484 2154215164 1769998774 2121511228 X SEE SCHEDULE O. 0 0 5476254260 3399926 5916471228 MEDICAID MANAGED CARE PROGRAM ("MEDICAID") IS A NEW YORK STATE PROGRAM ADMINISTERED BY FIDELIS THAT PROVIDES FREE COMPREHENSIVE HEALTH COVERAGE FOR ELIGIBLE INDIVIDUALS AND FAMILIES WHO ARE RESIDENTS OF NEW YORK STATE AND HAVE LOW INCOME AND LIMITED RESOURCES.THE NEW YORK STATE DEPARTMENT OF HEALTH ESTABLISHES ELIGIBILITY CRITERIA WITH REGARD TO INCOME (IN RELATION TO A PERCENTAGE OF THE FEDERAL POVERTY LEVEL), RESIDENCY, RESOURCES, AGE, AND IMMIGRATION STATUS, AMONG OTHER FACTORS, AND ELIGIBILITY FOR THE PROGRAM IS DETERMINED BASED ON INCOME, RESOURCES, AND FAMILY SIZE.AS OF DECEMBER 31, 2017, THE PLAN SERVED APPROXIMATELY 1,207,300 MEDICAID BENEFICIARIES. 941977700 53723 1082402987 FIDELIS CARE AT HOME IS A MEDICAID LONG-TERM CARE CAPITATED PROGRAM WITH THE NEW YORK STATE DEPARTMENT OF HEALTH WHICH PROVIDES AN ARRAY OF HOME, COMMUNITY, AND INSTITUTIONALLY BASED, LONG-TERM CARE SERVICES TO PERSONS WHO ARE ELIGIBLE FOR MEDICAID AND WHO HAVE BEEN CERTIFIED AS APPROPRIATE CANDIDATES FOR NURSING HOME PLACEMENT. AS OF DECEMBER 31, 2017, THE PLAN SERVED APPROXIMATELY 20,400 FIDELIS CARE AT HOME PROGRAM BENEFICIARIES. 892676786 183213 920296727 MEDICARE ADVANTAGE PROGRAM IS A PROGRAM AVAILABLE TO ADULTS AGED 65 AND OVER WHO ARE ELIGIBLE UNDER MEDICARE. BENEFICIARIES MAY CHOOSE TO USE PRIVATE PAY OPTIONS, ESTABLISH MEDICAL SAVINGS ACCOUNT, USE MANAGED CARE PLANS SUCH AS FIDELIS, OR JOIN PROVIDER-SPONSORED PLAN.AS OF DECEMBER 31, 2017, THE PLAN SERVED APPROXIMATELY 67,000 MEDICARE ADVANTAGE PROGRAM BENEFICIARIES. 1588122937 1547348 1798647034 OTHER PROGRAMS ADMINISTERED BY THE PLAN INCLUDE THE CHILD HEALTH PLUS PROGRAM, MEDICARE/MEDICAID DUAL ADVANTAGE PROGRAM, MEDICAID ADVANTAGE PLUS PROGRAM, THE NEW YORK HEALTH BENEFIT EXCHANGE PROGRAM ("HEALTH BENEFIT EXCHANGE"), THE FULLY INTEGRATED DUALS ADVANTAGE ("FIDA") PROGRAM, HEALTH AND RECOVERY PLAN ("HARP") PROGRAM, AND THE ESSENTIAL PLAN PROGRAM. CHILD HEALTH PLUS PROGRAM IS A PROGRAM THAT COVERS UNINSURED CHILDREN UNDER THE AGE OF 19, WHO ARE RESIDENTS OF NEW YORK STATE AND ARE NOT ELIGIBLE FOR MEDICAID. AS OF DECEMBER 31, 2017, THE PLAN SERVED APPROXIMATELY 113,800 CHILD HEALTH PLUS PROGRAM BENEFICIARIES.MEDICARE/MEDICAID DUAL ADVANTAGE IS A PROGRAM FOR THOSE WHO MEET ELIGIBILITY REQUIREMENTS FOR BOTH MEDICARE AND MEDICAID AND ARE ENROLLED IN BOTH PROGRAMS. AS OF DECEMBER 31, 2017, THE PLAN SERVED APPROXIMATELY 1,400 MEDICARE/MEDICAID DUAL ADVANTAGE PROGRAM BENEFICIARIES.MEDICAID ADVANTAGE PLUS IS A FULL-RISK MANAGED LONG-TERM CARE PROGRAM FOR INDIVIDUALS 18 YEARS OF AGE AND OLDER WITH MEDICARE AND MEDICAID COVERAGE WHO HAVE A CHRONIC ILLNESS OR DISABILITY. MEMBERS MUST BE IN NEED OF LONG-TERM CARE SERVICES AND MAY NEED CARE TYPICALLY GIVEN IN A NURSING HOME. AS OF DECEMBER 31, 2017, THE PLAN SERVED APPROXIMATELY 100 MEDICAID ADVANTAGE PLUS PROGRAM BENEFICIARIES. HEALTH BENEFIT EXCHANGE IS A PROGRAM PROVIDING HEALTH COVERAGE TO INDIVIDUALS UNDER THE HEALTH CARE REFORM ACT. AS OF DECEMBER 31, 2017, THE PLAN SERVED APPROXIMATELY 69,600 HEALTH BENEFIT EXCHANGE BENEFICIARIES. FIDA PROGRAM IS A PLAN DESIGNED TO PROVIDE MANAGED CARE TO INDIVIDUALS WHO HAVE BOTH MEDICARE AND MEDICAID. THE FIDA PLAN ALLOWS THE INDIVIDUAL'S MEDICARE AND MEDICAID BENEFITS TO BE COVERED AND MANAGED UNDER ONE PLAN, INCLUDING LONG-TERM CARE NEEDS, SUPPORTS AND PRESCRIPTION DRUGS. THE FIDA PROGRAM ENDED ON DECEMBER 31, 2017 WITH 300 BENEFICIARIES.HARP PROGRAM IS A MEDICAID PROGRAM THAT PROVIDES CARE MANAGEMENT SERVICES TO INDIVIDUALS ELIGIBLE FOR MEDICAID REQUIRING BEHAVIORAL HEALTH SERVICES. AS OF DECEMBER 31, 2017, THE PLAN SERVED APPROXIMATELY 27,000 HARP BENEFICIARIES.ESSENTIAL PLAN IS A PROGRAM THAT PROVIDES MINIMUM ESSENTIAL COVERAGE TO QUALIFIED INDIVIDUALS WHO ARE NOT ELIGIBLE FOR MEDICAID OR THE CHILD HEALTH PLUS PROGRAMS. AS OF DECEMBER 31, 2017, THE PLAN SERVED APPROXIMATELY 157,000 ESSENTIAL PLAN BENEFICIARIES. 1588122937 1547348 1798647034 8899031683 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 17214 0 1 4468 1 0 0 0 0 0 0 0 0 0 0 X 18 18 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X ANNE C KONTOPOULOS 7183936403 95-25 QUEENS BLVD REGO PARK NY 113744510 X KARL P ADLER MD DIRECTOR 1.00 0.00 X 0 0 0 JACK BALINSKY DIRECTOR 1.00 0.00 X 0 0 0 M WILLIAM BENEDETTO DIRECTOR 1.00 0.00 X 0 0 0 SR PATRICIA BURKARD DIRECTOR/SECRETARY 1.00 0.00 X X 0 0 0 JAMES M CORRIGAN DIRECTOR 1.00 0.00 X 0 0 0 REVEREND JOHN COUGHLIN DIRECTOR 1.00 0.00 X 0 0 0 THOMAS F DOODIAN DIRECTOR 1.00 0.00 X 0 0 0 REVEREND DONALD J HARRINGTON CHAIRMAN OF THE BOARD 1.00 0.00 X X 0 0 0 JOHN J HURLEY DIRECTOR 1.00 0.00 X 0 0 0 THOMAS L KELLY DIRECTOR 1.00 0.00 X 0 0 0 DONNA O' BRIEN DIRECTOR 1.00 0.00 X 0 0 0 REVEREND LEO J O'DONOVAN DIRECTOR 1.00 0.00 X 0 0 0 GINO J PAZZAGLINI DIRECTOR/VICE-CHAIRMAN 1.00 0.00 X X 0 0 0 JOHN RYDZEWSKI DIRECTOR 1.00 0.00 X 0 0 0 JOSEPH SLAVIK DIRECTOR (THRU OCT. 2017) 1.00 0.00 X 0 0 0 DEACON FRANK J THOMAS MD DIRECTOR 1.00 0.00 X 0 0 0 MARY THOMPSON DIRECTOR 1.00 0.00 X 0 0 0 MICHAEL J TOOLEY DIRECTOR 1.00 0.00 X 0 0 0 JOHN A WERWAISS DIRECTOR/TREASURER 1.00 0.00 X X 0 0 0 PATRICK J FRAWLEY CEO 37.50 0.00 X 5496616 0 162545 DAVID THOMAS PRESIDENT & COO 34.70 2.80 X 1823483 92192 86482 THOMAS HALLORAN EVP & CHIEF FINANCIAL OFFICER 33.75 3.75 X 761088 85736 363173 PAMELA HASSEN CHIEF MARKETING OFFICER 37.50 0.00 X 4275328 0 61599 MARTIN KREBS CHIEF INFORMATION OFFICER 37.50 0.00 X 562888 0 230133 SANTO RUSSO CHIEF LEGAL OFFICER 33.75 3.75 X 609565 68915 272923 THOMAS BROWN CHIEF ADMINISTRATIVE OFFICER 37.50 0.00 X 575638 0 182858 ROBERT FAZZOLARI SVP, GOV'T RELATIONS & CORP. COMP. 37.50 0.00 X 515193 0 29762 SANJIV SHAH MD FMR CHIEF MED. OFF. (THRU MAY 2017) 32.80 4.70 X 275432 39356 31639 14895231 286199 1421114 527 1 1 0 COTIVITI DOMESTIC HOLDINGS INC 50 DANBURY ROAD WILTON CT 06897 MEDICAL CLAIMS REVIEW 14153858 AARETE LLC 8574 SOLUTION CENTER CHICAGO IL 606778005 CONSULTING/COST SAVINGS 8996359 HEALTH MANAGEMENT SYSTEMS INC PO BOX 27151 NEW YORK NY 10087 COORDINATION OF BENEFITS REVIEW 4713163 DELOITTE CONSULTING LLP 4022 SELLS DR HERMITAGE TN 37076 CONSULTING 4696043 NORTON ROSE FULBRIGHT US LLP 1301 MCKINNEY SUITE 5100 HOUSTON TX 770103095 LEGAL 3105539 79 25000 293706 97043 415749 MEDICAID 524114 5916471228 5916471228 FIDELIS CARE AT HOME 524114 1082402987 1082402987 MEDICARE ADVANTAGE 524114 920296727 920296727 ESSENTIAL PLAN 524114 602478643 602478643 HARP 524114 577245277 577245277 593403580 593403580 9692298442 34066417 34066417 1149476382 1128020297 21456085 21456085 21456085 VBP QIP & OTHER ADMIN 524298 25345370 25345370 EQUITY FROM SUBSIDIARY 900099 131496 131496 PURCHASE REBATES 524298 11904 11904 30764 30764 25519534 9773756227 9717817976 0 55522502 X 4884420 4884420 299790 299790 8893847473 8893847473 8443819 8443819 270891360 270891360 7860122 7860122 36072287 36072287 19703082 19703082 3884414 3884414 1365433 1365433 88869 88869 972975 972975 30916122 30916122 20148038 20148038 3364020 3364020 23237608 23237608 11518794 11518794 4512426 4512426 965798 965798 2473736 2473736 34570481 34570481 1414629 1414629 CLAIMS PROCESSING 22722111 22722111 POSTAGE AND SHIPPING 9400852 9400852 TELEPHONE EXPENSE 5550777 5550777 PRINTING AND PUBLICATIO 4784764 4784764 38086711 38086711 9461980911 8899031683 562949228 0 69579692 87994994 1720092292 2309422521 203708261 209850337 124910660 101271384 363373276 153267659 57486951 210105617 650604208 748498315 46486899 31615519 269092 420366 15849778 15849778 481312425 560697561 3370300258 4275726392 187631041 246349322 14245393 30784525 100000000 85714286 1298425050 1791367031 1600301484 2154215164 X 1769344153 2119731353 654621 1779875 1769998774 2121511228 3370300258 4275726392 311775316 39737138 0 X 0 1 X 1 1 1 X 353245 196215 470690 896865 415749 2332764 4086015198 5282714979 6469839473 8422090289 9717643812 33978303751 4086368443 5282911194 6470310163 8422987154 9718059561 33980636515 0 0 0 33980636515 11866741 18001330 16525457 21015784 34066417 101475729 11866741 18001330 16525457 21015784 34066417 101475729 153519 209418 -10983 50142 174164 576260 4098388703 5301121942 6486824637 8444053080 9752300142 34082688504 0.99700 0.99720 0.00300 0.00280 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 88869 88869 0 PART II-B, LINE 1: FIDELIS IS A MEMBER OF CERTAIN ASSOCIATIONS, TO WHICH IT PAYS ANNUAL DUES. A PORTION OF THOSE DUES ARE DETERMINED TO BE EXPENDITURES FOR LOBBYING PURPOSES. IN 2017, THAT PORTION WAS $88,869. 26562244 26562244 113716659 2186769 111529890 26423581 12817708 13605873 16226098 13723578 2502520 180444694 124539604 55905090 210105617 OTHER RECEIVABLES 14818996 PHARMACY RECEIVABLES 96398183 ASSETS WHOSE USE IS LIMITED (RESTRICTED FUNDS) - CURRENT 33160 ASSETS WHOSE USE IS LIMITED (RESTRICTED FUNDS) 449447222 560697561 CAPITAL LEASE PAYABLE 1 CLAIMS PAYABLE 1361667109 DUE TO THIRD PARTIES 429699921 1791367031 9813070603 39737138 -422762 39314376 9773756227 0 9773756227 9461558149 -422762 -422762 9461980911 0 9461980911 PART XI, LINE 2D - OTHER ADJUSTMENTS: EQUITY INVESTMENT IN SALUS ADMINISTRATIVE SERVICES, INC. ("SALUS") -131,496. SALUS CONTRIBUTION ELIMINATED IN CONSOLIDATION -25,000. GOVERNMENT GRANTS -293,706. SALUS INTEREST INCOME ELIMINATED IN CONSOLIDATION 27,440. PART XII, LINE 2D - OTHER ADJUSTMENTS: EQUITY INVESTMENT IN SALUS ADMINISTRATIVE SERVICES, INC. ("SALUS") -131,496. SALUS CONTRIBUTION ELIMINATED IN CONSOLIDATION -25,000. GOVERNMENT GRANTS -293,706. SALUS INTEREST INCOME ELIMINATED IN CONSOLIDATION 27,440. 1 1199SEIU HOME CARE INDUSTRY EDUCATION 330 WEST 42ND STREET NEW YORK NY 10036 711028611 501(C)(3) 5000 CASH PART IV, SUPPLEMENTAL INFORMATION ALICE HYDE MEDICAL CENTER 133 PARK STREET MALONE NY 12953 150346515 501(C)(3) 2500 CASH PART IV, SUPPLEMENTAL INFORMATION AMAUS HEALTH SERVICES AT THE CATHEDRAL OF THE IMMACULATE CONCEPTION 259 EAST ONONDAGA STREET SYRACUSE NY 13202 611548780 501(C)(3) 30000 CASH PART IV, SUPPLEMENTAL INFORMATION CARDINAL EDWARD M EGAN PAVILION OF THE ST JOHN VIANNEY CLERGY RESIDENCE 5655 ARLINGTON AVENUE BRONX NY 10471 133089351 501(C)(3) 950000 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC CHARITIES DIOCESE OF OGDENSBURG 6866 STATE HIGHWAY 37 OGDENSBURG NY 13669 150614025 501(C)(3) 200500 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC CHARITIES OF BUFFALO 741 DELAWARE AVENUE BUFFALO NY 14209 160743251 501(C)(3) 413000 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC CHARITIES OF FULTON & MONTGOMERY 55 EAST MAIN STREET JOHNSTOWN NY 12095 141340033 501(C)(3) 6000 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC CHARITIES OF LIVINGSTON COUNTY 34 EAST STATE STREET MT MORRIS NY 14510 205493091 501(C)(3) 15000 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC CHARITIES OF STEUBEN COUNTY 23 LIBERTY STREET BATH NY 14810 300553416 501(C)(3) 15000 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC CHARITIES OF THE ARCHDIOCESE OF TEXAS 2900 LOUISIANA STREET HOUSTON TX 77006 741109733 501(C)(3) 13340 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC CHARITIES OF THE DIOCESE OF ALBANY 40 NORTH MAIN AVENUE ALBANY NY 12203 141340033 501(C)(3) 380000 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC CHARITIES OF THE DIOCESE OF BROOKLYN 191 JORALEMON ST 4TH FLOOR BROOKLYN NY 11201 112047151 501(C)(3) 361000 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC CHARITIES OF THE DIOCESE OF ROCHESTER 1150 BUFFALO RD ROCHESTER NY 14624 160743944 501(C)(3) 235500 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC CHARITIES OF THE DIOCESE OF ROCKVILLE CENTRE 90 CHERRY LANE HICKSVILLE NY 11801 111843801 501(C)(3) 386000 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC CHARITIES OF THE DIOCESE OF SYRACUSE 240 EAST ONONDAGA STREET SYRACUSE NY 13202 150532085 501(C)(3) 315280 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC CHARITIES OF THE FINGER LAKES 94 EXCHANGE STREET GENEVA NY 14456 142005241 501(C)(3) 15000 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC CHARITIES OF TOMPKINSTIOGA 324 WEST BUFFALO STREET ITHACA NY 14850 510621633 501(C)(3) 15000 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC CHARITIES OF WAYNE COUNTY 1141 EAST UNION STREET NEWARK NY 14513 204649120 501(C)(3) 15000 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC MEDICAL MISSION BOARD INC 100 WALL STREET 9TH FLOOR NEW YORK NY 10005 135602319 501(C)(3) 40000 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC MIGRATION SERVICES 191 JORALEMON ST 4TH FLOOR BROOKLYN NY 11201 112634818 501(C)(3) 500000 CASH PART IV, SUPPLEMENTAL INFORMATION CATHOLIC SCHOOLS IN THE ARCHDIOCESE OF NEW YORK 1011 FIRST AVENUE NEW YORK NY 10022 530196617 501(C)(3) 90000 CASH PART IV, SUPPLEMENTAL INFORMATION CHARLES B WANG COMMUNITY HEALTH CENTER 268 CANAL STREET NEW YORK NY 10013 132739694 501(C)(3) 10000 CASH PART IV, SUPPLEMENTAL INFORMATION COLUMBIA MEMORIAL HOSPITAL 71 PROSPECT AVENUE HUDSON NY 12534 141338373 501(C)(3) 5000 CASH PART IV, SUPPLEMENTAL INFORMATION COMMUNITY ENRICHMENT NETWORK TOWARDS EMPOWERMENT 50 WEST BROAD STREET HAVERSTRAW NY 10927 455233944 501(C)(3) 15000 CASH PART IV, SUPPLEMENTAL INFORMATION CORTLAND CHENANGO RURAL SERVICES INC 2704 LOWER CINCINNATUS RD PO BOX 57 57 CINCINNATUS NY 13040 455599324 501(C)(3) 16000 CASH PART IV, SUPPLEMENTAL INFORMATION DIOCESE OF BUFFALO 795 MAIN STREET BUFFALO NY 14203 160743984 501(C)(3) 60000 CASH PART IV, SUPPLEMENTAL INFORMATION DIOCESE OF OGDENSBURG 100 ELIZABETH STREET OGDENSBURG NY 13669 150532120 501(C)(3) 60000 CASH PART IV, SUPPLEMENTAL INFORMATION DIOCESE OF ROCHESTER- DEPARTMENT OF CATHOLIC SCHOOLS 1150 BUFFALO ROAD ROCHESTER NY 14624 160743944 501(C)(3) 60000 CASH PART IV, SUPPLEMENTAL INFORMATION DIOCESE OF ROCKVILLE CENTRE 128 CHERRY LANE HICKSVILLE NY 11801 300868138 501(C)(3) 60000 CASH PART IV, SUPPLEMENTAL INFORMATION DIOCESE OF SYRACUSE CATHOLIC SCHOOLS 240 E ONONDAGA STREET SYRACUSE NY 13207 150532137 501(C)(3) 60000 CASH PART IV, SUPPLEMENTAL INFORMATION FOOD BANK OF WESTERN NEW YORK INC 91 HOLT STREET BUFFALO NY 14206 222470820 501(C)(3) 44000 CASH PART IV, SUPPLEMENTAL INFORMATION FRANCISCAN NORTHSIDE MINISTRIES 812 NORTH SALINA STREET SYRACUSE NY 13208 150532104 501(C)(3) 28720 CASH PART IV, SUPPLEMENTAL INFORMATION LONG ISLAND HEADSTART 98 AUSTIN STREET PATCHOGUE NY 11772 112771919 501(C)(3) 15000 CASH PART IV, SUPPLEMENTAL INFORMATION MATERNITY & EARLY CHILDHOOD FOUNDATION INC 40 NORTH MAIN AVENUE ALBANY NY 12203 141650131 501(C)(3) 50000 CASH PART IV, SUPPLEMENTAL INFORMATION MORRIS HEIGHTS HEALTH CENTER 85 WEST BURNSIDE AVENUE BRONX NY 10453 061081232 501(C)(3) 5000 CASH PART IV, SUPPLEMENTAL INFORMATION PS 130 M PARENTS ASSOCIATION 143 BAXTER STREET NEW YORK NY 10013 200766928 501(C)(3) 5000 CASH PART IV, SUPPLEMENTAL INFORMATION REGIONAL FOOD BANK 965 ALBANY - SHAKER RD LATHAM NY 12110 222470885 501(C)(3) 44000 CASH PART IV, SUPPLEMENTAL INFORMATION ROMAN CATHOLIC DIOCESE OF BROOKLYN 310 PROSPECT PARK WEST BROOKLYN NY 11215 111631807 501(C)(3) 90000 CASH PART IV, SUPPLEMENTAL INFORMATION SCHENECTADY FAMILY HEALTH SERVICES INC 1044 STATE STREET SCHENECTADY NY 12307 141636222 501(C)(3) 7500 CASH PART IV, SUPPLEMENTAL INFORMATION SCHOOLS OF THE ROMAN CATHOLIC CHARITIES DIOCESE OF ALBANY 40 NORTH MAIN AVENUE ALBANY NY 12203 141605502 501(C)(3) 60000 CASH PART IV, SUPPLEMENTAL INFORMATION SEAMEN'S SOCIETY FOR CHILDREN & FAMILIES 50 BAY STREET STATEN ISLAND NY 10301 135563010 501(C)(3) 12000 CASH PART IV, SUPPLEMENTAL INFORMATION ST ELIZABETH MEDICAL FOUNDATION 2209 GENESEE STREET UTICA NY 13501 222562170 501(C)(3) 7580 CASH PART IV, SUPPLEMENTAL INFORMATION ST JOSEPH'S HOME 950 LINDEN STREET OGDENSBURG NY 13669 150532217 501(C)(3) 69000 CASH PART IV, SUPPLEMENTAL INFORMATION THE ALFRED E SMITH MEMORIAL FOUNDATION 1011 FIRST AVE SUITE 1400 NEW YORK NY 10022 131553263 501(C)(3) 30000 CASH PART IV, SUPPLEMENTAL INFORMATION THE CHILDREN'S FOUNDATION OF ASTOR 6339 MILL STREET RHINEBECK NY 12572 223056183 501(C)(3) 5000 CASH PART IV, SUPPLEMENTAL INFORMATION THE DOOR - A CENTER OF ALTERNATIVES INC 121 AVENUE OF THE AMERICAS NEW YORK NY 10013 136127348 501(C)(3) 5000 CASH PART IV, SUPPLEMENTAL INFORMATION THE FOUNDATION FOR ELLIS MEDICINE 1101 NOTT STREET SCHENECTADY NY 12308 141638957 501(C)(3) 7500 CASH PART IV, SUPPLEMENTAL INFORMATION THE POINT COMMUNITY DEVELOPMENT 940 GARRISON AVENUE BRONX NY 10474 133765140 501(C)(3) 10000 CASH PART IV, SUPPLEMENTAL INFORMATION UNITED HOSPITAL FUND OF NEW YORK INC 1411 BROADWAY 12TH FLOOR NEW YORK NY 10018 131562656 501(C)(3) 10000 CASH PART IV, SUPPLEMENTAL INFORMATION WESTHAB INC 8 BASHFORD STREET YONKERS NY 10701 061064281 501(C)(3) 10000 CASH PART IV, SUPPLEMENTAL INFORMATION WHITNEY M YOUNG JR HEALTH CENTER INC 920 LARK DRIVE ALBANY NY 12207 132922147 501(C)(3) 10000 CASH PART IV, SUPPLEMENTAL INFORMATION WILLIAM F RYAN COMMUNITY HEALTH CENTER 110 WEST 97TH STREET NEW YORK NY 10025 132884976 501(C)(3) 5000 CASH PART IV, SUPPLEMENTAL INFORMATION YOUNG MEN'S CHRISTIAN ASSOCIATION OF CORTLAND 22 TOMPKINS STREET CORTLAND NY 13045 150533570 501(C)(3) 5000 CASH PART IV, SUPPLEMENTAL INFORMATION 53 0 HEALTHY KIDS FUND 31553 299790 0 CASH PAID N/A PART I, LINE 2: RECIPIENTS OF GRANT AWARDS UNDER THE COMMUNITY GRANT FUND ARE REQUIRED TO PROVIDE PERIODIC UPDATES ON THE ACCOMPLISHMENTS OF THE GRANT AND DISBURSEMENTS. IT IS THE RESPONSIBILITY OF THE GRANT RECIPIENT TO ENSURE THAT THE GRANT IS USED FOR THE PURPOSE(S) STATED IN THE ORIGINAL APPLICATION. FIDELIS MONITORS GRANT USAGE BY CORRESPONDENCE, TELEPHONE OR SITE VISITS. AN EVALUATION OF THE PROJECT IS REQUIRED UPON THE GRANTEE'S COMPLETION. NON-COMPLIANCE WITH THESE GUIDELINES MAY RESULT IN A REQUEST FOR RETURN OF THE FUNDS IN QUESTION OR INELLIGIBILITY OF THE ORGANIZATION FOR FUTURE GRANTS FROM FIDELIS. PART II, COLUMN H: SINCE 2004, THE PURPOSE OF THE FIDELIS CARE COMMUNITY GRANT FUND IS TO OFFER SUPPORT ANNUALLY THROUGH CHARITABLE CONTRIBUTIONS TO SELECTED TAX-EXEMPT NONPROFIT ORGANIZATIONS THAT SHARE SIMILAR MISSIONS AND VALUES OF SERVICE TO LOW-INCOME VULNERABLE INDIVIDUALS. PROPOSALS ARE EVALUATED ON THEIR RELEVANCE TO FIDELIS' MISSION OF CARING FOR THE NEEDS AND CONCERNS OF THE POOR AND MEDICALLY UNDERSERVED IN CONSULTATION WITH FIDELIS' MEMBERS. THE TOTAL AMOUNT TO BE DISTRIBUTED EACH YEAR IS APPROVED BY THE BOARD OF DIRECTORS AND DISTRIBUTED IN ACCORDANCE WITH THE APPROVED BOARD POLICY. IN ADDITION TO THE GRANTS MADE THROUGH ITS COMMUNITY GRANT FUND, FIDELIS PROVIDES SUPPORT THROUGH CHARITABLE CONTRIBUTIONS THROUGH ITS CATHOLIC SCHOOLS GRANT INITIATIVE TO SELECTED CATHOLIC SCHOOLS OR DIOCESAN SCHOOL SYSTEMS IN THEIR EFFORT TO IMPROVE THE HEALTH STATUS OF CHILDREN AND THEIR FAMILIES. LASTLY, FIDELIS MAKES CHARITABLE DONATIONS TO ORGANIZATIONS CLASSIFIED AS TAX-EXEMPT NONPROFIT ORGANIZATIONS UNDER STATE AND FEDERAL LAW THAT WORK WITH FIDELIS TO SUPPORT THE PLAN'S MISSION. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 PATRICK J FRAWLEY CEO 1356097 0 0 0 4140519 0 18576 0 143969 0 5659161 0 0 0 DAVID THOMAS PRESIDENT & COO 593775 51000 314500 25500 915208 15692 17183 1393 63683 4223 1904349 97808 0 0 THOMAS HALLORAN EVP & CHIEF FINANCIAL OFFICER 486775 58000 182700 20300 91613 7436 309789 1858 47534 3992 1118411 91586 0 0 PAMELA HASSEN CHIEF MARKETING OFFICER 439711 0 175780 0 3659837 0 18576 0 43023 0 4336927 0 0 0 MARTIN KREBS CHIEF INFORMATION OFFICER 384082 0 143500 0 35306 0 189033 0 41100 0 793021 0 0 0 SANTO RUSSO CHIEF LEGAL OFFICER 383386 44327 183600 20400 42579 4188 219025 1858 47986 4054 876576 74827 0 0 THOMAS BROWN CHIEF ADMINISTRATIVE OFFICER 372328 0 175500 0 27810 0 172712 0 10146 0 758496 0 0 0 ROBERT FAZZOLARI SVP, GOV'T RELATIONS & CORP. COMP. 295903 0 194000 0 25290 0 18576 0 11186 0 544955 0 0 0 SANJIV SHAH MD FMR CHIEF MED. OFF. (THRU MAY 2017) 152099 25207 99041 14149 24292 0 16254 2322 11262 1801 302948 43479 0 0 PART I, LINE 4B SERP COMPENSATION OF OFFICERS AND HIGHEST COMPENSATED EMPLOYEES: PATRICK J. FRAWLEY - $4,112,709*; DAVID THOMAS - $696,979*; PAMELA HASSEN - $3,642,070*; THOMAS HALLORAN - $293,071**; MARTIN KREBS - $170,457**; SANTO RUSSO - $202,307**; THOMAS BROWN - $154,136** *THE ABOVE AMOUNTS INCLUDE GROSS-UP TAXES PAID ON BEHALF OF THE PARTICIPANTS (LINE 1A). **THESE REPRESENT NON-VESTED SERP BENEFITS. PART I, LINE 7 PERFORMANCE-BASED INCENTIVES ARE PAID AS PART OF THE PLAN'S ANNUAL INCENTIVE PROGRAM. THE CHIEF EXECUTIVE OFFICER DOES NOT PARTICIPATE IN ANY INCENTIVE PROGRAM. PART II, COLUMN (B)(III): IN 2017, THE PLAN PAID GRANDFATHERED PAID TIME OFF BALANCES TO ELIGIBLE EMPLOYEES INCLUDING EXECUTIVES. SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 30960112 BUSINESS TRANSACTION 0 FORM 990, PART I, LINE 1: TO PROMOTE HEALTH THROUGH QUALITY, ACCESSIBLE CARE AND SERVICES TO THE COMMUNITY, ESPECIALLY TO THE POOR AND UNDERSERVED; TO PROMOTE HEALTH EDUCATION AND PREVENTATIVE MEDICINE. FORM 990, PART III, LINE 1: THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC. ("FIDELIS OR THE "PLAN") STRIVES TO PROMOTE HEALTH THROUGH QUALITY, ACCESSIBLE CARE AND SERVICES FOR ALL; TO JOIN IN PARTNERSHIP WITH HEALTH PROFESSIONALS TO ASSIST THEM IN THEIR HEALING WORK; TO ACT AS A FACILITATOR TO BUILD LINKAGES AND SYSTEMS FOR THE COORDINATION OF CARE AND SERVICES AMONG HEALTHCARE, BEHAVIORAL AND SOCIAL SERVICES, AS WELL AS EDUCATORS AND RELIGIOUS LEADERS, TO ADDRESS THE SPIRITUAL, EMOTIONAL AND PHYSICAL NEEDS OF THOSE IT SERVES; TO ADVOCATE FOR A HEALTH POLICY THAT ACCORDS TRUE DIGNITY AND RESPECT FOR ALL HUMAN PERSONS, ESPECIALLY THE POOR AND UNDERSERVED. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS. THE MEMBERSHIP OF THE ORGANIZATION SHALL BE LIMITED TO THE DIOCESAN BISHOPS OF THE STATE AND THE ECCLESIASTICAL PROVINCE OF NEW YORK. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION IS A MEMBERSHIP CORPORATION UNDER THE NEW YORK NOT-FOR-PROFIT CORPORATION LAW (THE "N-PCL"). THE ORGANIZATION'S MEMBERS ELECT ITS BOARD OF DIRECTORS AND, AS MEMBERS OF A NEW YORK NOT-FOR-PROFIT CORPORATION, POSSESS CERTAIN OTHER POWERS UNDER THE N-PCL. FURTHERMORE, THE ORGANIZATION'S BY-LAWS, WHICH ARE FILED WITH THE NEW YORK STATE DEPARTMENT OF HEALTH ("NYSDOH"), DEFINE THE FOLLOWING RESERVED POWERS OF THE MEMBERS: (I) THE INTERPRETATION OF THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH CARE SERVICES TO WHICH THE ORGANIZATION, AS A FAITH-BASED ORGANIZATION, IS SUBJECT; (II) APPROVAL OF THE MISSION STATEMENT; (III) STANDING TO ENSURE THE ORGANIZATION'S COMPLIANCE WITH ITS PHILOSOPHY AND MISSION STATEMENT; (IV) APPROVAL OF AMENDMENTS TO THE ORGANIZATION'S CERTIFICATE OF INCORPORATION AND BY-LAWS; (V) APPROVAL OF CERTAIN TRANSACTIONS INVOLVING REAL PROPERTY; (VI) APPROVAL OF CERTAIN ACTIONS BY THE ORGANIZATION WHEN ACTING AS A SHAREHOLDER OR MEMBER OF ANOTHER ENTITY; (VII) APPROVAL OF THE ACCEPTANCE AND ISSUANCE OF SUBVENTIONS; (VIII) APPROVAL OF ANY MERGER, DISSOLUTION OR CONSOLIDATION; (IX) REMOVAL OF DIRECTORS AND CERTAIN OFFICERS OF THE CORPORATION; (X) APPROVAL OF THE ELECTION OF THE CHIEF EXECUTIVE OFFICER; AND (XI) REVIEW OF THE AUDITED FINANCIAL STATEMENTS. CERTAIN OF THESE POWERS ALREADY EXIST BY VIRTUE OF THE N-PCL (I.E., THE POWER TO APPROVE ANY MERGER, DISSOLUTION OR CONSOLIDATION UNDER N-PCL 903(A)(2) & 1002(A)). FORM 990, PART VI, SECTION A, LINE 7B PLEASE SEE LINE 11B NARRATIVE. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE FORM 990 PREPARED BY THE ORGANIZATION'S FINANCE DEPARTMENT IS REVIEWED BY THE ORGANIZATION'S EXECUTIVE VICE PRESIDENT & CHIEF FINANCIAL OFFICER, ASSISTANT VICE PRESIDENT FOR FINANCE AND CHIEF LEGAL OFFICER, IN COLLABORATION WITH THE ORGANIZATION'S OUTSIDE INDEPENDENT TAX ADVISORS. THEREAFTER, THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER AND PRESIDENT & CHIEF OPERATING OFFICER REVIEW THE DRAFT FORM 990 WITH THE EXECUTIVE VICE PRESIDENT & CHIEF FINANCIAL OFFICER, ASSISTANT VICE PRESIDENT FOR FINANCE AND CHIEF LEGAL OFFICER. THE ORGANIZATION'S BOARD OF DIRECTORS HAS AUTHORIZED THE EXECUTIVE COMMITTEE OF THE BOARD TO REVIEW AND ACCEPT THE DRAFT FORM 990 BEFORE ITS FILING WITH THE IRS. ACCORDINGLY, AFTER THE ORGANIZATION'S MANAGEMENT HAS COMPLETED ITS REVIEW OF THE DRAFT FORM 990, IT IS CIRCULATED IN DRAFT FOR REVIEW, COMMENT AND APPROVAL TO THE MEMBERS OF THE EXECUTIVE COMMITTEE. ONCE ANY COMMENTS HAVE BEEN INCORPORATED AND THE FORM 990 HAS BEEN ACCEPTED BY THE EXECUTIVE COMMITTEE, A COPY OF THE FORM 990 IS PROVIDED TO EACH MEMBER OF THE BOARD OF DIRECTORS PRIOR TO ITS FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE ORGANIZATION'S OFFICERS, DIRECTORS AND SENIOR EXECUTIVES ARE PROVIDED WITH A COPY OF THE CONFLICTS OF INTEREST POLICY AND AN ACKNOWLEDGEMENT FORM. THESE INDIVIDUALS ARE INSTRUCTED TO SIGN AND RETURN THE FORM, (A) TO ACKNOWLEDGE THAT THEY HAVE REVIEWED THE POLICY AND (B) TO DISCLOSE ANY CONFLICTS OR POTENTIAL CONFLICTS. THE CONFLICTS OF INTEREST POLICY DEFINES "DISCLOSABLE INTERESTS", I.E., THOSE INTERESTS THAT AN INDIVIDUAL COVERED BY THE POLICY MUST HAVE IN ANOTHER ENTITY IN ORDER FOR A TRANSACTION BETWEEN THE ORGANIZATION AND THAT ENTITY TO BE COVERED BY THE POLICY. THE POLICY ALSO DEFINES THE TYPES OF TRANSACTIONS BETWEEN THE ORGANIZATION AND ANOTHER ENTITY INVOLVING AN INDIVIDUAL COVERED BY THE POLICY THAT IS SUBJECT TO BY THE POLICY. THE POLICY REQUIRES DISCLOSURE TO THE BOARD OF DIRECTORS AND/OR THE EXECUTIVE COMMITTEE BY ANY PERSON WITH A DISCLOSABLE INTEREST IN A TRANSACTION AS DEFINED IN THE POLICY OF ALL CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST. INITIALLY, AFTER THE INTERESTED INDIVIDUAL HAS RECUSED HIMSELF, THE ORGANIZATION'S BOARD OF DIRECTORS OR EXECUTIVE COMMITTEE DETERMINES WHETHER A POTENTIAL CONFLICT OF INTEREST EXISTS. IF A CONFLICT OF INTEREST IS FOUND TO EXIST, THE BOARD OF DIRECTORS OR THE EXECUTIVE COMMITTEE DECIDES WHETHER TO ENTER INTO THE TRANSACTION BASED ON ITS DETERMINATION OF WHETHER (A) A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, (B) THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND (C) THE TRANSACTION IS FAIR AND REASONABLE TO THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 OUTSIDE COUNSEL FOR THE ORGANIZATION, A NATIONAL LAW FIRM WITH EXPERTISE IN ADVISING TAX-EXEMPT ORGANIZATIONS ON EXCESS BENEFIT TRANSACTIONS LAW, HAS ADVISED FIDELIS AS TO WHICH EMPLOYEES ARE DISQUALIFIED PERSONS WITHIN THE MEANING OF SECTION 4958 OF THE INTERNAL REVENUE CODE. THE ORGANIZATION EMPLOYS A COMPENSATION CONSULTANT FIRM, A NATIONAL HUMAN RESOURCES CONSULTING FIRM WITH EXPERTISE IN ADVISING TAX-EXEMPT ORGANIZATIONS ON EXCESS BENEFIT TRANSACTIONS LAW, TO PREPARE ANNUALLY A DETAILED REPORT ON THE PROPOSED COMPENSATION FOR THE ORGANIZATION'S DISQUALIFIED PERSONS THAT INCLUDES DATA AS TO COMPARABLE COMPENSATION FOR SIMILAR QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY-SITUATED ORGANIZATIONS. THE EXECUTIVE COMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS, WHICH HAS BEEN AUTHORIZED BY THE BOARD TO REVIEW AND APPROVE ALL MATTERS CONCERNING EXECUTIVE COMPENSATION, IS PROVIDED WITH THE COMPENSATION CONSULTANT'S DETAILED EXECUTIVE COMPENSATION REPORT. THE REVIEW AND APPROVAL OF THE COMPENSATION OF THE ORGANIZATION'S DISQUALIFIED PERSONS IS ACCOMPLISHED IN TWO PHASES: FIRST WITH RESPECT TO THE CHIEF EXECUTIVE OFFICER AND THEN WITH RESPECT TO ALL OTHER DISQUALIFIED PERSONS, NAMELY, (I) THE PRESIDENT & CHIEF OPERATING OFFICER, (II) THE EXECUTIVE VICE PRESIDENT & CHIEF FINANCIAL OFFICER, (III) THE CHIEF LEGAL OFFICER, (IV) THE CHIEF MEDICAL OFFICER, (V) CHIEF MARKETING OFFICER, (VI) CHIEF INFORMATION OFFICER AND (VII) CHIEF ADMINISTRATIVE OFFICER. FIRST, THE AFOREMENTIONED OUTSIDE COUNSEL AND HUMAN RESOURCES CONSULTING FIRM, AT THE INVITATION OF THE EXECUTIVE COMMITTEE, REVIEW WITH THE COMMITTEE THE DETAILED EXECUTIVE COMPENSATION REPORT WITH RESPECT TO THE CHIEF EXECUTIVE OFFICER. THE EXECUTIVE COMMITTEE ALSO RETAINS THE SERVICES OF A SECOND HUMAN RESOURCES CONSULTING FIRM TO ASSIST IN ITS EVALUATION OF THE PERFORMANCE OF THE CHIEF EXECUTIVE OFFICER. THE FULL REVIEW OF THE COMPENSATION AND PERFORMANCE OF THE CHIEF EXECUTIVE OFFICER IS PERFORMED BY THE EXECUTIVE COMMITTEE AT LEAST BI-ANNUALLY. AFTER ESTABLISHING THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER, THE EXECUTIVE COMMITTEE REPORTS ON ITS DELIBERATIONS AND DETERMINATIONS TO THE ORGANIZATION'S BOARD OF DIRECTORS. SECOND, THE EXECUTIVE COMMITTEE REVIEWS THE DETAILED EXECUTIVE COMPENSATION REPORT WITH RESPECT TO THE ORGANIZATION'S OTHER DISQUALIFIED PERSONS WITH THE ASSISTANCE OF THE SAME OUTSIDE COUNSEL AND COMPENSATION CONSULTANTS PARTICIPATING IN THE REVIEW OF THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER. THE EXECUTIVE COMMITTEE DETERMINES WHETHER TO APPROVE THE COMPENSATION ANALYSIS AND CONCLUSIONS CONTAINED IN THE COMPENSATION REPORT WITH RESPECT TO THE ORGANIZATION'S OTHER DISQUALIFIED PERSONS. AFTER CONSULTING WITH OUTSIDE COUNSEL, THE EXECUTIVE COMMITTEE HAS DESIGNATED THE CHIEF EXECUTIVE OFFICER TO SERVE AS AN "AUTHORIZED BODY" AS CONTEMPLATED BY THE EXCESS BENEFIT TRANSACTION REGULATIONS FOR THE PURPOSE OF SETTING THE COMPENSATION OF THOSE DISQUALIFIED PERSONS WITHIN AN APPROVED RANGE. THE ORGANIZATION MAINTAINS CONTEMPORANEOUS DOCUMENTATION AND RECORD KEEPING WITH RESPECT TO THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS FOR ALL DISQUALIFIED PERSONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION IS A NEW YORK NOT-FOR-PROFIT CORPORATION. ITS CERTIFICATE OF INCORPORATION IS READILY AVAILABLE TO THE GENERAL PUBLIC FROM THE NEW YORK STATE DEPARTMENT OF STATE UNDER THE NEW YORK FREEDOM OF INFORMATION LAW ("FOIL"). ITS CERTIFICATE OF INCORPORATION AND BY-LAWS ARE ALSO ON FILE WITH THE NYSDOH AND LIKEWISE AVAILABLE TO THE GENERAL PUBLIC UNDER FOIL. THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE TO ENROLLEES IN ITS MEDICAID PROGRAM AND TO INDIVIDUALS CONSIDERING BECOMING ENROLLEES BY INCLUDING IN THE MEMBER HANDBOOKS, WHICH ARE PROVIDED TO ENROLLEES AND ARE ACCESSIBLE ON THE ORGANIZATION'S WEB SITE, A STATEMENT THAT THE FINANCIAL STATEMENTS (AS WELL AS OTHER INFORMATION DESCRIBED IN THE HANDBOOKS) ARE AVAILABLE UPON REQUEST BY CALLING A TOLL-FREE NUMBER PROVIDED IN THE HANDBOOKS. FORM 990, PART VII, SECTION A, COLUMN B: AVG. HOURS DEVOTED TO RELATED ORG(S) WHEN RELATED COMP IS REPORTED: THE FOLLOWING INDIVIDUALS DEVOTE A PERCENTAGE OF THEIR TIME TO SALUS ADMINISTRATIVE SERVICES, INC. ("SALUS"), A RELATED ORGANIZATION, AS DETAILED BELOW: DAVID THOMAS, PRESIDENT & CHIEF OPERATING OFFICER - 7.5% THOMAS HALLORAN, EXECUTIVE VICE PRESIDENT & CHIEF FINANCIAL OFFICER - 10% SANJIV SHAH, MD, CHIEF MEDICAL OFFICER (THRU MAY 2017) - 12.5% SANTO RUSSO, CHIEF LEGAL OFFICER - 10% THIS ARRANGEMENT IS COVERED BY AN EMPLOYEE SERVICE AGREEMENT BETWEEN FIDELIS AND SALUS. FORM 990, PART IX, LINE 12: THE ORGANIZATION'S PART IX, LINE 12, ADVERTISING AND PROMOTION EXPENSES INCLUDE PAYMENTS TO OTHER EXEMPT ORGANIZATIONS IN SUPPORT OF THEIR CHARITABLE PURPOSES, TO BENEFIT THE COMMUNITY, OR IN SPONSORSHIP OF THEIR FUNDRAISING EVENTS. THE EXPENDITURES INCLUDE THE AMOUNTS PAID TO THE FOLLOWING: THANKSGIVING CONTRIBUTION TO NEEDY - $185,341 SCHEDULE O, NOT APPLICABLE QUESTIONS: TO THE EXTENT THAT A QUESTION ON THE FORM 990 HAS BEEN LEFT BLANK, THE RESPONSE TO THIS QUESTION SHOULD BE NOT APPLICABLE. DUE TO SOFTWARE LIMITATIONS, FIDELIS COULD NOT PROPERLY RESPOND TO THE RESPECTIVE QUESTION AS N/A. REGO PARK OFFICE TOWER LLC 95-25 QUEENS BLVD 8TH FLOOR REGO PARK NY 11374 815473320 REAL PROPERTY OWNER NY 8570252 144769329 NEW YORK STATE CATHOLIC HEALTH PLAN INC SALUS ADMINISTRATIVE SERVICES INC 95-25 QUEENS BOULEVARD REGO PARK NY 11374 550878053 THIRD PARTY ADMINISTRATOR NY NEW YORK STATE CATHOLIC HEALTH PLAN INC C 15640024 111402727 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 SALUS ADMINISTRATIVE SERVICES INC M 15612584 SALUS ADMINISTRATIVE SERVICES INC N 1037408 SALUS ADMINISTRATIVE SERVICES INC O 14310120 SCHEDULE R, PART V: SCHEDULE R, PART V RELATED PARTY TRANSACTIONS: FIDELIS REPORTS CERTAIN RELATED PARTY TRANSACTIONS BETWEEN ITSELF AND SALUS ADMINISTRATIVE SERVICES, INC. ("SALUS"), A RELATED PARTY, ON SCHEDULE R, PART V. THE METHODS USED FOR DETERMINING THE AMOUNTS REPORTED DIFFER BASED ON THE TYPE OF TRANSACTION BUT ARE ALL CONTAINED IN WRITTEN CONTRACTS BETWEEN THE TWO PARTIES. SALUS REPORTS A PERFORMANCE OF SERVICES TO FIDELIS. THE WRITTEN AGREEMENT SPECIFIES A FIXED DISPENSING FEE PER PHARMACY CLAIM PROCESSED. THE FEE IS AN ESTIMATE DESIGNED TO COVER DIRECT AND INDIRECT COSTS AS WELL AS A MODEST AMOUNT OF PROFIT. THE AMOUNT IS DEEMED CONSISTENT WITH AN INDEPENDENT THIRD PARTY TRANSACTION. FIDELIS REPORTS A SHARING OF FACILITIES, EQUIPMENT, AND OTHER ASSETS. THE OVERHEAD AND ADMINISTRATIVE COSTS ARE ALLOCATED BASED ON THE SHARE OF FACILITIES AND ASSETS SALUS IS DEEMED TO USE. FIDELIS SHARES PAID EMPLOYEES WITH SALUS. FIDELIS ALLOCATES SALARIES FOR EACH EMPLOYEE BASED ON THE PERCENTAGE OF TOTAL HOURS SPENT PROVIDING SERVICES TO SALUS.