2017-11-14T16:43:43-06:00 2016-12-31 ERNST & YOUNG US LLP 55 IVAN ALLEN JR BLVD 1000 ATLANTA GA 30308 990 2016-01-01 050477052 Neighborhood Health Plan of Rhode Island % Peter Marino CEO NEIG 4014596000 910 Douglas Pike Smithfield RI 02917 Frank Meaney CFO 2017-11-09 true MICHAEL KUCZYNSKI P01226533 4048748300 164.57.159.253 26308520173185000065 2017-11-14 P 58E4EF637F6ED594D3BCB9F35B0E6FE454F65236 85868073965687212239AA369D140FAEDE3756F9 2016 2017-02-10 21:41:12Z Peter M Marino CEO 910 Douglas Pike Smithfield RI 02917 1223899400 false X www.nhpri.org X 1993 RI NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND SECURES ACCESS TO HIGH QUALITY, COST-EFFECTIVE HEALTH CARE FOR RHODE ISLAND'S AT-RISK POPULATIONS. 16 15 552 1 1418641 0 11987 980546905 1165729604 1624627 2037430 0 0 982171532 1167779021 5506 2682 849673019 1023914429 38714520 44448745 0 0 0 65201245 79681885 953594290 1148047741 28577242 19731280 369480153 348826156 283924104 246123485 85556049 102702671 NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND, AN INNOVATIVE HEALTH PLAN IN PARTNERSHIP WITH THE COMMUNITY HEALTH CENTERS, SECURES ACCESS TO HIGH QUALITY, COST-EFFECTIVE HEALTH CARE FOR RHODE ISLAND'S AT-RISK POPULATIONS. false false 1075816414 2682 1164310963 NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND IS A NON-PROFIT HEALTH MAINTENANCE ORGANIZATION (HMO) THAT PROVIDES HIGH-QUALITY, LOW-COST HEALTH CARE SERVICES ON A PREPAID BASIS PRINCIPALLY TO MEDICAID RECIPIENTS AND CERTAIN OTHER ELIGIBLE PERSONS UNDER STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS MANAGED CARE PROGRAM, RITECARE. THE ORGANIZATION ALSO EXTENDS ITS SERVICE, BENEFITS AND VALUE TO INDIVIDUALS AND BUSINESSES THROUGH HEALTHSOURCE RI, THE STATE'S HEALTH INSURANCE EXCHANGE. AS OF DECEMBER 31, 2016, THE ORGANIZATION IS RESPONSIBLE FOR PROVIDING HEALTH CARE SERVICES TO OVER 192,000 MEMBERS. 1075816414 true true false true false false false false false false true false false true true false true false 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 false false false false true 2702 0 true 552 true true true false false false false false false false false false X 16 15 true false false false true true false true true true false true false false false true true false X Peter Marino CEO 4014596000 910 Douglas Pike Smithfield RI 02917 X Brenda Dowlatshahi Secretary 1.0 0.0 X 0 0 0 Peter Walsh Treasurer 1.0 0.0 X 0 0 0 Merrill Thomas Trustee 1.0 0.0 X 0 0 0 Christopher Little Trustee 1.0 0.0 X 0 0 0 Charles Jones Trustee 1.0 0.0 X 0 0 0 Michael Lichtenstein Trustee 1.0 0.0 X 0 0 0 Pablo Rodriguez MD Trustee 1.0 0.0 X 0 0 0 Doris De Los Santos Trustee 1.0 0.0 X 0 0 0 William Hochstrasser-Walsh Trustee 1.0 0.0 X 0 0 0 Patricia Martinez Trustee 1.0 0.0 X 0 0 0 Raymond Joseph Lavoie Jr Trustee 1.0 0.0 X 0 0 0 Dennis Roy Trustee 1.0 0.0 X 0 0 0 Richard Besdine MD Trustee 1.0 0.0 X 0 0 0 Peter Marino CEO 38.0 0.0 X X 441733 0 33109 Peter Bancroft Board Chair 1.0 0.0 X 0 0 0 Jane Hayward Vice Chair 1.0 0.0 X 0 0 0 Shantha Diaz Chief Operating Officer 38.0 0.0 X 255739 0 25667 Francisco Trilla MD Chief Medical Officer 38.0 0.0 X 341888 0 10600 Frank Meaney CFO 38.0 0.0 X 266389 0 8303 Douglas Byrd General Counsel 38.0 0.0 X 268351 0 36664 Jeffrey Meyer VP/Chief Information Officer 38.0 0.0 X 200643 0 9254 Joanne Roux Director of Fiscal Operations 38.0 0.0 X 197423 0 22784 Nancy Hermiz Vice President Medicaid 38.0 0.0 X 194763 0 15682 MICHELLE LUPOLI VP MEDICAL MANAGEMENT 0.0 0.0 X 182254 0 33168 2349183 0 195231 67 false true false Beacon Health Strategies LLC 500 Unicorn Park Woburn MA 01801 Healthcare Services 154230213 Argus Health Systems Inc 1300 Washington Street Kansas City MO 64105 Healthcare Services 131670367 Integra Dimension LLC 100 Wall Street Suite 2502 New York NY 10005 Healthcare Services 11627516 DST Health Solutions Inc 13804 Collection Center Drive Chicago IL 60693 Healthcare Services 3704298 Accenture LLP 161 North Clark Street Chicago IL 60601 Consulting 3466988 62 11987 11987 Premiums Earned 524114 1153821827 1153821827 0 0 Reinsurance Recoveries 524114 4069687 4069687 0 0 PPC Admin Services 524114 1418641 0 1418641 0 Pharmacy Dividends 524114 4200000 4200000 0 0 ALL OTHER PROGRAM SERVICE REVENUE 524114 2219449 2219449 0 0 1165729604 1721501 1721501 0 0 56436308 56120379 315929 315929 315929 0 1167779021 1164310963 1418641 2037430 0 0 2682 2682 0 0 1023914429 1023914429 1498414 0 1498414 0 0 0 0 0 33689944 19585692 14104252 0 1025399 596117 429282 0 5305055 3028717 2276338 0 2929933 1703320 1226613 0 0 0 0 0 112951 2353 110598 0 899065 0 899065 0 122400 0 122400 0 0 0 472791 0 472791 0 31183326 22298609 8884717 0 2799578 19928 2779650 0 2258898 14671 2244227 0 5100492 0 5100492 0 0 0 0 0 4740195 2755955 1984240 0 145506 116932 28574 0 0 0 0 0 0 0 0 0 26756 0 26756 0 0 0 0 0 1179315 512375 666940 0 517204 0 517204 0 STATE PREMIUM TAX 21092334 0 21092334 0 Temporary Help 1972402 1264634 707768 0 HSRI CARRIER ASSESSMENT 2311815 0 2311815 0 CLAIMS ADJUSTMENT EXPENSE 1010736 0 1010736 0 3736121 3736121 1148047741 1075816414 72231327 0 0 0 64473862 104324476 0 0 0 18975798 15705700 0 0 0 0 0 0 0 0 0 0 5824263 4306562 957430 1517701 245222449 243230402 0 0 0 0 0 0 0 23898491 369480153 348826156 18181715 30756197 0 0 0 0 0 0 0 0 0 0 0 0 0 0 265742389 215367288 283924104 246123485 X 85556049 102702671 0 0 0 0 85556049 102702671 369480153 348826156 X 19731280 274551 0 0 0 -2859209 X X false true X true false X 0 0 35400 0 11987 47387 423570696 430147979 848055027 980546905 1165729604 3848050211 0 0 0 423570696 430147979 848090427 980546905 1165741591 3848097598 0 0 0 3848097598 756428 518891 1005897 1477997 1721501 5480714 0 756428 518891 1005897 1477997 1721501 5480714 0 0 424327124 430666870 849096324 982024902 1167463092 3853578312 0.99858 0.99840 0.00142 0.00160 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false 0 false 0 false 0 false 0 true 122400 false 0 false 0 122400 false Lobbying Activities SCHEDULE C, PART II-B, LINE 1G NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND DOES NOT DIRECTLY ENGAGE IN ANY LOBBYING ACTIVITIES BUT RETAINS A GOVERNMENT RELATIONS COMPANY, CAPITOL CITY GROUP, TO ADVOCATE THAT FUNDING FOR THE MEDICAID PROGRAM NOT BE REDUCED. FOR THE YEAR ENDED DECEMBER 31, 2016, THE ORGANIZATION PAID CAPITOL CITY GROUP $122,400. 0 5824263 4306562 1517701 1517701 RECOV. - REINS/RX/STOP-LOSS 14492507 INVESTMENT INC. DUE 657918 OTHER ADMITTED ASSETS 8748066 23898491 0 IBNR Liabilities 126718007 Unearned Premiums 88649281 215367288 1123456000 -274551 2976684 2702133 1120753867 473489 46551665 47025154 1167779021 1103723000 586125 586125 1103136875 44910866 44910866 1148047741 FIN 48 (ASC 740) FOOTNOTE SCHEDULE D, PART X, LINE 2 THERE WAS NO FIN 48 (ASC 740) FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS. RECONCILIATION OF EXPENSES ON AFS TO TAX RETURN SCHEDULE D, PART XI, LINE 2D AND LINE 4B LINE 2D RECLASS OF REINSURANCE PREMIUMS $3,288,258 RECLASS OF UNREALIZED GAIN FROM PRIOR YEAR ($ 311,574) ------------ TOTAL $2,976,684 LINE 4B RECLASS OF PHARMACY DIVIDENDS $4,200,000 RECLASS OF REINSURANCE RECOVERIES $4,069,687 RECLASS OF RISK SHARE SETTLEMENTS $1,174,955 RECLASS STOP LOSS RECOVERY $15,953,308 RECLASS OF STOP LOSS RECOVERY $14,923,349 RECLASS OF PPC ADMIN SERVICES $1,418,641 RECLASS OF SUBSIDIES $3,285,419 RECLASS OF ACA FEES $168,741 RECLASS OF BAD DEBT $1,358,596 ROUNDING ($1,029) ------------ TOTAL $46,551,665 SCHEDULE D, PART XII, LINE 2D AND LINE 4B LINE 2D RECLASS OF UNREALIZED GAIN $586,125 LINE 4B RECLASS OF PHARMACY DIVIDENDS $4,200,000 RECLASS OF REINSURANCE RECOVERIES $4,069,687 RECLASS OF RISK SHARE SETTLEMENTS $1,174,955 RECLASS STOP LOSS RECOVERY $15,953,308 RECLASS OF STOP LOSS RECOVERY $14,923,349 RECLASS OF PPC ADMIN SERVICES $1,418,641 RECLASS OF SUBSIDIES $3,285,419 RECLASS OF PC CHANGES IN IBNR $114,318 ROUNDING $175 ------------ TOTAL $44,910,866 X X X X false false false false false false false true false Peter Marino CEO 381006 0 60000 0 727 0 6277 0 26832 0 474842 0 0 0 Shantha Diaz Chief Operating Officer 232563 0 21585 0 1591 0 8212 0 17455 0 281406 0 0 0 Francisco Trilla MD Chief Medical Officer 307858 0 31117 0 2913 0 10600 0 0 0 352488 0 0 0 Frank Meaney CFO 257551 0 7905 0 933 0 8303 0 0 0 274692 0 0 0 Douglas Byrd General Counsel 249030 0 17583 0 1738 0 9732 0 26932 0 305015 0 0 0 Jeffrey Meyer VP/Chief Information Officer 183127 0 16343 0 1173 0 8054 0 1200 0 209897 0 0 0 Joanne Roux Director of Fiscal Operations 152952 0 43513 0 958 0 5430 0 17354 0 220207 0 0 0 Nancy Hermiz Vice President Medicaid 175777 0 17271 0 1715 0 7806 0 7876 0 210445 0 0 0 MICHELLE LUPOLI VP MEDICAL MANAGEMENT 165468 0 16238 0 548 0 7236 0 25932 0 215422 0 0 0 NON-FIXED PAYMENTS SCHEDULE J, PART I, LINE 7 PURPOSE: NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND'S (NHPRI) PERFORMANCE INCENTIVE PLAN (THE PLAN) HAS BEEN IMPLEMENTED TO OFFER A PERFORMANCE-BASED INCENTIVE AWARD OPPORTUNITY TO ELIGIBLE NHPRI EMPLOYEES BASED ON ACHIEVEMENT OF THE ORGANIZATION'S ANNUAL BUSINESS OBJECTIVES AS WELL AS THEIR OWN JOB PERFORMANCE. THE PLAN ALLOWS A PORTION OF NHPRI'S ANNUAL COMPENSATION COSTS TO BE VARIABLE IN RELATION TO THE ORGANIZATION'S PERFORMANCE. AMOUNTS PAID IN 2016 UNDER THE PLAN ARE INCLUDED IN PART II COLUMN (B) (II). OTHER OBJECTIVES: THE PLAN IS EXPECTED TO PROVIDE INCLUDE THE FOLLOWING: A) FOCUS THE ATTENTION, EFFORT AND TEAMWORK OF PLAN PARTICIPANTS ON THE ACCOMPLISHMENT OF NHPRI'S KEY BUSINESS OBJECTIVES; B) ENABLE NHPRI TO OFFER A COMPENSATION PROGRAM WITH METHODS AND LEVELS OF PAY THAT ARE COMPETITIVE WITH OTHER ORGANIZATIONS SEEKING COMPARABLE EMPLOYEE RESOURCES; C) REINFORCE NHPRI'S COMMITMENT TO A PERFORMANCE-BASED CULTURE FOR ITS EMPLOYEES AT ALL LEVELS OF THE ORGANIZATION; D) ASSIST NHPRI'S EFFORTS TO RETAIN ITS VALUED EMPLOYEES. DESCRIPTION OF RELATIONSHIPS FORM 990, PART VI, LINE 2 A MEMBER OF THE ORGANIZATION'S BOARD OF DIRECTORS IS AN EXECUTIVE DIRECTOR OF A COMMUNITY HEALTH CENTER (CHC), BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC. BLACKSTONE VALLEY HEALTH CARE, THROUGH A GRANT, INVESTED IN EQUIPMENT AND SOFTWARE FOR AN ELECTRONIC MEDICAL RECORD (EMR) SYSTEM. ONE OTHER CHC, TRI-TOWN, HAS USE OF THE EMR AND BILLING SYSTEM. THE CHCS SHARE THE COST OF RUNNING THE SYSTEM. DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PART VI, LINE 6 THE ORGANIZATION IS A 501(C)(3) CORPORATION AND HAS MEMBERS, BUT DOES NOT HAVE ANY STOCKHOLDERS. THE ORGANIZATION HAS A BOARD OF DIRECTORS WHO ARE MEMBERS OF THE ORGANIZATION THAT MEET ON A REGULAR BASIS AND FUNCTION AS THE GOVERNING BODY OF THE ORGANIZATION. DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, LINE 7A THE MEMBERS OF THE ORGANIZATION ARE RHODE ISLAND COMMUNITY HEALTH CENTERS WHO HAVE THE AUTHORITY TO APPOINT A PORTION OF THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS ALSO APPROVES THE HIRING OF THE CHIEF EXECUTIVE OFFICER WHO IS A VOTING MEMBER OF THE BOARD. OTHER MAILING ADDRESSES FOR OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES FORM 990, PART VI, LINE 9 SHANTHA DIAZ, FORMER CHIEF OPERATING OFFICER, RESIGNED FROM HER POSITION AT NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND ON 06/02/17. SHE CAN BE REACHED AT 8738 TERRACINA LAKE DRIVE, TAMPA, FL 33625. DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, LINE 11B THE ORGANIZATION'S FISCAL OPERATIONS DEPARTMENT ACCUMULATES THE INFORMATION AND DATA NECESSARY TO COMPLETE THE FEDERAL FORM 990. AUDITED FINANCIAL STATEMENTS AND APPROVED POLICIES AND PROCEDURES ARE USED AS INPUT TO COMPLETE THE 990. A DRAFT RETURN IS PREPARED AND REVIEWED BY THE ORGANIZATION'S INDEPENDENT CERTIFIED PUBLIC ACCOUNTANTS. AFTER THE REVIEW PROCESS IS COMPLETED BY THE INDEPENDENT ACCOUNTANTS, THE FINANCE STAFF REVIEW THE RETURN PRIOR TO FILING WITH THE IRS. THE FINANCE AND AUDIT COMMITTEE AND BOARD OF DIRECTORS ARE PROVIDED A DRAFT COPY OF THE RETURN FOR APPROVAL PRIOR TO FILING WITH THE IRS. POLICIES FORM 990, PART VI, LINES 12A, 12B, 13 & 14 PURSUANT TO THE INSTRUCTIONS FOR FORM 990, THE ORGANIZATION MUST ANSWER NO TO QUESTION 12A BECAUSE THE BOARD OF DIRECTORS DOES NOT APPROVE OR ADOPT THESE POLICIES. HOWEVER, THE ORGANIZATION HAS ISSUED THESE POLICIES AT THE DIRECTION OF MANAGEMENT AND THESE POLICIES AND PROCEDURES ARE STRICTLY ENFORCED BY THE ORGANIZATION'S MANAGEMENT TEAM. THE ORGANIZATION HAS WRITTEN WHISTLEBLOWER AND DOCUMENT RETENTION AND DESTRUCTION POLICIES. CONFLICT OF INTEREST FORM 990, PART VI, LINE 12C AS PROMULGATED BY THE ORGANIZATION'S COMPLIANCE PLAN, THE ORGANIZATION'S DIRECTOR OF COMPLIANCE IS ALSO THE ORGANIZATION'S CHIEF PRIVACY OFFICIAL. ALL BOARD MEMBERS, COMMITTEE MEMBERS AND EMPLOYEES MUST DISCLOSE ALL CONFLICTS ON A SIGNED DISCLOSURE FORM ON A YEARLY BASIS. IF A POTENTIAL CONFLICT OF INTEREST IS REPORTED, THE PRIVACY OFFICIAL REVIEWS THE CIRCUMSTANCES TO DETERMINE IF A POSSIBLE CONFLICT EXISTS. IF IT IS DETERMINED THAT A CONFLICT EXISTS, THE PRIVACY OFFICIAL WILL MONITOR THE CONFLICT OF INTEREST AS NECESSARY AND/OR REFERS THE APPROPRIATE ITEMS THROUGH THE CHIEF FINANCIAL OFFICER TO THE CHIEF EXECUTIVE OFFICER FOR A RESOLUTION/DECISION. BOARD AND COMMITTEE MEMBERS REFRAIN FROM VOTING ON ISSUES WHERE THERE IS AN APPEARANCE OF A CONFLICT. OFFICERS & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN FORM 990, PART VI, LINES 15A & 15B THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS AND APPROVES THE CONTRACT OF THE CEO AND ANY CHANGES TO THE CONTRACT. THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS THE COMPENSATION OF THE CHIEF FINANCIAL OFFICER, CHIEF MEDICAL OFFICER AND THE CHIEF OPERATING OFFICER BASED ON COMPENSATION SURVEYS. THE EXECUTIVE COMMITTEE SUBSCRIBES TO THREE OR FOUR SALARY SURVEYS THAT LIST SALARY AND SALARY INCREASES BY POSITION, GEOGRAPHY, PLAN SIZE AND PROFIT VS. NON-PROFIT ORGANIZATIONS. THESE SURVEYS ARE USED TO SET COMPENSATION ANNUALLY. AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC FORM 990, PART VI, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ORGANIZATION'S LOCATION AT 910 DOUGLAS PIKE, SMITHFIELD, RI 02917. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 CHANGE IN NON-ADMITTED ASSETS ($2,861,000) ROUNDING $1,791 ------------ TOTAL ($2,859,209) ACCOUNTING METHOD FORM 990, PART XII, LINE 1 THE ORGANIZATION USES THE STATUTORY METHOD OF ACCOUNTING.