2019-11-14T13:31:53-06:00 2018-12-31 ERNST & YOUNG LLP 5 TIMES SQUARE NEW YORK NY 100366530 990 2018-01-01 113029569 Healthfirst Health Plan Inc % CRAIG BARATTIN-VP CONTROLLER HEAL 2128016000 100 CHURCH ST FL 18 New York NY 100072601 JOHN BERMEL CFO 2128016000 2019-11-01 Laura Kielczewski P00740769 2127733000 12.41.123.251 26528220193185000003 2019-11-14 P F8CF979C896E6BB1C9DB6A543F277ABDFE28F7DB 48376AC60715834143EC7E8D06BB46C111BC8BCB 2018 2020-04-17 16:48:07Z PATRICIA J WANG 100 CHURCH ST FL 18 NEW YORK NY 100072601 2630132602 false X www.healthfirst.org X 1990 NY IMPROVE THE HEALTH AND WELL-BEING OF UN DERSERVED POPULATIONS BY PROVIDING AFFORDABLE QUALITY HEALTH PLANS TO ELIGIBLE MEDICARE,COMPLETE CARE,FIDA&COMMERCIAL INSURANCE RECIPIENTS. 4 2 0 0 0 0 0 0 2284126679 2615768739 7012719 14363863 0 0 2291139398 2630132602 0 0 0 0 0 0 0 0 0 2294732932 2601432167 2294732932 2601432167 -3593534 28700435 778498574 798683966 468286175 448217619 310212399 350466347 IMPROVE THE HEALTH AND WELL-BEING OF UNDERSERVED POPULATIONS BY PROVIDING AFFORDABLE QUALITY HEALTH PLANS TO ELIGIBLE MEDICARE, COMPLETE CARE, FIDA & COMMERCIAL INSURANCE RECIPIENTS. false false 1861929662 1927116860 MEDICARE: HEALTHFIRST HEALTH PLAN, INC. (HFHP), IS INCORPORATED UNDER THE NOT-FOR-PROFIT LAW OF THE STATE OF NEW YORK AND IS LICENSED UNDER ARTICLE 44 OF THE PUBLIC HEALTH LAW OF THE STATE OF NEW YORK AS A HEALTH MAINTENANCE ORGANIZATION THAT PROVIDES ACCESS TO AFFORDABLE, QUALITY CARE THROUGH ITS NETWORK OF PARTICIPATING PROVIDERS AND HOSPITALS. HFHP PROVIDES HEALTH CARE SERVICES TO MEDICARE ADVANTAGE MEMBERS WHO ARE INDIGENT, AGED, DISABLED AND/OR MEDICALLY UNDERSERVED. IN 2018, HFHP SERVED 168,178 MEDICARE MEMBERS. 561073574 602934885 COMPLETECARE: HEALTHFIRST HEALTH PLAN, INC. (HFHP), IS INCORPORATED UNDER THE NOT-FOR-PROFIT LAW OF THE STATE OF NEW YORK AND IS LICENSED UNDER ARTICLE 44 OF THE PUBLIC HEALTH LAW OF THE STATE OF NEW YORK AS A HEALTH MAINTENANCE ORGANIZATION THAT PROVIDES ACCESS TO AFFORDABLE, QUALITY CARE THROUGH ITS NETWORK OF PARTICIPATING PROVIDERS AND HOSPITALS. HFHP PROVIDES HEALTH CARE SERVICES TO COMPLETE CARE MEMBERS. COMPLETECARE IS A MEDICAID ADVANTAGE PLUS SPECIAL NEEDS PLAN THAT COMBINES MEDICARE AND MEDICAID BENEFITS, WITH ADDED LONG-TERM CARE SERVICES FOR QUALIFIED DUAL-ELIGIBLE MEMBERS. IN 2018, HFHP SERVED 9,622 COMPLETE CARE MEMBERS. 84120824 85589779 Fully Integrated Duals Advantage Programs (FIDA): HEALTHFIRST HEALTH PLAN, INC. (HFHP), IS INCORPORATED UNDER THE NOT-FOR-PROFIT LAW OF THE STATE OF NEW YORK AND IS LICENSED UNDER ARTICLE 44 OF THE PUBLIC HEALTH LAW OF THE STATE OF NEW YORK AS A HEALTH MAINTENANCE ORGANIZATION THAT PROVIDES ACCESS TO AFFORDABLE, QUALITY CARE THROUGH ITS NETWORK OF PARTICIPATING PROVIDERS AND HOSPITALS. HFHP PROVIDES HEALTH CARE SERVICES TO FIDA MEMBERS, WHOSE BENEFIT CAN BE INTEGRATED AND CARE ACROSS THE MEDICARE AND MEDICAID PROGRAMS. IN 2018, HFHP SERVED 1,262 FIDA MEMBERS. HEALTHY NEW YORK : IN 2018 THERE ARE 9 HEALTHY NEW YORK MEMBERS AND APPROXIMATELY 4 PROVIDER ORGANIZATIONS. A PROGRAM OVERSEEN BY NY STATE DEPARTMENT OF FINANCIAL SERVICES TO PROVIDE AFFORDABLE HEALTH CARE. 78699 127215 2507202759 false false false false false false false false false false false false false true false true true false false false false false false false false false false false true false false false false false false false false false false false false false true true true false true X 12241 0 false 0 false false false false false false true false X 4 2 false true false false false true true true true false false true true true true true true false false false NY X CRAIG BARATTIN-VP CONTROLLER 2128016000 100 CHURCH ST FL 18 NEW YORK NY 100072601 JAY A SCHECHTMAN CHIEF MEDICAL OFFICER 1.0 40.0 X 0 874471 129982 LINDA TIANO CHIEF LEGAL OFFICER/SECRETARY 1.0 40.0 X X 0 727624 114975 STEPHEN ROSENTHAL BOARD DIRECTOR 1.0 0.0 X 0 0 0 ERIC SCALETTAR BOARD DIRECTOR 1.0 0.0 X 0 0 0 PATRICIA J WANG PRESIDENT AND CEO 1.0 40.0 X 0 2994978 470870 JOHN J BERMEL Treasurer and CFO 1.0 40.0 X 0 1080512 33512 ROBERT P BLANCHARD BEGIN 12/13/18 Treasurer 1.0 40.0 X 0 170457 13879 SEAN M NATARO END 22818 SECRETARY 1.0 40.0 X 0 383871 15994 STEVEN H BLACK CHIEF OPERATING OFFICER 1.0 40.0 X 0 855774 125031 PAUL E PORTSMORE JR SVP, GROWTH 1.0 40.0 X 0 837573 115071 GERALD T SWEENEY SVP CHIEF INFORMATION OFFICER 1.0 40.0 X 0 1161601 144771 SEAN KANE CHIEF HR OFFICER 1.0 40.0 X 0 887677 108990 JOHN FINGER - END 111618 SVP STRATEGIC PLANNING 1.0 40.0 X 0 830815 74587 BARBARA MONTRESOR SVP Comm & Marketing 1.0 40.0 X 0 708703 78293 DANIEL P MCCARTHY-END 63017 PRESIDENT & COO 0.0 0.0 X 0 1228999 0 0 12743055 1425955 0 true true false CAREMARK LLC ONE CVS DRIVE WOONSOCKET RI 02895 PHARMACY 898941171 NEW YORK CITY HEALTH AND HOSPITAL C 125 WORTH STREET ROOM 514 NEW YORK NY 10013 MEDICAL/HOSPITAL 243339843 MONTEFIORE MEDICAL CENTER PO BOX 4296 CHURCH STREET STATION NEW YORK NY 10261 MEDICAL/HOSPITAL 157589019 NY PRESBYTERIAN HOSP-COLUMBIA PO BOX 6154 NEW YORK NY 10249 MEDICAL/HOSPITAL 103461126 MOUNT SINAI HOSPITAL 1 GUSTAVE L LEVY PLACE NEW YORK NY 10029 MEDICAL/HOSPITAL 62366062 1257 0 MEDICARE (INCLUDES PART D) 524114 1927116860 1927116860 COMPLETECARE (INCLUDES PART D) 524114 602934885 602934885 FIDA 524114 85589779 85589779 HEALTHY NY 524114 127215 127215 2615768739 14745104 14745104 0 0 0 0 0 -381241 -381241 -381241 -381241 0 0 0 0 0 0 0 0 0 0 2630132602 2615768739 14363863 0 0 0 0 0 0 0 0 0 0 294424000 200750849 93673151 0 0 0 0 0 0 1535763 1064317 471446 6488057 6488057 0 512662 427851 84811 0 0 0 0 0 0 0 0 0 0 0 HEALTHCARE SERVICE COSTS 2223493324 2223493324 MEDICAL ADMINISTRATIVE 74978361 74978361 2601432167 2507202759 94229408 0 0 0 136409460 5070553 0 0 61353164 291130254 0 0 0 0 0 0 0 0 0 0 0 0 435791051 494877932 0 0 0 0 0 0 144944899 7605227 778498574 798683966 382022489 397843426 0 0 8350627 16909285 0 0 0 0 0 0 0 0 0 0 77913059 33464908 468286175 448217619 X 310212399 350466347 0 0 0 0 310212399 350466347 778498574 798683966 X 28700435 -4079361 15632874 X X false true X true false 0 DUE TO CMS 6598391 MEDICARE PART D DEPOSIT LIABIL 21851210 DUE TO STATE - CURRENT 904781 PASS THRU PROGRAM LIABILITIES 4110526 33464908 2641686115 -4079361 15632874 11553513 2630132602 2630132602 2601432167 2601432167 2601432167 PART XI, LINE 2D - OTHER ADJUSTMENTS ADMINISTRATIVE CHARGES: $17,975,437. The health care services agreements with certain hospitals require that a portion of the premiums are retained as an administrative cost by Healthfirst Health Plan (HFHP), which represents the capital required for its statutory financial reserves. EQUITY LOSS FROM INVESTMENT IN AFFILIATE: ($2,342,563) represents 50% share of loss in Healthfirst Insurance Co. Inc. true true false false false false false false false JAY A SCHECHTMAN CHIEF MEDICAL OFFICER 483998 388955 1518 0 112970 0 17433 0 1004874 0 0 LINDA TIANO CHIEF LEGAL OFFICER/SECRETARY 474014 248899 4711 0 109200 0 5887 0 842711 0 0 PATRICIA J WANG PRESIDENT AND CEO 1292893 1225477 476608 0 465106 0 6328 0 3466412 0 454539 DANIEL P MCCARTHY-END 63017 PRESIDENT & COO 0 442500 786499 0 0 0 0 0 1228999 0 87 PAUL E PORTSMORE JR SVP, GROWTH 457623 297856 82094 0 115071 0 617 0 953261 0 40552 GERALD T SWEENEY SVP CHIEF INFORMATION OFFICER 506231 521165 134205 0 126265 0 18927 0 1306793 0 66344 SEAN KANE CHIEF HR OFFICER 439334 355169 93174 0 108990 0 330 0 996997 0 46092 STEVEN H BLACK CHIEF OPERATING OFFICER 641196 211140 3438 0 125031 0 115 0 980920 0 0 JOHN J BERMEL Treasurer and CFO 636198 381147 63167 0 16500 0 17522 0 1114534 0 0 ROBERT P BLANCHARD BEGIN 12/13/18 Treasurer 157341 12000 1116 0 0 0 13963 0 184420 0 0 JOHN FINGER - END 111618 SVP STRATEGIC PLANNING 456983 329102 44730 0 59149 0 15549 0 905513 0 0 SEAN M NATARO END 22818 SECRETARY 109715 112000 162156 0 11368 0 4720 0 399959 0 0 BARBARA MONTRESOR SVP Comm & Marketing 384845 261020 62838 0 61281 0 17122 0 787106 0 0 SCHEDULE J, PART I, LINE 4A THE FOLLOWING INDIVIDUALS ENTERED INTO SEVERANCE AGREEMENTS AND/OR RECEIVED SEVERANCE PAYMENTS FROM HF MANAGEMENT SERVICES, LLC - AN AFFILIATE ORGANIZATION OF HEALTHFIRST. JOHN FINGER - TOTAL SEVERANCE: $ 463,500, SEVERANCE PAID IN 2018: $35,654 SEVERANCE DEFERRED: $427,846. DAN MCCARTHY - TOTAL SEVERANCE: $1,106,248, SEVERANCE PAID IN 2018: $ 737,499 SEVERANCE PAID IN 2017: $340,384 SEVERANCE DEFERRED: $28,365. SEAN NATARO - TOTAL SEVERANCE: $ 161,494, SEVERANCE PAID IN 2018: $ 161,494. SCHEDULE J, PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE NON-QUALIFIED RETIREMENT PLAN PROVIDED BY HF MANAGEMENT SERVICES, LLC - A RELATED ORGANIZATION. THE AMOUNTS BELOW REPRESENT CONTRIBUTIONS TO THE PLAN SPONSOR FOR 2018: PATRICIA J. WANG $448,606, JAY A. SCHECHTMAN $96,470, GERALD T. SWEENEY $109,765, SEAN KANE $92,490, PAUL PORTSMORE $98,571, LINDA TIANO $92,700, STEVE BLACK $120,000, JOHN FINGER $50,625, BARBARA MONTRESOR 58,500. FORM 990, PART V, LINE 1c In 2018 it came to our attention that our processes for backup withholding were not fully effective. In January 2019 the Organization made the necessary changes to those processes in order to ensure the proper backup withholding is taking place, when required. FORM 990, PART VI, SECTION A, LINE 3 HEALTHFIRST HEALTH PLAN INC. (HFHP), CONTRACTS WITH HF MANAGEMENT SERVICES, LLC (HFMS), A RELATED ORGANIZATION, TO PROVIDE ALL OF ITS MANAGEMENT AND ADMINISTRATIVE SERVICES. THE NOT-FOR-PROFIT ENTITY DOES NOT MAINTAIN ITS OWN STAFF OR OFFICE SPACE; THESE ARE PROVIDED BY HFMS. HFMS CHARGES A PERCENT OF PREMIUMS ON A PER MEMBER PER MONTH BASIS OR A FLAT FEE PER MEMBER PER MONTH. THE ARRANGEMENT IS APPROVED BY STATE REGULATORS. ALL OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES WERE PAID BY, AND WORKED FOR, HFMS A MANAGEMENT COMPANY WHICH PROVIDES MANAGEMENT SERVICES FOR MULTIPLE ENTITIES. NONE OF THE INDIVIDUALS LISTED EARNED ANY COMPENSATION FROM HFHP. FORM 990, PART VI, SECTION A, LINE 6 HEALTHFIRST HEALTH PLAN INC. HAS A SOLE CORPORATE MEMBER, WHICH IS HEALTHFIRST, INC. FORM 990, PART VI, SECTION A, LINE 7A HEALTHFIRST, INC., A RELATED NOT-FOR-PROFIT ORGANIZATION, HAS THE RIGHT TO APPOINT THE MEMBERS OF THE BOARD OF DIRECTORS OF HEALTHFIRST HEALTH PLAN, INC. FORM 990, PART VI, SECTION A, LINE 7B SOME DECISIONS OF THE GOVERNING BODY, SHOULD THEY OCCUR, ARE SUBJECT TO APPROVAL BY OTHER ENTITIES: * REPAYMENT OF THE ORGANIZATION'S DEBT OBLIGATIONS REQUIRES STATE REGULATORY APPROVAL * DISTRIBUTION OF THE ORGANIZATION'S NET ASSETS REQUIRES STATE REGULATORY APPROVAL * CERTAIN CHANGES TO PREMIUM RATES ARE SUBJECT TO FEDERAL OR STATE REGULATORY APPROVAL * EXPANSION TO OTHER MANAGED CARE BUSINESSES REQUIRES STATE LICENSURE * MANAGEMENT FEE RATE CHANGES REQUIRE APPROVAL FROM THE MANAGEMENT COMPANY AND STATE REGULATORS FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED BY THE HF MANAGEMENT SERVICES, LLC (HFMS) CORPORATE FINANCE DEPARTMENT STAFF AND THEN REVIEWED BY THE HFMS VICE PRESIDENT CONTROLLER AND TREASURER. SECONDARY REVIEWS ARE ALSO PERFORMED BY THE HFMS CHIEF LEGAL OFFICER AND CHIEF FINANCIAL OFFICER. THE DRAFT 990 IS THEN REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE DRAFT 990 IS THEN PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW. THE FINAL 990 IS SUBMITTED AFTER THE BOARD OF DIRECTORS REVIEWS IT. FORM 990, PART VI, SECTION B, LINE 12C A CONFLICT OF INTEREST DISCLOSURE STATEMENT IS COMPLETED ANNUALLY BY EACH BOARD MEMBER, OFFICER AND KEY EMPLOYEE. A NOMINATED BOARD MEMBER WHO DOES NOT COMPLETE THE STATEMENT WITHIN THE CALENDAR YEAR WILL NOT BE PERMITTED TO CARRY OUT DUTIES. THE SAME APPLIES TO AN OFFICER OR KEY EMPLOYEE WHO DOES NOT COMPLETE THE APPROPRIATE DISCLOSURES. ANY DISCLOSURE OF A CONFLICT OR POTENTIAL CONFLICT IS REVIEWED BY THE CHIEF COMPLIANCE OFFICER. CONFLICTS ARE ADDRESSED BY EXAMINING THE RELATIONSHIP OF THE INDIVIDUAL TO THE ORGANIZATION AND THE NATURE OF THE DISCLOSURE. A REPORT OF ANY CONFLICTS IS PREPARED FOR DISCUSSION WITH AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS OF HEALTHFIRST, INC., THE NOT FOR PROFIT CORPORATE PARENT, AS WELL AS THE FULL BOARD OF DIRECTORS OF HEALTHFIRST HEALTH PLAN, INC. AS APPROPRIATE. GUIDANCE IS PROVIDED TO THE NECESSARY PARTIES AND ACTION IS TAKEN, INCLUDING BUT NOT LIMITED TO DISCLOSURE AND RECUSAL FROM DECISION-MAKING, MODIFICATIONS TO BUSINESS AGREEMENTS, CHANGES IN VENDORS OR REPLACEMENT OF THE DIRECTOR, OFFICER OR KEY EMPLOYEE WITH A NON-CONFLICTED INDIVIDUAL. FORM 990, PART VI, SECTION B, LINE 15 BECAUSE THE REPORTING ORGANIZATION DID NOT COMPENSATE ANY OFFICERS OR EMPLOYEES, THE ORGANIZATION HAS RESPONDED "NO." HOWEVER, THE COMPENSATION OF THE CEO, OTHER OFFICERS AND KEY EMPLOYEES IS DETERMINED BY THE COMPENSATION COMMITTEE OF HF MANAGEMENT SERVICES, LLC, THE MANAGEMENT COMPANY THAT PROVIDES ALL SERVICES TO HFHP (A RELATED ORGANIZATION). THE COMMITTEE CONSISTS ONLY OF HFMS MEMBER HOSPITAL EXECUTIVES (WHO ARE NOT EMPLOYED NOR COMPENSATED BY HFMS OR ANY OF ITS AFFILIATES). THE PROCESS FOR DETERMINING COMPENSATION IS DESCRIBED IN THE COMMITTEE'S CHARTER. THE PROCESS INCLUDES ENGAGEMENT OF AN OUTSIDE HUMAN RESOURCES CONSULTING FIRM TO CONDUCT A COMPARABILITY ANALYSIS. THE ANALYSIS INCLUDES COMPARABLE RANGES OF EXECUTIVE COMPENSATION USING THE COMPANY'S INDUSTRY CLASSIFICATION. THE COMMITTEE MEETS PRIOR TO IMPLEMENTATION OF ANY CHANGE IN COMPENSATION. CONTEMPORANEOUS MINUTES OF EACH MEETING ARE PREPARED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC BY PROVIDING COPIES ON REQUEST FOR INSPECTION AT ITS CORPORATE OFFICES. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS - ADMINISTRATIVE CHARGES: $17,975,437 and EQUITY LOSS IN INVESTMENT IN HEALTHFIRST INSURANCE CO. INC. - A 50% OWNED SUBSIDIARY: ($2,342,563). TOTAL OTHER CHANGES IN NET ASSETS -$15,632,874. FORM 990, PART XII, LINE 2C THE SELECTION OF THE INDEPENDENT AUDITOR IS ADMINISTERED BY THE AUDIT RISK AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS OF HEALTHFIRST, INC. (A RELATED ORGANIZATION). HEALTHFIRST PHSP INC 100 CHURCH ST FL 18 NEW YORK NY 10007 133783732 MANAGED CARE NY 501 (C)3 10 HEALTHFIRST true HEALTHFIRST INC 100 CHURCH ST FL 18 NEW YORK NY 10007 133714932 MANAGED CARE NY 501 (C)3 12 Type I N/A false HEALTHFIRST HEALTH PLAN OF NJ INC 1 WASHINGTON ST STE 1405 NEWARK NJ 07102 510609967 MANAGED CARE NJ 501 (C)4 HF MGMT SVCS true HF Managmt SCVSLLC 100 CHURCH ST FL 18 NEW YORK NY 100072601 134069806 3RD PTY ADM SCVS NY NA false 0 HF ADMINISTRATIVE SERVICES INC 100 CHURCH ST FL 18 NEW YORK NY 100072601 133873482 3RD PTY ADM SCVS NY HF MGMT SVCS C CORP true HEALTHFIRST INSURANCE COMPANY INC 100 CHURCH STREET FL 18 New York NY 100072601 464545744 Insur. Provid NY NA C corp -2342563 7458027 0.50000 false false false false false true false false false false false false false true false false false false true false HF MANAGEMENT SERVICES LLC M 294424000 COST HEALTHFIRST PHSP INC R 42798084 ACTUAL AMOUNT