2024-10-04T13:15:01-05:00 2023-12-31 390859910 BAKER TILLY ADVISORY GROUP LP 790 N WATER ST SUITE 2000 MILWAUKEE WI 53202 990 2023-01-01 550585592 THE HEALTH PLAN OF WEST VIRGINIA INC HEAL 8006246961 1110 MAIN STREET WHEELING WV 26003 RYAN RALSTON CHIEF FINANCIAL OFFICER 8006246961 2024-09-30 1 1 SHELBY NETZ CPA P01405265 4147775500 2024-09-27 2023 2024-10-15 13:58:12Z THE HEALTH PLAN JEFFREY M KNIGHT 1110 MAIN STREET WHEELING WV 26003 1011696487 0 X WWW.HEALTHPLAN.ORG X 1979 WV ESTABLISHED AS A COMMUNITY HEALTH ORGANIZATION, THE HEALTH PLAN DELIVERS A CLINICALLY-DRIVEN, TECHNOLOGY-ENHANCED, CUSTOMER-FOCUSED PLATFORM BY DEVELOPING AND IMPLEMENTING PRODUCTS AND SERVICES THAT MANAGE AND IMPROVE THE HEALTH AND WELL-BEING OF OUR MEMBERS. WE ACHIEVE THESE RESULTS THROUGH A TEAM OF HEALTHCARE PROFESSIONALS AND PARTNERS ACROSS OUR COMMUNITY. 9 9 650 0 0 0 0 0 813165802 778768443 5505805 14376241 109656 72840 818781263 793217524 896948 856558 715722948 697332785 37432807 42840535 0 0 0 39079164 39744500 793131867 780774378 25649396 12443146 409672896 452146751 136622503 145077868 273050393 307068883 X ESTABLISHED AS A COMMUNITY HEALTH ORGANIZATION, THE HEALTH PLAN DELIVERS A CLINICALLY-DRIVEN, TECHNOLOGY-ENHANCED, CUSTOMER-FOCUSED PLATFORM BY DEVELOPING AND IMPLEMENTING PRODUCTS AND SERVICES THAT MANAGE AND IMPROVE THE HEALTH AND WELL-BEING OF OUR MEMBERS. WE ACHIEVE THESE RESULTS THROUGH A TEAM OF HEALTHCARE PROFESSIONALS AND PARTNERS ACROSS OUR COMMUNITY. 0 0 107215036 856558 109088924 THE PRIMARY EXEMPT PURPOSE OF THE HEALTH PLAN OF WEST VIRGINA, INC. (THE HEALTH PLAN) IS TO OPERATE A STATE CERTIFIED, FEDERALLY QUALIFIED HEALTH MAINTENANCE ORGANIZATION (HMO) WHICH PROVIDES COMPREHENSIVE HEALTH CARE SERVICES ON A PREPAID BASIS. THE NUMBER OF COMMERCIAL HMO MEMBERS AT DECEMBER 31, 2023 WAS 19,140. 525807882 534486134 THE HEALTH PLAN OFFERS A MANAGED CARE PROGRAM FOR MOUNTAIN HEALTH TRUST (MHT), WEST VIRGINIA'S MEDICAID PROGRAM. AT DECEMBER 31, 2023, THE HEALTH PLAN'S MHT PLAN SERVICED 108,341 MEMBERS WITH 46,576 MEMBERS ENROLLED FROM THE EXPANSION POPULATION, 46,167 MEMBERS ENROLLED FOR THE TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) POPULATION, 10,361 MEMBERS ENROLLED FROM THE SUPPLEMENTAL SECURITY INCOME (SSI) POPULATION, AND 5,237 MEMBERS ENROLLED FROM THE WV CHILDREN'S HEALTH INSURANCE PROGRAM (WVCHIP). 132998300 135193385 THE HEALTH PLAN OFFERS A MEDICARE ADVANTAGE PROGRAM KNOWN AS SECURE CARE AND A PROGRAM FOR MEMBERS ELIGIBLE FOR BOTH MEDICARE AND MEDICAID KNOWN AS A MEDICARE DUAL SPECIAL NEEDS PLAN (DSNP). SECURE CARE ENABLES THE MEDICARE ELIGIBLE POPULATION TO SELECT MEDICARE COVERAGE AT A MUCH LOWER COST DUE TO THEIR AGREEMENT TO UTILIZE THE HEALTH PLAN NETWORK AND WITH PLAN OPTIONS FOR EXPANDED BENEFITS SUCH AS DENTAL, VISION, HEARING, TELEHEALTH, GYM MEMBERSHIPS, COVERAGE FOR "OVER-THE-COUNTER" ITEMS, IN-HOME MEAL DELIVERY AFTER HOSPITAL STAYS, AND ROUTINE TRANSPORTATION TO HEALTH-RELATED LOCATIONS. ENROLLMENT AT DECEMBER 31, 2023 FOR THESE PROGRAMS INCLUDED 8,322 MEMBERS. 766021218 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 3431 0 1 650 1 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X RYAN RALSTON CFO 7406996236 1110 MAIN STREET WHEELING WV 26003 JEFFREY KNIGHT PRESIDENT & CEO 40.00 1.00 X 686899 0 46276 RYAN RALSTON VP - CFO 40.00 1.00 X 412620 0 62279 ED KAIRIS MD MMM CHIEF MEDICAL OFFICER (THRU 09/23) 40.00 1.00 X 402896 0 33384 JAMIE LEARY CHIEF LEGAL COUNCIL 40.00 1.00 X 332288 0 24674 RICHARD LEGG SVP - SALES & ACCOUNT MANAGEMENT (THRU 06/23) 40.00 1.00 X 331527 0 17137 KENNETH BRYAN CHIEF INFORMATION OFFICER 40.00 1.00 X 289873 0 47682 ANTOINETTE GEYER SVP PROVIDER DELIVERY SERVICES 40.00 1.00 X 285042 0 32405 E DAVID MATHIEU SVP - UNDERWRITING & REGULATORY SERVICES 40.00 1.00 X 258833 0 45998 ROBERT CROSS MEDICAL DIRECTOR 40.00 1.00 X 251373 0 44783 ROBERT J ROSET SVP - IT OPERATIONS & QUALITY 40.00 1.00 X 247235 0 32038 CHRISTINA DONOHUE SVP MHT 40.00 1.00 X 240051 0 34652 DAVID THOMAS DIRECTOR - SALES NATIONAL (THRU 06/23) 40.00 1.00 X 238363 0 31249 LARRY WELLING DIRECTOR - IT SOFTWARE 40.00 1.00 X 221126 0 39005 RYAN JEWELL SVP SALES & ACCOUNT MGMT 40.00 1.00 X 225283 0 33502 CHARLES F LUCAS VP, IT SOFTWARE DEVELOPMENT 40.00 1.00 X 216820 0 28412 JOHN WRIGHT IV MEMBER 1.00 1.00 X 23000 0 0 DENISE D PENTINO CHAIR OF THE BOARD 1.00 1.00 X X 21000 0 0 WESLEY NICKELL VICE CHAIR OF THE BOARD 1.00 1.00 X X 20000 0 0 SUSAN BUCHANAN CPA SECRETARY 1.00 1.00 X X 17500 0 0 LEA RIDENHOUR MEMBER 1.00 1.00 X 17500 0 0 MARK LANCELLOTTI MEMBER 1.00 1.00 X 17500 0 0 JOSEPH G DONZELLA DO MEMBER 1.00 1.00 X 17500 0 0 MANINDER SINGH BEDI MD MEMBER 1.00 1.00 X 12500 0 0 WILLIAM D CRONIN MEMBER 1.00 1.00 X 10000 0 0 4796729 0 553476 55 0 1 0 SCION DENTAL LLC 10201 NORTH PORT WASHINGTON RD MEQUON WI 53092 DENTAL CLAIMS PROCESSING AND ADMINISTRAT 26053105 EVICORE HEALTHCARE MSI LLC 400 BUCKWALTER PLACE BLVD BLUFFTON SC 29910 MEDICAL BENEFIT MANAGEMENT SERVICES 4844242 INCOMM HEALTHCARE & AFFINITY INC 250 WILLIAMS ST NW SUITE 500 ATLANTA GA 30303 MEMBER INCENTIVE CARDS FOR ACHIEVING HEA 4564090 MILLIMAN INC 8500 NORMANDALE LAKE BLVD SUITE 18 BLOOMINGTON MN 55437 ACTUARIAL SERVICES 3734147 OPTUMINSIGHT INC 2771 MOMENTUM PLACE CHICAGO IL 606895327 MEDICAL MANAGEMENT SERVICES 1946373 79 MEDICARE 524114 534486134 534486134 MEDICAID 524114 135193385 135193385 COMMERCIAL HMO 524114 108984578 108984578 CLAIM PROCESSING 524292 104346 104346 778768443 11963008 11963008 47843 0 47843 47843 47843 220892196 218478963 2413233 2413233 2413233 MISCELLANEOUS REVENUE 900099 24997 24997 24997 793217524 778768443 0 14449081 608480 608480 248078 248078 697332785 697332785 3901804 1950902 1950902 20252513 15681350 4571163 2252935 1898469 354466 13574569 10592280 2982289 2858714 2413255 445459 469067 332366 136701 2574728 2307503 267225 27547 27547 630283 630283 12797520 12222758 574762 4305029 4294142 10887 2374614 1913248 461366 6876719 6212566 664153 1190007 754051 435956 364543 293676 70867 301201 167900 133301 351115 263336 87779 1983056 1487292 495764 1532772 1140808 391964 BROKER EXPENSE 1731485 1731485 NET REINSURANCE EXPENSE 1655292 1655292 MISCELLANEOUS EXPENSES 459994 372121 87873 PREMIUM TAX EXPENSE 119528 119528 780774378 766021218 14753160 0 63184590 28711967 30242070 36320258 14968599 7302412 7967844 7666187 258787423 320946651 47224759 56314738 2266210 2186950 409672896 452146751 126556561 133755638 1614257 1793752 8451685 9528478 136622503 145077868 X 272550393 306568883 0 0 500000 500000 273050393 307068883 409672896 452146751 X 12443146 25297155 -3721811 X X 0 1 X 1 0 600000 600000 10999729 4431416 6568313 3368870 2870996 497874 7666187 INVESTMENT IN SUBSIDIARIES 56314738 C 56314738 POST RETIREMENT BENEFIT OBLIGATION 1456092 PAYABLE FOR SECURITY SETTLEMENT 680734 OTHER LIABILITIES 853058 DUE TO THP INSURANCE COMPANY 6538594 9528478 790423201 -2164040 -2164040 792587241 630283 630283 793217524 776769042 0 776769042 630283 3375053 4005336 780774378 PART XI, LINE 2D - OTHER ADJUSTMENTS: REINSURANCE EXPENSE -1,655,291. DEPRECIATION -508,749. PART XII, LINE 4B - OTHER ADJUSTMENTS: REINSURANCE EXPENSE 1,655,291. CHANGE IN PREMIUM DEFICIENCY RESERVE 1,211,013. DEPRECIATION 508,749. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 EQUITY AND BOND INVESTMENTS 4360456 EAST ASIA AND THE PACIFIC - AUSTRALIA, BRUNEI, BURMA, CAMBODIA, 0 0 EQUITY AND BOND INVESTMENTS 1723671 EUROPE (INCLUDING ICELAND & GREENLAND) - ALBANIA, ANDORRA, AUSTRIA, BELGIUM 0 0 EQUITY AND BOND INVESTMENTS 5653689 NORTH AMERICA - CANADA AND MEXICO, BUT NOT THE UNITED STATES 0 0 EQUITY AND BOND INVESTMENTS 2104902 0 0 0 0 0 0 13842718 0 13842718 0 0 0 0 0 0 1 CAMPBELLS CREEK CHURCH 543 CAMPBELLS CREEK DRIVE CHARLESTON WV 25306 556066229 501C(3) 40000 0 FOOD PANTRY CATHOLIC CHARITIES WEST VIRGINIA INC 2000 MAIN STREET WHEELING WV 26003 550391262 501C(3) 40000 0 FOOD PANTRY CHRISTIAN HELP INC 219 WALNUT STREET MORGANTOWN WV 26505 550568989 501C(3) 40000 0 FOOD PANTRY HOUSE OF THE CARPENTER LLC 200 SOUTH FRONT STREET WHEELING WV 26003 550751892 501C(3) 40000 0 FOOD PANTRY HUNTINGTON CITY MISSION 624 10TH ST P O BOX 3 HUNTINGTON WV 25701 550356991 501C(3) 40000 0 FOOD PANTRY MOUNTAINEER FOOD BANK INC 484 ENTERPRISE DRIVE GASSAWAY WV 26624 550611100 501C(3) 54994 0 FOOD PANTRY OLD MAN RIVERS MISSION 703 PIKE STREET PARKERSBURG WV 26101 550727794 501C(3) 40000 0 FOOD PANTRY SOUP KITCHEN OF GREATER WHEELING INC P O BOX 546 WHEELING WV 26003 550639285 501C(3) 41000 0 FOOD PANTRY ST JAMES EVANGELICAL LUTHERAN CHURCH 1409 CHAPLINE STREET WHEELING WV 26003 550361021 501C(3) 40000 0 FOOD PANTRY ST LUKES EPISCOPAL CHURCH 200 SOUTH PENN STREET WHEELING WV 26003 556000712 501C(3) 40000 0 FOOD PANTRY ST MATTHEWS EPISCOPAL CHURCH P O BOX 508 WHEELING WV 26003 550397070 501C(3) 40000 0 FOOD PANTRY UNION MISSION MINISTRIES INC P O BOX 112 CHARLESTON WV 25321 556000896 501C(3) 40000 0 FOOD PANTRY AMERICAN HEART ASSOCIATION INC 7272 GREENVILLE AVENUE DALLAS TX 752315129 135613797 501C(3) 65000 0 PROMOTE HEART HEALTH RURAL EMERGENCY TRAUMA INSTITUTE 2265 MARKET STREET WHEELING WV 26003 743071038 501C(3) 22486 0 SUPPORT FOR PRE-HOSPITAL AND HEALTHCARE ETHICS ECHO PROGRAM WEST VIRGINIA MEDICAL FOUNDATION 2018 KANAWHA BLVD E CHARLESTON WV 25311 020543681 501C(3) 15000 0 SPONSOR LEADERSHIP PROGRAM CAMC FOUNDATION 3414 STAUNTON AVE CHARLESTON WV 25304 310887133 501C(3) 10000 0 PREVENTION FIRST PROGRAM FUND 16 0 MEDICAL AND NURSING STUDENT SCHOLARSHIPS 14 248078 PART I, LINE 2: THE HPWV MEDICAL STUDENT (DOCTORS/NURSES) SCHOLARSHIP PROGRAM BEGAN IN THE FALL OF 2009. MEDICAL STUDENTS SUBMIT SCHOLARSHIP APPLICATION TO A SUB-COMMITTEE OF THE BOARD. THESE APPLICATIONS ARE REVIEWED BY THE SUB-COMMITTEE BASED ON THE STUDENT'S FINANCIAL NEED. THE TUITION PAYMENTS ARE MADE DIRECTLY TO THE SCHOOL AND BOOK EXPENSES ARE REIMBURSED DIRECTLY TO THE STUDENTS. THE GRANT TERM IS OPEN UNTIL THE STUDENT GRADUATES. X 1 1 X X X X 1 0 0 1 1 1 1 1 0 JEFFREY KNIGHT PRESIDENT & CEO 549136 0 136538 0 1225 0 22304 0 23972 0 733175 0 0 0 RYAN RALSTON VP - CFO 347599 0 64481 0 540 0 24466 0 37813 0 474899 0 0 0 ED KAIRIS MD MMM CHIEF MEDICAL OFFICER (THRU 09/23) 304183 0 69694 0 29019 0 23092 0 10292 0 436280 0 0 0 JAMIE LEARY CHIEF LEGAL COUNCIL 289046 0 42000 0 1242 0 23092 0 1582 0 356962 0 0 0 RICHARD LEGG SVP - SALES & ACCOUNT MANAGEMENT (THRU 06/23) 137677 0 27583 0 166267 0 11033 0 6104 0 348664 0 0 0 KENNETH BRYAN CHIEF INFORMATION OFFICER 248944 0 37365 0 3564 0 20000 0 27682 0 337555 0 0 0 ANTOINETTE GEYER SVP PROVIDER DELIVERY SERVICES 236420 0 47380 0 1242 0 18952 0 13453 0 317447 0 0 0 E DAVID MATHIEU SVP - UNDERWRITING & REGULATORY SERVICES 231302 0 23340 0 4191 0 18672 0 27326 0 304831 0 0 0 ROBERT CROSS MEDICAL DIRECTOR 236236 0 11429 0 3708 0 17797 0 26986 0 296156 0 0 0 ROBERT J ROSET SVP - IT OPERATIONS & QUALITY 234109 0 11320 0 1806 0 18767 0 13271 0 279273 0 0 0 CHRISTINA DONOHUE SVP MHT 222376 0 16444 0 1231 0 18000 0 16652 0 274703 0 0 0 DAVID THOMAS DIRECTOR - SALES NATIONAL (THRU 06/23) 104697 0 121534 0 12132 0 13440 0 17809 0 269612 0 0 0 LARRY WELLING DIRECTOR - IT SOFTWARE 153444 0 67682 0 0 0 12360 0 26645 0 260131 0 0 0 RYAN JEWELL SVP SALES & ACCOUNT MGMT 206333 0 18512 0 438 0 10360 0 23142 0 258785 0 0 0 CHARLES F LUCAS VP, IT SOFTWARE DEVELOPMENT 197765 0 18948 0 107 0 15860 0 12552 0 245232 0 0 0 PART I, LINE 1A DR. KAIRIS HAS A MONTHLY RELOCATION STIPEND PAID THROUGH THE NORMAL PAYROLL PROCESS. PART I, LINE 4A RICHARD LEGG RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $144,036 IN 2023. PART I, LINE 5 SALES TEAM MEMBERS RECEIVE SALES COMMISSIONS BASED ON NEW BUSINESS SALES AND CLIENT RETENTION. PART I, LINE 6 BONUS PAYMENTS ARE BASED ON THE ACHIEVEMENT OF INDIVIDUAL AND STRATEGIC PLAN GOALS AND THE COMPANY'S (CONSOLIDATED) OVERALL FINANCIAL GOALS. THE AMOUNTS ARE DISCRETIONARY AND ARE NOT FIXED. PART I, LINE 7 BONUS PAYMENTS ARE BASED ON THE ACHIEVEMENT OF INDIVIDUAL AND STRATEGIC PLAN GOALS AND THE COMPANY'S (CONSOLIDATED) OVERALL FINANCIAL GOALS. THE AMOUNTS ARE DISCRETIONARY AND ARE NOT FIXED. FORM 990, PART VI, SECTION B, LINE 11B THE CFO AND CONTROLLER REVIEW THE FORM 990 FOR REASONABLENESS COMPARED TO THE INTERNAL FINANCIAL STATEMENTS. THE CFO PROVIDES COPIES TO THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES ARE DISTRIBUTED COMPANYWIDE AND TO THE BOARD OF DIRECTORS BY THE COMPLIANCE DEPARTMENT. ANY POTENTIAL CONFLICT WITH A BOARD MEMBER MIGHT RESULT IN THE BOARD MEMBER RECUSING IF THE CONFLICT IS RELATED TO A VOTING MATTER. IF THE CONFLICT ARISES AMONG EMPLOYEE(S), THE MATTER IS REVIEWED WITH HR AND THE EMPLOYEE COULD BE REASSIGNED OR OTHER CORRECTIVE ACTION MAY BE REQUIRED TO RESOLVE THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS AND/OR IMMEDIATE SUPERVISOR REVIEWS PERFORMANCE. THE COMPENSATION COMMITTEE OF THE BOARD APPROVES COMPENSATION FOR THE CEO AND EXECUTIVE MANAGEMENT, AND THE CEO APPROVES ALL OTHERS' COMPENSATION. OUTSIDE COMPENSATION SURVEY TOOLS AND CONSULTATION WITH OUTSIDE COUNSEL (WHERE NEEDED) ARE USED TO ESTABLISH APPROPRIATE COMPENSATION LEVELS WITHIN THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE FILED WITH THE DEPARTMENT OF INSURANCE AND ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN NONADMITTED ASSETS -4,932,824. CHANGE IN RESERVES 1,211,013. FORM 990, PART XII, LINE 2C: NO CHANGE TO THE OVERSIGHT PROCESS. PART IX, LINE 11D: $27,547 WAS PAID TO MEGAN ROSKOVENSKY FOR PROFESSIONAL SERVICES RELATED TO GOVERNMENT RELATIONS AND LOBBYING DURING 2023. THE FILING ORGANIZATION REPORTED THIS AMOUNT ON FORM 990, PART IX, LINE 11D. THP INSURANCE COMPANY 1110 MAIN STREET WHEELING WV 26003 550765726 INSURANCE AND THIRD PARTY ADMINISTRATOR WV THE HEALTH PLAN OF WEST VIRGINIA INC C 45867629 75557450 1.00000 1 HOMETOWN HHP SERVICES CORPORATION 1110 MAIN STREET WHEELING WV 26003 341588625 THIRD-PARTY ADMINISTRATOR OH THE HEALTH PLAN OF WEST VIRGINIA INC C 1296329 4249050 1.00000 1 0 0 0 1 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 THP INSURANCE COMPANY L 12697222 ACTUAL ALLOC. - ADMIN. AGREEMENT THP INSURANCE COMPANY E 6538594 ACTUAL AMOUNT THP INSURANCE COMPANY D 2186950 ACTUAL AMOUNT HOMETOWN HHP SERVICES CORPORATION L 976040 ACTUAL ALLOC. - ADMIN. AGREEMENT