2017-10-17T14:17:19-05:00 2016-12-31 420714325 RSM US LLP 1185 AVENUE OF THE AMERICAS NEW YORK NY 100362602 990 2016-01-01 134154068 AMIDA CARE INC AMID 6467577000 14 PENN PLAZA NO 2ND FL NEW YORK NY 10122 DOUGLAS WIRTH CEO 6467577000 2017-10-17 1 LYNNE JOHNSON P00757336 2123721000 108.171.131.186 2017-10-17 13:48:39 ED P 4B27630E9B71C1178CF76823066D44BD77E6F3A2 74945D2FC77B6F91CA20B0294C60E870FB0C5B8E 2016 2021-01-29 14:40:06Z DOUGLAS WIRTH 14 PENN PLAZA NO 2ND FL NEW YORK NY 10122 411226437 0 X WWW.AMIDACARENY.ORG X 2000 NY AMIDA CARE INC. IS A HEALTH MAINTENANCE ORGANIZATION FORMED TO OBTAIN A COMPREHENSIVE HIV SPECIAL NEEDS CERTIFICATE OF AUTHORITY IN ORDER TO PROVIDE OR ARRANGE FOR ALL MEDICAL ASSISTANCE SERVICES TO PERSONS ENROLLED IN THE PLAN AND FOR ASSISTING ENROLLEES IN THE PRUDENT SELECTION OF SERVICES. 11 11 245 12 0 0 690094 1750106 343625217 397174076 60447 222973 -16041 -5395 344359717 399141760 0 0 0 0 21665084 19424653 0 0 0 342511317 368912998 364176401 388337651 -19816684 10804109 59119433 77755501 56914529 64826001 2204904 12929500 X AMIDA CARE INC. IS A MEDICAID HIV SPECIAL NEEDS MANAGED CARE PLAN THAT PROVIDES ASSISTANCE AND/OR ARRANGES FOR MEDICAL CARE AND NON-MEDICAL SUPPORT FOR PERSONS ENROLLED IN THE PLAN. IN 2014, THE PLAN EXPANDED ITS SERVICES INTO THE MEDICARE ADVANTAGE PROGRAM. STAFF ALSO ASSISTS ENROLLEES IN THE PRUDENT SELECTION OF SERVICES. 0 0 331827353 383249168 AMIDA CARE IS A MEDICAID MANAGED CARE PLAN THAT PROVIDES ASSISTANCE AND/OR ARRANGES FOR MEDICAL CARE AND NON-MEDICAL SUPPORT FOR PERSONS ENROLLED IN THE PLAN. STAFF ALSO ASSISTS ENROLLEES IN THE PRUDENT SELECTION OF SERVICES. THE PLAN COVERED 73,369 MEMBER MONTHS IN 2016. 17849292 13924908 THE PLAN PROVIDES SERVICES THROUGH ITS CONTRACT WITH THE CENTERS FOR MEDICARE AND MEDICAID (CMS) TO RECIPIENTS ELIGIBLE TO PARTICIPATE IN ONE OF THE PLAN'S THREE MEDICARE ADVANTAGE PRODUCTS. THE PRODUCTS INCLUDE MEDICARE ADVANTAGE PRESCRIPTION DRUG PLAN, MEDICARE ADVANTAGE PRESCRIPTION DRUG CHRONIC CONDITION SPECIAL NEEDS PLAN, AND MEDICARE ADVANTAGE PRESCRIPTION DRUG DUAL ELIGIBLE SPECIAL NEED PLAN. STAFF ALSO ASSISTS ENROLLEES IN THE PRUDENT SELECTION OF SERVICES. THE PLAN COVERED 10,884 MEMBER MONTHS FOR MEDICARE IN 2016. 349676645 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 988 0 1 245 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 NY X DOUGLAS WIRTH CEO 6467577000 14 PENN PLAZA 2ND FLOOR NEW YORK NY 10122 PAUL VITALE CHAIRPERSON 0.50 X X 0 0 0 EMMA DEVITO VICE CHAIR 0.50 X X 0 0 0 CHARLES KING SECRETARY 0.50 X X 0 0 0 TOMAS DEL RIO TREASURER - THRU MAY 2016 0.50 X X 0 0 0 HOLLY ARGENT-TARIQ MEMBER 0.50 X 0 0 0 PAM MATTEL MEMBER 0.50 X 0 0 0 JACQUELYN KILMER MEMBER 0.50 X 0 0 0 DR MATTHEW WEISSMAN MEMBER 0.50 X 0 0 0 ARTHUR WEBB INDEP. DIRECTOR - FROM JULY 2016 0.50 X 0 0 0 C VIRGINA FIELDS INDEP. DIRECTOR - FROM NOV. 2016 0.50 X 0 0 0 ROMANO JOHNSON INDEP. DIRECTOR 0.50 X 0 0 0 MICHELE STEELE INDEP. DIRECTOR - FROM JAN. 2016 0.50 X 0 0 0 DOUGLAS WIRTH PRESIDENT & CEO 40.00 X 443002 0 57702 JAMES CRAMER - THRU SEPT 2016 CHIEF OPERATING OFFICER 40.00 X 231582 0 21887 JEROME A ERNST MD CHIEF MEDICAL OFFICER 40.00 X 262405 0 37332 FELICE KUSSOY CHIEF FINANCIAL OFFICER 40.00 X 227801 0 22825 MAURA MCGRATH CHIEF COMPLIANCE & PRIVACY 40.00 X 176646 0 12749 NICHOLAS LIGUORI-FROM JUNE 2016 EXECUTIVE VICE PRESIDENT 40.00 X 155899 0 357 TERRY LEACH VP OF PHARMACY 40.00 X 222428 0 35622 MARIA DASILVA VP OF RISK & NETWORK MGMT 40.00 X 185732 0 34668 KATHY FRANK-KLEIN VP OF VENDOR MANAGEMENT 40.00 X 195859 0 49257 STEPHANE HOWZE OMBUDSMAN 40.00 X 173061 0 43364 JAMES MORRILL VP OF HUMAN RESOURCES 40.00 X 171833 0 34002 LISA RODGERS VP OF INFORMATION TECHNOLOGY 40.00 X 170506 0 22373 2616754 0 372138 37 0 1 0 STAR ADMINISTRATORS LLC 272 SW LANGELIER DRIVE FORT WHITE FL 32038 MANAGEMENT SERVICES 2639742 BEACON HEALTH STRATEGIES LLC 200 STATE STREET SUITE 302 BOSTON MA 02109 MANAGEMENT SERVICES 2270133 KEPRO ACQUISITIONS INC 99 SE MIZNER BLVDSUITE 120 BOCA RATON FL 33432 UTILIZATION MANAGEMENT SERVICES 780124 ROPES & GRAY LLP 800 BOYLSTON STREET SUITE 3600 BOSTON MA 021993600 LEGAL SERVICES 633560 CONSENTIAHEALTH LLC 12100 SINGLETREE LANE SUITE 123 EDEN PRAIRIE NY 55344 CONSULT-CLAIMS, NETWORK & FINANCE 302992 6 146865 1603241 1750106 MEDICAID PAYMENTS 900099 383249168 383249168 MEDICARE PAYMENTS 900099 13924908 13924908 397174076 284800 284800 12011585 12073412 -61827 -61827 -61827 0 146865 11265 -11265 -11265 OTHER REVENUE 900099 5870 5870 5870 399141760 397174076 0 217578 1880585 1880585 13540389 13540389 274353 274353 2511949 2511949 1217377 1217377 3948686 3948686 1143566 1143566 64173 64173 72262 72262 1556579 1556579 182414 182414 1096129 1096129 1281513 1281513 3235304 3235304 104698 104698 73501 73501 930176 930176 898729 898729 487599 487599 PHARMACY COSTS 221343607 220665897 677710 MEDICAL SERVICES 123882129 123882129 HEALTH ASSESSMENTS & SU 5128619 5128619 UTILIZATION MANAGEMENT 1586461 1586461 1896853 1896853 388337651 349676645 38661006 0 24559997 9108080 3373353 200084 1047465 33213623 29386762 532095 742561 5600449 2630016 2963018 2970433 12392270 14653119 710263 1021811 59119433 77755501 37878959 53228316 5000000 6067038 6522066 7968532 5075619 56914529 64826001 X 2204904 12929500 2204904 12929500 59119433 77755501 10804109 -79513 0 X 0 1 X 1 0 X 758965 920185 1240607 690094 1750106 5359957 218214600 263795280 307993102 343625302 397174076 1530802360 218973565 264715465 309233709 344315396 398924182 1536162317 0 0 0 1536162317 7413 3867 7010 65517 284800 368607 7413 3867 7010 65517 284800 368607 5870 5870 218980978 264719332 309240719 344380913 399214852 1536536794 0.99980 0.99990 0.00020 0.00010 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUE RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1035919 169265 866654 2917156 1693104 1224052 1647374 767647 879727 2970433 SUBVENTION PAYABLE TO 501(C) ORG 3233652 DEFERRED RENT 1841967 5075619 X 399073512 -79513 -79513 399153025 -11265 -11265 399141760 388348916 11265 11265 388337651 0 388337651 PART X, LINE 2: THE PLAN WAS INCORPORATED AS A NOT-FOR-PROFIT CORPORATION UNDER THE LAWS OF THE STATE OF NEW YORK AND IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THEREFORE, THERE IS NO PROVISION FOR INCOME TAXES INCLUDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. IN ADDITION, MANAGEMENT HAS ASSESSED WHETHER THERE WERE ANY UNCERTAIN TAX POSITIONS WHICH MAY GIVE RISE TO INCOME TAX LIABILITIES AND DETERMINED THAT WERE NO SUCH MATTERS REQUIRING RECOGNITION IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE PLAN FILES INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED AGAINST FUNDRAISING REVENUE -11,265. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED AGAINST FUNDRAISING REVENUE 11,265. LIVE YOUR LIFE FUNDRAISER 146865 146865 11265 146865 146865 11265 11265 -11265 X X 0 0 0 0 0 0 0 1 0 DOUGLAS WIRTH PRESIDENT & CEO 402450 0 40000 0 552 0 26923 0 30779 0 500704 0 0 0 JAMES CRAMER - THRU SEPT 2016 CHIEF OPERATING OFFICER 230513 0 0 0 1069 0 7539 0 14348 0 253469 0 0 0 JEROME A ERNST MD CHIEF MEDICAL OFFICER 257461 0 0 0 4944 0 9173 0 28159 0 299737 0 0 0 FELICE KUSSOY CHIEF FINANCIAL OFFICER 227299 0 0 0 502 0 8641 0 14184 0 250626 0 0 0 MAURA MCGRATH CHIEF COMPLIANCE & PRIVACY 175980 0 0 0 666 0 8925 0 3824 0 189395 0 0 0 NICHOLAS LIGUORI-FROM JUNE 2016 EXECUTIVE VICE PRESIDENT 155769 0 0 0 130 0 0 0 357 0 156256 0 0 0 TERRY LEACH VP OF PHARMACY 221918 0 0 0 510 0 7929 0 27693 0 258050 0 0 0 MARIA DASILVA VP OF RISK & NETWORK MGMT 184571 0 0 0 1161 0 6199 0 28469 0 220400 0 0 0 KATHY FRANK-KLEIN VP OF VENDOR MANAGEMENT 190592 0 5000 0 267 0 10224 0 39033 0 245116 0 0 0 STEPHANE HOWZE OMBUDSMAN 172806 0 0 0 255 0 9335 0 34029 0 216425 0 0 0 JAMES MORRILL VP OF HUMAN RESOURCES 171152 0 0 0 681 0 7032 0 26970 0 205835 0 0 0 LISA RODGERS VP OF INFORMATION TECHNOLOGY 170133 0 0 0 373 0 0 0 22373 0 192879 0 0 0 PART I, LINE 7 THE FOLLOWING INDIVIDUALS, LISTED ON PART VII, RECEIVED A NON-FIXED PAYMENT IN THE FORM OF A BONUS DURING 2016: DOUGLAS WIRTH - $40,000 KATHY FRANK-KLEIN - $5,000 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 FOR 2016 IS REVIEWED IN DETAIL BY THE ORGANIZATION'S CFO. ANY QUESTIONS ARISING FROM THAT REVIEW WILL BE DISCUSSED WITH THE PREPARER OF THE RETURN. SUBSEQUENT TO THE DETAILED CFO REVIEW, THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S CEO. ANY QUESTIONS ARISING FROM THAT REVIEW WILL BE DISCUSSED WITH THE CFO AND THE PREPARER OF THE RETURN, AS NEEDED. FOLLOWING CFO AND CEO REVIEW, THE FORM 990 IS REVIEWED BY THE BOARD OF DIRECTORS AT A REGULARLY SCHEDULED BOARD MEETING. THE CEO AND CFO WILL RESPOND TO ANY QUESTIONS RAISED BY THE BOARD MEMBERS. ONCE ALL QUESTIONS HAVE BEEN ANSWERED, THE BOARD, CEO AND CFO WILL APPROVE THE FINALIZATION AND FILING OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE REQUIRED ANNUALLY TO COMPLETE AND SIGN A DETAILED CONFLICT OF INTEREST DISCLOSURE STATEMENT. EMPLOYEES ARE REQUIRED TO PROMPTLY DISCLOSE ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST TO HIS OR HER SUPERVISOR (OR IN THE CASE OF THE CEO TO THE CHAIR OF THE BOARD OF DIRECTORS). MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED TO PROMPTLY DISCLOSE ANY REAL OR POTENTIAL CONFLICTS OF INTEREST TO THE CHAIR OF THE BOARD OF DIRECTORS (OR IN THE CASE THE CONFLICT IS REPORTABLE BY THE CHAIR THEN TO THE VICE CHAIR). THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY THE CHIEF COMPLIANCE & PRIVACY OFFICER, WHO RECORDS ANY POTENTIAL CONFLICTS AND MONITORS BUSINESS RELATIONSHIPS BETWEEN AMIDA CARE AND THE INDIVIDUAL REPORTING A POTENTIAL CONFLICT OR ANY ORGANIZATION THAT INDIVIDUAL MAY BE AFFILIATED WITH THAT DOES BUSINESS WITH AMIDA CARE. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION'S BOARD OF DIRECTORS COMMISSIONED A CEO COMPENSATION STUDY TO ESTABLISH COMPENSATION PACKAGES FOR THE CEO. THE BOARD OF DIRECTORS CHAIR COMPLETES AN ANNUAL PERFORMANCE EVALUATION ON THE CEO AND RECOMMENDS ANY COMPENSATION ADJUSTMENTS TO THE BOARD FOR APPROVAL. THE ORGANIZATION'S CEO UTILIZES THE ASSOCIATION FOR COMMUNITY AFFILIATED PLAN ("ACAP") COMPENSATION STUDY TO ESTABLISH THE COMPENSATION OF THE MEDICAL DIRECTOR, CFO, COO, EXECUTIVE VICE PRESIDENT AND CHIEF COMPLIANCE & PRIVACY OFFICER ("CCPO"). ACAP IS AN ASSOCIATION OF NONPROFIT MEDICAID AND MEDICARE HEALTH PLAN ORGANIZATIONS. THE ORGANIZATION'S CEO COMPLETES AN ANNUAL PERFORMANCE EVALUATION OF THE CMO, CFO, COO, EVP AND CCPO. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, FORM 990, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION UPON WRITTEN REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). FORM 990 PART VI SECTION A - GOVERNING BODY AND MANAGEMENT, LINE 1A NUMBER OF VOTING MEMBERS = 11. TWO OF THE ELEVEN BOARD MEMBERS, LISTED IN PART VII, SECTION A, ARE FROM THE SAME ORGANIZATION AND SHARE ONE VOTE ON ALL MATTERS DISCUSSED. ALL MEMBERS PARTICIPATE IN BOARD MEETINGS AND VOTE ON ALL MATTERS, EXCEPT THOSE WHICH ASSESS A FINANCIAL CONTRIBUTION REQUIREMENT, IN WHICH CASE, ONLY BOARD MEMBERS WHO REPRESENT ORGANIZATIONS WHICH WOULD BE REQUIRED TO MAKE THE FINANCIAL CONTRIBUTION MAY VOTE.