2014-11-13T08:19:04-06:00 2013-12-31 420714325 MCGLADREY LLP 1185 AVENUE OF THE AMERICAS NEW YORK NY 100362602 990 2013-01-01 134154068 AMIDA CARE INC AMID 6467577000 248 WEST 35TH STREET NO 7TH FL NEW YORK NY 10001 DOUGLAS WIRTH CEO 6467577000 2014-11-12 1 MARTIN GREIF P00029738 2123721000 2013 2015-11-30 17:44:51Z DOUGLAS WIRTH 248 WEST 35TH STREET NO 7TH FL NEW YORK NY 10001 264719332 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. 8 8 209 9 0 0 758965 920185 218214600 263795280 7413 3867 -5183 -8411 218975795 264710921 0 0 0 0 7179939 10523261 0 0 0 208028983 247408311 215208922 257931572 3766873 6779349 36115749 53708290 19380166 30193358 16735583 23514932 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. STAFF ALSO ASSISTS ENROLLEES IN THE PRUDENT SELECTION OF SERVICES. 0 0 234272043 263795280 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 69,850 MEMBER MONTHS IN 2013. 234272043 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 1 704 0 1 209 1 0 0 0 0 0 0 0 0 0 0 X 8 8 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 248 WEST 35TH STREET 7TH FLOOR NEW YORK NY 10001 PAUL VITALE CHAIRPERSON 0.50 X X 0 0 0 EMMA DEVITO VICE CHAIR 0.50 X X 0 0 0 STEVEN BUSSEY SECRETARY 0.50 X X 0 0 0 TOMAS DEL RIO TREASURER 0.50 X X 0 0 0 HOLLY ARGENT-TARIQ BOARD MEMBER 0.50 X 0 0 0 CHARLES KING BOARD MEMBER 0.50 X 0 0 0 PAM MATTEL BOARD MEMBER 0.50 X 0 0 0 SABRINA JOHNSON BOARD MEMBER 0.50 X 0 0 0 ROSLYN GILL BOARD MEMBER 0.50 X 0 0 0 ALLEN COX BOARD MEMBER - THRU 2/20/13 0.50 X 0 0 0 LORENA BISE BOARD MEMBER - THRU 2/20/13 0.50 X 0 0 0 DOUGLAS WIRTH CEO 40.00 X 399360 0 50198 JEROME ERNST MD CMO 40.00 X 220223 0 33265 FELICE KUSSOY CFO 40.00 X 215980 0 20117 JAMES CRAMER COO 40.00 X 166878 0 20499 MAURA MCGRATH CCPO 40.00 X 98522 0 2231 STEPHANE HOWZE DIRECTOR OF SPECIAL PROJECTS 40.00 X 161548 0 16245 VIRPI RANTA DIRECTOR OF CQI 40.00 X 132864 0 17206 STEPHANIE VELUZ SR. DIRECTOR OF MEDICAL INFORMATICS 40.00 X 126390 0 33369 VERONICA MONES DIRECTOR OF CARE COORDINATION 40.00 X 116978 0 14124 ALEXANDRA SHUSS DIRECTOR OF IS 40.00 X 116604 0 11640 JOHN MOORE DIRECTOR OF PHARMACY 40.00 X 106433 0 13243 1861780 0 232137 11 0 1 0 ROYAL HEALTH CARE 521 5TH AVENUE NEW YORK NY 10175 MANAGEMENT SERVICES 2421094 ROPES & GRAY LLP ONE INTERNATIONAL PLACE BOSTON MA 02110 LEGAL SERVICES 1053851 BEACON HEALTH STRATEGIES LLC 200 STATE STREET SUITE 302 BOSTON MA 02109 MANAGEMENT SERVICES 342000 STAR HEALTH MANAGEMENT LLC 936 BRUCE AVENUE CLEARWATER BEACH FL 33767 CONSULTING SERVICES 330559 WEISERMAZARS LLP 135 WEST 50TH STREET NEW YORK NY 10020 CONSULTING SERVICES 317000 9 86675 833510 920185 MEDICAID PAYMENTS 900099 263795280 263795280 263795280 3867 3867 0 86675 8411 -8411 -8411 264710921 263795280 0 -4544 1376453 1376453 7397883 7397883 121946 121946 909572 909572 717407 717407 1509210 1509210 685835 685835 47700 47700 4034775 4034775 1154402 1154402 164667 164667 1188388 1188388 108612 108612 155292 155292 257296 257296 348193 348193 66932 66932 PHARMACY COSTS 157550024 157091967 458057 MEDICAL SERVICES 73406345 73406345 HEALTH ASSESSMENTS & SU 3773731 3773731 UTILIZATION MANAGEMENT 1214160 1214160 1742749 1742749 257931572 234272043 23659529 0 1183 1843 28288994 28178171 135929 9586 6553583 23579034 274897 377535 1461844 796281 598290 665563 262873 896558 36115749 53708290 17146514 22709706 5250000 2233652 2233652 19380166 30193358 X 16735583 23514932 16735583 23514932 36115749 53708290 6779349 0 X 0 1 X 1 0 X 49111 358185 804111 758965 920185 2890557 24162232 29875365 88329851 218214600 263795280 624377328 24211343 30233550 89133962 218973565 264715465 627267885 0 0 0 627267885 77579 92379 81306 7413 3867 262544 77579 92379 81306 7413 3867 262544 24288922 30325929 89215268 218980978 264719332 627530429 0.99960 0.99930 0.00040 0.00070 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 295219 117611 177608 820237 553058 267179 346388 125612 220776 665563 SUBVENTION PAYABLE TO 501(C) ORG 2233652 2233652 X 264719332 8411 8411 264710921 0 264710921 257939983 8411 8411 257931572 0 257931572 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 THERE WERE NO SUCH MATTERS REQUIRING RECOGNITION IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE PLAN FILES INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION. THE PLAN IS NO LONGER SUBJECT TO U.S. FEDERAL INCOME TAX EXAMINATIONS BY TAXING AUTHORITIES FOR YEARS BEFORE DECEMBER 31, 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED AGAINST FUNDRAISING REVENUE 8,411. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED AGAINST FUNDRAISING REVENUE 8,411. LIVE YOUR LIFE FUNDRAISER 86675 86675 8411 86675 86675 8411 8411 -8411 X X 0 0 0 0 0 0 0 1 0 DOUGLAS WIRTH CEO 324000 0 75000 0 360 0 28519 0 21679 0 449558 0 0 0 JEROME ERNST MD CMO 215897 0 0 0 4326 0 11250 0 22015 0 253488 0 0 0 FELICE KUSSOY CFO 205581 0 10000 0 399 0 8958 0 11159 0 236097 0 0 0 JAMES CRAMER COO 163462 0 2500 0 916 0 8536 0 11963 0 187377 0 0 0 STEPHANE HOWZE DIRECTOR OF SPECIAL PROJECTS 156408 0 5000 0 140 0 2704 0 13541 0 177793 0 0 0 VIRPI RANTA DIRECTOR OF CQI 132178 0 0 0 686 0 6759 0 10447 0 150070 0 0 0 STEPHANIE VELUZ SR. DIRECTOR OF MEDICAL INFORMATICS 126288 0 0 0 102 0 4984 0 28385 0 159759 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 2013: DOUGLAS WIRTH - $75,000 FELLICE KUSSOY - $10,000 JAMES CRAMER - $2,500 STEPHANE HOWZE - $5,000 JOHN MOORE - $5,000 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 FOR 2013 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 CORPORATE COMPLIANCE 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 AND CORPORATE COMPLIANCE AND 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 AND CCPO. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC, BASED UPON WRITTEN REQUEST. FORM 990 PART VI SECTION A - GOVERNING BODY AND MANAGEMENT, LINE 1A NUMBER OF VOTING MEMBERS = 8. 6 MEMBERS ARE THE DIRECTORS OF THE 6 NOT-FOR-PROFIT ORGANIZATIONS WHICH FOUNDED AMIDA CARE INC. AND 2 ARE ENROLLED MEMBERS OF THE ORGANIZATION. 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.