2014-10-24T16:36:09-05:00 2013-12-31 ERNST & YOUNG LLP 5 TIMES SQUARE NEW YORK NY 100366530 990 2013-01-01 133783732 Healthfirst PHSP Inc % MARYBETH TITA HEAL 2128016000 100 CHURCH ST FL 18 Suite NEW YORK NY 100072601 MARYBETH TITA SVP/TREASURER 2014-10-24 CHRISTOPHER BOGGS P00032493 2013 2015-11-30 17:44:51Z PATRICIA J WANG 100 CHURCH ST FL 18 NEW YORK NY 100072601 3307259420 false X WWW.HEALTHFIRSTNY.ORG X 1994 NY IMPROVE THE HEALTH & WELL-BEING OF UNDER- SERVED POPULATIONS BY PROVIDING COMPREHENSIVE PREPAID HEALTHCARE CO- VERAGE TO MEDICAID,CHILD HEALTH PLUS AND FAMILY HEALTH PLUS RECIPIENTS 5 3 0 0 0 0 0 2462763165 3305343319 3392262 1916101 0 0 2466155427 3307259420 0 0 0 0 0 0 0 0 0 2466103551 3287232831 2466103551 3287232831 51876 20026589 605495403 789982541 403472200 536942794 202023203 253039747 TO IMPROVE THE HEALTH AND WELL-BEING OF UNDERSERVED POPULATIONS BY PROVIDING COMPREHENSIVE PREPAID HEALTHCARE COVERAGE TO MEDICAID, CHILD HEALTH PLUS AND FAMILY HEALTH PLUS RECIPIENTS. false false 2924016844 2993096540 MEDICAID MANAGED CARE: HEALTHFIRST PHSP, INC. (PHSP) IS A LICENSED PREPAID HEALTH SERVICES PLAN THAT PROVIDES COMPREHENSIVE PREPAID HEALTH CARE COVERAGE TO MEDICAID RECIPIENTS PURSUANT TO ARTICLE 44 OF THE NEW YORK STATE PUBLIC HEALTH LAW. PHSP HAS PARTICIPATED IN NEW YORK'S MEDICAID PROGRAM SINCE OCTOBER 1994. FOR 2013 THERE WERE 687,859 MEMBERS ENROLLED IN PHSP'S MEDICAID PLAN. PHSP'S NETWORK INCLUDES 64 REGIONAL HOSPITALS THAT PROVIDE SERVICES TO MEMBERS. 248509158 254327589 FAMILY HEALTH PLUS (FHP): HEALTHFIRST PHSP, INC. (PHSP) IS A LICENSED PREPAID HEALTH SERVICES PLAN THAT PROVIDES COMPREHENSIVE PREPAID HEALTH CARE COVERAGE TO FHP RECIPIENTS PURSUANT TO ARTICLE 44 OF THE NEW YORK STATE PUBLIC HEALTH LAW. PHSP HAS PARTICIPATED IN NEW YORK'S FHP PROGRAM SINCE 1997. FOR 2013 THERE WERE 72,692 MEMBERS ENROLLED IN PHSP'S FHP PLAN. PHSP'S NETWORK INCLUDES 66 REGIONAL HOSPITALS THAT PROVIDE SERVICES TO MEMBERS. 54865658 57919190 CHILD HEALTH PLUS (CHP) HEALTHFIRST PHSP, INC. (PHSP) IS A LICENSED PREPAID HEALTH SERVICES PLAN THAT PROVIDES COMPREHENSIVE PREPAID HEALTH CARE COVERAGE TO CHP RECIPIENTS PURSUANT TO ARTICLE 44 OF THE NEW YORK STATE PUBLIC HEALTH LAW. PHSP HAS PARTICIPATED IN NEW YORK'S CHP PROGRAM SINCE 1997. FOR 2013 THERE WERE 29,005 MEMBERS ENROLLED IN PHSP'S CHP PLAN. PHSP'S NETWORK INCLUDES 61 REGIONAL HOSPITALS THAT PROVIDE SERVICES TO MEMBERS. 3227391660 true false false false false false false false false false false false false false true false true true false false false false false false false false false false false true false false false false false false false true false false false false false true true true true false true 9074 0 true 0 false false false false false false false false false false X 5 3 false true false false true true true true true false false true true true true true true false false false NY X MARYBETH TITA 2128016000 100 CHURCH ST FL 18 NEW YORK NY 100072601 X JAY A SCHECHTMAN CHIEF MEDICAL OFFICER 1.0 40.0 X 0 589373 90479 ELIZABETH R ST CLAIR SVP/GENERAL COUNSEL 1.0 40.0 X X 649837 121101 EVELYN DEL ORBE COMMUNITY REPRESENTATIVE 1.0 0.0 X STEPHEN ROSENTHAL DIRECTOR 1.0 0.0 X ERIC SCALETTAR DIRECTOR 1.0 0.0 X MARYBETH A TITA SVP/CHIEF FINANCIAL OFFICER 1.0 40.0 X 610978 111385 PATRICIA J WANG PRESIDENT/CEO 1.0 40.0 X 1286944 307077 DANIEL P MCCARTHY EVP/COO 1.0 40.0 X 833034 150193 DEBORAH E HAMMOND VP, MEDICAL DIRECTOR 1.0 40.0 X 367802 15300 ARUN K BHATIA SVP/CIO 1.0 40.0 X 450195 86195 ANDREA C FORINO SVP, HUMAN RESOURCES 1.0 40.0 X 574273 60634 YI QI WU VP, FACILITATED ENROLLMENT 1.0 40.0 X 388488 15300 PAUL E PORTSMORE JR SVP, BUS DEV AND MBR ACQUISI 1.0 40.0 X 368107 15300 0 6119031 972964 0 false true false CAREMARK LLC ONE CVS DRIVE WOONSOCKET RI 02895 PHARMACY 630292290 MONTEFIORE MEDICAL CENTER PO BOX 4296 CHURCH STREET STATION NEW YORK NY 10261 MEDICAL/HOSPITAL 178958303 DENTAQUEST 465 MEDFORD STREET BOSTON MA 021291454 MEDICAL/HOSPITAL 98885589 NYC HEALTH AND HOSPITAL CORP 125 WORTH STREET NEW YORK NY 10013 MEDICAL/HOSPITAL 190720178 MOUNT SINAI HOSPITAL P O BOX 27759 NEW YORK NY 100877759 MEDICAL/HOSPITAL 58554263 1584 0 MEDICAID MANAGED CARE 524114 2993096540 2993096540 FAMILY HEALTH PLUS 524114 254327589 254327589 CHILD HEALTH PLUS 524114 57919190 57919190 3305343319 1916101 1916101 0 0 0 0 0 0 0 0 0 0 3307259420 3305343319 1916101 0 0 0 0 0 0 0 0 0 0 209758292 151025970 58732322 0 0 0 0 0 73182 9149 64033 4691719 3796649 895070 334685 184939 149746 0 0 0 0 0 0 0 0 0 0 HEALTHCARE SERVICE COSTS 3072364841 3072364841 CLAIMS PROCESSING 10112 10112 3287232831 3227391660 59841171 0 0 0 57131965 75279394 0 0 178123835 194180838 0 0 0 0 0 0 0 0 0 0 0 348453456 491854393 0 0 0 0 0 0 21786147 28667916 605495403 789982541 382775486 508849131 0 0 449872 428799 0 0 0 0 0 0 0 0 0 0 20246842 27664864 403472200 536942794 X 202023203 253039747 0 0 0 0 202023203 253039747 605495403 789982541 X 20026589 -2130686 33120641 X X true true X true true true X 0 0 0 0 0 0 1176018993 1373305871 1709235704 2462763165 3305343319 10026667052 0 0 0 1176018993 1373305871 1709235704 2462763165 3305343319 10026667052 0 0 0 10026667052 4314310 3115511 2239456 3392262 1916101 14977640 0 4314310 3115511 2239456 3392262 1916101 14977640 0 0 1180333303 1376421382 1711475160 2466155427 3307259420 10041644692 0.99851 0.99771 0.00149 0.00229 X 0 DUE TO STATE OF NEW YORK 27664864 27664864 3338249375 -2130686 33120641 30989955 3307259420 3307259420 3287232831 3287232831 3287232831 Schedule D PART XI, LINE 2D - OTHER ADJUSTMENTS RETAINED HOSPITAL PAYMENTS: $33,120,641. The health care services agreements with certain hospitals provide that payments due to these hospitals, as a health care providers to PHSP Members, attributable to a % of premium are retained by PHSP. These hospitals may be entitled to have their retained payments refunded in the future, without interest, upon the dissolution of PHSP or similar circumstances, subject to any restrictions by the State of New York, as detailed in such agreement. Retained payments required to be withheld by PHSP totaled $33,120,641 for 2013. true true false false false false false false false JAY A SCHECHTMAN CHIEF MEDICAL OFFICER 0 414432 173865 1076 90479 17272 0 697124 ELIZABETH R ST CLAIR SVP/GENERAL COUNSEL 453483 182487 13867 121101 11196 782134 9535 MARYBETH A TITA SVP/CHIEF FINANCIAL OFFICER 426559 172135 12284 111385 17328 739691 10988 PATRICIA J WANG PRESIDENT/CEO 826007 402833 58104 307077 10699 1604720 55266 DANIEL P MCCARTHY EVP/COO 548258 267631 17145 150193 17328 1000555 13703 DEBORAH E HAMMOND VP, MEDICAL DIRECTOR 285779 80142 1881 15300 11519 394621 ARUN K BHATIA SVP/CIO 341008 108202 985 86195 15595 551985 ANDREA C FORINO SVP, HUMAN RESOURCES 211848 112826 249599 60634 7552 642459 YI QI WU VP, FACILITATED ENROLLMENT 275301 106245 6942 15300 17272 421060 PAUL E PORTSMORE JR SVP, BUS DEV AND MBR ACQUISI 330625 35625 1857 15300 383407 SCHEDULE J, PART 1, LINE 4A THE FOLLOWING INDIVIDUAL ENTERED INTO SEVERANCE AGREEMENTS AND/OR RECEIVED SEVERANCE PAYMENTS FROM HF MANAGEMENT SERVICES, LLC - A RELATED ORGANIZATION: ANDREA FORINO TOTAL OF SEVERANCE AGREEMENT IN 2013: $442,771 SEVERANCE PAID IN 2013: $85,148. SEVERANCE DEFERRED: $357,623. SCHEDULE J, PART 1, LINE 4B THE FOLLOWING INDIVIDUAL PARTICIPATED IN THE NON-QUALIFIED REQUIREMENT PLAN PROVIDED BY HF MANAGEMENT SERVICES, LLC - A RELATED ORGANIZATION. THE AMOUNTS BELOW REPRESENT CONTRIBUTIONS FROM THE PLAN SPONSOR FOR 2013: PATRICIA J. WANG $81,900. [Col. C] DANIEL P. McCARTHY $36,604. [Col. C] ELIZABETH R. ST CLAIR $28,539. [Col. C] JAY A. SCHECHTMAN $20,401 [Col. C] MARYBETH A. TITA $25,943. [Col. C] ARUN K.BHATIA $19,238. [Col. C] SEAN KANE $9,188. [Col. C]. HF MANAGEMENT SERVICES LLC COMMON OFFICERS/DIRECTORS 209758292 MANAGEMENT AND ADMIN SERVICES false FORM 990, PART VI, SECTION A, LINE 3 HEALTHFIRST PHSP, INC. (PHSP) CONTRACTS WITH HF MANAGEMENT SERVICES, LLC (HFMS) TO PROVIDE ALL OF ITS MANAGEMENT AND ADMINISTRATIVE SERVICES. PHSP DOES NOT MAINTAIN ITS OWN STAFF OR OFFICE SPACE; THESE ARE PROVIDED BY HFMS. HFMS CHARGES A PERCENT OF PREMIUM ON A PER MEMBER PER MONTH BASIS OR A FLAT FEE PER MEMBER PER MONTH. THE ARRANGEMENT IS APPROVED BY RESOLUTION OF THE BOARD OF DIRECTORS AND THE NY STATE DEPARTMENT OF HEALTH. 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 PHSP. FORM 990, PART VI, SECTION A, LINE 6 HEALTHFIRST PHSP, INC. IS A NEW YORK STATE NOT-FOR-PROFIT MEMBERSHIP CORPORATION. HEALTHFIRST PHSP'S SOLE CORPORATE MEMBER IS HEALTHFIRST, INC. FORM 990, PART VI, SECTION A, LINE 7A HEALTHFIRST PHSP, INC. (PHSP) IS A NEW YORK STATE NOT-FOR-PROFIT MEMBERSHIP CORPORATION. HEALTHFIRST PHSP'S SOLE CORPORATE MEMBER IS HEALTHFIRST, INC. HEALTHFIRST, INC. HAS THE RIGHT TO APPOINT MEMBERS TO THE BOARD OF DIRECTORS OF PHSP. FORM 990, PART VI, SECTION A, LINE 7B THE AMENDMENT OF THE ORGANIZATION'S GOVERNING DOCUMENTS IS SUBJECT TO THE APPROVAL OF HEALTHFIRST, INC. SOME OF THE DECISIONS OF THE GOVERNING BODY, SHOULD THEY OCCUR, ARE SUBJECT TO APPROVAL BY STATE REGULATORS: * DISTRIBUTION OF THE ORGANIZATION'S NET ASSETS * CERTAIN CHANGES TO PREMIUM RATES * EXPANSION TO OTHER MANAGED CARE BUSINESSES * SPECIFIC TYPES OF CHANGES TO THE ORGANIZATION'S BENEFIT PLANS * MANAGEMENT FEE RATE CHANGES [APPROVAL IS ALSO REQUIRED FROM THE MANAGEMENT COMPANY] 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. SECONDARY REVIEWS ARE ALSO PERFORMED BY THE HFMS GENERAL COUNSEL, SENIOR VICE PRESIDENT OF CORPORATE FINANCE 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. EACH BOARD MEMBER, OFFICER AND KEY EMPLOYEE IS GIVEN A COPY OF THE DISCLOSURE STATEMENT TO COMPLETE ON AN ANNUAL BASIS. A MEMBER WHO DOES NOT COMPLETE THE STATEMENT IS NOT ALLOWED TO ATTEND BOARD MEETINGS AND MAY BE REMOVED FROM THE BOARD. AN OFFICER OR KEY EMPLOYEE WHO DOES NOT COMPLETE THE STATEMENT WILL BE DISCIPLINED, UP TO TERMINATION FROM THE POSITION. 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 PHSP, INC. AS APPROPRIATE, 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 OFFICER OR EMPLOYEE, THE REPORTING 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 PHSP.(A RELATED ORGANIZATION). THE COMMITTEE CONSISTS ONLY OF INDEPENDENT DIRECTORS. 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 RETAINED HOSPITAL PAYMENTS: 33,120,641. FORM 990, PART XII, LINE 2C THE SELECTION OF THE INDEPENDENT AUDITOR IS ADMINISTERED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS OF HEALTHFIRST, INC. (A RELATED ORGANIZATION). MANAGED HEALTH INC 100 CHURCH ST FL 18 NEW YORK NY 10007 113029569 MANAGED CARE NY 501 (C)4 HEALTHFIRST true HEALTHFIRST INC 100 CHURCH ST FL 18 NEW YORK NY 10007 133714932 MANAGED CARE NY 501 (C)3 11 Type I NA 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 9 HF MGMT SVCS true NEIGHBORHOOD HEALTH PROVIDERS INC 100 CHURCH ST FL 18 NEW YORK NY 10007 943474115 MANAGED CARE 501 (C) 3 9 HEALTHFIRST true HF MANAGEMENT SERVICES LLC 100 CHURCH ST FL 18 NEW YORK NY 100072601 134069806 3RD PTY ADM S NY NA false 0 HF ADMINISTRATIVE SERVICES INC 100 CHURCH ST FL 18 NEW YORK NY 100072601 133873482 3RD PTY ADM S NY HF MGMT SVCS C CORP true false false false false false false false false false false false false true false false false false false true HF MANAGEMENT SERVICES LLC M 209758292 CONTRACTED RATE MANAGED HEALTH INC S 6800000 CONTRACT FORM 990, SCHEDULE R, PART V, LINE 2 METHOD OF DETERMINING AMOUNT INVOLVED ITEM (1): 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 BY STATE REGULATORS. ITEMS (2): IN ACCORDANCE WITH THE ORGANIZATION'S CONTRACTUAL ARRANGEMENTS WITH HOSPITALS , RISK-SHARING POOL BALANCES IN PHSP MAY BE OFFSET BY OR MAY BE USED TO OFFSET A PERCENTAGE OF THE SAME HOSPITAL(S)RISK-SHARING POOL BALANCE IN MHI THROUGH AN INTERCOMPANY TRANSFER. THE CURRENT POLICIES PERMIT THE OFFSETTING OF ANY DEFICITS THAT MAY ACCRUE FOR A HOSPITAL, OR ITS AFFILIATE INSTITUTIONS, WITH UP TO 100% OF SURPLUSES THAT MAY ACCRUE.