2023-10-05T09:45:35-05:00 2022-12-31 390859910 BAKER TILLY US LLP 225 S 6TH ST 2300 MINNEAPOLIS MN 55402 990 2022-01-01 550585592 THE HEALTH PLAN OF WEST VIRGINIA INC HEAL 8006246961 1110 MAIN STREET WHEELING WV 26003 RYAN RALSTON CHIEF FINANCIAL OFFICER 8006246961 2023-09-29 1 RYAN RALSTON XXX-XX-XXXX 0 LAWRENCE H MOHR CPA P00447603 6128764500 2023-09-29 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z THE HEALTH PLAN JEFFREY M KNIGHT 1110 MAIN STREET WHEELING WV 26003 1008192139 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. 8 7 677 0 0 0 0 0 781679902 813165802 7477861 5505805 57893 109656 789215656 818781263 834537 896948 656328334 715722948 33551550 37432807 0 0 0 32102672 39079164 722817093 793131867 66398563 25649396 406104117 409672896 128757432 136622503 277346685 273050393 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 108389872 896948 113546812 THE PRIMARY EXEMPT PURPOSE OF THE HEALTH PLAN OF WEST VIRGINIA, 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, 2022 WAS 21,073. 541091135 566294273 THE HEALTH PLAN OFFERS A MANAGED CARE PROGRAM FOR MOUNTAIN HEALTH TRUST (MHT), WEST VIRGINIA'S MEDICAID PROGRAM. AT DECEMBER 31, 2022, THE HEALTH PLAN'S MHT PLAN SERVICED 132,602 MEMBERS WITH 61,294 MEMBERS ENROLLED FROM THE EXPANSION POPULATION, 56,061 MEMBERS ENROLLED FOR THE TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) POPULATION, 10,934 MEMBERS ENROLLED FROM THE SUPPLEMENTAL SECURITY INCOME (SSI) POPULATION, AND 4,313 MEMBERS ENROLLED FROM THE WV CHILDREN'S HEALTH INSURANCE PROGRAM (WVCHIP). 127391051 133324717 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, 2022 FOR THESE PROGRAMS INCLUDED 8,957 MEMBERS. 776872058 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 3842 0 1 677 1 0 0 0 0 0 0 0 0 X 8 7 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 657784 0 35807 DAVID THOMAS DIRECTOR - SALES NATIONAL 40.00 1.00 X 521388 0 56909 ED KAIRIS MD MMM CHIEF MEDICAL OFFICER 40.00 1.00 X 479393 0 29859 RYAN RALSTON CHIEF FINANCIAL OFFICER 40.00 1.00 X 372660 0 52042 RICHARD LEGG SVP - SALES & ACCOUNT MANAGEMENT 40.00 1.00 X 334487 0 31183 KENNETH BRYAN CHIEF INFORMATION OFFICER 40.00 1.00 X 296854 0 43226 E DAVID MATHIEU SVP - UNDERWRITING & REGULATORY SERVICES 40.00 1.00 X 284143 0 42655 ANTOINETTE GEYER SVP PROVIDER DELIVERY SERVICES 40.00 1.00 X 284630 0 30401 JAMIE LEARY CHIEF LEGAL COUNCIL 40.00 1.00 X 292011 0 15341 JASON LANDERS SVP-MOUNTAIN HEALTH TRUST (THROUGH 11/2022) 40.00 1.00 X 254557 0 36999 ROBERT CROSS MEDICAL DIRECTOR 40.00 1.00 X 238068 0 39724 ROBERT J ROSET SVP - IT OPERATIONS & QUALITY 40.00 1.00 X 238877 0 29357 RYAN JEWELL VP - SALES AND ACCOUNT MANAGEMENT 40.00 1.00 X 202453 0 45827 CHARLES LUCAS VP - IT SOFTWARE DEVELOPMENT 40.00 1.00 X 208278 0 26106 CHRISTINA DONOHUE SVP - MOUNTAIN HEALTH TRUST 40.00 1.00 X 178506 0 34050 JOHN WRIGHT IV MEMBER PAST CHAIRMAN/PAST INTERIM CEO 1.00 1.00 X 117500 0 0 DENISE PENTINO CHAIRMAN OF THE BOARD 1.00 1.00 X X 20000 0 0 JOHN HOLLOWAY MEMBER 1.00 1.00 X 19350 0 0 WESLEY NICKELL VICE CHAIRMAN OF THE BOARD 1.00 1.00 X X 17500 0 0 SUSAN BUCHANAN CPA SECRETARY 1.00 1.00 X X 15000 0 0 LEA RIDENHOUR MEMBER 1.00 1.00 X 15000 0 0 MARK LANCELLOTTI MEMBER 1.00 1.00 X 15000 0 0 MANINDER SINGH BEDI MD MEMBER 1.00 1.00 X 12750 0 0 JOHN GIANOLA VICE CHAIRMAN OF THE BOARD (THROUGH 05/2022) 1.00 1.00 X X 4500 0 0 5080689 0 549486 59 0 1 0 SCION DENTAL LLC 10201 NORTH PORT WASHINGTON RD MEQUON WI 53092 DENTAL CLAIMS PROCESSING AND ADMINISTRAT 25726335 EVICORE HEALTHCARE MSI LLC 400 BUCKWALTER PLACE BLVD BLUFFTON SC 29910 MEDICAL BENEFIT MANAGEMENT SERVICES 7202715 OPTUMINSIGHT INC 2771 MOMENTUM PLACE CHICAGO IL 606895327 MEDICAL MANAGEMENT SERVICES 4186662 CONVEY HEALTH SOLUTIONS INC 100 SE 3RD AVE 14TH FORT LAUDERDALE FL 33394 OVER-THE-COUNTER DRUGS AND SERVICES 2287960 INCOMM HEALTHCARE & AFFINITY INC 250 WILLIAMS ST NW SUITE 500 ATLANTA GA 30303 MEMBER INCENTIVE CARDS FOR ACHIEVING HEA 2107709 64 MEDICAID 524114 566294273 566294273 MEDICARE 524114 133324717 133324717 COMMERCIAL HMO 524114 113438495 113438495 CLAIM PROCESSING 524292 108317 108317 813165802 6466393 6466393 46991 0 46991 46991 46991 188450288 189410876 -960588 -960588 -960588 MISCELLANEOUS REVENUE 900099 62665 62665 62665 818781263 813165802 0 5615461 621236 621236 275712 275712 715722948 715722948 3943587 1971793 1971794 18225429 13437862 4787567 2245345 1860783 384562 10163751 7126201 3037550 2854695 2400303 454392 541204 235245 305959 2203786 1945682 258104 50767 50767 609676 609676 15537458 14374065 1163393 1765432 1763782 1650 2067046 1665696 401350 5466598 4696436 770162 1180801 752586 428215 333812 251611 82201 270499 169953 100546 310072 232554 77518 2017978 1513483 504495 1549329 841248 708081 BROKER EXPENSE 2266224 2266224 NET REINSURANCE EXPENSE 1924385 1924385 MISCELLANEOUS EXPENSES 843655 631061 212594 PREMIUM TAX EXPENSE 140442 140442 793131867 776872058 16259809 0 17403641 63184590 30707607 30242070 14307484 6339640 7625827 7967844 294014165 258787423 53578743 47224759 2774134 2266210 406104117 409672896 109793148 126556561 1451951 1614257 17512333 8451685 128757432 136622503 X 276846685 272550393 0 0 500000 500000 277346685 273050393 406104117 409672896 X 25649396 -28840864 -1104824 X X 0 1 X 1 0 600000 600000 10430787 3922667 6508120 3276697 2416973 859724 7967844 INVESTMENT IN SUBSIDIARIES 47224759 C 47224759 POST RETIREMENT BENEFIT OBLIGATION 1227288 DUE TO THP INSURANCE COMPANY 4588996 OTHER LIABILITIES 1587232 PAYABLE FOR SECURITY SETTLEMENT 1048169 8451685 815743089 -2428498 -2428498 818171587 609676 609676 818781263 791179510 0 791179510 609676 1342681 1952357 793131867 PART XI, LINE 2D - OTHER ADJUSTMENTS: REINSURANCE EXPENSE -1,924,385. DEPRECIATION -504,113. PART XII, LINE 4B - OTHER ADJUSTMENTS: REINSURANCE EXPENSE 1,924,385. CHANGE IN PREMIUM DEFICIENCY RESERVE -1,085,817. DEPRECIATION 504,113. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 EQUITY AND BOND INVESTMENTS 12926619 EAST ASIA AND THE PACIFIC - AUSTRALIA, BRUNEI, BURMA, CAMBODIA, 0 0 EQUITY AND BOND INVESTMENTS 2757788 EUROPE (INCLUDING ICELAND & GREENLAND) - ALBANIA, ANDORRA, AUSTRIA, BELGIUM 0 0 EQUITY AND BOND INVESTMENTS 10567836 NORTH AMERICA - CANADA AND MEXICO, BUT NOT THE UNITED STATES 0 0 EQUITY AND BOND INVESTMENTS 2244128 0 0 0 0 0 0 28496371 0 28496371 0 0 0 0 0 0 PART III ACCOUNTING METHOD: 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) 40000 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) 40000 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) 35000 0 PROMOTE HEART HEALTH YWCA 1100 CHAPLINE STREET WHEELING WV 26003 550357063 501C(3) 25000 0 PROVIDE ASSISTANCE TO VICTIMS OF DOMESTIC VIOLENCE 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 GILMER COUNTY FAMILY RESOURCE NETWORK INC P O BOX 115 GLENVILLE WV 26351 550754524 501C(3) 10000 0 SUPPORT FOR SANTA'S ANGELS WHEELING HEALTH RIGHT INC 61 29TH STREET WHEELING WV 260034161 311149085 501C(3) 10000 0 PROVIDE PRIMARY HEALTHCARE, SUPPORT, EDUCATION AND RESOURCES TO THOSE UNABLE TO OBTAIN CARE CAMC FOUNDATION 3414 STAUNTON AVE CHARLESTON WV 25304 310887133 501C(3) 7500 0 PREVENTION FIRST PROGRAM FUND THE DOLLYWOOD FOUNDATION 111 E MAIN ST 2ND FLOOR SEVIERVILLE TN 37862 621348105 501C(3) 6000 0 PROMOTE EDUCATION AND LITERACY FOR BROOKE CO., WV THE SALVATION ARMY - BOYS & GIRLS CLUB OF CHARLESTON WV 301 TENNESSEE AVE CHARLESTON WV 25302 530196484 501C(3) 5250 0 PROMOTE ACADEMICS, HEALTH, LEADERSHIP, SAFETY AND MENTORSHIP 21 0 MEDICAL AND NURSING STUDENT SCHOLARSHIPS 13 275712 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 0 0 0 1 1 1 1 1 0 JEFFREY KNIGHT PRESIDENT & CEO 545434 0 111540 0 810 0 15477 0 20330 0 693591 0 0 0 DAVID THOMAS DIRECTOR - SALES NATIONAL 198178 0 322244 0 966 0 23657 0 33252 0 578297 0 0 0 ED KAIRIS MD MMM CHIEF MEDICAL OFFICER 397854 0 79217 0 2322 0 18063 0 11796 0 509252 0 0 0 RYAN RALSTON CHIEF FINANCIAL OFFICER 321168 0 50952 0 540 0 20324 0 31718 0 424702 0 0 0 RICHARD LEGG SVP - SALES & ACCOUNT MANAGEMENT 275438 0 54858 0 4191 0 19960 0 11223 0 365670 0 0 0 KENNETH BRYAN CHIEF INFORMATION OFFICER 248224 0 45066 0 3564 0 19928 0 23298 0 340080 0 0 0 E DAVID MATHIEU SVP - UNDERWRITING & REGULATORY SERVICES 231482 0 46418 0 6243 0 18672 0 23983 0 326798 0 0 0 ANTOINETTE GEYER SVP PROVIDER DELIVERY SERVICES 236504 0 46884 0 1242 0 18952 0 11449 0 315031 0 0 0 JAMIE LEARY CHIEF LEGAL COUNCIL 280000 0 10769 0 1242 0 13785 0 1556 0 307352 0 0 0 JASON LANDERS SVP-MOUNTAIN HEALTH TRUST (THROUGH 11/2022) 208106 0 44308 0 2143 0 16452 0 20547 0 291556 0 0 0 ROBERT CROSS MEDICAL DIRECTOR 227702 0 6658 0 3708 0 17143 0 22581 0 277792 0 0 0 ROBERT J ROSET SVP - IT OPERATIONS & QUALITY 225994 0 11077 0 1806 0 18111 0 11246 0 268234 0 0 0 RYAN JEWELL VP - SALES AND ACCOUNT MANAGEMENT 184109 0 17924 0 420 0 14612 0 31215 0 248280 0 0 0 CHARLES LUCAS VP - IT SOFTWARE DEVELOPMENT 189087 0 16419 0 2772 0 14945 0 11161 0 234384 0 0 0 CHRISTINA DONOHUE SVP - MOUNTAIN HEALTH TRUST 162219 0 15321 0 966 0 13155 0 20895 0 212556 0 0 0 PART I, LINE 1A DR. KAIRIS HAS A MONTHLY RELOCATION STIPEND PAID THROUGH THE NORMAL PAYROLL PROCESS. 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 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 -19,007. CHANGE IN RESERVES -1,085,817. FORM 990, PART XII, LINE 2C: NO CHANGE TO THE OVERSIGHT PROCESS. PART IX, LINE 11D: $48,000 WAS PAID TO LARRY SWANN FOR PROFESSIONAL SERVICES RELATED TO GOVERNMENT RELATIONS AND LOBBYING DURING 2022. 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 44528489 65339411 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 1061070 4047285 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 15095286 ACTUAL ALLOC. - ADMIN. AGREEMENT THP INSURANCE COMPANY E 4588996 ACTUAL AMOUNT THP INSURANCE COMPANY D 2266210 ACTUAL AMOUNT HOMETOWN HHP SERVICES CORPORATION L 429529 ACTUAL ALLOC. - ADMIN. AGREEMENT