2015-10-30T15:52:43-05:00 2014-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2014-01-01 133330672 AFFINITY HEALTH PLAN INC % Stephen Giasi AFFI 7187947700 1776 Eastchester Road Bronx NY 10461 STEVE GIASI CFO 2015-10-30 2014 2016-04-25 22:37:26Z X Glenn MacFarlane 1776 Eastchester Road Bronx NY 10461 1438286646 false X www.affinityplan.org X 1981 NY THE MISSION OF AFFINITY HEALTH PLAN IS TO IMPROVE THE HEALTH AND WELL- IMPROVE THE HEALTH AND WELL-BEING OF ITS MEMBERS, THEIR FAMILIES, AND THEIR COMMUNITIES IN COLLABORATION WITH PRIMARY CARE PROVIDERS. 11 11 1068 0 0 0 0 1181375348 1301755722 4107792 11207917 0 0 1185483140 1312963639 0 0 0 0 65073711 68397253 0 0 0 1136785583 1228562971 1201859294 1296960224 -16376154 16003415 279784162 348873880 162247765 221488263 117536397 127385617 X THE MISSION OF AFFINITY HEALTH PLAN IS TO IMPROVE THE HEALTH AND WELL-BEING OF ITS MEMBERS, THEIR FAMILIES, AND THEIR COMMUNITIES IN COLLABORATION WITH PRIMARY CARE PROVIDERS. AFFINITY STRIVES TO BE THE HEALTH PLAN OF CHOICE FOR ITS MEMBERS AND ITS PROVIDERS -- KNOWN FOR ASSURING ACCESS TO HIGH QUALITY, COST-EFFECTIVE CARE; DELIVERING THE BEST CUSTOMER EXPERIENCE; AND CONTRIBUTING SIGNIFICANTLY TO ACHIEVING A PATIENT-CENTERED HEALTH CARE SYSTEM. true true 1016359003 1138156349 AFFINITY HEALTH PLAN'S MEDICAID PROGRAM IS FUNDED BY THE STATE OF NEW YORK TO MANAGE THE HEALTHCARE AND RELATED COSTS OF MEDICAID PATIENTS IN NEW YORK CITY AND THE SURROUNDING COUNTIES OF NASSAU, SUFFOLK, WESTCHESTER, ROCKLAND AND ORANGE COUNTY. 69251936 69626366 The Plan also operates a Medicare Advantage program that is administered under an agreement with the Centers for Medicare and Medicaid Services (CMS) and includes a prescription drug benefit component under Part D of Title XVIII of the Social Security Act. The Plan's Special Needs Plan (SNP) is administered under an agreement with NYSDOH. The SNP provides coverage to members dually eligible for Medicare Advantage and Medicaid Advantage programs. 52588788 54973250 THE FAMILY HEALTH PLUS (FHP) PROGRAM PROVIDES HEALTH INSURANCE COVERAGE FOR LOW INCOME SINGLE ADULTS AND ADULTS WITH CHILDREN. THE FHP PROGRAM IS ADMINISTERED UNDER AGREEMENTS WITH THE NYS DEPARTMENT OF HEALTH. 32779516 38999757 1170979243 true false false false false false false false false true true false false true true false true false 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 false false false true 6094 0 true 1068 true false false false false false false false false false false X 11 11 false false false false false false false true true false false true true true true true true true true false NY X Stephen Giasi 7187947700 1776 Eactchester Avenue Bronx NY 10461 Caleb DesRosiers Trustee 1.0 0.0 X 0 0 0 Craig Keyes MD Trustee 1.0 0.0 X 0 0 0 Robert Schiller MD Trustee 1.0 0.0 X 0 0 0 James Hooley Trustee 1.0 0.0 X 0 0 0 Yvette Walker Trustee 1.0 0.0 X 0 0 0 Nanette Falkenberg Trustee 1.0 0.0 X 0 0 0 Verona Greenland Trustee 1.0 0.0 X 0 0 0 Paloma Hernandez Trustee 1.0 0.0 X 0 0 0 Amy Knapp Trustee 1.0 0.0 X 0 0 0 Lynn Sherman Trustee 1.0 0.0 X 0 0 0 John Sardelis Trustee 1.0 0.0 X 0 0 0 Bertram Scott President - CEO 37.5 0.0 X 452601 0 48009 Glenn MacFarlane Chief Financial Officer 37.5 0.0 X 284715 0 42503 Robert Allen EVP - COO 37.5 0.0 X 331084 0 36108 Dr Munish Khaneja SVP - Chief Medical Officer 37.5 0.0 X 250497 0 46292 Abenna Udochi Exec Dir -State Gov't Programs 37.5 0.0 X 241489 0 39681 Caron Cullen SVP - Chief Compliance Officer 37.5 0.0 X 398146 0 29968 Joseph Karp Medical Director 37.5 0.0 X 232267 0 7924 Camille Kurtz VP-Med Mgmt & Exc Dir-Medicare 37.5 0.0 X 247407 0 23340 Claire DeMatteis SVP - General Counsel & CCO 37.5 0.0 X 230497 0 26734 Mark Corcoran EVP & Chief Financial Officer 37.5 0.0 X 261993 0 9052 2930696 0 309611 78 true true false Transaction Applications Group Inc 200 West Plano Pkwy Plano TX 75075 Cosulting Services 2864318 Cognizant Technology Solutions 500 Frank W Burr Blvd Teaneck NJ 07666 Consulting Services 946685 CVS CAREMARK 695 GEORGE WASHINGTON HWY LINCOLN RI 02865 PHARM BENEFITS MGMT 1155174 The TriZetto Group Inc 60 East 42nd Street New York NY 10020 Consulting Services 1195819 TMG Health Inc PO Box 200521 Pittsburgh PA 152510521 Consulting Services 971939 6904 0 0 0 Medicaid 1138156349 1138156349 0 0 MEDICARE 69626366 69626366 0 0 FHP 54973250 54973250 0 0 CHP 27104599 27104599 0 0 QHP 11895158 11895158 0 0 1301755722 2998965 2998965 0 0 0 0 0 133531959 125323007 8208952 8208952 8208952 0 0 0 0 1312963639 1301755722 0 11207917 0 0 0 0 0 0 0 0 1491809 0 1491809 0 0 0 0 0 53266088 0 53266088 0 1812450 0 1812450 0 7204868 0 7204868 0 4622038 0 4622038 0 0 0 0 0 458500 0 458500 0 457849 0 457849 0 0 0 0 0 0 0 424612 0 424612 0 19604564 19604564 4474948 4474948 0 4765477 0 4765477 0 6281533 0 6281533 0 0 0 0 0 7701366 0 7701366 0 391266 0 391266 0 0 0 0 0 1004589 0 1004589 0 2411112 0 2411112 0 0 0 0 0 9157274 0 9157274 0 450638 0 450638 0 INPATIENT CLAIMS 271267218 271267218 0 0 PHARMACY 241908085 241908085 0 0 PHYSICIAN REFERRAL 171562336 171562336 0 0 PRIMARY CARE 160665757 160665757 0 0 325575847 325575847 1296960224 1170979243 125980981 0 0 0 0 95235378 85504826 0 0 72130860 151990118 0 0 0 0 0 0 0 0 0 0 57066271 30261496 28190187 26804775 55382690 46035844 0 0 0 0 0 0 28845047 38538317 279784162 348873880 159914833 219445725 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2332932 2042538 162247765 221488263 X 7757872 7990233 109778525 119395384 0 0 117536397 127385617 279784162 348873880 16003415 -6154195 X X false true X true true true X 109778525 9616859 119395384 107381700 2396825 109778525 94154933 13226767 107381700 105757586 -11602653 94154933 86616257 19141329 105757586 0.17000 0.83000 true false 6487058 1362746 5124312 4727058 3586053 1141005 45852155 25312697 20539458 26804775 Advances to Providers 28665961 Other Assets 9872356 38538317 0 Deferred Rent 1865070 Other Lease Obligations 177468 2042538 1306809444 -6154195 0 0 -6154195 1312963639 1312963639 1296960224 0 0 0 0 1296960224 1296960224 ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 1B, COLUMN A THE PLAN MUST MAINTAIN MINIMUM LEVELS OF RESTRICTED ASSETS (CONTINGENT RESERVE) AS REQUIRED BY THE NEW YORK STATE DEPARTMENT OF HEALTH (NYSDOH). THE REQUIREMENT IS RECALCULATED ANNUALLY BASED ON STATUTORY PREMIUM REVENUE FOR THE YEAR. DURING 2014, THE NYSDOH AMENDED THE REGULATIONS GOVERNING THE CONTINGENT RESERVE. THE AMENDMENT PROVIDED SPECIAL REDUCED PERCENTAGES TO BE APPLIED TO THE REVENUES FROM THE MEDICAID MANAGE CARE, CHP AND FHP PROGRAMS OFFERED BY NEW YORK STATE. X X X X X true false false false false false false false false Abenna Udochi Exec Dir -State Gov't Programs 241129 0 0 0 360 0 23788 0 15893 0 281170 0 0 0 Caron Cullen SVP - Chief Compliance Officer 141380 0 0 0 256766 0 19951 0 10017 0 428114 0 0 0 Dr Munish Khaneja SVP - Chief Medical Officer 250294 0 0 0 203 0 26120 0 20172 0 296789 0 0 0 Joseph Karp Medical Director 230413 0 0 0 1854 0 6912 0 1012 0 240191 0 0 0 Bertram Scott President - CEO 400821 0 41000 0 10780 0 21580 0 26429 0 500610 0 0 0 Glenn MacFarlane Chief Financial Officer 284163 0 0 0 552 0 18416 0 24087 0 327218 0 0 0 Mark Corcoran EVP & Chief Financial Officer 8091 0 0 0 253902 0 3362 0 5690 0 271045 0 0 0 Robert Allen EVP - COO 329500 0 0 0 1584 0 25664 0 10444 0 367192 0 0 0 Camille Kurtz VP-Med Mgmt & Exc Dir-Medicare 246375 0 0 0 1032 0 13526 0 9814 0 270747 0 0 0 Claire DeMatteis SVP - General Counsel & CCO 230137 0 0 0 360 0 1544 0 25190 0 257231 0 0 0 Form 990, Schedule J, Part I-13, Line 4a A SEVERANCE PAYMENT IN THE AMOUNT OF $225,385 WAS PAID TO MARK CORCORAN IN JANUARY 2014 AFTER HE LEFT THE ORGANIZATION IN DECEMBER, 2013. A SEVERANCE PAYMENT IN THE AMOUNT OF $233,663 WAS PAID TO CARON CULLEN WHEN SHE LEFT THE ORGANIZATION IN AUGUST, 2014. DESCRIPTION OF OTHER PROGRAM SERVICES FORM 990, PART III, LINE 2 THE PLAN ESTABLISHED A QUALIFIED HEALTH PLAN (QHP) UNDER HEALTH CARE REFORM, WHICH IS CERTIFIED BY THE NEW YORK STATE HEALTH INSURANCE MARKETPLACE. QHP PROVIDES ESSENTIAL HEALTH BENEFITS, FOLLOWS ESTABLISHED LIMITS ON COST-SHARING (DEDUCTIBLE, COPAYMENT AND OUT-OF-POCKET MAXIMUM AMOUNTS), AND MUST MAINTAIN COMPLIANCE WITH OTHER PROVISIONS OF HEALTH CARE REFORM. COVERAGE FOR QHP MEMBERS BEGAN JANUARY 1, 2014 FORM 990, PART III LINE 3 THE PLAN'S FAMILY HEALTH PLUS (FHP) PROGRAM BEGAN OPERATIONS ON OCTOBER 1, 2001. FHP PROVIDES HEALTH INSURANCE COVERAGE FOR LOW-INCOME SINGLE ADULTS AND ADULTS WITH CHILDREN. THE FHP PROGRAM IS ADMINISTERED UNDER THE SAME AGREEMENT AS THE MEDICAID PROGRAM. THE FHP PROGRAM ENDED ON DECEMBER 31, 2014, AND NO COVERAGE WILL BE AUTHORIZED PAST THAT DATE. FORM 990, PART III LINE 4d THE CHILD HEALTH PLUS (CHP) PROGRAM IS FUNDED BY THE STATE OF NEW YORK TO PROVIDE HEALTH INSURANCE COVERAGE FOR CHILDREN THAT ARE UNDER THE AGE OF 19. START UP COST FOR TWO PROGRAMS MEDICAL LONG TERM CARE AND THE QUALITY HEALTH PLAN. THE PLAN ESTABLISHED A QUALIFIED HEALTH PLAN (QHP) UNDER HEALTH CARE REFORM, WHICH IS CERTIFIED BY THE NEW YORK STATE HEALTH INSURANCE MARKETPLACE. QHP PROVIDES ESSENTIAL HEALTH BENEFITS, FOLLOWS ESTABLISHED LIMITS ON COST-SHARING (DEDUCTIBLE, COPAYMENT AND OUT-OF-POCKET MAXIMUM AMOUNTS), AND MUST MAINTAIN COMPLIANCE WITH OTHER PROVISIONS OF HEALTH CARE REFORM. COVERAGE FOR QHP MEMBERS BEGAN JANUARY 1, 2014. DESCRIBE THE PROCESS TO REVIEW THE FORM 990 FORM 990, PART VI, LINE 11B THE FINANCIAL STAFF COMPILES THE FINANCIAL AND OTHER INFORMATION REQUIRED IN THE 990 RETURN. ERNST & YOUNG, LLP, PREPARES THE RETURN AND THE INFORMATION IS REVIEWED BY THE COMPANY'S CFO. A FINAL COPY OF THE FORM 990 IS MADE AVAILABLE TO THE ENTIRE GOVERNING BODY BEFORE FILING. DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, QUESTION 12C 1. ACTUAL OR POTENTIAL CONFLICTS OF INTEREST MUST BE DISCLOSED TO APPROPRIATE MANAGEMENT PERSONNEL, HUMAN RESOURCES OR THE CORPORATE COMPLIANCE OFFICER. 2. EMPLOYEES MUST SEEK GUIDANCE AND APPROVAL FROM APPROPRIATE MANAGEMENT PERSONNEL PRIOR TO PURSUING ANY BUSINESS OR PERSONAL ACTIVITY THAT MAY CONSTITUTE A CONFLICT OF INTEREST. 3. MANAGEMENT, WITH PURCHASING AUTHORITY, WILL COMPLETE A RELATED PARTY QUESTIONNAIRE ANNUALLY TO IDENTIFY ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST. 4. EMPLOYEES, UPON HIRE AND ANNUALLY THEREAFTER, REVIEW THE CODE OF ETHICS WHICH INCLUDES INFORMATION ON CONFLICTS OF INTEREST. IN ADDITION, EMPLOYEES ARE REQUIRED TO SIGN AN ATTESTATION UPON HIRE AND ANNUALLY THEREAFTER, THAT THEY ACKNOWLEDGE AND UNDERSTOOD THE CODE OF ETHICS. OFFICERS & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN FORM 990, PART VI, QUESTION 15A AND 15B THE PROCESS FOR DETERMINING COMPENSATION FOR THE CEO, CFO AND COO INCLUDED REVIEW AND APPROVAL BY A COMPENSATION COMMITTEE (THE "COMMITTEE") COMPRISED OF INDEPENDENT DIRECTORS CHARGED WITH THIS RESPONSIBILITY, CONSIDERATION OF COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION AND DOCUMENTATION OF THE DELIBERATION AND DECISION. AFFINITY HEALTH PLAN'S COMPENSATION PROGRAM FOR THESE POSITIONS AND OTHER OFFICERS AND KEY EMPLOYEES INCLUDES ESTABLISHED POLICIES FOR JOB EVALUATION USING A POINT FACTOR SYSTEM; MERIT INCREASES; AND SALARY ACTIONS ASSOCIATED WITH NEW HIRES, PROMOTIONS, TRANSFERS AND DEMOTIONS. SPECIFICALLY, FOR: A) THE CEO - COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER IS ESTABLISHED BY THE COMPENSATION COMMITTEE AND RATIFIED BY THE BOARD OF DIRECTORS OF AFFINITY HEALTH PLAN. THE BOARD AND THE COMMITTEE HAS ESTABLISHED COMPENSATION TERMS FOR THE CEO CONSIDERING COMPARABILITY DATA FOR CEO POSITIONS IN SIMILAR ORGANIZATIONS IN THEIR DELIBERATIONS AND DECISION MAKING. THESE DECISIONS ARE DOCUMENTED IN ACCORDANCE WITH LEGAL REQUIREMENTS AND BEST PRACTICES. B) OTHER OFFICERS AND KEY EMPLOYEES - JOBS HELD BY OTHER OFFICERS AND JOBS HELD BY KEY EMPLOYEES ARE EVALUATED USING THE POINT FACTOR JOB EVALUATION PROCESS APPLICABLE TO ALL JOBS AT AFFINITY HEALTH PLAN. BASED ON THE POINT FACTOR EVALUATION, JOBS ARE PLACED IN A SALARY GRADE. MERIT INCREASES ARE AWARDED BASED ON PERFORMANCE AFTER A FORMAL YEAR END PERFORMANCE EVALUATION. THIS PROGRAM APPLIES TO ALL EMPLOYEES INCLUDING OTHER OFFICERS AND KEY EMPLOYEES. DISCRETIONARY COMPENSATION DECISIONS APPLICABLE FOR OTHER OFFICERS AND KEY EMPLOYEES, INCLUDING PROMOTIONAL SALARY ADJUSTMENTS, MARKET/EQUITY SALARY ADJUSTMENTS AND STARTING SALARIES FOR NEWLY HIRED OFFICERS AND KEY EMPLOYEES ARE MADE AFTER REVIEW OF COMPARABILITY DATA FROM PUBLISHED SOURCES FOR SIMILAR POSITIONS IN THE RELEVANT LABOR MARKET. PUBLISHED COMPARABILITY DATA UTILIZED INCLUDES INDUSTRY SPECIFIC DATA. INTERNAL DATA IS REVIEWED AS WELL WITH THE OBJECTIVE OF ENSURING INTERNAL EQUITY WITH SIMILARLY SITUATED STAFF. DISCRETIONARY COMPENSATION DECISIONS IMPACTING THOSE OF THE FOREGOING POSITIONS THAT ARE ALSO DEEMED TO BE "DISQUALIFIED PERSONS" UNDER THE INTERNAL REVENUE CODE (E.G., CHIEF OPERATING OFFICER AND CHIEF FINANCIAL OFFICER) ARE MADE BY THE COMMITTEE (AND RATIFIED BY THE BOARD) IN ACCORDANCE WITH "INTERMEDIATE SANCTIONS SAFE HARBOR" STANDARDS UTILIZING THE SAME PROCESSES AS ARE APPLIED TO THE CEO (DISCUSSED ABOVE). Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public Form 990, Part VI, Question 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:PROFESSIONAL COSTS TOTAL EXPENSES:116006222 PROGRAM SERVICES:116006222 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:RADIOLOGY/LAB & DIAGNOSTIC TOTAL EXPENSES:78404270 PROGRAM SERVICES:78404270 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:MEDICAID TOTAL EXPENSES:48692654 PROGRAM SERVICES:48692654 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:EMERGENCY ROOM TOTAL EXPENSES:38915322 PROGRAM SERVICES:38915322 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:DENTAL TOTAL EXPENSES:38237242 PROGRAM SERVICES:38237242 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:SURGICAL TOTAL EXPENSES:18201215 PROGRAM SERVICES:18201215 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:VISION TOTAL EXPENSES:3823366 PROGRAM SERVICES:3823366 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:BEHAVIORAL TOTAL EXPENSES:3424390 PROGRAM SERVICES:3424390 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:TRANSPORTATION TOTAL EXPENSES:3393757 PROGRAM SERVICES:3393757 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:NURSING TOTAL EXPENSES:2758582 PROGRAM SERVICES:2758582 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:COVERED LIVES TOTAL EXPENSES:1443377 PROGRAM SERVICES:1443377 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:BEACON TOTAL EXPENSES:1130860 PROGRAM SERVICES:1130860 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:FAMILY PLANNING TOTAL EXPENSES:1075326 PROGRAM SERVICES:1075326 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:AMBULATORY TOTAL EXPENSES:237308 PROGRAM SERVICES:237308 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:OUTPATIENT CLAIMS TOTAL EXPENSES:172036 PROGRAM SERVICES:172036 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:OTHER MEDICAL TOTAL EXPENSES:56847 PROGRAM SERVICES:56847 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:PRENATAL TOTAL EXPENSES:19301 PROGRAM SERVICES:19301 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:MEDICAL SUPPLIES TOTAL EXPENSES:6514 PROGRAM SERVICES:6514 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:HOME HEALTHCARE TOTAL EXPENSES:1388 PROGRAM SERVICES:1388 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:THIRD PARTY RECOVERIES TOTAL EXPENSES:-30424130 PROGRAM SERVICES:-30424130 AHP ENTERPRISES INC 1776 EASTCHESTER ROAD BRONX NY 10461 MGMT SVCS DE AHP C CORP 0 0 0.00000 true false false false false false false false false false false false false false false false false false false false