YOURCARE HEALTH PLAN INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- YOURCARE HEALTH PLAN INC (EIN 16-1500379)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-09-21
- IRS object ID
- 201232729349300618
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule D
- Schedule I
- Schedule J
- Schedule O
- Schedule R
- Reasonable Cause Explanation
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-09-21T13:02:01-07:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161500379 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UNIVERA COMMUNITY HEALTH INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | UNIV | NameControl |
| Phone | 7165040560 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 205 Park Club Lane | AddressLine1 |
| City | Buffalo | City |
| State | NY | State |
| ZIP Code | 142215239 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Brandi Bishop | Name |
| Title | Director of Finance | Title |
| Phone | 5852384554 | Phone |
| Date Signed | 2012-09-20 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Brandi Bishop | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 165 Court Street | AddressLine1 |
| City | Rochester | City |
| State | NY | State |
| ZIP Code | 14647 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 150749345 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.univeracommunityhealth.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1995 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | To serve the needs of the underserved in Western New York, by providing affordable health insurance options, by improving access to health care and by improving quality of care. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 6 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 8 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 128673590 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 150735752 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 17135 | InvestmentIncomePriorYear |
| Investment Income Current Year | 13593 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 128690725 | TotalRevenuePriorYear |
| Total Revenue Current Year | 150749345 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 94105021 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 131830589 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 28523558 | OtherExpensePriorYear |
| Other Expenses Current Year | 14492424 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 122628579 | TotalExpensesPriorYear |
| Total Expenses Current Year | 146323013 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 6062146 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 4426332 | RevenuesLessExpensesCY |
| Total Assets BOY | 51451401 | TotalAssetsBOY |
| Total Assets EOY | 71574931 | TotalAssetsEOY |
| Total Liabilities BOY | 34232162 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 49929360 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 17219239 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 21645571 | NetAssetsOrFundBalancesEOY |
| Mission Description | To serve the needs of the under served in Western New York, by providing affordable health insurance options, by improving access to health care and by improving quality of care. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 131830589 | Expense |
| Revenue | 150735752 | Revenue |
| Description | Univera Community Health, Inc. provides a comprehensive health service plan on a prepaid contractual basis to persons eligible to receive benefits (569,758 member months) under the medical assistance program throughout Erie, Chautauqua, Cattaraugus and Allegany counties. | Description |
| Total Of Other Program Service Exp | 0 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 0 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 0 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 131830589 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 0 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 6 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 1 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NY | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Brandi Bishop | NamePerson |
| Telephone Number | 5852384554 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 165 Court Street | AddressLine1 |
| City | Rochester | City |
| State | NY | State |
| ZIP Code | 14647 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (8 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| Art Wingerter | ||||||
| Chairman of the Board | 1 | X | X | 0 | 354481 | 39694 |
| Dennis Graziano | ||||||
| Vice Chairman of the Board | 1 | X | 0 | 0 | 0 | |
| Michael Messier | ||||||
| Secretary/Treasurer | 1 | X | X | 0 | 0 | 0 |
| Richard Vienne | ||||||
| Co - Medical Director | 20 | X | 0 | 274456 | 33691 | |
| Joseph Stankaitis | ||||||
| Co - Medical Director | 0 | X | 0 | 0 | 0 | |
| Lisa Meyers-Alessi | ||||||
| Vice President - Provider & Network Management | 5 | X | 0 | 200263 | 18656 | |
| Robert Thompson | ||||||
| Executive Director | 10 | X | 0 | 361448 | 65626 | |
| Brandi Bishop | ||||||
| Director of Finance | 20 | X | 0 | 115223 | 26427 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1305871 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 184094 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Kaleida Health | |||||
| 100 High Street | Buffalo | NY | 14203 | Medical | 17267689 |
| Excellus Health Plan Inc | |||||
| 165 Court Street | Rochester | NY | 14647 | Administrative / Medical | 14168918 |
| Erie County Medical Center | |||||
| 462 Grider Street | Buffalo | NY | 14215 | Medical | 9304316 |
| Roswell Park Center Institute | |||||
| Elm and Carlton Street | Buffalo | NY | 14263 | Medical | 5283753 |
| Sisters of Charity Hospital | |||||
| 2157 Main Street | Buffalo | NY | 14214 | Medical | 4578731 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 61 | NumberOfContractorsGT100K |
| Total Contributions | 0 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| PlusMed | 524114 | 117220538 | 117220538 | 0 | $0 |
| Child Health Plus | 524114 | 11574882 | 11574882 | 0 | $0 |
| Family Health Plus | 524114 | 21940332 | 21940332 | 0 | $0 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 150735752 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 13593 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $13,593 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 150749345 | TotalRevenueColumn |
| Related Or Exempt Function Income | 150735752 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $13,593 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 131830589 | Total |
| Program Services | 131830589 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12940366 | Total |
| Management And General | 12940366 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1293 | Total |
| Management And General | 1293 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 194817 | Total |
| Management And General | 194817 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Risk Sharing | 781580 | 0 | 781580 | 0 |
| Bad Debt | 469346 | 0 | 469346 | 0 |
| Claim Adjustment Expense | 105022 | 0 | 105022 | 0 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 146323013 | Total |
| Program Services | 131830589 | ProgramServices |
| Management And General | 14492424 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27084568 | BOY |
| EOY | 5285399 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5698895 | BOY |
| EOY | 42319980 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18412393 | BOY |
| EOY | 23902060 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 255545 | BOY |
| EOY | 67492 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51451401 | BOY |
| EOY | 71574931 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2334794 | BOY |
| EOY | 687137 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 124695 | BOY |
| EOY | 137754 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31772673 | BOY |
| EOY | 49104469 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34232162 | BOY |
| EOY | 49929360 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 627010 | BOY |
| EOY | 627010 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16592229 | BOY |
| EOY | 21018561 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17219239 | BOY |
| EOY | 21645571 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51451401 | BOY |
| EOY | 71574931 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 4426332 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 81423872 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 105551330 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 113181099 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 128166198 | CurrentTaxYearMinus1Year |
| Current Tax Year | 147402207 | CurrentTaxYear |
| Total | 575724706 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 0 | CurrentTaxYear |
| Total | 0 | Total |
Gross Receipts From Non UBI GrossReceiptsFromNonUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 0 | CurrentTaxYear |
| Total | 0 | Total |
Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 0 | CurrentTaxYear |
| Total | 0 | Total |
Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 0 | CurrentTaxYear |
| Total | 0 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 81423872 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 105551330 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 113181099 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 128166198 | CurrentTaxYearMinus1Year |
| Current Tax Year | 147402207 | CurrentTaxYear |
| Total | 575724706 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 575724706 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 673987 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 269691 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 38699 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 13907 | CurrentTaxYearMinus1Year |
| Current Tax Year | 9078 | CurrentTaxYear |
| Total | 1005362 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 673987 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 269691 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 38699 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 13907 | CurrentTaxYearMinus1Year |
| Current Tax Year | 9078 | CurrentTaxYear |
| Total | 1005362 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 82097859 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 105821021 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 113219798 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 128180105 | CurrentTaxYearMinus1Year |
| Current Tax Year | 147411285 | CurrentTaxYear |
| Total | 576730068 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.99826 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.99704 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00174 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.00296 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (8 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Risk Sharing Agreement | $18,906,939 |
| Due to Univera IPA | $15,271,007 |
| Incurred But Not Received Claims | $9,587,595 |
| Accrued Claim Expense | $3,161,421 |
| UCH Management Fee Payable | $1,094,272 |
| Accrued Pharmacy Claims | $841,176 |
| UCH - NYCRA Surcharge Payable | $221,437 |
| UCH - GME Covered Lives Assessment | $20,622 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 49104469 | TotalOfAmounts |
| Total Revenue | 150749345 | TotalRevenue |
| Total Expenses | 146323013 | TotalExpenses |
| Excess Or Deficit For Year | 4426332 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 0 | NetUnrealizedGLOnInvestments |
| Donated Services And Facilities | 0 | DonatedServicesAndFacilities |
| Investment Expenses | 0 | InvestmentExpenses |
| Prior Period Adjustments | 0 | PriorPeriodAdjustments |
| Other | $0 | OtherAmount |
| Total Adjustments | 0 | TotalAdjustments |
| Excess Or Deficit Per FS | 4426332 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 150279999 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 0 | NetUnrealizedGainsInvestments |
| Donated Srvc And Use Of Facilities | 0 | DonatedSrvcAndUseOfFacilities |
| Recoveries Of Prior Year Grants | 0 | RecoveriesOfPriorYearGrants |
| Other Revenues | -469346 | OtherRevenues |
| Revenue Not Rptd F990 | -469346 | RevenueNotRptdF990 |
| Revenue Subtotal | 150749345 | RevenueSubtotal |
| Investment Expenses Not Included | 0 | InvestmentExpensesNotIncluded |
| Other Revenues Not Included | 0 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 150749345 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 145853667 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 0 | DonatedServicesUseOfFacilities |
| Prior Year Adjustments | 0 | PriorYearAdjustments |
| Losses Reported | 0 | LossesReported |
| Other Expenses Included | 0 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 145853667 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 0 | InvestmentExpensesNotIncluded2 |
| Other Expenses Not Included | 469346 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 469346 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 146323013 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchD_P10_S00_L02 | Schedule D, Part X, Line 2 | The company does not anticipate significant increases or decreases in its uncertain tax positions within the next twelve months. |
| SchD_P12_S00_L02d | Schedule D, Part XII, Line 2d | Bad debt is a reduction of revenue on the audited financial statements |
| SchD_P13_S00_L04b | Schedule D, Part XIII, Line 4b | Bad debt is an expense on the form 990 statement. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | Health care services paid for eligible members | TypeOfGrant |
| Number Of Recipients | 48022 | NumberOfRecipients |
| Amount Of Cash Grant | 131830589 | AmountOfCashGrant |
| Amount Of Non Cash Assistance | 0 | AmountOfNonCashAssistance |
| Method Of Valuation | Book | MethodOfValuation |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SchI_P01_S00_L02 | Identifier |
| Return Reference | Schedule I, Part I, Line 2 | ReturnReference |
| Explanation | Not applicable. Government assistance received, not grants. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Richard Vienne | |||||||||||||
| 0 | 233697 | 0 | 39509 | 0 | 1250 | 0 | 17379 | 0 | 16312 | 0 | 308147 | 0 | 0 |
| Lisa Meyers-Alessi | |||||||||||||
| 0 | 176567 | 0 | 21288 | 0 | 2408 | 0 | 12073 | 0 | 6583 | 0 | 218919 | 0 | 0 |
| Art Wingerter | |||||||||||||
| 0 | 263295 | 0 | 73149 | 0 | 18037 | 0 | 23056 | 0 | 16638 | 0 | 394175 | 0 | 0 |
| Robert Thompson | |||||||||||||
| 0 | 302330 | 0 | 50000 | 0 | 9118 | 0 | 55716 | 0 | 9910 | 0 | 427074 | 0 | 0 |
| Brandi Bishop | |||||||||||||
| 0 | 96222 | 0 | 18309 | 0 | 692 | 0 | 5752 | 0 | 20675 | 0 | 141650 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SchJ_P01_S00_L04 | Identifier |
| Return Reference | Schedule J, Part I, Line 4 | ReturnReference |
| Explanation | Robert Thompson, Richard Vienne and Arthur Wingerter all participate in a non-qualified supplemental retirement plan sponsored by a related party. No payments were made in 2011. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| F990_P06_S0A_L03 | Form 990, Part VI, Section A, Line 3 | All administrative services for UCH were completed by Excellus Health Plan under a Management Service Agreement. |
| F990_P06_S0A_L06 | Form 990, Part VI, Section A, Line 6 | The organization has two corporate members: Excellus BC/BS and Monroe Plan for Medical Care. |
| F990_P06_S0A_L07a | Form 990, Part VI, Section A, Line 7a | Each corporate member of the organization may elect up to three voting members. |
| F990_P06_S0A_L07b | Form 990, Part VI, Section A, Line 7b | Decisions of the governing body are subject to approval of the six voting members. |
| F990_P06_S0A_L09 | Form 990, Part VI, Section A, Line 9 | Dennis Graziano - 1120 Pittsford-Victor Road, Pittsford, NY 14534, Michael Messier - 1120 Pittsford-Victor Road, Pittsford, NY 14534, Joseph Stankaitis, MD - 1120 Pittsford-Victor Road, Pittsford, NY 14534, Robert Thompson - 165 Court Street, Rochester, NY 14647, Brandi Bishop - 165 Court Street, Rochester, NY 14647. |
| F990_P06_S0B_L11b | Form 990, Part VI, Section B, Line 11b | The organization's management company prepares and reviews the Form 990. A draft version is reviewed and approved by the the Finance Committee before being sent to the Board of Directors. Once approved by the Board of Directors the Form 990 is filed. |
| F990_P06_S0B_L12c | Form 990, Part VI, Section B, Line 12c | Annually UCH board members complete a UCH Conflict of Interest Questionnaire. All responses are reviewed by legal counsel. There were no conflicts for 2011. |
| F990_P06_S0C_L19 | 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 upon request. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| Genesee Valley Group Health Association | ||||||||||
| 165 Court Street | Rochester | NY | 14647 | 161005419 | Provide Health Services | NY | 501(c)(3) | 17(b)(1)(a)(iii) | Excellus Health Plan | 0 |
| Genesee Region Home Care Association Inc | ||||||||||
| 165 Court Street | Rochester | NY | 14647 | 160844109 | Provides Home Health Services | NY | 501(c)(3) | 509(a)(2) | Excellus Health Plan | 0 |
| Genesee Region Home Cre of Ontario County Inc | ||||||||||
| 165 Court Street | Rochester | NY | 14647 | 223257719 | Provide Home Health | NY | 501(c)(3) | 509(a)(2) | Excellus Health Plan | 0 |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|
| Univera IPA LLC | |||||||
| 165 Court Street | Rochester | NY | 14647 | 454058523 | Independent Practice Association | NY | N/A |
| Lifetime Pharmacy LLC | |||||||
| 165 Court Street | Rochester | NY | 14647 | 264629835 | Pharmacy | NY | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV (21 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| Excellus Health Plan Inc | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 150329043 | Health Insurer | NY | N/A | C |
| Beacon Network | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 141830065 | Inactive | NY | N/A | C |
| Upstate Professional Liability Corporation | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 141783968 | Inactive | NY | N/A | C |
| Excellus Acquisition Inc | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 061680689 | Holding Company | NY | N/A | C |
| MedAmerica Inc | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 161581817 | Holding Company | NY | N/A | C |
| North Star Home Health | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 161548051 | Holding Company | NY | N/A | C |
| Excellus Ventures Inc | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 161550984 | Holding Company | NY | N/A | C |
| MedAmerica Insurance Company of NY | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 161310986 | Long Term Care Insurance | NY | N/A | C |
| MedAmerica Insurance Company | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 340977231 | Long Term Care Insurance | NY | N/A | C |
| MedAmerica Insurance Company of FL | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 141993330 | Long Term Care Insurance | NY | N/A | C |
| EBS-RMSCO Inc | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 161171765 | Third Party Administrator | NY | N/A | C |
| 344 South Warren Street Corporation | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 010718849 | Real Estate Holding Company | NY | N/A | C |
| Sibley Nursing Personnel Service Inc | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 161447472 | Home Health Services | NY | N/A | C |
| Support Servcies Alliance Inc | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 133033862 | Benefit Plan Administration | NY | N/A | C |
| Excellus Insurance Agency Inc | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 161588653 | Insurance Agency | NY | N/A | C |
| MIG Assurance | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 980210843 | Long Term Care Insurance | NY | N/A | C |
| EBS-RMSCO Insurance Agency Inc | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 161611043 | Inactive | NY | N/A | C |
| Charles A Walker Corporation | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 150483335 | Broker | NY | N/A | C |
| Human Care Consortium I Inc | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 454039701 | Inactive | NY | N/A | C |
| Human Care Consortium II | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 454039630 | Inactive | NY | N/A | C |
| Lifetime Healthcare Inc | ||||||||
| 165 Court Street | Rochester | NY | 14647 | 161514675 | Holding Company | NY | N/A | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Excellus Health Plan Inc | ||
| l | 12978940 | Per Member Per Month (PMPM) Basis |
| Excellus Health Plan Inc | ||
| m | 0 | PMPM: Amount involved is included in the amount disclosed in Part V, Line 2(b), Transaction Type l |
| Excellus Health Plan Inc | ||
| o | 0 | PMPM: Amount involved is included in the amount disclosed in Part V, Line 2(b), Transaction Type l |
Form990 Schedule R Part VII Form990ScheduleRPartVII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchR_P05_S00_L01l | Schedule R, Part V, Line 1l | The Corporation's business activities are primarily administered using Excellus Health Plan's claims processing, operating systems, for which Excellus Health Plan receives a management fee. |
| SchR_P05_S00_L01m | Schedule R, Part V, Line 1m | The Corporation's business activities are primarily administered using Excellus Health Plan's claims processing, operating systems, for which Excellus Health Plan receives a management fee. |
| SchR_P05_S00_L01o | Schedule R, Part V, Line 1o | The Corporation's business activities are primarily administered using Excellus Health Plan's claims processing, operating systems, for which Excellus Health Plan receives a management fee. |
Reasonable Cause Explanation ReasonableCauseExplanation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | A request for extention was submitted and accepted. The need for the extension: Unviera Community, Inc. began consolidating with parent company Excellus BC/BS in 2011. In doing so, a number of new/additional Form 990 schedules were required. The Organizations Finance Committee requested additional time to review the schedules before approving. | Explanation |