2021-11-15T08:31:08-06:00 2020-12-31 271235638 MCM CPAS & ADVISORS LLP 462 S FOURTH ST SUITE 2600 LOUISVILLE KY 402023445 990 2020-01-01 611325905 UNIVERSITY HEALTH CARE INC UNIV 5025857324 5100 COMMERCE CROSSINGS DRIVE LOUISVILLE KY 40229 WILLIAM B WAGNER VICE CHAIR 5025857324 2021-11-14 1 WILLIAM WAGNER 999009999 ELEANOR A LIVINGSTON CPA MST P00226461 5027491900 2021-11-13 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z STEVE TUTEWOHL 5100 COMMERCE CROSSINGS DRIVE LOUISVILLE KY 40229 4468118 0 X N/A X 1997 KY PROVIDING/ ARRANGING HEALTH CARE SERVICES TO ELIGIBLE MEDICAID AND MEDICARE SPECIAL NEEDS RECIPIENTS IN KENTUCKY. 7 7 0 7 0 0 0 0 1950827910 4384624 45128673 83494 2905167 0 1998861750 4468118 50000 0 1803459863 0 16715634 0 0 0 0 165626000 3044418 1985851497 3044418 13010253 1423700 54115565 8730554 33210272 666887 20905293 8063667 X PROVIDING OR ARRANGING FOR THE PROVISION OF HEALTH CARE SERVICES TO ELIGIBLE MEDICAID RECIPIENTS PURSUANT TO A MANAGED CARE INITIATIVE WITH THE DEPARTMENT FOR MEDICAID SERVICES OF THE COMMONWEALTH OF KENTUCKY AND TO ELIGIBLE MEDICARE SPECIAL NEEDS RECIPIENTS THROUGH A CONTRACT WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. 0 0 0 4384624 UNIVERSITY HEALTH CARE, INC. (UHC) IS A NONPROFIT, COMMUNITY-BASED, PROVIDER-SPONSORED HEALTH PLAN WITH TWENTY-ONE YEARS OF EXPERIENCE ADMINISTERING KENTUCKY MEDICAID BENEFITS.UHC'S PARTNERSHIP WITH THE COMMONWEALTH OF KENTUCKY WAS FIRST ESTABLISHED IN 1997 BY SEVERAL PRIVATE PROVIDER SPONSORS TO HELP THE COMMONWEALTH CONTROL THE RISING COSTS OF THE MEDICAID PROGRAM AND TO IMPROVE HEALTH OUTCOMES FOR MEDICAID MEMBERS IN ADDITION TO PROVIDING SERVICES TO MEDICARE SPECIAL NEEDS PATIENTS.THE ACTIVITY DURING 2020 REPRESENTS THE WIND-DOWN OF UHC'S ACTIVITIES AFTER ITS ACQUISTION IN 2019 BY EVOLENT. 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 605 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 0 0 0 KY X STEVE TUTEWOHL 5025857324 5100 COMMERCE CROSSINGS DRIVE LOUISVILLE KY 40229 X DR KIMBERLY A BOLAND DIRECTOR 1.00 X 0 0 0 JENNIFER E DAVIS DIRECTOR 1.00 X 0 0 0 KENNETH P MARSHALL DIRECTOR 1.00 X 0 0 0 SETH B BLACKLEY DIRECTOR 1.00 X 0 0 0 FRANK JOHN WILLIAMS CHAIR 1.00 X X 0 0 0 WILLIAM B WAGNER VICE CHAIR 1.00 X X 0 0 0 JONATHAN D WEINBERG SECRETARY 1.00 X X 0 0 0 0 0 0 0 0 0 0 CVS PHARMACY ONCE CVS DRIVE WOONSOCKET RI 02895 PHARMACY CLAIM PAYMENTS 18760303 NORTON HOSPITAL INC 210 E GRAY ST 154 LOUISVILLE KY 40202 CLAIM PAYMENTS 6519199 UNIVERSITY OF LOUISVILLE HOSPITAL 530 S JACKSON ST LOUISVILLE KY 40202 CLAIM PAYMENTS 4349916 UOFL HEALTH LOUISVILLE INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 CLAIM PAYMENTS 4225423 EVOLENT HEALTH 800 N GLEBE ROAD ARLINGTON VA 22203 THIRD PARTY ADMINISTRATION 3723773 43 RETURN OF BENEFITS PAI 900099 3755254 3755254 PATIENT SERVICE 624100 629370 629370 4384624 83494 83494 4468118 4384624 0 83494 X 380222 380222 36208 36208 11395 11395 2371230 2371230 16566 16566 110105 110105 55739 55739 44147 44147 17238 17238 EQUIPMENT RENTAL & MAIN 704 704 LICENSE & FEES 564 564 DUES & SUBSCRIPTIONS 300 300 3044418 0 3044418 0 13937038 57353 20577225 2029 236706 0 8000000 0 19200000 8000000 164596 671172 54115565 8730554 1158837 0 32051435 666887 33210272 666887 X 20905293 8063667 20905293 8063667 54115565 8730554 X 1423700 95926 -14361252 X 0 0 0 X 1752410968 1932183073 1953210500 1950827910 4384624 7593017075 1752410968 1932183073 1953210500 1950827910 4384624 7593017075 0 0 0 7593017075 4906657 5277062 6241150 3966003 83494 20474366 4906657 5277062 6241150 3966003 83494 20474366 15000000 87087 2905167 17992254 1772317625 1937460135 1959538737 1957699080 4468118 7631483695 0.99500 0.99540 0.00270 0.00270 X 2347720 2347720 5652280 5652280 8000000 MARKETABLE SECURITIES 671172 C 671172 DUE FROM UHC 666887 666887 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS FIVE (5) INITIAL MEMBERS (ALSO KNOWN AS SPONSORS). IN ADDITION, UPON AN AFFIRMATIVE VOTE OF SEVENTY-FIVE (75%) OF THE VOTES HELD BY THE MEMBERS ENTITLED TO VOTE, THE MEMBERS MAY PROVIDE THAT THERE SHALL BE OTHER MEMBERS OF THE ORGANIZATION. THE OTHER MEMBERS MUST BE EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE CODE OR ARE DESCRIBED IN SECTION 170(C)(1) OF THE CODE; PROVIDED, THE BOARD OF DIRECTORS MAY PROVIDE IN THE BYLAWS FOR A SEPARATE CLASS OF MEMBERS THAT ARE NOT EXEMPT UNDER SECTION 501(C)(3) OR ARE NOT DESCRIBED IN SECTION 170(C)(1), BUT THE CREATION OR EXISTENCE OF ANY SUCH SEPARATE CLASS OF MEMBERS MUST NOT CAUSE THE CORPORATION TO CEASE TO BE AN EXEMPT ORGANIZATION UNDER SECTION 501(C)(3). EACH INITIAL MEMBER SHALL BE ENTITLED TO APPOINT A CERTAIN NUMBER OF DIRECTORS. ONE MEMBER MAY APPOINT 5 DIRECTORS AND 4 MEMBERS MAY APPOINT 1 DIRECTOR. OTHER MEMBERS (OTHER THAN THE INITIAL MEMBERS) MAY HAVE THE RIGHT TO APPOINT DIRECTORS. CURRENTLY THERE ARE NO OTHER MEMBERS. MEMBERS, THROUGH THEIR BOARD OF DIRECTOR APPOINTMENTS, APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BODY. UPON DISSOLUTION OF THE ORGANIZATION, ASSETS THAT HAVE BEEN RECEIVED AND ARE HELD BY THE ORGANIZATION SUBJECT TO LIMITATIONS PERMITTING THEIR USE ONLY FOR CHARITABLE, SCIENTIFIC, LITERARY, RELIGIOUS, EDUCATIONAL OR SIMILAR PURPOSES, AND THAT ARE NOT HELD UPON A CONDITION REQUIRING RETURN, TRANSFER, OR CONVEYANCE BY REASON OF DISSOLUTION, SHALL BE TRANSFERRED OR CONVEYED TO EACH MEMBER PURSUANT TO CERTAIN PROVISIONS OF THEIR MEMBER AGREEMENT. IN ADDITION, OTHER ASSETS, IF ANY, SHALL BE TRANSFERRED OR CONVEYED TO THE MEMBERS FOR A PUBLIC PURPOSE, PURSUANT TO A PLAN OF DISTRIBUTION ADOPTED AS PROVIDED BY LAW. IN ADDITION, THE ORGANIZATION HAS AN AFFILIATION AGREEMENT WITH THE PARTNERSHIP COUNCIL, INC. (PARTNERSHIP COUNCIL) UNDER WHICH THE PARTNERSHIP COUNCIL PROVIDES SUPPORT AND ASSISTANCE TO THE ORGANIZATION TO AID THE ORGANIZATION IN ITS ROLE AS THE PROVIDER OF MEDICAID SERVICES IN DESIGNATED REGIONS OF KENTUCKY UNDER A PROGRAM ESTABLISHED BY THE COMMONWEALTH OF KENTUCKY. THE PARTNERSHIP COUNCIL HAS THE RIGHT TO APPOINT THREE MEMBERS TO THE GOVERNING BODY OF PASSPORT. FORM 990, PART VI, SECTION A, LINE 7A ONE INITIAL MEMBER MAY APPOINT 5 DIRECTORS. THE OTHER FOUR INITIAL MEMBERS MAY EACH APPOINT ONE DIRECTOR. THE PARTNERSHIP COUNCIL SHALL HAVE THE RIGHT TO APPOINT 3 DIRECTORS. SUCH APPOINTED DIRECTORS HAVE THE RIGHT TO APPOINT 3 COMMUNITY AT-LARGE DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE TAX RETURN IS REVIEWED AND APPROVED BY THE COMPANY'S CHIEF FINANCIAL OFFICER. PERTINENT DATA IS COMPARED TO AUDITED FINANCIAL STATEMENTS TO ENSURE ACCURACY. FORM 990, PART VI, SECTION B, LINE 12C PASSPORT HAS TWO CONFLICT OF INTEREST POLICIES -- ONE FOR ITS BOARD MEMBERS AND EXECUTIVES; AND ONE FOR ALL OTHER ASSOCIATES. WE HAVE TWO CONFLICT OF INTEREST POLICIES TO ACCOUNT FOR THE HEIGHTENED SCRUTINY WE BELIEVE WE SHOULD GIVE TO THE ACTIVITIES AND FINANCIAL INTERESTS OF OUR BOARD MEMBERS AND EXECUTIVES. WE HAVE DEVELOPED A PROCESS FOR CONFLICT OF INTEREST TRAINING AND FOR MONITORING AND ENFORCING COMPLIANCE WITH THE CONFLICT OF INTEREST POLICIES. WE REQUIRE BOARD MEMBERS, EXECUTIVES AND ALL OTHER ASSOCIATES TO DISCLOSE POTENTIAL CONFLICT OF INTEREST SITUATIONS ON AN ANNUAL BASIS. ASSOCIATES INCLUDING EXECUTIVES PARTICIPATE IN CONFLICT OF INTEREST TRAINING ON AN ANNUAL BASIS. THE ANNUAL TRAINING INCLUDES HAVING ASSOCIATES AND EXECUTIVES DISCLOSE ANY POSSIBLE CONFLICT-OF-INTEREST SITUATIONS. THE KEY TO OUR PLAN IS TO IDENTIFY ANY POSSIBLE CONFLICT-OF-INTEREST SITUATIONS AND THEN HAVE THE VP, HUMAN RESOURCES AND VP, CHIEF COMPLIANCE OFFICER REVIEW THE DISCLOSURES TO DETERMINE WHETHER ANY ACTION SHOULD BE TAKEN. THE PASSPORT BOARD HAS DEVELOPED ITS PROCESS FOR REVIEW OF CONFLICT OF INTEREST DISCLOSURES. THE BOARD HAS FORMED A COMPLIANCE COMMITTEE TO OVERSEE AND DIRECT THAT PASSPORT CONDUCTS A THOROUGH AND PROMPT INVESTIGATION OF ANY CONFLICT OF INTEREST AND THAT EACH BOARD MEMBER COMPLETES A CONFLICT OF INTEREST FORM ANNUALLY. BOARD MEMBERS ARE ASKED TO ABSTAIN FROM VOTING IN CONNECTION WITH THE CONFLICT OF INTEREST WHILE THE COMPLIANCE COMMITTEE DECIDES IF A CONFLICT OF INTEREST EXISTS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G OTHER CONSULTING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,371,230. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,371,230. FORM 990, PART XI, LINE 9: IMPAIRMENT OF REAL PROPERTY -14,361,252. PASSPORT HEALTH SOLUTIONS LLC 5100 COMMERCE CROSSINGS DRIVE LOUISVILLE KY 40229 822430292 REAL ESTATE KY 2024 6637853 UNIVERSITY HEALTH CARE INC PASSPORT HEALTH SOLUTIONS TWO LLC 5100 COMMERCE CROSSINGS DRIVE LOUISVILLE KY 40229 REAL ESTATE KY 0 1362147 UNIVERSITY HEALTH CARE INC 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0