2020-10-05T07:00:27-05:00 2019-12-31 390859910 BAKER TILLY US LLP 777 E WISCONSIN AVENUE 32ND FLOOR MILWAUKEE WI 53202 990 2019-01-01 550585592 THE HEALTH PLAN OF WEST VIRGINIA INC HEAL 8006246961 1110 MAIN STREET WHEELING WV 26003 RYAN RALSTON VP OF FINANCE & CFO 8006246961 2020-09-28 1 LAWRENCE H MOHR CPA P00447603 4147775500 2020-09-28 65.26.60.15 2020-09-28 17:06:42 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 61F2587C9083E5D801196A980749F72D4837C79B 2019 2021-04-22 16:20:28Z THE HEALTH PLAN JEFFREY M KNIGHT 1110 MAIN STREET WHEELING WV 26003 725672021 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 HEALTH CARE PROFESSIONALS AND PARTNERS ACROSS THE COMMUNITY. 9 8 662 0 0 0 0 0 576389128 626918840 6125562 7382660 72096 135088 582586786 634436588 445613 444410 538710005 590510654 36536502 34889422 0 0 0 21329354 25021317 597021474 650865803 -14434688 -16429215 232379264 259859925 106405745 132679108 125973519 127180817 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 HEALTH CARE PROFESSIONALS AND PARTNERS ACROSS THE COMMUNITY. 0 0 113446599 444410 111401270 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, 2019 WAS 23,998. 331303782 325330707 THE HEALTH PLAN CONTINUES TO OFFER THE MEDICAID PROGRAM SERVICING 94,039 MEMBERS, 39,594 OF WHICH WERE ENROLLED AS MEMBERS OF THE EXPANSION POPULATION, 42,289 OF WHICH WERE ENROLLED AS MEMBERS OF THE TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) POPULATION, AND 12,156 OF WHICH WERE ENROLLED AS MEMBERS OF THE SUPPLEMENTAL SECURITY INCOME (SSI) POPULATION AT DECEMBER 31, 2019. 193525486 190036415 THE HEALTH PLAN CONTINUES TO OFFER A MEDICARE ADVANTAGE PROGRAM KNOWN AS SECURE CARE, WHICH ALSO INCLUDES A MEDICARE DUAL SPECIAL NEEDS PLAN (DSNP). THIS PRODUCT ENABLES THE MEDICARE ELIGIBLE POPULATION TO SELECT MEDICARE COVERAGE AT A MUCH LOWER COST DUE TO THEIR AGREEMENT TO UTILIZE THE HEALTH PLAN NETWORK. THE ENROLLMENT AT DECEMBER 31, 2019 FOR THIS PROGRAM WAS 14,471. 638275867 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 1 0 0 0 0 0 0 1 1 1 0 1 4759 0 1 662 1 0 0 0 0 0 0 0 0 X 9 8 1 0 1 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 JOHN HOLLOWAY MEMBER 1.00 1.00 X 14000 0 0 JOHN WRIGHT IV CHAIRMAN OF THE BOARD 1.00 1.00 X X 16000 0 0 E PHILLIPS POLACK MD MEMBER 1.00 1.00 X 12000 0 0 MARK LANCELLOTTI MEMBER 1.00 1.00 X X 12000 0 0 JOHN MCDONALD CPA SECRETARY 1.00 1.00 X X 7200 0 0 SUSAN BUCHANAN CPA MEMBER 1.00 1.00 X 12000 0 0 JILL E HALL VICE CHAIR OF THE BOARD 1.00 1.00 X 11800 0 0 JOHN GIANOLA MEMBER 1.00 1.00 X 12000 0 0 JAMES PENNINGTON PRESIDENT/CEO 40.00 1.00 X X 579396 0 29385 JEFFREY KNIGHT - SVP - PAYMENT INTEGRITY & POPULATION HEALTH MGMT 40.00 1.00 X 239371 0 24196 RYAN RALSTON VP - CFO 40.00 1.00 X 201675 0 29278 PATRICIA M FAST SVP- GOVERNMENT PROGRAMS 40.00 1.00 X 221523 0 18385 E DAVID MATHIEU - VP UNDERWRITING & REGULATORY SERVICES 40.00 1.00 X 220047 0 31425 ROBERT J ROSET SVP - IS/CIO 40.00 1.00 X 210445 0 17861 RICHARD LEGG SVP - SALES & ACCOUNT MANAGEMENT 40.00 1.00 X 266179 0 16455 JOHN FISCHER THRU 10182019 SVP - CLINICAL SERVICES 40.00 1.00 X 203561 0 20698 JASON LANDERS SVP-PROVIDER DELIVERY SERVICES 40.00 1.00 X 205253 0 24676 JAMES MILLER SVP-ADMINISTRATIVE SERVICES 40.00 1.00 X 181698 0 24490 MARK KENAMOND THRU 10162019 MEDICAL DIRECTOR 40.00 1.00 X 196751 0 14481 DAVID THOMAS DIRECTOR - SALES NATIONAL 40.00 1.00 X 336331 0 35868 KENTON ROEPKE DIRECTOR - ACTUARIAL SERVICES 40.00 1.00 X 397189 0 32511 ROBERT CROSS MEDICAL DIRECTOR 40.00 1.00 X 211802 0 24529 KATIE STANICH VP INTERNAL AUDIT & QUALITY 40.00 1.00 X 171284 0 29489 3939505 0 373727 41 0 1 0 SCION DENTAL OF WEST VIRGINIA LLC 10201 NORTH PORT WASHINGTON RD MEQUON WI 53092 DENTAL CLAIMS PROCESSING AND ADMINISTRAT 10209284 SUPERIOR VISION 939 ELKRIDGE LANDING RD SUITE 200 LINTHICUM MD 21090 MANAGED EYE HEALTH AND VISION PLAN FOR M 1403954 LIBERTY DENTAL PLAN CORPORATION 340 COMMERCE SUITE 100 IRVINE CA 92602 MANAGED DENTAL PLAN FOR MEMBERS 1380569 BEECHER EVERGREEN MANAGED CARE BEECHER CARLSON/MASTER TRUST PO BO ATLANTA GA 303686531 REINSURANCE BROKER 1168375 EPISOURCE LLC 500 WEST 190TH ST 4TH FL GARDENA CA 90248 PAYER HEALTHCARE ANALYTICS & TECHNOLOGY 1164137 55 MEDICAID 524114 325330707 325330707 MEDICARE 524114 190036415 190036415 COMMERCIAL HMO 524114 111401270 111401270 CLAIM PROCESSING 524292 150448 150448 626918840 5127212 5127212 47250 0 47250 47250 47250 93490881 91235433 2255448 2255448 2255448 MISCELLANEOUS REVENUE 900099 87838 87838 87838 634436588 626918840 0 7517748 161000 161000 283410 283410 590510654 590510654 3012176 1506088 1506088 21478909 16695283 4783626 1651543 1359600 291943 6412173 4951197 1460976 2334621 1916049 418572 1170749 594416 576333 487899 487899 44000 44000 403532 403532 6501917 5769477 732440 1973342 1972529 813 2091413 1702915 388498 2692994 2252611 440383 1310986 819476 491510 540142 428509 111633 401913 217978 183935 509596 382197 127399 1074847 806135 268712 628402 464862 163540 BROKER EXPENSE 3187383 3187383 NET REINSURANCE EXPENSE 734904 734904 PREMIUM TAX EXPENSE 223519 223519 1043779 803776 240003 650865803 638275867 12589936 0 33477998 17854411 33906770 30443235 8784414 5083996 3801921 3700418 138502144 174027569 19364136 31936310 3326295 1897982 232379264 259859925 90922513 119648705 2012099 2526966 13471133 10503437 106405745 132679108 X 125473519 126680817 0 0 500000 500000 125973519 127180817 232379264 259859925 X -16429215 22115056 -4478543 X X 0 1 X 1 0 600000 600000 5331305 2431313 2899992 2853109 2652683 200426 3700418 INVESTMENT IN SUBSIDIARIES 31936310 C 31936310 POST RETIREMENT BENEFIT OBLIGATION 1730394 INTERCOMPANY PAYABLE 5991846 OTHER LIABILITIES 2781197 10503437 632095576 -1937480 -1937480 634033056 403532 403532 634436588 653109131 0 653109131 403532 -2646860 -2243328 650865803 PART XI, LINE 2D - OTHER ADJUSTMENTS: REINSURANCE EXPENSE -1,434,229. DEPRECIATION -503,251. PART XII, LINE 4B - OTHER ADJUSTMENTS: REINSURANCE EXPENSE 1,434,229. CHANGE IN PREMIUM DEFICIENCY RESERVE -4,584,340. DEPRECIATION 503,251. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 EQUITY AND BOND INVESTMENTS 1860792 EAST ASIA AND THE PACIFIC - AUSTRALIA, BRUNEI, BURMA, CAMBODIA, 0 0 EQUITY AND BOND INVESTMENTS 2594463 EUROPE (INCLUDING ICELAND & GREENLAND) - ALBANIA, ANDORRA, AUSTRIA, BELGIUM 0 0 EQUITY AND BOND INVESTMENTS 5377290 NORTH AMERICA - CANADA AND MEXICO, BUT NOT THE UNITED STATES 0 0 EQUITY AND BOND INVESTMENTS 2495457 0 0 0 0 0 0 12328002 0 12328002 0 0 0 0 0 0 PART III ACCOUNTING METHOD: 1 DIABETES CAMP OF WV - CAMP KNO KOMA 735 GREEN VALLEY DRIVE ST ALBANS WV 25177 550738182 501C(3) 25000 CAMPER TRANSPORTATION, STAFFING/SUPPORT OF CAMP. UNITED HEALTH FOUNDATION CAMP CATCH YOUR BREATH NO 3 HOSPITAL PLAZA CLARKSBURG WV 26302 550621706 501C(3) 15000 CAMPER SCHOLARSHIPS, EQUIPMENT/SUPPLIES, EDUCATIONAL MATERIALS. DISCOVER THE REAL WEST VIRGINIA FOUNDATION INC 405 CAPITOL STREET SUITE 512 CHARLESTON WV 25301 550725474 501C(3) 10000 CORPORATE SPONSOR TO SUPPORT THE MISSION OF FOUNDATION. WVU FOUNDATION PO BOX 877 MORGANTOWN WV 265070877 556017181 501C(3) 96000 STUDENT ATHLETE AND ACADEMIC PROGRAM SUPPORT. NEW LIFE CLINIC INC 3471 OHIO RIVER RD POINT PLEASANT WV 25550 464852367 501C(3) 10000 BREAKING THE CHAINS ADDICTION AWARENESS EVENT AMERICAN HEART ASSOCIATION PO BOX 4002907 DES MOINES IA 503402907 135613797 501C(3) 5000 DONATION 6 MEDICAL AND NURSING STUDENT SCHOLARSHIPS 15 283410 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 JAMES PENNINGTON PRESIDENT/CEO 497642 0 41563 0 40191 0 14000 0 15385 0 608781 0 0 0 JEFFREY KNIGHT - SVP - PAYMENT INTEGRITY & POPULATION HEALTH MGMT 238561 0 0 0 810 0 12000 0 12196 0 263567 0 0 0 RYAN RALSTON VP - CFO 186268 0 15000 0 407 0 9462 0 19816 0 230953 0 0 0 PATRICIA M FAST SVP- GOVERNMENT PROGRAMS 219201 0 0 0 2322 0 11000 0 7385 0 239908 0 0 0 E DAVID MATHIEU - VP UNDERWRITING & REGULATORY SERVICES 216483 0 0 0 3564 0 11000 0 20425 0 251472 0 0 0 ROBERT J ROSET SVP - IS/CIO 209203 0 0 0 1242 0 10500 0 7361 0 228306 0 0 0 RICHARD LEGG SVP - SALES & ACCOUNT MANAGEMENT 259834 0 0 0 6345 0 13000 0 3455 0 282634 0 0 0 JOHN FISCHER THRU 10182019 SVP - CLINICAL SERVICES 196997 0 0 0 6564 0 9923 0 10775 0 224259 0 0 0 JASON LANDERS SVP-PROVIDER DELIVERY SERVICES 204011 0 0 0 1242 0 10289 0 14387 0 229929 0 0 0 JAMES MILLER SVP-ADMINISTRATIVE SERVICES 179753 0 0 0 1945 0 5086 0 19404 0 206188 0 0 0 MARK KENAMOND THRU 10162019 MEDICAL DIRECTOR 179860 0 0 0 16891 0 9026 0 5455 0 211232 0 0 0 DAVID THOMAS DIRECTOR - SALES NATIONAL 335701 0 0 0 630 0 14000 0 21868 0 372199 0 0 0 KENTON ROEPKE DIRECTOR - ACTUARIAL SERVICES 236223 0 160000 0 966 0 12000 0 20511 0 429700 0 0 0 ROBERT CROSS MEDICAL DIRECTOR 208602 0 0 0 3200 0 10518 0 14011 0 236331 0 0 0 KATIE STANICH VP INTERNAL AUDIT & QUALITY 170864 0 0 0 420 0 8148 0 21341 0 200773 0 0 0 PART I, LINE 1A JAMES PENNINGTON, PRESIDENT / CEO, HAS AN ANNUAL STIPEND PER HIS EMPLOYEE AGREEMENT TO SPEND AT HIS DISCRETION. THE STIPEND IS PAID THROUGH THE NORMAL PAYROLL PROCESS. PART I, LINE 4A THOMAS MINTON RECEIVED SEVERANCE $3692.34 IN 2019. 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. RICHARD LEGG IN-LAW OF JAMES PENNINGTON 282467 EMPLOYED BY ORGANIZATION 0 JESSICA LEGG DAUGHTER OF RICHARD LEGG 57208 EMPLOYED BY ORGANIZATION 0 FORM 990, PART VI, SECTION A, LINE 1 THE FINANCE AND INVESTMENT COMMITTEE IS COMPRISED OF THREE OR MORE DIRECTORS AS DETERMINED BY THE BOARD OF DIRECTORS BASED ON NOMINATIONS BY THE BOARD CHAIRPERSON, A MAJORITY OF WHOM CANNOT BE EMPLOYEES OF THE COMPANY. THE CEO IS AN EX-OFFICIO VOTING MEMBER OF THE COMMITTEE. THE CFO, WHO IS NOT A BOARD MEMBER, IS ALSO A VOTING MEMBER OF THE COMMITTEE. THE OPERATION OF THE COMMITTEE IS SUJECT TO THE BYLAWS OF THE COMPANY. THE PRIMARY PURPOSE OF THE COMMITTEE IS TO ASSIST THE BOARD OF DIRECTORS IN FULFILLING ITS OVERSIGHT RESPONSIBILITIES FOR BUDGETING, CAPITAL EXPENDITURES, THE INVESTMENT PORTFOLIO, AND SIGNIFICANT DEBT AND CAPITAL TRANSACTIONS. THE COMMITTEE HAS THE POWER TO RETAIN, COMPENSATE, DIRECT AND OVERSEE AND TERMINATE THE WORK OF ANY OUTSIDE FINANCIAL ADVISOR TO CARRY OUT ITS DUTIES AND TO MEET WITH COMPANY OFFICERS, EMPLOYEES, INDEPENDENT AUDITORS, EXTERNAL FINANCIAL ADVISORES OR OUTSIDE COUNSEL. THE COMMITTEE'S ROLE IS TO OVERSEE FINANCING AND INVESTMENT POLICIES AND TO OVERSEE THE INVESTMENT PORTFOLIO AND TRANSACTIONAL ACTIVITY AS MORE FULLY DESCRIBED IN ITS CHARTER. FORM 990, PART VI, SECTION A, LINE 2 FAMILY MEMBER: JESSICA LEGG RELATED OFFICER: RICHARD LEGG TITLE: PROVIDER RELATIONS REP COMPENSATION: $57,208 FAMILY MEMBER: RICHARD LEGG RELATED OFFICER: JAMES M. PENNINGTON TITLE: VP - BENEFIT SERVICES COMPENSATION: $282,467 FORM 990, PART VI, SECTION A, LINE 4 THE APPROVAL TO AMEND THE ORGANIZATION'S BYLAWS OCCURRED IN DECEMBER 2019. THE BYLAWS WERE AMENDED TO LOWER THE AMOUNT OF BOARD MEMBERS REQUIRED. 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 QUESTIONNAIRE IS 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 THE CEO APPROVES ALL OTHERS' COMPENSATION. OUTSIDE COMPENSATION SURVEY TOOLS 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 105,797. CHANGE IN RESERVES -4,584,340. FORM 990, PART XII, LINE 2C: NO CHANGE TO THE OVERSIGHT PROCESS. THE HEALTH PLAN OF OHIO 1110 MAIN STREET WHEELING WV 26003 341523541 INSURANCE OH 501(C)(4) N/A THE HEALTH PLAN OF WEST VIRGINIA INC 1 THP INSURANCE COMPANY 1110 MAIN STREET WHEELING WV 26003 550765726 INSURANCE WV THE HEALTH PLAN OF WEST VIRGINIA INC C 109113738 62004102 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 805314 1885315 1.00000 1 HP AGENCY INC 1110 MAIN STREET WHEELING WV 26003 341764520 THIRD-PARTY ADMINISTRATOR OH THE HEALTH PLAN OF WEST VIRGINIA INC C 485699 1.00000 1 0 0 0 1 1 0 0 0 0 0 0 1 0 1 1 1 1 0 0 THP INSURANCE COMPANY L 5886823 ACTUAL ALLOC. - ADMIN. AGREEMENT THP INSURANCE COMPANY P 103130233 ACTUAL AMOUNT THP INSURANCE COMPANY Q 19098891 ACTUAL AMOUNT THP INSURANCE COMPANY E 5991846 ACTUAL AMOUNT THP INSURANCE COMPANY D 1897982 ACTUAL AMOUNT