2021-11-12T18:20:00-06:00 2020-12-31 PricewaterhouseCoopers LLP 101 SEAPORT BLVD BOSTON MA 02210 990 2020-01-01 237442369 FALLON COMMUNITY HEALTH PLAN INC % TODD BAILEY FALL 5087992100 10 Chestnut Street Worcester MA 01608 Todd Bailey CFO 5087992100 2021-11-11 true Todd Bailey 999009999 GWEN SPENCER P00641463 6175305000 2021-11-10 2 2020 2022-09-23 18:48:47Z FALLON HEALTH RICHARD P BURKE 10 Chestnut Street Worcester MA 01608 1842363743 false X www.fchp.org X 1975 MA SEE SCHEDULE O making our communities healthy 11 10 1274 77 0 -6568 0 0 1569180946 1629023510 18648246 14645893 -7295403 294325 1580533789 1643963728 708084 804840 1483013757 1432910362 91003613 100444140 0 0 0 32286980 34483812 1607012434 1568643154 -26478645 75320574 461233945 617122763 282934744 347691090 178299201 269431673 X FALLON HEALTH'S MISSION IS TO MAKE OUR COMMUNITIES HEALTHY BY IMPROVING THE HEALTH AND WELL-BEING OF THE DIVERSE COMMUNITIES WE SERVE. false false 205295985 242610339 SEE SCHEDULE O 1227614377 1386413171 SEE SCHEDULE O 1093547 804840 SEE SCHEDULE O 1434003909 true false false true false false false false false false true false false false false false true true false false false false false false false false false true false true false false false false false false true false false false false false true true true true false false true 6547 0 true 1274 true true true false false false false false false false false false false false X 11 10 true false false false false false false true true false false true true true true true true true true false MA X X TODD BAILEY 5087992100 10 CHESTNUT STREET WORCESTER MA 01608 X Richard P Burke PRESIDENT & CEO 45.0 5.0 X X 844594 0 586407 CAROLYN LANGER MD SVP, CHIEF MED OFFICER 50.0 0.0 X 455229 0 197005 TODD BAILEY SVP, CHIEF FINANCIAL OFFICER 47.0 3.0 X 431626 0 190556 EMILY WEST SVP, CHIEF OPERATING OFFICER 50.0 0.0 X 423641 0 150913 MARY RITTER See Schedule O for title 48.0 2.0 X 347733 0 188195 JILL LEBOW SVP, CHIEF HR OFFICER 48.0 2.0 X 336735 0 171311 LINDA WEINREB MD MEDICAL DIRECTOR, MCD ACO 50.0 0.0 X 350992 0 138482 mark dichter md vp, med.dir util.mgmt/cl. info 50.0 0.0 X 321787 0 142558 ROBERT SCHREIBER MD VP, MEDICAL DIRECTOR 50.0 0.0 X 320404 0 135811 CHRISTINE CASSIDY SVP, CHIEF COMM. OFFICER 49.0 1.0 X 279910 0 141478 JAMES GENTILE SVP, CHIEF COMPLIANCE OFFICER 50.0 0.0 X 273034 0 130731 Janis Liepins See Schedule O for title 48.0 2.0 X 280043 0 120288 DAVID BRUMLEY MD VP, MEDICAL AFFAIRS 50.0 0.0 X 298942 0 84239 PERRY FARB MD PACE ASSOCIATE MEDICAL DIR. 50.0 0.0 X 278273 0 100366 Kevin McGovern VP, Treasurer 50.0 0.0 X 259961 0 106510 KRISTINE BOSTEK VP, SEC & FHW PACE EFF. 4/20 49.0 1.0 X 247604 0 118491 ELIZABETH HELENIUS VP, SALES 48.0 2.0 X 226822 0 106909 LISA COHEN INTERIM CFO, 6/11/19-8/25/19 48.0 2.0 X 230785 0 79488 David Przesiek SVP, CHIEF SALES OFF UNTL 3/20 45.0 5.0 X 271648 0 15724 DEBORAH DAVIAU See Schedule O for title 50.0 0.0 X 219360 0 31811 ANDRE GABRYJELSKI DIR, MEDICARE ADV. UNTL 9/20 50.0 0.0 X 140291 0 24788 FREDERICK MISILO ESQ CHAIR 3.0 2.0 X 42000 0 0 JAMES BUONOMO CLERK 2.0 2.0 X 39500 0 0 Ann K Tripp TREASURER 2.0 2.0 X 37250 0 0 B JOHN DILL VICE CHAIR 2.0 2.0 X 37250 0 0 JANET S RICO DIRECTOR 2.0 1.0 X 36500 0 0 deborah enos DIRECTOR 2.0 0.0 X 34250 0 0 KARIN LANDRY DIRECTOR 2.0 0.0 X 29250 0 0 Joseph N Stolberg CPA Director 2.0 0.0 X 27000 0 0 PETER STRALEY DIRECTOR 2.0 0.0 X 27000 0 0 alice bonner director, effective 6/20 2.0 0.0 X 21000 0 0 DAVID FRIEND MD director until 6/20 2.0 0.0 X 6750 0 0 6995414 0 2962061 255 true true false VHS ACQUISITION SUBSIDIARY 123 SUMMER STREET WORCESTER MA 01608 HOSPITAL SERVICES 52050442 LOWELL GENERAL HOSPITAL 295 Varnum Street LOWELL MA 01854 MEDICAL SERVICES 41238798 BEACON HEALTH STRATEGIES LLC 200 STATE STREET BOSTON MA 02109 MENTAL HEALTH SVC. 118992661 UMASS MEMORIAL MEDICAL CENTER 55 N LAKE AVENUE WORCESTER MA 01655 MEDICAL SERVICES 84306783 Reliant Medical Group 630 Plantation STREET WORCESTER MA 01605 MEDICAL SERVICES 66501273 724 0 PREMIUM-COMMERCIAL 524114 242610339 242610339 PREMIUM-GOVERNMENTAL 524114 1386413171 1386413171 1629023510 8950919 8950919 0 0 66405 66405 0 0 0 204028584 198333610 5694974 5694974 5694974 0 0 0 0 0 0 0 0 0 SUBSIDIARY LOSS/GAIN 524298 2091946 2091946 MINORITY INTEREST 900099 -2068399 -2068399 MEDICAL CONSULTING 900099 267117 267117 3661 3661 294325 1643963728 1629023510 14940218 804840 804840 0 0 1432910362 1432910362 7657098 7657098 410142 410142 70753505 68861 70684644 2904102 2914 2901188 11352462 22306 11330156 7366831 7366831 0 2006134 2006134 2373658 2373658 193996 193996 0 883382 883382 843974 843974 1328296 1328296 5116953 5116953 12708334 12708334 0 2504979 2504979 6518 6518 0 51088 51088 94881 94881 0 4794007 4794007 690196 690196 DUES/SUBSCRIPTIONS 882716 882716 MEDICAL SUPPLIES 630 630 OTHER TAXES 4070 4070 1568643154 1434003909 134639245 0 0 0 23402979 145524310 0 0 79025948 58395299 0 0 0 0 0 0 26612 26447 8391131 6128764 43092867 33029154 11706579 10063713 314369822 366549810 0 0 0 0 0 0 24310874 30434420 461233945 617122763 271753335 329435293 0 0 11181409 18255797 0 0 0 0 0 0 0 0 0 0 0 0 282934744 347691090 X 178299201 269431673 0 0 178299201 269431673 461233945 617122763 75320574 15811898 X false true X true false X 154942 134776 125589 0 0 415307 1148972862 1242226460 1514381036 1569180946 1629023510 7103784814 0 0 0 1149127804 1242361236 1514506625 1569180946 1629023510 7104200121 1518073 1518073 105812855 99072267 66679504 27794779 33713513 333072918 107330928 99072267 66679504 27794779 33713513 334590991 6769609130 7351852 7240581 7966759 9252715 9017324 40829231 0 7351852 7240581 7966759 9252715 9017324 40829231 0 69310 68769 155409 152170 270778 716436 1156548966 1249670586 1522628793 1578585831 1638311612 7145745788 0.94736 0.93058 0.00571 0.00620 X SUPPORT TEST FORM 990, SCHEDULE A, PART III THE ORGANIZATION'S IRS DETERMINATION LETTER INDICATES THAT THIS ORGANIZATION QUALIFIES AS A PUBLICLY SUPPORTED CHARITY UNDER SECTION 170(B)(1)(a)(vi); HOWEVER, THE ORGANIZATION QUALIFIES AS A 509(A)(2) ORGANIZATION. SCHEDULE A HAS BEEN COMPLETED IN ACCORDANCE WITH THE FORM INSTRUCTIONS UNDER THE 509(A)(2) TEST. false false true false false false false true 259844 false false 259844 false Direct Lobbying Expense FORM 990, SCHEDULE C, PART IV SUPPLEMENTAL INFORMATION: FCHP PAID A TOTAL OF $259,844 LOBBYING EXPENSES AS FOLLOWS: AHIP DUES (AMERICA'S HEALTH INS. PLANS) 44,017 MAHP DUES (MASS ASSOC OF HEALTH PLANS) 82,315 NATIONAL PACE ASSOCIATION 3,822 ALLIANCE OF COMMUNITY HEALTH PLANS 58,800 MASSPACE INC 5,042 ----------- SUBTOTAL NON-EMPLOYEES $193,996 STAFF SALARIES ASSOCIATED WITH LOBBYING 65,848 ------------ TOTAL OF ALL LOBBYING EXPENSES PAID $259,844 KEY LEGISLATIVE AND REGULATORY ISSUES IN 2020: AMERICA'S HEALTH INSURANCE PLANS (AHIP) - LEGISLATIVE ACTIVITY IN THE HOUSE AND THE SENATE REGARDING THE AFFORDABLE CARE ACT (ACA), DRUG PRICING, SURPRISE BILLING, COVID-19 RELATED HEALTH ISSUES - REGULATORY ACTIVITY ADDRESSING IMPLEMENTATION OF NUMEROUS ACA PROVISIONS HEALTH INSURANCE EXCHANGES, DELIVERY SYSTEM REFORMS, ADMINISTRATIVE SIMPLIFICATION, HEALTH INFORMATION TECHNOLOGY, ACCOUNTABLE CARE ORGANIZATIONS (ACOS), COVID-19 RELATED HEALTH ISSUES - PUBLIC PROGRAM ISSUES AFFECTING MEDICARE ADVANTAGE, DUAL PROGRAMS, MEDICARE PART D, AND MEDICAID MASSACHUSETTS ASSOCIATION OF HEALTH PLANS (MAHP) -ANY NEW POLICIES IMPLEMENTED BY DIVISION OF INSURANCE THAT AFFECT FALLON HEALTH - OTHER REGULATORY HEARINGS AND LEGISLATIVE MEETINGS THAT AFFECT HEALTHCARE POLICIES AND GUIDELINES -LEGISLATIVE MEETINGS AND INTERNAL MEETINGS ON NEW LEGISLATION THAT WILL REFORM AND/OR AFFECT HEALTH CARE -MEETINGS WITH MASSHEALTH AND MEDICAID OFFICIALS ON DUALS PROGRAMS INCLUDING SENIOR CARE OPTIONS AND PACE -MEETINGS WITH MASSHEALTH ON ACCOUNTABLE CARE ORGANIZATIONS, CHANGING PAYMENT MODELS, AND BETTER MANAGING THE CARE OF OUR MEMBERS. IN 2020, FALLON HEALTH WORKED WITH THESE REGULATORY AGENCIES ON: DEPARTMENT OF PUBLIC HEALTH - EARLY INTERVENTION PROGRAM - CHANGES TO HOSPITAL GUIDELINES HEALTHCARE POLICY COMMISSION - COST TRENDS - TOTAL MEDICAL EXPENSES & RELATIVE PRICES TECHNICAL ADVISORY GROUP MEETINGS, CONSULTATIVE SESSIONS & REGULATIONS - CONSULTATIVE SESSIONS & REGULATIONS CENTER FOR HEALTH INFORMATION AND ANALYSIS - HOSPITAL FINANCIAL REPORTS - TECHNICAL ADVISORY GROUP MEETINGS, - CONSULTATIVE SESSIONS & REGULATIONS DIVISION OF INSURANCE - SPECIAL SESSIONS AND OTHER - MEDICAL LOSS RATIO - SESSIONS AND REGULATIONS - FINANCIAL REPORTING - LIMITED & TIERED NETWORKS - OPEN ENROLLMENT - PLAN TERMINATION - PROVIDER DIRECTORIES - PROVIDER CONTRACTING - SMALL GROUP RATE REVIEWS - CREDENTIALING - ADMINISTRATIVE SIMPLIFICATION PROVISIONS - CODING COMMISSION MASSACHUSETTS CONNECTOR - RISK ADJUSTMENT - SEAL OF APPROVALS FOR CONNECTOR PLANS - OPEN ENROLLMENT EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES - WORKED ON MANAGED CARE ORGANIZATION ISSUES - DUAL MEDICARE/MEDICAID PROGRAMS (SENIOR CARE OPTIONS), - PACE PROGRAMS - WORKED WITH EOHHS STAFF ON NEW LEGISLATIVE APPROACHES TO COST, ACCESS AND COVID-19 ISSUES ATTORNEY GENERAL'S OFFICE - RECOMMENDATIONS TO ADDRESS HEALTHCARE COST INCREASES - CONVERSATIONS AROUND MENTAL HEALTH PARITY - PROVIDER CONSOLIDATIONS 1928342 1407132 521210 7076056 4694141 2381915 34088469 26927881 7160588 10063713 1750136000 15812000 91254358 107066358 1643069642 883382 10704 894086 1643963728 1659003000 91253932 91253932 1567749068 883382 10704 894086 1568643154 SCHEDULE D, PART XI, LINE 2D: SUBSIDIARY ACTIVITIES & ELIMINATIONS 91,253,435 FINANCIAL STATEMENT ROUNDING 923 ---------------- TOTAL 91,254,358 SCHEDULE D, PART XI, LINE 4B: LINE OF CREDIT INTEREST RE-CLASS TO EXPENSE 10,704 ---------------- TOTAL 10,704 SCHEDULE D, PART XII, LINE 2C: SUBSIDIARY ACTIVITIES & ELIMINATIONS 91,253,435 FINANCIAL STATEMENT ROUNDING 497 ----------------- TOTAL 91,253,932 SCHEDULE D, PART XII, LINE 4B: Line of credit INTEREST re-class TO EXPENSE 10,704 ----------------- TOTAL 10,704 true Worcester Regional Chamber of Commerce 446 Main Street Suite 200 Worcester MA 01608 041988780 501(c)(6) 35000 GENERAL SUPPORT WORCESTER COUNTY FOOD BANK 474 BOSTON TURNPIKE SHREWSBURY MA 01545 043071457 501(c)(3) 50000 GENERAL SUPPORT THE FOOD BANK OF WESTERN MA 97 NORTH HATFIELD RD PO BOX 160 HATFIELD MA 01038 042751023 501(c)(3) 31000 GENERAL SUPPORT Boys and Girls Club of Worcester 65 Boys Girls Club Way Worcester MA 01610 042105851 501(c)(3) 13500 GENERAL SUPPORT United Way of Central MA 484 Main Street Worcester MA 01608 042104017 501(C)(3) 17500 GENERAL SUPPORT Greater Boston Food Bank 70 South Bay Avenue Boston MA 02118 042717782 501(C)(3) 10000 GENERAL SUPPORT Lovin' Spoonfuls 1304 Commonwealth Avenue Suite E Boston MA 02134 271810597 501(C)(3) 10000 GENERAL SUPPORT Genesis Club House 274 Lincoln Street Worcester MA 01605 042983234 501(c)(3) 10000 GENERAL SUPPORT Community Health Programs 444 Stockbridge Road Great Barrington MA 01230 042582119 501(C)(3) 7500 GENERAL SUPPORT Town of Clinton 200 West Boylston Street Clinton MA 01510 046001118 501(C)(3) 6000 GENERAL SUPPORT Worcester Regional Research Bureau 500 Salisbury Street WORCESTER MA 01609 042901298 501(C)(3) 9000 GENERAL SUPPORT MERRIMACK VALLEY FOOD BANK INC PO BOX 8638 LOWELL MA 01853 223241609 501(C)(3) 30000 GENERAL SUPPORT GENERAL SUPPORT MEYERS PRIMARY CARE INSTITUTE 385 GROVE STREET WORCESTER MA 01605 043211678 501(C)(3) 15000 GENERAL SUPPORT REGIONAL ENVIRONMENTAL COUNCIL INC 9 Castle Street 1 WORCESTER MA 01610 046364350 501(C)(3) 7500 GENERAL SUPPORT CENTRAL MA HOUSING ALLIANCE 6 INSTITUTE ROAD WORCESTER MA 01609 042791448 501(C)(3) 10000 GENERAL SUPPORT WORCESTER ART MUSEUM 55 SALISBURY STREET WORCESTER MA 01609 041988530 501(C)(3) 10000 GENERAL SUPPORT HEYWOOD MEMORIAL HOSPITAL 242 GREEN STREET Gardner MA 01440 042103581 501(C)(3) 26200 GENERAL SUPPORT UMASS MEMORIAL HEALTH CARE 365 PLANTATION STREET WORCESTER MA 01605 043358566 501(C)(3) 15000 GENERAL SUPPORT RON BURTON TRAINING VILLAGE PO BOX 2 HUBBARDSTON MA 01452 222570218 501(C)(3) 25000 GENERAL SUPPORT GREATER WORCESTER COMMUNITY FOUNDATION 370 MAIN STREET SUITE 650 WORCESTER MA 01608 042572276 501(C)(3) 25000 GENERAL SUPPORT Catholic Charities of the Diocese of Worcester 10 Hammond Street Worcester MA 01610 042103979 501(C)(3) 17000 GENERAL SUPPORT Friendly House 36 Wall Street WORCESTER MA 01604 042104239 501(C)(3) 16000 GENERAL SUPPORT The Open Pantry of Greater Lowell 13 Hurd Street PO Box 7258 Lowell MA 01852 222474729 501(C)(3) 14000 GENERAL SUPPORT Saint Paul's Elder Outreach 19 Chatham Street Worcester MA 01609 042106744 501(C)(3) 13000 GENERAL SUPPORT PERNET FAMILY HEALTH SERVICES INC 237 Millbury Street WORCESTER MA 01610 042453851 501(C)(3) 10000 GENERAL SUPPORT Open Sky 4 Mann Street Worcester MA 01602 042701581 501(C)(3) 12500 GENERAL SUPPORT AMERICAN HEART ASSOCIATION 300 5TH AVENUE SUITE 6 WALTHAM MA 02451 135613797 501(C)(3) 10000 GENERAL SUPPORT MASSACHUSETTS TAXPAYERS FOUNDATION 333 Washington Street Ste 853 BOSTON MA 02108 041590310 501(C)(3) 14000 GENERAL SUPPORT Centro 11 Sycamore Street WORCESTER MA 01608 042714991 501(C)(3) 12500 GENERAL SUPPORT VETERANS INC 69 Grove Street WORCESTER MA 01605 043098024 501(C)(3) 24000 GENERAL SUPPORT Worcester Hibernian Cultural Foundation 19 Temple Street Worcester MA 01604 202148447 501(C)(3) 12000 general support Worcester Center for Performing Arts (the Hanover 2 Southbridge Street worcester MA 01608 050521735 501(C)(3) 11400 general support Spanish American Center 112 Spruce Street Leominster MA 01453 042761759 501(C)(3) 11040 general support Elder Services of the Berkshires 877 South Street Suite 4E Pittsfield MA 01201 042542001 501(C)(3) 11000 general support Elder Services of the Merrimack Valley 280 Merrimack Street Suite 400 Lawrence MA 01843 042545136 501(C)(3) 11000 general support Community Harvest Project 37 Wheeler Road North Grafton MA 01536 043424018 501(C)(3) 11000 general support Coastline Elderly Services 1646 Purchase Street New Bedford MA 02740 042622121 501(C)(3) 11000 general support Take & Eat 69 Stryker Road Florida MA 01247 841620450 501(C)(3) 10000 general support Net of Compassion 674 Main Street Worcester MA 01610 475387634 501(C)(3) 10000 general support United Way of Tri-County 46 Park Street Framingham MA 01702 042104231 501(C)(3) 10000 general support Roots Rising 437 North Street Pittsfield MA 01201 832950864 501(C)(3) 10000 general support 40 1 Form 990, Schedule I, PART I, LINE 2 Description of Organization's Procedures for Monitoring the Use of Grants FCHP GRANTS ARE CLASSIFIED EITHER AS A COMMUNITY BENEFIT GRANT OR A COMMUNITY RELATIONS GRANT. THE COMMUNITY BENEFIT GRANTS ARE VERIFIED TO ENSURE THAT EACH RECIPIENT IS A 501(C)(3) ORGANIZATION. THE COMMUNITY RELATIONS GRANTS ARE VERIFIED TO ENSURE THAT THE RECIPIENT ORGANIZATION'S IRS STATUS IS LISTED AS A TAX-EXEMPT ORGANIZATION IN THE INTERNAL REVENUE CODE SECTION 501(C). EACH RECIPIENT OF FCHP GRANT HAS SPECIFIC INSTRUCTIONS TO BE FOLLOWED AS TO THE USE OF THE GRANT, AND THAT THE GRANT IS TO BE EXPENDED WITHIN 1 YEAR FROM THE AWARD. FOR ANY GRANTS IN EXCESS OF $10,000, fchp REQUESTS A GRANT REPORT DETAILING THE GRANT USES. THESE REPORTS ARE REVIEWED AND KEPT ON FILE AT FCHP. X true true X X X X true true false false false false false true false Richard P Burke PRESIDENT & CEO 684995 0 0 159599 0 553225 0 33182 0 1431001 0 117033 0 David Przesiek SVP, CHIEF SALES OFF UNTL 3/20 92161 0 0 0 179487 0 4361 0 11363 0 287372 0 0 0 JAMES GENTILE SVP, CHIEF COMPLIANCE OFFICER 241121 0 10840 0 21073 0 117886 0 12845 0 403765 0 25724 0 Kevin McGovern VP, Treasurer 238534 0 13165 0 8262 0 80532 0 25978 0 366471 0 13165 0 Janis Liepins See Schedule O for title 261967 0 14512 0 3564 0 91222 0 29066 0 400331 0 14512 0 CHRISTINE CASSIDY SVP, CHIEF COMM. OFFICER 241789 0 10881 0 27240 0 118744 0 22734 0 421388 0 29679 0 ELIZABETH HELENIUS VP, SALES 208975 0 16605 0 1242 0 74957 0 31952 0 333731 0 16605 0 EMILY WEST SVP, CHIEF OPERATING OFFICER 311407 0 13881 0 98353 0 127431 0 23482 0 574554 0 71211 0 JILL LEBOW SVP, CHIEF HR OFFICER 295798 0 13346 0 27591 0 144039 0 27272 0 508046 0 33843 0 mark dichter md vp, med.dir util.mgmt/cl. info 298121 0 16808 0 6858 0 103623 0 38935 0 464345 0 16808 0 KRISTINE BOSTEK VP, SEC & FHW PACE EFF. 4/20 241898 0 4464 0 1242 0 86382 0 32109 0 366095 0 0 0 TODD BAILEY SVP, CHIEF FINANCIAL OFFICER 392484 0 25881 0 13261 0 187825 0 2731 0 622182 0 19115 0 ANDRE GABRYJELSKI DIR, MEDICARE ADV. UNTL 9/20 97230 0 33479 0 9582 0 6430 0 18358 0 165079 0 33479 0 DAVID BRUMLEY MD VP, MEDICAL AFFAIRS 284195 0 7839 0 6908 0 55173 0 29066 0 383181 0 7839 0 PERRY FARB MD PACE ASSOCIATE MEDICAL DIR. 269130 5569 3574 65699 34667 378639 0 MARY RITTER See Schedule O for title 305650 0 23371 0 18712 0 155013 0 33182 0 535928 0 22588 0 CAROLYN LANGER MD SVP, CHIEF MED OFFICER 411923 0 18265 0 25041 0 194758 0 2247 0 652234 0 31377 0 ROBERT SCHREIBER MD VP, MEDICAL DIRECTOR 300207 0 16623 0 3574 0 102629 0 33182 0 456215 0 16623 0 LINDA WEINREB MD MEDICAL DIRECTOR, MCD ACO 330412 0 17016 0 3564 0 111495 0 26987 0 489474 0 17016 0 DEBORAH DAVIAU See Schedule O for title 191224 0 27111 0 1025 0 21883 0 9928 0 251171 0 0 0 LISA COHEN INTERIM CFO, 6/11/19-8/25/19 218625 0 11340 0 820 0 75073 0 4415 0 310273 0 11340 0 FORM 990, Schedule J PART I, LINE 1 & 2 HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES PURSUANT TO A POLICY ADOPTED AND APPROVED BY THE EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE (EECC) OF THE BOARD OF DIRECTORS, A PORTION OF THE DUES AND FEES FOR THE BUSINESS USE OF A SOCIAL CLUB ARE PAID BY THE ORGANIZATION FOR THE FOLLOWING INDIVIDUALS: President and Chief Executive Officer and the Senior Vice President, Chief Strategy and Government Programs Officer. EACH EXECUTIVE IS REQUIRED TO PAY FOR HIS OR HER OWN PERSONAL USE EXPENSES, AS WELL AS A PERSONAL USE PORTION OF THE MEMBERSHIP DUES AND FEES AS DETERMINED BY THE EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE. SOCIAL CLUB DUES ARE NOT REPORTED AS TAXABLE COMPENSATION TO THE LISTED PERSONS SINCE FALLON COMMUNITY HEALTH PLAN ONLY PAYS FOR THE PORTION USED FOR BUSINESS PURPOSES. PART 1, LINE 4A FCHP PAID SEVERANCE PAYMENTs TO DAVID Przesiek, SVP, Chief Sales Officer (until March 30, 2020), FOR A TOTAL OF $179,004. THE PERIODIC PAYMENTs BEGAN ON APRIL 2, 2020 AND ENDED ON OCTOBER 16, 2020. PART I, LINE 4B SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN THE ORGANIZATION HAS A SUPPLEMENTAL EXECUTIVE RETIREMENT 457(F) PLAN THAT COVERS CERTAIN EXECUTIVES OF THE ORGANIZATION. UNDER THE TERMS OF THE PLAN, INDIVIDUALS VEST AS PROVIDED, DEPENDING ON THE DATE OF ELIGIBILITY TO PARTICIPATE IN THE PLAN. FOR INDIVIDUALS LISTED WHO WERE ELIGIBLE ON OR BEFORE MARCH 1, 2007, 50% OF THE YEARLY CONTRIBUTION VESTS IMMEDIATELY WITH THE REMAINING CONTRIBUTION SUBJECT TO VESTING UPON NORMAL RETIREMENT AGE, OR IF EARLIER, UPON DEATH, DISABILITY, OR INVOLUNTARY SEPARATION FROM SERVICE FOR A REASON OTHER THAN CAUSE, INCLUDING INVOLUNTARY SEPARATION FROM SERVICE FOR A REASON OTHER THAN CAUSE FOLLOWING A CHANGE IN CONTROL. FOR INDIVIDUALS LISTED WHO WERE ELIGIBLE ON OR BEFORE DECEMBER 31, 2012, 50% OF THE YEARLY CONTRIBUTION VESTS IMMEDIATELY IF THE PARTICIPANT HAS BEEN COVERED FOR AT LEAST 36 MONTHS, WITH THE REMAINING CONTRIBUTION SUBJECT TO VESTING UPON NORMAL RETIREMENT AGE, OR IF EARLIER, UPON DEATH, DISABILITY, OR INVOLUNTARY SEPARATION FROM SERVICE FOR A REASON OTHER THAN CAUSE, INCLUDING INVOLUNTARY SEPARATION FROM SERVICE FOR A REASON OTHER THAN CAUSE FOLLOWING A CHANGE IN CONTROL. FOR INDIVIDUALS WHO FIRST BECOME ELIGIBLE FOR A PLAN YEAR THAT BEGINS IN 2013 OR 2014, 50% OF THE YEARLY CONTRIBUTIONS VEST IMMEDIATELY IF THE PARTICIPANT HAS BEEN COVERED FOR AT LEAST 60 MONTHS, WITH THE REMAINING CONTRIBUTIONS SUBJECT TO VESTING UPON THE EARLIEST OF NORMAL RETIREMENT AGE, DEATH, DISABILITY OR INVOLUNTARY SEPARATION FROM SERVICE FOR A REASON OTHER THAN CAUSE, INCLUDING INVOLUNTARY SEPARATION FROM SERVICE FOR A REASON OTHER THAN CAUSE FOLLOWING A CHANGE IN CONTROL. Effective January 1, 2015, SERP Contributions may be made on behalf of an employee who is the President and Chief Executive Officer, the Division President, Senior Care Services, an Executive Vice President or Senior Vice President. In addition, contributions may be made on behalf of an employee who is designated as eligible for a plan by the board at its discretion. The SERP contribution made for an employee for the 2015 Plan year or a later plan year will vest 20% each year beginning in the year of the contribution and ending on the last day of the fifth plan year. Effective January 1, 2016, an employee will not have contributions made to a post 457(F) account if becoming first eligible for the plan in November or December of that same year. An employee who is eligible for a post 457(f) account for the plan year in which they are first employed by the health plan and has a date of hire that is after January 31st of such plan year, the contribution for the employee for such plan year shall be a portion of the amount that would otherwise have been contributed on their behalf for that plan year. This portion shall be determined on their behalf for the Plan year of their initial employment by a fraction with a numerator equal to the number of months in the plan year during which they are employed by the Health Plan in the eligible position and denominator equal to 12. If a participant incurs a separation from service prior to normal retirement age and prior to the last day of the fifth plan year for which their contribution for a plan year has been credited, the entire amount of the unvested contribution for such plan year shall be forfeited, provided that they shall become vested in such contribution upon the earliest of death, disability, or involuntary separation from service for a reason other than for cause, including involuntary separation from service for reason other than cause, following a change in control. In 2020, THE FOLLOWING INDIVIDUALS LISTED IN SCHEDULE J, PART II PARTICIPATED IN THE PLAN. AMOUNTS VESTED AND PAID UNDER THE PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B) (III). AMOUNTS DEFERRED ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). CONTRIBUTIONS THAT WERE PREVIOUSLY REPORTED ON A PRIOR FORM 990, AND ARE PAID OUT IN THE CURRENT YEAR ARE REPORTED IN SCHEDULE J, PART II, COLUMN (F). OFFICER/KEY EE AMOUNT PAID AMOUNT DEFERRED RICHARD P. BURKE $152,033 $140,000 TODD BAILEY $11,234 $32,000 CHRISTINE CASSIDY $23,656 $19,430 James Gentile $19,824 $19,760 CAROLYN LANGER $21,429 $33,268 JILL LEBOW $26,577 $24,320 MARY RITTER $15,717 $26,000 EMILY WEST $89,387 $0 PART I, LINE 7 THE FCHP BOARD HAS THE AUTHORITY AND DISCRETION TO DETERMINE COMPENSATION OF THE SENIOR EXECUTIVES AND EXECUTIVE INCENTIVES. THE DISCRETION IS TYPICALLY EXERCISED THROUGH THE BOARD'S EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE, WHICH HAS THE AUTHORITY TO DISCHARGE THE BOARD'S RESPONSIBILITIES FOR COMPENSATION AND EXECUTIVE INCENTIVES. HOWEVER, THE DISCRETIONARY COMPENSATION/INCENTIVES RECOMMENDED MUST BE WITHIN THE PARAMETERS OF THE STANDARDS THAT THE COMMITTEE HAS ESTABLISHED AND NEEDS TO BE CONSISTENT WITH THE IRS STANDARDS OF REASONABLENESS FOR SUCH INCENTIVES PROVIDED TO NONPROFIT EXECUTIVES. LAURIE MCGOVERN EMPLOYEE-FAMILY MEMBER OF KEY EMPLOYEE, KEVIN MCGOVERN 99870 FCHP EMPLOYEE false ORGANIZATION MISSION AND PROGRAM ACTIVITIES FORM 990, Part I line 1 Founded in 1977, Fallon Community Health Plan, INC. (FCHP) is a leading health care services organization with a simple but powerful mission: Making our communities healthy. With a focus on improving the health and well-being of the diverse communities we serve, FCHP works to deliver high-quality, affordable care. In 2020, FCHP offered a full range of commercial products and a wide variety of government programs, including the most options for seniors than any other health plan in Massachusetts. This enables FCHP to serve members of all ages, at all income levels and with all types of health needs. Offerings and activities include innovative health insurance solutions; a variety of Medicaid and Medicare products; unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs; health and wellness programs and events; a community benefits grants program designed to target unmet community health needs; corporate sponsorships; in-kind donations; advocacy and volunteer hours. FORM 990, Part III, Line 4A COMMERCIAL PRODUCTS AND SERVICES FCHP commercial plans are offered through employer groups and, in some cases, can be purchased directly by the consumer. Commercial plans cover all counties in Massachusetts with the exception of Barnstable, Dukes and Nantucket. Regardless of how they get their coverage, members of FCHP's commercial plans have access to a variety of providers, including individual physicians, group practices, community hospitals and large medical facilities throughout Massachusetts and southern New Hampshire. To help members manage their health care costs, FCHP offers a unique choice of provider networks, including a lower cost limited network, which was the first of its kind in Massachusetts. FCHP also offers a wide range of care management programs for those with acute, chronic or complex health conditions. These voluntary programs are designed to help members improve both their health and quality of life. To best support the changing needs of those we serve, FCHP has a history of offering innovations to commercial members including the following: . 2002: Introduced Direct Care, the first limited network product in Massachusetts . 2004: Began reimbursing members for fitness-related activity fees through the It Fits! program - the first health plan in Massachusetts to do so . 2005: Eliminated copays for adult and pediatric preventive care, years before it became required by the ACA . 2005: Offered the first qualified high-deductible HMO plans in Massachusetts . 2013: Launched "The Healthy Health Plan," making FCHP the first plan in Massachusetts to include a wellness incentive as part of its standard benefit package . 2016: Developed new specialized plans for people with chronic conditions such as asthma, diabetes and coronary artery disease . 2017: Expanded access to care with telemedicine, allowing members to receive adult and pediatric care over the phone or by video FORM 990, PART III, LINE 4B GOVERNMENT PROGRAMS From its very start in 1977, FCHP has always been committed to serving the health care needs of individuals enrolled in Medicare and Medicaid programs. It has worked to expand those offerings over the years. Listed below is the complete list of the government-sponsored programs FCHP offers in Massachusetts and New York. . Medicare Advantage and Medicare Supplement (Massachusetts) . MassHealth Accountable Care Organization Partnership Plans (Massachusetts) . Medicare Advantage Special Needs Plan and Senior Care Options (Massachusetts) . Program of All-Inclusive Care for the Elderly (PACE) (Massachusetts and New York) . Subsidized, limited-network plan in Central Mass. and Metro West (Massachusetts) . Managed Long Term Care (MLTC) plan (New York) These programs enable FCHP to serve members of all ages, at all income levels and with all types of health needs. There are several notable facts when it comes to FCHP's government programs: . In 1979, FCHP receives the first contract in Massachusetts to cover Medicaid beneficiaries. . In 1980, FCHP was the first HMO in the country to receive a Medicare risk contract. Today, FCHP's Medicare Advantage plans continue to serve the needs of seniors across the Commonwealth of Massachusetts. . In 1995, FCHP started its PACE in Massachusetts. Called Summit ElderCare, it is the largest PACE program in New England. FCHP has six PACE sites - five in Massachusetts and one in western New York. Through its PACE program, FCHP is also a provider of care. . In 2010, FCHP launched NaviCare, a Medicare Advantage Special Needs Plan and Senior Care Options program in Massachusetts. . In 2017, FCHP formed MassHealth Accountable Care Organization Partnership Plans with the following provider groups: . Berkshire Health Systems and Community Health Programs . Reliant Medical Group . Wellforce and its provider organizations . In 2019, FCHP opened a new, state-of-the-art PACE site in Worcester. . In 2020, FCHP celebrated 25 years as a PACE provider. FORM 990, PART III, LINE 4c Community giving Fallon Community Health Plan, Inc. is a not-for-profit health care services organization headquartered in Worcester, Massachusetts. Our mission guides us in the work we do directly in the communities we serve in addressing health care barriers that impact positive health outcomes. Today we spread our mission across Massachusetts and western New York State. We are a forward-thinking, cohesive group that works with local providers and leaders in the communities we serve to improve residents' health and well-being, regardless of whether they are Fallon members. In addition to our products and services, Fallon provides corporate donations, and our employees contribute both in-kind and monetary donations to help build and sustain healthy communities. Community focus is core to who we are as an organization and with a highly engaged and committed workforce, we are able to make a meaningful difference at the grassroots level and beyond. Our community giving programs include grants, sponsorships, in-kind donations, advocacy and volunteering. As partners, advocates and volunteers, Fallon has a long history of leadership in addressing health care barriers that have a real impact on the health and well-being of underserved communities. The two main ways we address these barriers is through grant-making and community engagement. Some examples include: Building and stocking food pantries, helping first-generation students complete their college applications, supporting programs that help to keep older adults safe, and providing holiday meals for those in need. We are guided by our funding priorities that have been determined in collaboration with our provider partners and other key community stakeholders. Through a comprehensive community health needs assessment, the following three funding priorities drove giving in 2020: . Senior health initiatives: With a focus on those most impacted by the pandemic, Fallon aimed to support organizations and programs that provide services to seniors that overcome or mitigate social isolation and loneliness. Particular attention was paid to programs that ensure access to care including behavioral health resources, safety in homes and communities, and access to food and utilities. Examples include: . Caregiver support services . Transportation to medical appointments . Healthy living programs . Falls/community/home safety . Access to nutritious foods/mobile pantries and markets/Meals on Wheels . Children and youth health initiatives: Fallon supported community-based programs or organizations that provide access to programs that wrap services and resources around children and youth. These programs work collaboratively to engage other community partners that are committed to finding solutions that will positively impact children and youth directly in their neighborhood, schools and communities in a positive and progressive manner utilizing both evidence based/informed and innovative models to impact change. . Food insecurity: Fallon's goal was to help maintain food assistance programs for those areas or populations that are particularly vulnerable to food insecurity as a result of the COVID-19 pandemic. In 2020, FCHP distributed $1,003,746 to programs that met the goals of Fallon's Community Benefits Programs. This was accomplished through the distribution of $804,840 through our Community Benefits grants and Corporate Sponsorship programs. In addition, we provided $198,906 in direct expenses, leveraged expenses, staff hours and volunteer time along with our Fallon Health Feed a Family Initiative and food pantry builds. We personally visit the organizations who serve our most vulnerable communities to distribute funds and learn more about the region's needs and how we can work together to be a continued resource. Fallon's employees throughout the organization are encouraged to volunteer in the community where they work or live and are provided eight hours of paid work time to do so. Employees volunteer thousands of hours for initiatives such as the United Way's "Day of Caring" as well as building and stocking food pantries in local public schools or community-based agencies. Our employees volunteered 2,897 hours of their time in 2020 with 421.5 hours for Fallon-driven initiatives. FORM 990, PART VI, LINE 2 FAMILY OR BUSINESS RELATIONSHIP BETWEEN OFFICERS, DIRECTORS, AND KEY EMPLOYEES. FALLON HEALTH & LIFE ASSURANCE CO., INC. (FHLAC) IS A WHOLLY-OWNED SUBSIDIARY OF FCHP. THE FOLLOWING FCHP BOARD MEMBERS AND OFFICER SERVED ON THE FHLAC BOARD OF DIRECTORS IN 2020: JAMES BUONOMO, B. JOHN DILL, ANN TRIPP, FREDERICK MISILO, JANET S. RICO, deborah enos, and Richard p. burke (ex officio). ULTRABENEFITS, INC. (UBI) IS A WHOLLY-OWNED SUBSIDIARY OF FHLAC. THE FOLLOWING FCHP OFFICERS AND KEY EMPLOYEE SERVED ON THE UBI BOARD OF DIRECTORS IN 2020: RICHARD P. BURKE, DAVID PRZESIEK, TODD BAILEY, AND ELIZABETH HELENIUS. GROUP INSURANCE SERVICE CENTER, INC. (GISC), (UNTIL 11/30/20) AND GROUP INSURANCE SERVICE CENTER AGENCY, INC. (GISC AGENCY), ARE WHOLLY-OWNED SUBSIDIARIES OF UBI. UBI ACQUIRED GISC AND GISC AGENCY IN September 2015. THE FOLLOWING FCHP OFFICERS AND KEY EMPLOYEES SERVED ON THE BOARD OF THESE TWO CORPORATIONS IN 2020: RICHARD P. BURKE, DAVID PRZESIEK, TODD BAILEY, AND ELIZABETH HELENIUS. FORM 990, PART VI, LINE 11B THE PROCESS USED BY MANAGEMENT AND GOVERNING BODY TO REVIEW FORM 990 A DRAFT OF THE FORM 990 IS PREPARED BY FCHP AND REVIEWED BY ITS TAX CONSULTING FIRM. THE FINAL VERSION OF THE FORM 990 IS PROVIDED TO BOARD MEMBERS FOR REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, LINE 12C THE PROCESS USED TO MONITOR CONFLICTS OF INTEREST FCHP'S BYLAWS REQUIRE ALL DIRECTORS AND OFFICERS TO DISCLOSE ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AS DEFINED IN THE ORGANIZATION'S CONFLICT OF INTEREST POLICY RELATING TO DIRECTORS, OFFICERS AND MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS. THIS IS ENFORCED BY THE REQUIREMENT THAT SUCH INDIVIDUALS ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. EACH YEAR THE COMPLETED CONFLICT OF INTEREST DISCLOSURE STATEMENTS ARE REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD WHICH REPORTS ANY ACTUAL OR POTENTIAL CONFLICTS TO THE FULL BOARD. ANY BOARD MEMBER OR OFFICER WITH A CONFLICT OF INTEREST IS PROHIBITED FROM PARTICIPATING IN ANY DISCUSSION OF, OR VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. TWO INDEPENDENT BOARD MEMBERS ALSO CONDUCT AN ANNUAL REVIEW OF ANY BUSINESS TRANSACTIONS INVOLVING THE ORGANIZATION THAT COULD POTENTIALLY BENEFIT A BOARD MEMBER OR OFFICER, TO ENSURE THAT THE TRANSACTIONS DO NOT INVOLVE ANY UNDUE INFLUENCE, ARE AT FAIR MARKET VALUE, AND ARE IN THE ORGANIZATION'S BEST INTEREST. THE REVIEWING BOARD MEMBERS REPORT THEIR FINDINGS TO THE FULL BOARD. FURTHERMORE, AT BOARD MEETINGS, INDIVIDUAL BOARD MEMBERS ARE ASKED TO IDENTIFY, AND RECUSE THEMSELVES FROM ANY DISCUSSION AND VOTE ON ANY MATTER BEFORE THE BOARD IN WHICH THEY MAY HAVE A CONFLICT. FCHP ALSO REQUIRES ALL DIRECTORS, OFFICERS, AND KEY EMPLOYEES TO COMPLETE A WRITTEN DISCLOSURE STATEMENT DESIGNED TO IDENTIFY POTENTIAL CONFLICTS. FCHP ALSO HAS GENERAL CORPORATE-WIDE CONFLICT OF INTEREST POLICIES THAT REQUIRE REPORTING OF POTENTIAL CONFLICTS AND MANAGEMENT APPROVAL OF CERTAIN TRANSACTIONS, AND PROHIBITS CERTAIN SPECIFIC TRANSACTIONS. THESE POLICIES ARE ENFORCED BY SENIOR MANAGEMENT, INCLUDING THE CHIEF COMPLIANCE OFFICER. FORM 990, PART VI, LINES 15A & 15b PROCESS OF DETERMINING COMPENSATION FOR CEO, TOP MANAGEMENT OFFICIALS, OFFICERS, AND KEY EMPLOYEES. FCHP HAS ESTABLISHED AN EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE (THE "COMMITTEE") OF THE BOARD OF DIRECTORS THAT ESTABLISHES POLICIES AND THE COMPENSATION STRUCTURE OF CERTAIN FCHP EXECUTIVE OFFICERS. THIS COMMITTEE IS RESPONSIBLE FOR ASSURING THAT THE TOTAL COMPENSATION PROVIDED TO THESE EXECUTIVE OFFICERS IS DETERMINED BY A FAIR AND EQUITABLE PROCESS, INFORMED BY CURRENT AND CREDIBLE MARKET PRACTICE INFORMATION, AND COMPLIANT WITH APPLICABLE LEGAL AND REGULATORY GUIDELINES. IN 2020, THE COMMITTEE CONSISTED OF FOUR MEMBERS OF FCHP'S BOARD OF DIRECTORS WHO ARE NOT EMPLOYED BY THE ORGANIZATION. FCHP'S CEO SERVED AS AN EX OFFICIO MEMBER OF THE COMMITTEE WITHOUT A VOTING RIGHT. THE EXECUTIVE OFFICERS OVER WHOSE COMPENSATION THE COMMITTEE IS RESPONSIBLE ARE COMPRISED OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER ("CEO"), AND THE EXECUTIVE VICE PRESIDENT, AND SENIOR VICE PRESIDENT POSITIONS THAT REPORT DIRECTLY TO THE CEO ("EXECUTIVE GROUP"). IN 2020, TO DETERMINE THE COMPENSATION STRUCTURE OF THE EXECUTIVE GROUP, THE COMMITTEE RELIED ON A WRITTEN COMPENSATION SURVEY PRODUCED BY AN INDEPENDENT CONSULTING FIRM THAT ASSESSES EXECUTIVE COMPENSATION AND BENEFITS. THE COMMITTEE MET TO REVIEW THE COMPENSATION STRUCTURE OF THE EXECUTIVE GROUP AND REVIEWED THE COMPENSATION SURVEY PREPARED BY THE INDEPENDENT CONSULTING FIRM. THE COMMITTEE THEN VOTED TO APPROVE THE COMPENSATION OF THE EXECUTIVE GROUP (OTHER THAN THE CEO). FOR THE CEO'S COMPENSATION THE COMMITTEE (MEETING WITHOUT THE CEO) RECOMMENDED A COMPENSATION STRUCTURE THAT WAS PRESENTED TO THE FCHP'S BOARD OF DIRECTORS. THE BOARD OF DIRECTORS (WITHOUT THE CEO PRESENT), VOTED TO APPROVE THE COMMITTEE'S RECOMMENDATION. ALL THESE DELIBERATIONS WERE CONTEMPORANEOUSLY DOCUMENTED IN THE MINUTES OF THE COMMITTEE AND BOARD OF DIRECTORS. The process was used to establish the compensation for the executive group in 2020. FORM 990, PART VI, LINES 18 AND 19 HOW DOCUMENTS ARE MADE AVAILABLE TO PUBLIC FCHP'S FORM 990 AND ANNUAL AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE GENERAL PUBLIC ON THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE. FCHP'S ANNUAL REPORT IS AVAILABLE ON ITS OWN WEBSITE. FCHP'S 990, FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND ANNUAL REPORT ARE ALSO PROVIDED UPON REQUEST. FORM 990, PART VII, SECTION A, COLuMN A: NAME AND TITLE: THE FOLLOWING INDIVIDUALS' TITLES CHANGED DURING THE YEAR: JANIS LIEPINS: FROM: VP, PRODUCT MANAGEMENT, UNTIL 4/20. TO: VP, MASSHEALTH & COMMUNITY CARE, EFFECTIVE 4/20. MARY RITTER: FROM: SVP, STRATEGY & BUSINESS DEVELOPMENT, UNTIL 4/20. TO: SVP, CHIEF STRATEGY & GOVERNMENT PROGRAMS OFFICER, EFFECTIVE 4/20. DEBORAH DAVIAU: FROM: EXECUTIVE DIRECTOR NAVICARE, UNTIL 9/20. TO: VP, MEDICARE AND EXECUTIVE DIRECTOR NAVICARE, EFFECTIVE 9/20. FCHP NEW YORK LLC 10 CHESTNUT ST WORCESTER MA 01608 464193932 HEALTH CARE NY 0 0 FCHP FALLON TOTAL CARE INC 10 CHESTNUT STREET WORCESTER MA 01608 455591420 HEALTH CARE MA 501(C)(3) 10 FCHP true FALLON HEALTH WEINBERG INC 2700 NORTH FOREST RD GETZVILLE NY 14068 161580245 HEALTH CARE NY 501(C)(3) 10 FCHP true FALLON HEALTH & LIFE ASSURANCE COinc 10 CHESTNUT STREET WORCESTER MA 01608 043169246 HEALTH INS. MA FCHP C CORP 34601730 28508512 1.00000 true ULTRABENEFITS INC 22 ELM STREET WORCESTER MA 01608 043525752 3RD PARTY ADM MA FHLAC C CORP 5578283 5352423 1.00000 true GROUP INSURANCE SVC CTR INC UNTL 1120 20 WINTER STREET 1 PEMBROKE MA 02359 043271304 3RD PARTY ADM MA UBI C CORP 2158058 837263 1.00000 true GISC INSurance AGENCY INC 20 WINTER STREET 1 PEMBROKE MA 02359 043273688 INSURANCE AGN MA UBI C CORP 1270716 2466011 1.00000 true true true false true false false true false false true false true true true true false false false false ULTRABENEFITS INC A,J 66405 CASH FALLON HEALTH & LIFE ASSURANCE CO INC B 6100000 CASH ULTRABENEFITS INC G 292328 CASH FALLON HEALTH WEINBERG INC L 1658790 CASH ULTRABENEFITS INC L 105636 CASH ULTRABENEFITS INC M 176060 CASH FALLON HEALTH & LIFE ASSURANCE CO INC N 3344761 CASH GROUP INSURANCE SERVICE CENTER INC L 57634 CASH FALLON HEALTH & LIFE ASSURANCE CO INC O 9519706 CASH Schedule R, Part V LINE 1D FALLON COMMUNITY HEALTH PLAN, INC., (FCHP) IS THE GUARANTOR OF FALLON TOTAL CARE INC., (FTC). THE AGREEMENT WAS COMPLETED IN ORDER TO MEET THE FINANCIAL SOLVENCY REQUIREMENT OF FTC, WHICH WAS REQUIRED BY THE COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES (EOHHS) AS PART OF THE FTC DEMONSTRATION PROGRAM APPLICATION PROCESS. FCHP UNCONDITIONALLY GUARANTEES THE UNMET FINANCIAL OBLIGATIONS, AND NO DOLLAR AMOUNTS ARE SPECIFIED.