2013-05-14T16:15:38-07:00 2012-08-31 660561068 DIAZ & CANDELARIA PSC SUITE 112 PMB-294 10O GRAN BULEVAR SAN JUAN PR 00926 990 2011-09-01 660434923 COSSMA INC COSS 7877398182 PO BOX 1330 CIDRA PR 00739 Claribel Lara 7877398182 2013-01-11 1 JOSE G CANDELARIA CASTRO P01448309 7877606263 2013-01-11 2011 2016-02-24 21:20:13Z X ISOLINA MIRANDA PO BOX 1330 CIDRA PR 00739 26373492 0 X WWW.COSSMAPR.ORG X 1987 PR TO PROVIDE PRIMARY HEALTH CARE SERVICES TO MEDICALLY UNDERSERVED POPULATION, AGRICULTURAL MIGRANTS AND SEASONAL FARM WORKERS AS TO THEIR DEPENDENTS 9 0 271 205 0 0 5709290 4628852 15728700 21625675 15237 27295 8378 91670 21461605 26373492 0 0 0 0 5891977 7056216 0 0 0 13734434 16810013 19626411 23866229 1835194 2507263 23234549 25383195 13578892 7799758 9655657 17583437 TO PROVIDE AND PROMOTE INTEGRATED PRIMARY HEALTH CARE SERVICES WITH A COMMUNITY FOCUS THAT SUPPORTS THE PHYSICAL MENTAL AND SOCIAL WELL BEING OF THE INDIVIDUAL WITH THE COMMITMENT TO IMPROVE THEIR LIVES 0 0 19323025 0 18078804 Heath Services - During this year COSSMA, Inc. provide primary health services with a total of 183,357 encounters 450781 0 0 Eduacation and Prevention 350355 0 0 Housing and community services 0 0 0 20124161 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 271 1 0 0 0 0 0 0 X 9 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X CLARIBEL LARA 7877398182 AVE EL JIBARO CARR 172 INT KM 13 5 CIDRA PR 00739 EDUARDO MUNOZ OQUENDO 2 X 0 0 0 MARIA T FRET MERCADO 1 X 0 0 0 TEOFILA RIOS ORTIZ 2 X 0 0 0 ADA COTTO CARTAGENA 2 X 0 0 0 ISOLINA MIRANDA 38 X X X 102272 0 6136 EDGARDO SOTO 38 X 91980 0 5519 CLARIBEL LARA 38 X 33300 0 1998 227552 0 13653 1 0 0 0 QUEST DIAGNOSTICS 3 Giralda Farms Madison NJ 07940 LABORATORY SERVICES 619093 FELDESMAN TUCKER LEIFER FIDELL LLP PO BOX 1330 CIDRA PR 00739 PROFESIONAL SERVICES 322918 JOHN HANCOCK 654 Ave Munoz Rivera SAN JUAN PR 00926 PENSION PLAN 252986 Knowlity Corporation 89 Ave de Diego SAN JUAN PR 00927 CONSULTING 210429 CONSTRUCCIONES APONTE INC PO BOX 1330 CIDRA PR 00739 CONSTRUCTION 174143 10 0 0 0 0 4472577 156275 0 4628852 Premium Revenue - Capitation 621400 11520616 11520616 0 0 Net Patients Services 621400 6745615 6745615 0 0 Lawsuit PR health Department 621400 3359444 3359444 0 0 0 0 0 0 21625675 27295 27295 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 91670 91670 0 0 91670 26373492 21744640 0 0 227552 91980 135572 0 5661505 4556800 1104705 653907 529769 124138 513252 421002 92250 0 359653 359653 0 1766345 1676653 89692 19336 19336 125206 94061 31145 0 1191523 227168 964355 78603 28447 50156 62288 42683 19605 402775 402775 314959 166182 148777 82950 6887 76063 Health Claims 9817784 9817784 0 0 Drugs and Medicines 1859938 1859938 0 0 Supplies 522688 457366 65322 0 205965 128105 77860 23866229 20124161 3742068 0 6029681 6855300 562451 602254 228882 227993 316178 7569 73854 92116 72255 45871 18042929 1833443 15779319 16209486 441624 1072911 23234549 25383195 6516903 1688684 62805 26564 6056463 2995932 942721 3088578 13578892 7799758 X 9655657 17583437 0 0 0 0 9655657 17583437 23234549 25383195 X 2507263 5420517 X X 0 0 1 0 X 12088081 12033867 14758418 21437990 18814728 79133084 12088081 12033867 14758418 21437990 18814728 79133084 79133084 29409 8583 9730 8378 26254 82354 9261 8289 19625 15237 122475 174887 79390325 0.99676 0.99770 X Other Revenue: Vending and Convenience Store - $89,189 Others- $ 33,286 0 2193814 2193814 0 13244874 1033799 12211075 0 614846 196741 418105 0 1896595 512973 1383622 0 92800 89930 2870 16209486 0 Resrve for Medical Claims Incurred but not recorded (IBNR) 3088578 3088578 F990_P00_S00_L0B Form 990, Header, Line B The ammend to the return is to use the numbers of the audited financial statements that were not available in the original submission. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b A copy of the 990 was share with the Board Executive Commite; all government questions were revised by the Board in the December 2012 meeting. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c All Board members are required to complete a Conflict of Interest Statement in January each year. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Executive Director salary is determined and approved by the Board; others managers salaries are determined by the Executive Director. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The accounting & Finance Policy and Procedures Manual of COSSMA, Inc. establishes that:..."the Corporation will make the following forms available to the general public: a. Three most recent annual Return of Organization Exempt from Income Tax (Form 990) b. The original tax exempt application (Form 1023 or Form 1024) filed with the IRS. It is the policy of the Corporation to follow the following rules to fulfill the requirements of the public statements mentiones above. F990_P11_S00_L05 Form 990, Part XI, Line 5 On January 2012 COSSMA entered into a settlement agreement and mutual release with Humana Health Plans of Puerto Rico, Inc. and Humana Insurance of Puerto Rico. In this agreement all the parties agreed to settle any and all pending surplus or deficit compensation discrepancies, including but not limited to all the extinguishment of outstanding credits and claims related to the parties Health Care Organization (HCO) Participation Agreement. The agreement includes balances as of October 31, 2011. As of October 31, 2011 COSSMA had a balance payable to Humana of $5,420,517. These balances corresponded entirely to losses accumulated in the Manage Care Contract between COSSMA and Humana up to June 30, 2011. F990_P12_S00_L03b Form 990, Part XII, Line 3b The annual audit is in process and will be completed for Marc 2013, including the single audit.