2013-01-30T16:14:35-06:00 2011-12-31 SANDY STORM ERNST & YOUNG LLP 111 MONUMENT CIRCLE STE 2600 INDIANAPOLIS IN 462045120 990 2011-01-01 510609967 Healthfirst Health Plan of New Jersey Inc % MARYBETH TITA HEAL 9734972367 1 Washington Street STE 1405 Newark NJ 071023105 MARYBETH TITA 2012-11-11 Christopher Boggs 2127733000 2011 2016-02-25 16:41:14Z Healthfirst New Jersey TERENCE BYRD 1 Washington Street STE 1405 Newark NJ 071023105 182478432 false X WWW.HEALTHFIRSTNJ.ORG X 2006 NJ TO PROMOTE THE HEALTH OF THE PEOPLE OF THE STATE OF NEW JERSEY BY ARRANGING FOR THE PROVISION OF HEALTH CARE SERVICES TO MEDICARE AND MEDICAID BENEFICIARIES. 18 14 0 0 0 0 0 98887554 182394393 141669 84039 0 0 99029223 182478432 0 0 0 0 0 0 0 0 0 98607703 182600966 98607703 182600966 421520 -122534 29112536 57704549 22002764 42288126 7109772 15416423 TO PROMOTE THE HEALTH OF THE COMMUNITY BY ARRANGING FOR THE PROVISION OF HEALTH CARE SERVICES TO MEDICARE AND MEDICAID BENEFICIARIES AND TO RELIEVE THE POOR AND DISTRESSED BY MEETING THE SPECIAL HEALTH CARE NEEDS OF MEDICARE AND MEDICAID BENEFICIARIES. false false 61568119 63514990 MEDICARE HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC. (HFNJ) PROVIDES AFFORDABLE QUALITY HEALTH PLANS TO ELIGIBLE MEDICARE RECIPIENTS. FOR 2011 THERE WERE 6,076 MEMBERS ENROLLED IN HFNJ'S MEDICARE PLANS. HFNJ'S NETWORK INCLUDES APPROXIMATELY 30 REGIONAL HOSPITALS THAT PROVIDE SERVICES TO MEMBERS. 115235496 118879403 MEDICAID/NJFAMILYCARE HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC. (HFNJ) PROVIDES AFFORDABLE QUALITY HEALTH PLANS TO ELIGIBLE MEDICAID RECIPIENTS. FOR 2011 THERE WERE 46,423 MEMBERS ENROLLED IN HFNJ'S MEDICAID/NJFAMILYCARE PLANS. HFNJ'S NETWORK INCLUDES APPROXIMATELY 30 REGIONAL HOSPITALS THAT PROVIDE SERVICES TO MEMBERS. 176803615 false false false false false false false false false false false false true true true false 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 false true 2731 0 true 0 false false false false false false X 18 14 false true false false true true true true true false false true true true true true true false false false X MARYBETH TITA 2128016000 100 CHURCH ST FL 18 NEW YORK NY 100072601 X GARY HORAN 1.0 X 0 0 0 WILLIAM MCDONALD 1.0 X X GEORGE POPKO 1.0 X DANIEL P MCCARTHY 1.0 X 673189 93316 DEBORAH E HAMMOND 1.0 X X 330312 14700 MARYBETH A TITA 1.0 X X 465214 64541 MICHAEL D D'AGNES 1.0 X ANTHONY T ORLANDO 1.0 X AXEL RAMOS 1.0 X LESLIE D HIRSCH 1.0 X MICHAEL MARON 1.0 X JOHN CALANDRIELLO 1.0 X JAMES M MAHER 1.0 X TERENCE L BYRD 1.0 X X 318859 8013 WARREN MILLER 1.0 X VINCENT RICCITELLI 1.0 X JOHN GRYWALSKI 1.0 X JOHN BRAULT 1.0 X ELIZABETH R ST CLAIR 1.0 X 484057 63664 PATRICIA J WANG 1.0 X 1108563 219531 JAY A SCHECHTMAN 1.0 X 506932 85509 SEAN NATARO 1.0 X 330389 14700 JOHN CHENG 1.0 X 324973 14700 REBECCA SCHWIETZ 1.0 X 323369 14700 MARIA OLIVERI 1.0 X 244262 14640 STEVEN SAKOVITS 0.0 X 424227 MICHAEL H HONIG 1.0 X 485996 114385 0 6020342 722399 0 true true false EXPRESS SCRIPTS 21653 NETWORK PLACE CHICAGO IL 606731216 PHARMACY 16405943 RIVERSIDE PEDIATRIC GROUP INC 714 10TH STREET SECAUCUS NJ 07094 MEDICAL/HOSPITAL 3658925 JERSEY CITY MEDICAL CENTER 355 GRAND STREET JERSEY CITY NJ 07302 MEDICAL/HOSPITAL 3373237 TRINITAS REGIONAL MEDICAL CENTER 750 WALNUT AVENUE CRANFORD NJ 07016 MEDICAL/PROFESSIONAL 5307959 ST JOSEPH REGIONAL MEDICAL CENTER 703 MAIN STREET PATERSON NJ 07503 MEDICAL/HOSPITAL 5263108 93 0 MEDICARE ADVANTAGE (PART C) 524114 56481556 56481556 MEDICARE PRESCRIPTION DRUG CVG (PART D) 524114 7033433 7033433 MEDICAID / NJFAMILYCARE 524114 118879404 118879404 182394393 84039 84039 0 0 0 0 0 0 0 182478432 182394393 84039 0 0 0 0 0 0 0 0 0 0 20144898 14460876 5684022 0 0 0 0 0 435 435 0 0 0 0 0 0 0 0 112894 112894 0 0 0 HEALTHCARE SERVICE COSTS 162249496 162249496 UNPAID CLAIMS PROCESSING EXP 93243 93243 182600966 176803615 5797351 0 15258458 29934589 6243875 15607384 0 0 4619870 6661422 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2990333 5501154 29112536 57704549 16402989 33011481 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5599775 9276645 22002764 42288126 X 7109772 15416423 0 0 0 0 7109772 15416423 29112536 57704549 X -122534 8429185 X X false true true X false OTHER RECEIVABLES 1126718 RISK POOL BALANCE RECEIVABLE 4374436 5501154 0 NOTES PAYABLE TO AFFILIATE 4011743 DUE TO AFFILIATE 312492 DUE TO CMS 2157729 DUE TO STATE OF NJ 2041633 UPCAE/UNPAID VENDOR PAYABLE 753048 9276645 182478432 182600966 -122534 27404 8401781 8429185 8306651 190907617 27404 8401781 8429185 182478432 182478432 182600966 182600966 182600966 1 PART X, LINE 2 THE FOLLOWING IS DISCLOSED IN THE AUDITED FINANCIAL STATEMENTS OF HF MANAGEMENT SERVICES, LLC, THE PARENT COMPANY OF HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC.: It is the Companys policy to provide for uncertain tax positions and the related interest and penalties based upon managements assessment of whether a tax benefit is more likely than not to be sustained upon examination by tax authorities. At December 31, 2011, the Company believes it has appropriately accounted for any unrecognized tax benefits. To the extent the Company prevails in matters for which a liability for an unrecognized tax benefit is established or is required to pay amounts in excess of the liability, the Company's effective tax rate in a given financial statement period may be affected. 2 PART XI, LINE 8 - OTHER ADJUSTMENTS RETAINED HOSPITAL PAYMENTS: 8,401,781 The health care service agreements with Sponsors, provide that a portion of the premium revenue allocated to each Sponsor, as health care provider to Healthfirst Health Plan of New Jersey, Inc (HFNJ) plan members, attributable to a specified initial period of enrollment of each enrollee, is retained by HFNJ as additional capital contributions for the purpose of providing applicable statutory financial reserves. The portion may be subject to periodic adjustment by HFNJ's Board of Directors, subject to any restrictions by the State of New Jersey, as detailed in the health care service agreement. 3 PART XII, LINE 2D - OTHER ADJUSTMENTS RETAINED HOSPITAL PAYMENTS: 8,401,781 he health care service agreements with Sponsors, provide that a portion of the premium revenue allocated to each Sponsor, as health care provider to Healthfirst Health Plan of New Jersey, Inc (HFNJ) plan members, attributable to a specified initial period of enrollment of each enrollee, is retained by HFNJ as additional capital contributions for the purpose of providing applicable statutory financial reserves. The portion may be subject to periodic adjustment by HFNJ's Board of Directors, subject to any restrictions by the State of New Jersey, as detailed in the health care service agreement. true true false false false false false false false JAY A SCHECHTMAN 383174 122421 1337 85509 9168 601609 DANIEL P MCCARTHY 465257 186854 21078 93316 13962 780467 18324 DEBORAH E HAMMOND 264735 63864 1713 14700 9251 354263 MICHAEL H HONIG 280254 101709 104033 114385 8982 609363 MARYBETH A TITA 340269 112244 12701 64541 13358 543113 11716 ELIZABETH R ST CLAIR 353522 115258 15277 63664 9058 556779 12455 TERENCE L BYRD 248673 63315 6871 8013 326872 SEAN NATARO 260032 69425 932 14700 13962 359051 JOHN CHENG 248913 75000 1060 14700 13648 353321 PATRICIA J WANG 717447 326138 64978 219531 7998 1336092 62140 REBECCA SCHWIETZ 257883 65276 210 14700 13358 351427 STEVEN SAKOVITS 8080 96887 319260 8266 432493 MARIA OLIVERI 191799 49459 3004 14640 4118 263020 1 SCHEDULE J, PART 1, LINE 4A THE FOLLOWING INDIVIDUALS ENTERED INTO SEVERANCE AGREEMENTS AND/OR RECEIVED SEVERANCE PAYMENTS FROM HF MANAGEMENT SERVICES, LLC - A RELATED ORGANIZATION: STEVEN SAKOVITS TOTAL OF SEVERANCE AGREEMENT IN 2011: 488,266 SEVERANCE PAID IN 2011: 319,251 SEVERANCE DEFERRED TO 2012: 169,015 2 SCHEDULE J, PART 1, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE NON-QUALIFIED RETIREMENT PLAN PROVIDED BY HF MANAGEMENT SERVICES, LLC - A RELATED ORGANIZATION. THE AMOUNTS BELOW REPRESENT CONTRIBUTIONS FROM THE PLAN SPONSOR FOR 2011. Patrica J. Wang 204,831. [Col. C] Michael H. Honig 99,685. [Col. C] Daniel P. McCarthy 78,616. [Col. C] Jay A. Schechtman 70,809. [Col. C] Elizabeth R. St Clair 48,964. [Col. C] Marybeth A. Tita 49,841. [Col. C] Arun Bhatia 27,200 [Col. C] Andrea Forino 42,173 [Col. C] 3 SCHEDULE J, PART 1, LINE 6B A PORTION OF THE BONUS COMPENSATION RECEIVED BY OFFICERS OF THE ORGANIZATION IS CONTINGENT UPON THE NET EARNINGS OF HF MANAGEMENT SERVICES, LLC - A RELATED ORGANIZATION. HF MANAGEMENT SERVICES LLC SOLE CORPORATE MEMBER 4011743 SURPLUS NOTES OUTSTANDING false HF MANAGEMENT SERVICES LLC SOLE CORPORATE MEMBER 20144898 MANAGEMENT AND ADMIN SERVICES false 1 FORM 990, PART VI, SECTION A, LINE 3 HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC. CONTRACTS WITH HF MANAGEMENT SERVICES, LLC (HFMS) TO PROVIDE ALL OF ITS MANAGEMENT AND ADMINISTRATIVE SERVICES. THE NOT-FOR-PROFIT ENTITY DOES NOT MAINTAIN ITS OWN STAFF OR OFFICE SPACE, THESE ARE SUPPLIED 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. 2 FORM 990, PART VI, SECTION A, LINE 6 HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC. IS A NEW JERSEY NOT-FOR-PROFIT CORPORATION WITH ONE CORPORATE MEMBER, HF MANAGEMENT SERVICES, LLC. 3 FORM 990, PART VI, SECTION A, LINES 7A AND 7B 7A: HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC. IS A NEW JERSEY NOT FOR PROFIT CORPORATION WITH ONE CORPORATE MEMBER, HF MANAGEMENT SERVICES, LLC. THE CORPORATE MEMBER HAS THE RIGHT TO APPOINT THE BOARD OF DIRECTORS OF HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC. 7B: AMENDMENTS TO THE GOVERNING DOCUMENTS REQUIRE APPROVAL OF THE SOLE CORPORATE MEMBER, HF MANAGEMENT SERVICES, LLC. CERTAIN DECISIONS OF THE BOARD OF DIRECTORS RELATING TO PRODUCTS OFFERED, RELATED PARTY TRANSACTIONS AND REPAYMENT OF SURPLUS NOTES REQUIRE APPROVAL OF THE NEW JERSEY DEPARTMENT OF BANKING AND INSURANCE. 4 FORM 990, PART VI, SECTION A, LINE 11A THE 990 IS PREPARED BY THE HF MANAGEMENT SERVICES, LLC (HFMS) CORPORATE FINANCE DEPARTMENT STAFF AND THEN REVIEWED BY THE HFMS DIRECTOR OF TREASURY OPERATIONS. SECONDARY REVIEWS ARE ALSO PERFORMED BY THE HFMS ASSISTANT VICE PRESIDENT OF FINANCE, GENERAL COUNSEL AND CHIEF FINANCIAL OFFICER. THE DRAFT 990 IS THEN REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE DRAFT 990 IS THEN TRANSMITTED TO THE BOARD OF DIRECTORS. THE FINAL 990 IS SUBMITTED AFTER THE RETURN IS REVIEWED BY THE BOARD OF DIRECTORS. 5 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 MANAGERS OF HF MANAGEMENT SERVICES, LLC, THE NOT FOR PROFIT CORPORATE PARENT, AS WELL AS THE FULL BOARD OF DIRECTORS OF HEALTHFIRST HEALTH PLAN OF NEW JERSEY, 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. 6 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 PRESIDENT, CEO,OTHER OFFICERS AND CERTAIN KEY EMPLOYEES IS DETERMINED BY THE COMPENSATION COMMITTEE OF HF MANAGEMENT SERVICES, LLC (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. 7 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. 8 FORM 990, PART VII, SECTION A ALL OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES WERE PAID BY, AND WORKED 40 HOURS A WEEK FOR HF MANAGEMENT SERVICES, LLC (A RELATED ORGANIZATION) WHICH PROVIDES MANAGEMENT SERVICES FOR MULTIPLE ENTITIES. NO ALLOCATION OF TIME SPENT ON INDIVIDUAL NOT FOR PROFIT ENTITIES EXISTED FOR THE PERIOD COVERED BY THIS RETURN. NONE OF THE INDIVIDUALS LISTED EARNED ANY COMPENSATION FROM THE NOT-FOR-PROFIT ENTITY. 9 FORM 990, PART XI, LINE 5 RETAINED HOSPITAL PAYMENTS: 8,401,781 CHANGE IN UNREALIZED GAINS AND LOSSES ON INVESTMENTS: 27,404 10 FORM 990, PART XII, LINE 2B The filing organization does not publish stand-alone financial statements for general disclosure and use. Stand-alone financial statements are prepared solely for the New Jersey Department of Banking and Insurance and New Jersey Department of Human Services and are restricted as to their use. Such financial statements are prepared in conformity with accounting practices prescribed or permitted by the New Jersey Department of Banking and Insurance, which is a comprehensive basis of accounting other than accounting principles generally accepted in the United States. The statutory-basis financial statements are audited by an independent accountant. For purposes of general disclosure and use, including the Form 990, the filing organization is included in the consolidated financial statements of HF Management Services, LLC, a related organization, which are prepared in accordance with US GAAP and audited by an independent accountant. Other financial information included in the consolidated financial statements contains the GAAP-Basis balance sheet and income statement of the filing organization. 11 FORM 990, PART XII, LINE 2C THE SELECTION OF THE INDEPENDENT AUDITOR IS ADMINISTERED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF MANAGERS OF HF MANAGEMENT SERVICES, LLC (A RELATED ORGANIZATION). HEALTHFIRST INC 100 CHURCH ST FL 18 NEW YORK NY 10007 133714932 MANAGED CARE NY 501(c)(3) 11 Type I NA false MANAGED HEALTH INC 100 CHURCH ST FL 18 NEW YORK NY 10007 113029569 MANAGED CARE NY 501(c)(4) HEALTHFIRST true HEALTHFIRST PHSP INC 100 CHURCH ST FL 18 NEW YORK NY 10007 133783732 MANAGED CARE NY 501(c)(3) 9 HEALTHFIRST 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 HF MANAGEMENT SERVICES LLC 100 CHURCH ST FL 18 NEW YORK NY 100072601 134069806 3RD PTY ADM S NY NA NONE false 0 false HF ADMINISTRATIVE SERVICES INC 100 CHURCH ST FL 18 NEW YORK NY 100072601 133873482 3RD PTY ADM S NY MF MGMT SVCS C CORP HF PURCHASING SERVICES INC 100 CHURCH STREET 18FL NEW YORK NY 100072601 020537865 EQUIP. LEASING NY HF MGMT SVCS C CORP false false false false true false false false false false false true false false false false false false HF MANAGEMENT SERVICES LLC L 20144898 CONTRACTED RATE HF MANAGEMENT SERVICES LLC E 4011743 SURPLUS NOTE 1 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 ORGANIZATION'S BOARD OF DIRECTORS AND BY STATE REGULATORS. 2 FORM 990, SCHEDULE R, PART V, LINE 2 The Surplus Note Payable was monies borrowed from HF Management Services,LLC to fund Healthfirst Health Plan of New Jersey, Inc. This represents a 7 year note payable to HF Management Services, LLC. Interest is calculated and is adjusted at prime rate. The repayment date is on or before January 1, 2014