2016-11-08T10:09:37-06:00 2015-12-31 161131146 BONADIO & CO LLP 6 WEMBLEY COURT ALBANY NY 12205 990 2015-01-01 141641028 CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN INC CAPI 5186414085 500 PATROON CREEK BLVD ALBANY NY 122061057 BETHANY SMITH SVP FINANCE, CFO 5186414085 2016-11-07 1 GLORIA M NOSTRAMO P01385068 5184644080 2016-10-27 2015 2017-02-10 21:41:12Z BETHANY SMITH 500 PATROON CREEK BLVD ALBANY NY 122061057 1570223394 0 X WWW.CDPHP.COM X 1984 NY CDPHP PROVIDES QUALITY HEALTH CARE AT A REASONABLE COST FOR CDPHP MEMBERS AND OPERATES AS A MODEL FOR THE DELIVERY, FINANCING, AND ADMINISTRATION OF HEALTH CARE SERVICES. 15 7 1226 0 0 0 0 0 1428802485 1513143940 19234353 5478914 732 2301 1448037570 1518625155 46982 831456 1276821139 1292406086 66309798 66403961 0 0 0 81166307 73281340 1424344226 1432922843 23693344 85702312 477542554 514503766 197213701 195821998 280328853 318681768 X CDPHP PROVIDES QUALITY HEALTH CARE AT A REASONABLE COST FOR CDPHP MEMBERS AND OPERATES AS A MODEL FOR THE DELIVERY, FINANCING, AND ADMINISTRATION OF HEALTH CARE SERVICES. 0 0 480458578 304928 547073145 CDPHP PROVIDES HEALTH CARE BENEFITS TO EMPLOYER GROUP MEMBERS AND INDIVIDUALS IN OUR COMMUNITY. AS OF DECEMBER 31 2015, 84,970 MEMBERS WERE ENROLLED IN COMMERCIAL PRODUCTS. 458246520 337988 492445184 CDPHP'S MEDICAID PROGRAM PROVIDES HEALTH CARE BENEFITS TO 96,422 MEMBERS IN NEW YORK STATE. 414113201 136480 430073612 CDPHP'S MEDICARE PROGRAM PROVIDES HEALTH CARE BENEFITS TO 39,876 MEMBERS IN NEW YORK STATE. 35260254 52060 43551999 CHILD HEALTH PLUS - 12,820 MEMBERS. EXPENSES $30,977,639. INCL GRANTS OF $46,191. REVENUE $36,202,106.FAMILY HEALTH PLUS - 0 MEMBERS. EXPENSES $(631,158). INCL GRANTS OF $0. REVENUE $(30,575) RUNOUT.HEALTHY NEW YORK - 1,645 MEMBERS. EXPENSES $4,913,773. INCL GRANTS OF $5,869. REVENUE $7,380,468. 35260254 52060 43551999 1388078553 0 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 1 1 1 0 1 4891 0 1 1226 1 0 1 BD 0 0 0 0 X 15 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X TRACEY POISSANT CORPORATE CONTROLL 5186413000 500 PATROON CREEK BLVD ALBANY NY 12206 CATHERINE BARTHOLOMEW MD DIRECTOR 3.50 X 30500 0 0 HOLLY K CLENEY MD DIRECTOR 1.00 X 12100 0 0 BRUCE E COPLIN MD VICE CHAIRMAN 6.50 X 51800 0 0 GENNARO A DANIELS MD CHAIRMAN OF THE BOARD 8.00 X 72439 0 0 JOSEPH J DUDEK MD DIRECTOR 2.40 X 30750 0 0 RICHARD E GRANT TREASURER OF THE BOARD 11.40 X 80800 0 0 ROBERT GRIFFIN DIRECTOR 5.60 X 47461 0 0 GERALD JENNINGS DIRECTOR 4.00 X 36900 0 0 AMY JOHNSON DIRECTOR 7.30 X 54400 0 0 RICHARD E LAVIGNE MD DIRECTOR 4.00 X 27709 0 0 ANTHONY J MARINELLO MD DIRECTOR 6.50 X 56800 0 0 THOMAS J MARUSAK DIRECTOR 8.40 X 64700 0 0 CARMEN MAZZOTTA DIRECTOR 2.00 X 20500 0 0 HENRY M NEILLEY MD DIRECTOR 3.80 X 33600 0 0 WILLIAM P PHELAN DIRECTOR 9.50 X 75909 0 0 JOSEPH POLITO II MD DIRECTOR 5.00 X 14500 0 0 SUSAN CROSBY SCRIMSHAW DIRECTOR 6.00 X 42200 0 0 JOHN D BENNETT MD CEO/PRESIDENT 40.00 X 1100548 0 21625 BRUCE NASH MD CHIEF MEDICAL OFFICER 40.00 X 650329 0 20625 BARBARA DOWNS EVP CORP ADMIN/COO 40.00 X 637267 0 15781 BRIAN MORRISSEY EVP MARKETING/CMO 40.00 X 485630 0 29057 BETHANY SMITH EVP FINANCE AND CFO 40.00 X 475859 0 24807 FREDERICK GALT ESQ EVP GENERAL COUNSEL 40.00 X 468975 0 26557 ROBERT HINCKLEY EVP GOVT AND EXTERNAL RELATIONS 40.00 X 464690 0 24057 NEIL BRANDMAIER SVP CHIEF INFORMATION OFFICER 40.00 X 443967 0 25357 SCOTT KLENK SVP HUMAN CAPITAL MANAGEMENT 40.00 X 405809 0 14281 UMESH REGE VP APPLICATION SOLUTIONS 40.00 X 392237 0 10136 DAVID JEANS VP CORPORATE ANALYTICS 40.00 X 384735 0 26607 RICHARD DAL COL VP SENIOR MEDICAL DIRECTOR 40.00 X 376949 0 8475 CAROLE MONTEPARE FORMER SVP SALES 40.00 X 207726 0 8336 7247789 0 255701 245 1 1 0 SYNTEL INC 525 E BIG BEAVER RD SUITE 300 TROY MI 48083 IT PROCESSING AND CONSULTING 7011593 HEALTH DIALOG SERVICES CORP 100 SUMMER STREET BOSTON MA 02110 POPULATION HEALTHCARE SERVICES 2534892 EMDEON 3055 LEBANON PIKE NASHVILLE TN 37214 PRINT AND MAIL SERVICES 2288966 TRIZETTO CORPORATION PO BOX 122140 DALLAS TX 75312 IT SOFTWARE LICENSE AND MAINTENANCE 2271918 IBM PO BOX 64300 PITTSBURGH PA 15264 IT LAPTOPS AND SUPPORT 1894530 69 COMMERCIAL PREMIUMS 524114 547073145 547073145 MEDICAID PREMIUMS 524114 492445184 492445184 MEDICARE PREMIUMS 524114 430073612 430073612 CHILD HEALTH PLUS PREMIUMS 524114 36202106 36202106 HEALTHY NEW YORK PREMIUMS 524114 7380468 7380468 -30575 -30575 1513143940 5361656 5361656 51715497 51598239 117258 117258 117258 ADMINISTRATIVE CHARGES 524298 2301 2301 2301 1518625155 1513146241 0 5478914 831456 831456 1292406086 1292406086 3007556 1264409 1743147 56899 56899 50564287 23733827 26830460 1208009 408994 799015 7681239 3720701 3960538 3885971 1823994 2061977 108314 86651 21663 181587 145270 36317 169015 169015 434861 434861 1766763 1766763 4366844 2407200 1959644 9487913 9203275 284638 2811869 1405934 1405935 377777 264444 113333 294921 195995 98926 189917 151933 37984 3961250 2772875 1188375 486335 486335 FEDERAL ACA FEES 23501888 23501888 CONSULTING AND OUTSOURC 15058703 12046963 3011740 BROKER COMMISSIONS 9877109 9877109 MISCELLANEOUS 206274 62786 143488 1432922843 1388078553 44844290 0 24165035 42725927 126265361 124993542 6049717 7002634 80673944 65404154 19515843 15269790 212868411 213031246 88678187 94176148 0 17304479 477542554 514503766 178020629 181900024 16488880 11321179 2704192 2600795 197213701 195821998 X 280328853 318681768 280328853 318681768 477542554 514503766 X 85702312 -2847359 -44502038 X 0 1 X 1 1 1 0 0 0 1 0 0 0 169015 169015 169015 0 169015 7305725 2751457 4554268 73354400 62652697 10701703 13819 13819 15269790 INVESTMENT IN SUBSIDIARIES 94176148 F 94176148 DUE TO INTERCOMPANIES 17304479 17304479 CLAIM ADJUSTMENT EXPENSE LIABILITY 2600795 2600795 X 1470840897 -2847359 -44502038 -47349397 1518190294 434861 434861 1518625155 1432487982 0 1432487982 434861 434861 1432922843 PART X, LINE 2: EXPLANATION: UNDER ASC 740, CDPHP IS REQUIRED TO DETERMINE WHETHER A TAX POSITION OF THE PLAN IS MORE LIKELY THAN NOT TO BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTION OF ANY RELATED APPEALS OF THE LITIGATION PROCESS, BASED ON THE TECHNICAL MERITS OF THE POSITIONS. FOR TAX POSITIONS MEETING THE MORE LIKELY THAN NOT THRESHOLD, THE TAX AMOUNT RECOGNIZED IN THE FINANCIAL STATEMENT IS REDUCED BY THE LARGEST BENEFIT THAT HAS A GREATER THAN FIFTY PERCENT LIKELIHOOD OF BEING REALIZED UPON THE ULTIMATE SETTLEMENT WITH THE RELEVANT TAXING AUTHORITY. PART XI, LINE 2D - OTHER ADJUSTMENTS: CURRENT YEAR EQUITY METHOD LOSS ON INVESTMENT IN SUBSIDIARIES -44,502,038. CENTRAL AMERICA, CARIBBEAN 0 0 INVESTMENT 6199378 0 0 0 0 0 0 6199378 0 6199378 0 0 1 0 0 0 1 ELLIS MEDICINE FOUNDATION INC 1101 NOTT STREET SCHENECTADY NY 12308 141638957 501(C)(3) 205671 EMERGENCY PHARMACY STAFF ST PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES PC 315 S MANNING BLVD ALBANY NY 12208 461177336 501(C)(3) 625785 CARE LOGISTICS INITIATIVES 2 0 PART I, LINE 2: EXPLANATION: ELLIS MEDICINE FOUNDATION, INC. - AMOUNT OF GRANT REPRESENTS PORTION ALLOCATED TO THE PLAN. PER THE TERMS OF THE PROGRAM, THE GRANT RECIPIENT PROVIDES AN ACCOUNTING OF THE PAYMENT OF THE FUNDS TO ENSURE THEY ARE APPROPRIATELY APPLIED. EXPLANATION: ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES PC (CARE LOGISTICS) - AMOUNT OF GRANT REPRESENTS PORTION ALLOCATED TO THE PLAN. PER THE TERMS OF THE PROGRAM, THE GRANT RECIPIENT PROVIDES AN ACCOUNTING OF THE PAYMENT OF THE FUNDS TO ENSURE THEY ARE APPROPRIATELY APPLIED. 1 X X X X X 1 1 0 0 0 0 0 1 0 JOHN D BENNETT MD CEO/PRESIDENT 802815 0 268035 0 29698 0 8475 0 13150 0 1122173 0 0 0 BRUCE NASH MD CHIEF MEDICAL OFFICER 472443 0 129883 0 48003 0 8475 0 12150 0 670954 0 0 0 BARBARA DOWNS EVP CORP ADMIN/COO 480479 0 128156 0 28632 0 8475 0 7306 0 653048 0 0 0 BRIAN MORRISSEY EVP MARKETING/CMO 348825 0 99694 0 37111 0 8475 0 20582 0 514687 0 0 0 BETHANY SMITH EVP FINANCE AND CFO 366313 0 90715 0 18831 0 8475 0 16332 0 500666 0 0 0 FREDERICK GALT ESQ EVP GENERAL COUNSEL 334618 0 90715 0 43642 0 8475 0 18082 0 495532 0 0 0 ROBERT HINCKLEY EVP GOVT AND EXTERNAL RELATIONS 328189 0 92863 0 43638 0 8475 0 15582 0 488747 0 0 0 NEIL BRANDMAIER SVP CHIEF INFORMATION OFFICER 314631 0 102825 0 26511 0 8475 0 16882 0 469324 0 0 0 SCOTT KLENK SVP HUMAN CAPITAL MANAGEMENT 273995 0 89234 0 42580 0 8475 0 5806 0 420090 0 0 0 UMESH REGE VP APPLICATION SOLUTIONS 253962 0 94715 0 43560 0 8475 0 1661 0 402373 0 0 0 DAVID JEANS VP CORPORATE ANALYTICS 280812 0 84812 0 19111 0 8475 0 18132 0 411342 0 0 0 RICHARD DAL COL VP SENIOR MEDICAL DIRECTOR 253949 0 78450 0 44550 0 8475 0 0 0 385424 0 0 0 CAROLE MONTEPARE FORMER SVP SALES 0 0 0 0 207726 0 8336 0 0 0 216062 0 0 0 PART 1 LINES 4A-B: THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN 2015: CAROLE MONTEPARE $207,897. QUESTION 4B CURRENT YEAR EMPLOYER NON-QUALIFIED DEFERRED COMPENSATION PLAN CONTRIBUTION: JOHN D. BENNETT, MD $825 ROBERT HINCKLEY $17,025 NEIL BRANDMAIER $825 SCOTT KLENK $14,625 RICHARD DAL COL, MD $18,000 BRIAN MORRISSEY $18,000 BARBARA DOWNS $825 BRUCE NASH, MD $18,000 FRED GALT $18,000 UMESH REGE $18,000 TOTAL $124,125 PART 1 LINE 7: EXPLANATION: CDPHP HAS A MANAGEMENT INCENTIVE PROGRAM THAT IS BASED UPON THREE CRITERIA: ATTAINMENT OF PERSONAL AND COMPANY GOALS, ACHIEVEMENT OF QUALITY AND SERVICE TARGETS, AND ACHIEVEMENT OF ENROLLMENT TARGETS. THE BOARD ANNUALLY APPROVES THE METRICS TO BE USED TO ASSESS EACH CRITERION. THE MANAGEMENT INCENTIVE IS PAYABLE ONLY IF DETERMINED TO BE AFFORDABLE BY THE BOARD. IN ADDITION, THE BOARD HAS FINAL DISCRETION AT THE CLOSE OF THE YEAR TO MAKE THE INCENTIVE PAYMENT. CAROLYN NEARY DAUGHTER OF JOHN BENNETT, MD, PRESIDENT AND CEO 56899 EMPLOYEE 0 ST PETER'S HEALTH PARTNERS MEDICAL ASSOCIATION BRUCE E. COPLIN, MD, BOARD MEMBER 17613755 SEE EXPLANATION BELOW 0 ALBANY MEDICAL COLLEGE CATHERINE R. BARTHOLOMEW, BOARD MEMBER 30613632 SEE EXPLANATION BELOW 0 CAPITAL CARE MEDICAL GROUP ANTHONY J. MARINELLO, MD, BOARD MEMBER 14391699 SEE EXPLANATION BELOW 0 CAP DISTRICT COLONRECTAL SURG ASSOC GENNARO A. DANIELS, BOARD MEMBER 449669 SEE EXPLANATION BELOW 0 ALBANY CAPITAL REGION GASTROENTEROLOGY JOSEPH M. POLITO II, MD, BOARD MEMBER 4964802 SEE EXPLANATION BELOW 0 NEW YORK ONCOLOGY HEMATOLOGY JOSEPH JAMES DUDEK, MD, BOARD MEMBER 19296993 SEE EXPLANATION BELOW 0 SHAKER PEDIATRICS PC HENRY M. NEILLEY, MD, BOARD MEMBER 961541 SEE EXPLANATION BELOW 0 COMMUNITY CARE PHYSICIANS PC HOLLY K. CLENEY, MD, BOARD MEMBER 31609464 SEE EXPLANATION BELOW 0 FORM 990 SCHEDULE L PART IV LINES 2-9: PURSUANT TO ITS CERTIFICATE OF INCORPORATION AND BY-LAWS, EIGHT OF THE MEMBERS OF THE CDPHP BOARD OF DIRECTORS MUST BE PRACTICING PHYSICIANS. AS PRACTICING PHYSICIANS, EACH OF THESE PHYSICIAN DIRECTORS HAS A STANDARD PARTICIPATING PROVIDER AGREEMENT WITH CDPHP PURSUANT TO WHICH THEY ARE PAID FEES FOR SERVICES RENDERED TO CDPHP MEMBERS. PURSUANT TO THE PARTICIPATING PROVIDER AGREEMENT, GENERALLY, THE PHYSICIAN DIRECTORS ARE PAID IN ACCORDANCE WITH THE STANDARD FEE SCHEDULE APPLICABLE TO ALL PHYSICIANS.HOWEVER, ALTHOUGH EACH PHYSICIAN HAS AN INDIVIDUAL CONTRACT WITH CDPHP, PAYMENT FOR SERVICES RENDERED BY INDIVIDUAL PHYSICIANS ARE PAYABLE TO THAT PHYSICIAN'S PRACTICE, NOT TO THE PROVIDER INDIVIDUALLY. PAYMENTS MADE BY CDPHP TO THE PROVIDER PRACTICE ARE NOT ALLOCATED OR REPORTED BY CDPHP BY INDIVIDUAL PROVIDER. ACCORDINGLY, PAYMENTS REPORTED HEREIN REFLECT THE AMOUNTS PAID IN FULL TO THE PRACTICE. AMOUNTS REPORTED ABOVE WERE PAID TO THE ORGANIZATIONS WHERE THE PHYSICIAN DIRECTOR IS AN EMPLOYEE, PARTNER, SHAREHOLDER, OR BOARD MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 EXPLANATION: THE CORPORATION CURRENTLY HAS 620 CORPORATE MEMBERS ALL OF WHOM ARE OR WERE PARTICIPATING PHYSICIANS WITH CDPHP. FORM 990, PART VI, SECTION A, LINE 7A EXPLANATION: CDPHP'S CORPORATE MEMBERS ELECT THE BOARD OF DIRECTORS OF CDPHP. FORM 990, PART VI, SECTION A, LINE 7B EXPLANATION: CORPORATE MEMBERS MUST APPROVE ANY CHANGES IN THE CORPORATION'S MISSION STATEMENT, BY-LAWS, CLASSES OF CORPORATE MEMBERSHIP, OR CHANGES TO THE BOARD OF DIRECTORS. IN ADDITION, THE CLASS "A" MEMBERS MUST APPROVE ANY CHANGES TO THE BY-LAWS AND CERTIFICATE OF INCORPORATION THAT ALTER THE RIGHTS OF CLASS "A" MEMBERS, MERGER, CONSOLIDATION, REORGANIZATION, DISSOLUTION, OR ANY CONVERSION FROM NOT-FOR-PROFIT STATUS. FORM 990, PART VI, SECTION B, LINE 11 EXPLANATION: THE FORM 990 IS REVIEWED BY THE CORPORATE CONTROLLER AND THE CFO. IT IS THEN PRESENTED TO THE FINANCE COMMITTEE OF THE BOARD FOR REVIEW AND APPROVAL. FINALLY, IT IS PRESENTED TO THE BOARD FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C EXPLANATION: CDPHP HAS A CONFLICT OF INTEREST POLICY. CDPHP REGULARLY POLLS EMPLOYEES AND BOARD MEMBERS REGARDING POTENTIAL CONFLICT OF INTEREST SITUATIONS. ANY ACTUAL OR POTENTIAL CONFLICTS DISCLOSED ARE PRESENTED TO THE BOARD, AT LEAST ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 EXPLANATION: CDPHP USES OUTSIDE COMPENSATION CONSULTING FIRMS. THESE FIRMS UTILIZE CUSTOM AND PUBLISHED SURVEYS. INFORMATION IS PROVIDED TO CDPHP'S BOARD COMPENSATION COMMITTEE FOR ANNUAL APPROVAL OF EXECUTIVE POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 EXPLANATION: FINANCIAL DOCUMENTS ARE FILED QUARTERLY WITH THE DEPARTMENT OF FINANCIAL SERVICES AND ARE AVAILABLE THROUGH THE FREEDOM OF INFORMATION ACT (FOIA). GOVERNING DOCUMENTS ARE ALSO AVAILABLE THROUGH THE DEPARTMENT OF FINANCIAL SERVICES, ALSO THROUGH FOIA. THE CONFLICT OF INTEREST POLICY IS NOT AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CURRENT YEAR EQUITY METHOD LOSS ON INVESTMENT IN SUBSIDIARIES -44,502,038. FORM 990 SCHEDULE D PART VII LINE 3(A)(C): EXPLANATION: THE METHOD OF VALUATION IN COLUMN (C) IS THE EQUITY METHOD OF ACCOUNTING. CAPITAL DISTRICT PHYSICIANS' HEALTHCARE NETWORK INC 500 PATROON CRK BLVD ALBANY NY 12206 141745298 PREF PROV ORG NY N/A C 13501113 7034448 1.00000 0 CARTER INSURANCE COMPANY LTD 40 CHURCH ST PO BOX HM2062 HAMILTON BD 141641028 CAPTIVE REINSURANCE BD N/A C 1210448 6998043 1.00000 0 CDPHP UNIVERSAL BENEFITS INC 500 PATROON CRK BLVD ALBANY NY 12206 161520935 ARTICLE 43 INSURANCE NY N/A C 795844863 193924384 1.00000 0 CDPHP FOUNDATION INC 500 PATROON CRK BLVD ALBANY NY 12206 471619130 FOUNDATION NY N/A C 1.00000 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 CAPITAL DISTRICT PHYSICIANS' HEALTHCARE NETWORK INC N 1517886 ALLOCATION CAPITAL DISTRICT PHYSICIANS' HEALTHCARE NETWORK INC O 5890093 ALLOCATION CAPITAL DISTRICT PHYSICIANS' HEALTHCARE NETWORK INC Q 3184961 ALLOCATION CDPHP UNIVERSAL BENEFITS INC N 9590246 ALLOCATION CDPHP UNIVERSAL BENEFITS INC O 32299823 ALLOCATION CDPHP UNIVERSAL BENEFITS INC Q 19004329 ALLOCATION CDPHP UNIVERSAL BENEFITS INC B 50000000 CASH PAYMENT