2016-11-07T08:30:05-06:00 2015-12-31 420714325 RSM US LLP 1185 AVENUE OF THE AMERICAS NEW YORK NY 100362602 990 2015-01-01 134154068 AMIDA CARE INC AMID 6467577000 14 PENN PLAZA NO 2ND FL NEW YORK NY 10122 DOUGLAS WIRTH CEO 6467577000 2016-10-31 1 MARTIN GREIF P00029738 2123721000 2015 2017-02-10 21:41:12Z DOUGLAS WIRTH 14 PENN PLAZA NO 2ND FL NEW YORK NY 10122 360965536 0 X WWW.AMIDACARENY.ORG X 2000 NY AMIDA CARE INC. IS A HEALTH MAINTENANCE ORGANIZATION FORMED TO OBTAIN A COMPREHENSIVE HIV SPECIAL NEEDS CERTIFICATE OF AUTHORITY IN ORDER TO PROVIDE OR ARRANGE FOR ALL MEDICAL ASSISTANCE SERVICES TO PERSONS ENROLLED IN THE PLAN AND FOR ASSISTING ENROLLEES IN THE PRUDENT SELECTION OF SERVICES. 9 9 277 11 0 0 1240607 690094 307993102 343625217 7010 60447 -9726 -16041 309230993 344359717 0 0 0 0 17307006 21665084 0 0 0 293376865 342511317 310683871 364176401 -1452878 -19816684 56527742 59119433 34465688 56914529 22062054 2204904 X AMIDA CARE INC. IS A MEDICAID HIV SPECIAL NEEDS MANAGED CARE PLAN THAT PROVIDES ASSISTANCE AND/OR ARRANGES FOR MEDICAL CARE AND NON-MEDICAL SUPPORT FOR PERSONS ENROLLED IN THE PLAN. IN 2014, THE PLAN EXPANDED ITS SERVICES INTO THE MEDICARE ADVANTAGE PROGRAM. STAFF ALSO ASSISTS ENROLLEES IN THE PRUDENT SELECTION OF SERVICES. 0 0 315891648 336963254 AMIDA CARE IS A MEDICAID MANAGED CARE PLAN THAT PROVIDES ASSISTANCE AND/OR ARRANGES FOR MEDICAL CARE AND NON-MEDICAL SUPPORT FOR PERSONS ENROLLED IN THE PLAN. STAFF ALSO ASSISTS ENROLLEES IN THE PRUDENT SELECTION OF SERVICES. THE PLAN COVERED 72,036 MEMBER MONTHS IN 2015. 7405261 6661963 THE PLAN PROVIDES SERVICES THROUGH ITS CONTRACT WITH THE CENTERS FOR MEDICARE AND MEDICAID (CMS) TO RECIPIENTS ELIGIBLE TO PARTICIPATE IN ONE OF THE PLAN'S THREE MEDICARE ADVANTAGE PRODUCTS. THE PRODUCTS INCLUDE MEDICARE ADVANTAGE PRESCRIPTION DRUG PLAN, MEDICARE ADVANTAGE PRESCRIPTION DRUG CHRONIC CONDITION SPECIAL NEEDS PLAN, AND MEDICARE ADVANTAGE PRESCRIPTION DRUG DUAL ELIGIBLE SPECIAL NEED PLAN. STAFF ALSO ASSISTS ENROLLEES IN THE PRUDENT SELECTION OF SERVICES. THE PLAN COVERED 4,188 MEMBER MONTHS FOR MEDICARE IN 2015. 323296909 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 956 0 1 277 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 NY X DOUGLAS WIRTH CEO 6467577000 14 PENN PLAZA 2ND FLOOR NEW YORK NY 10122 PAUL VITALE CHAIRPERSON 0.50 X X 0 0 0 EMMA DEVITO VICE CHAIR 0.50 X X 0 0 0 CHARLES KING SECRETARY 0.50 X X 0 0 0 TOMAS DEL RIO TREASURER 0.50 X X 0 0 0 HOLLY ARGENT-TARIQ MEMBER 0.50 X 0 0 0 PAM MATTEL MEMBER 0.50 X 0 0 0 JACQUELYN KILMER MEMBER 0.50 X 0 0 0 DR MATTHEW WEISSMAN MEMBER 0.50 X 0 0 0 ROMANO JOHNSON MEMBER 0.50 X 0 0 0 WAYDE TOMAN MEMBER - FROM FEB. 2015 0.50 X 0 0 0 SABRINA JOHNSON MEMBER - THRU JAN. 2015 0.50 X 0 0 0 DOUGLAS WIRTH PRESIDENT & CEO 40.00 X 484057 0 55383 JAMES CRAMER CHIEF OPERATING OFFICER 40.00 X 193592 0 33849 JEROME A ERNST MD CHIEF MEDICAL OFFICER 40.00 X 287865 0 38372 FELICE KUSSOY CHIEF FINANCIAL OFFICER 40.00 X 249317 0 25251 MAURA MCGRATH CHIEF COMPLIANCE & PRIVACY OFFICER 40.00 X 189876 0 34332 SUSAN CAPUTO EXECUTIVE VICE PRESIDENT 40.00 X 277161 0 16158 TERRY LEACH VP OF PHARMACY 40.00 X 237365 0 26978 LISA ELLEN KEEHN VP OF MEDICARE OPERATION 40.00 X 224220 0 40855 OLADIPO ALAO MD MEDICAL DIRECTOR 40.00 X 216605 0 33992 MARIA DASILVA VP OF RISK & NETWORK MGMT 40.00 X 197696 0 31488 KATHY FRANK-KLEIN VP OF VENDOR MANAGEMENT 40.00 X 188838 0 44474 STEPHANE HOWZE OMBUDSMAN 40.00 X 177810 0 38734 JAMES MORRILL VP OF HUMAN RESOURCES 40.00 X 181600 0 29186 KEVIN STEFFENS VP OF HEALTH SERVICES OPERATIONS 40.00 X 155571 0 18572 DANIEL WARD SR DIR OF FINANCE 40.00 X 165195 0 15787 KIEU DIEM STEPHENS DIRECTOR OF FINANCE 40.00 X 161626 0 10156 VIRPI RANTA DIRECTOR OF CQI 40.00 X 145558 0 18277 MARK FINTZ VP OF MEMBER SERVICES 40.00 X 133622 0 42501 MICHELE PEDRETTI-MOSSALLY SR DIRECTOR OF BEHAVIORAL HEALTH 40.00 X 148524 0 45801 4016098 0 600146 41 0 1 0 STAR ADMINISTRATORS LLC 272 SW LANGELIER DRIVE FORT WHITE FL 32038 MANAGEMENT SERVICES 2176317 ROYAL HEALTH CARE 810 SEVENTH AVENUE STE 801 NEW YORK NY 10019 MANAGEMENT SERVICES 857050 KEPRO ACQUISIONS INC 99 SE MIZNER BLVDSUITE 120 BOCA RATON FL 33432 UTILIZATION MGMT SERVICES 789251 ROPES & GRAY LLP 800 BOYLSTON STREET SUITE 3600 BOSTON MA 021993600 LEGAL SERVICES 549225 BEACON HEALTH STRATEGIES LLC 200 STATE STREET SUITE 302 BOSTON MA 02109 MANAGEMENT SERVICES 313500 9 141822 548272 690094 MEDICAID PAYMENTS 900099 336963254 336963254 MEDICARE PAYMENTS 900099 6661963 6661963 343625217 65517 65517 16584708 16589778 -5070 -5070 -5070 0 141822 16041 -16041 -16041 344359717 343625217 0 44406 3983728 3983728 13683737 13683737 294018 294018 2341147 2341147 1362454 1362454 3058375 3058375 575480 575480 82220 82220 10474 10474 2126426 2126426 274842 274842 1514075 1514075 1658265 1658265 3459131 3459131 135578 135578 93521 93521 754240 754240 800647 800647 292685 292685 PHARMACY COSTS 225823544 225279599 543945 MEDICAL SERVICES 93881274 93881274 HEALTH ASSESSMENTS & SU 4136036 4136036 UTILIZATION MANAGEMENT 1513490 1513490 2321014 2321014 364176401 323296909 40879492 0 1432874 15553616 9108080 121313 200084 35162637 33213623 204402 532095 4732470 1769452 2951124 2963018 12392270 1101776 710263 56527742 59119433 25607036 37878959 5000000 5625000 6067038 3233652 7968532 34465688 56914529 X 22062054 2204904 22062054 2204904 56527742 59119433 -19816684 -40466 0 X 0 1 X 1 0 X 804111 758965 920185 1240607 690094 4413962 88329851 218214600 263795280 307993102 343625302 1221958135 89133962 218973565 264715465 309233709 344315396 1226372097 0 0 0 1226372097 81306 7413 3867 7010 65517 165113 81306 7413 3867 7010 65517 165113 89215268 218980978 264719332 309240719 344380913 1226537210 0.99990 0.99980 0.00010 0.00020 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1059812 138263 921549 2029898 1192641 837257 1642760 438548 1204212 2963018 SUBVENTION PAYABLE TO 501(C) ORG 6233652 DEFERRRED RENT 1734880 7968532 X 344335292 -40466 -40466 344375758 -16041 -16041 344359717 364192442 16041 16041 364176401 0 364176401 PART X, LINE 2: THE PLAN WAS INCORPORATED AS A NOT-FOR-PROFIT CORPORATION UNDER THE LAWS OF THE STATE OF NEW YORK AND IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THEREFORE, THERE IS NO PROVISION FOR INCOME TAXES INCLUDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. IN ADDITION, MANAGEMENT HAS ASSESSED WHETHER THERE WERE ANY UNCERTAIN TAX POSITIONS WHICH MAY GIVE RISE TO INCOME TAX LIABILITIES AND DETERMINED THAT WERE NO SUCH MATTERS REQUIRING RECOGNITION IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE PLAN FILES INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED AGAINST FUNDRAISING REVENUE -16,041. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED AGAINST FUNDRAISING REVENUE 16,041. LIVE YOUR LIFE FUNDRAISER 141822 141822 16041 141822 141822 16041 16041 -16041 X X 0 0 0 0 0 0 0 1 0 DOUGLAS WIRTH PRESIDENT & CEO 398697 0 85000 0 360 0 28051 0 27332 0 539440 0 0 0 JAMES CRAMER CHIEF OPERATING OFFICER 179614 0 12950 0 1028 0 9898 0 23951 0 227441 0 0 0 JEROME A ERNST MD CHIEF MEDICAL OFFICER 256421 0 26500 0 4944 0 12500 0 25872 0 326237 0 0 0 FELICE KUSSOY CHIEF FINANCIAL OFFICER 226319 0 22500 0 498 0 11778 0 13473 0 274568 0 0 0 MAURA MCGRATH CHIEF COMPLIANCE & PRIVACY OFFICER 172233 0 17000 0 643 0 9762 0 24570 0 224208 0 0 0 SUSAN CAPUTO EXECUTIVE VICE PRESIDENT 261169 0 15000 0 992 0 0 0 16158 0 293319 0 0 0 TERRY LEACH VP OF PHARMACY 221484 0 15400 0 481 0 3645 0 23333 0 264343 0 0 0 LISA ELLEN KEEHN VP OF MEDICARE OPERATION 208974 0 15050 0 196 0 11786 0 29069 0 265075 0 0 0 OLADIPO ALAO MD MEDICAL DIRECTOR 216395 0 0 0 210 0 0 0 33992 0 250597 0 0 0 MARIA DASILVA VP OF RISK & NETWORK MGMT 184032 0 12950 0 714 0 7083 0 24405 0 229184 0 0 0 KATHY FRANK-KLEIN VP OF VENDOR MANAGEMENT 175998 0 12600 0 240 0 9870 0 34604 0 233312 0 0 0 STEPHANE HOWZE OMBUDSMAN 172017 0 5550 0 243 0 8994 0 29740 0 216544 0 0 0 JAMES MORRILL VP OF HUMAN RESOURCES 169369 0 11900 0 331 0 4646 0 24540 0 210786 0 0 0 KEVIN STEFFENS VP OF HEALTH SERVICES OPERATIONS 151357 0 4027 0 187 0 4758 0 13814 0 174143 0 0 0 DANIEL WARD SR DIR OF FINANCE 157127 0 7500 0 568 0 4000 0 11787 0 180982 0 0 0 KIEU DIEM STEPHENS DIRECTOR OF FINANCE 156867 0 4650 0 109 0 6717 0 3439 0 171782 0 0 0 VIRPI RANTA DIRECTOR OF CQI 139975 0 4180 0 1403 0 7344 0 10933 0 163835 0 0 0 MARK FINTZ VP OF MEMBER SERVICES 123046 0 10150 0 426 0 2487 0 40014 0 176123 0 0 0 MICHELE PEDRETTI-MOSSALLY SR DIRECTOR OF BEHAVIORAL HEALTH 143597 0 4800 0 127 0 4097 0 41704 0 194325 0 0 0 PART I, LINE 7 THE FOLLOWING INDIVIDUALS, LISTED ON PART VII, RECEIVED A NON-FIXED PAYMENT IN THE FORM OF A BONUS DURING 2015: DOUGLAS WIRTH - $85,000 JAMES CRAMER - $12,950 JEROME A. ERNST, M.D. - $26,500 FELICE KUSSOY - $22,500 MAURA MCGRATH - $17,000 SUSAN CAPUTO - $15,000 TERRY LEACH - $15,400 LISA ELLEN KEEHN - $15,050 MARIA DASILVA - $12,950 KATHY FRANK-KLEIN - $12,600 STEPHANE HOWZE - $5,550 JAMES MORRILL - $11,900 KEVIN STEFFENS - $4,027 DANIEL WARD - $ 7,500 KIEU DIEM STEPHENS - $4,650 VIRPI RANTA - 4,180 MARK FINTZ - $10,150 MICHELE PEDRETTI-MOSSALLY - $4,800 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 FOR 2015 IS REVIEWED IN DETAIL BY THE ORGANIZATION'S CFO. ANY QUESTIONS ARISING FROM THAT REVIEW WILL BE DISCUSSED WITH THE PREPARER OF THE RETURN. SUBSEQUENT TO THE DETAILED CFO REVIEW, THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S CEO. ANY QUESTIONS ARISING FROM THAT REVIEW WILL BE DISCUSSED WITH THE CFO AND THE PREPARER OF THE RETURN, AS NEEDED. FOLLOWING CFO AND CEO REVIEW, THE FORM 990 IS REVIEWED BY THE BOARD OF DIRECTORS AT A REGULARLY SCHEDULED BOARD MEETING. THE CEO AND CFO WILL RESPOND TO ANY QUESTIONS RAISED BY THE BOARD MEMBERS. ONCE ALL QUESTIONS HAVE BEEN ANSWERED, THE BOARD, CEO AND CFO WILL APPROVE THE FINALIZATION AND FILING OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE REQUIRED ANNUALLY TO COMPLETE AND SIGN A DETAILED CONFLICT OF INTEREST DISCLOSURE STATEMENT. EMPLOYEES ARE REQUIRED TO PROMPTLY DISCLOSE ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST TO HIS OR HER SUPERVISOR (OR IN THE CASE OF THE CEO TO THE CHAIR OF THE BOARD OF DIRECTORS). MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED TO PROMPTLY DISCLOSE ANY REAL OR POTENTIAL CONFLICTS OF INTEREST TO THE CHAIR OF THE BOARD OF DIRECTORS (OR IN THE CASE THE CONFLICT IS REPORTABLE BY THE CHAIR THEN TO THE VICE CHAIR). THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY THE CHIEF COMPLIANCE & PRIVACY OFFICER, WHO RECORDS ANY POTENTIAL CONFLICTS AND MONITORS BUSINESS RELATIONSHIPS BETWEEN AMIDA CARE AND THE INDIVIDUAL REPORTING A POTENTIAL CONFLICT OR ANY ORGANIZATION THAT INDIVIDUAL MAY BE AFFILIATED WITH THAT DOES BUSINESS WITH AMIDA CARE. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION'S BOARD OF DIRECTORS COMMISSIONED A CEO COMPENSATION STUDY TO ESTABLISH COMPENSATION PACKAGES FOR THE CEO. THE BOARD OF DIRECTORS CHAIR COMPLETES AN ANNUAL PERFORMANCE EVALUATION ON THE CEO AND RECOMMENDS ANY COMPENSATION ADJUSTMENTS TO THE BOARD FOR APPROVAL. THE ORGANIZATION'S CEO UTILIZES THE ASSOCIATION FOR COMMUNITY AFFILIATED PLAN ("ACAP") COMPENSATION STUDY TO ESTABLISH THE COMPENSATION OF THE MEDICAL DIRECTOR, CFO, COO, EXECUTIVE VICE PRESIDENT AND CHIEF COMPLIANCE & PRIVACY OFFICER ("CCPO"). ACAP IS AN ASSOCIATION OF NONPROFIT MEDICAID AND MEDICARE HEALTH PLAN ORGANIZATIONS. THE ORGANIZATION'S CEO COMPLETES AN ANNUAL PERFORMANCE EVALUATION OF THE CMO, CFO, COO, EVP AND CCPO. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, FORM 990, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION UPON WRITTEN REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). FORM 990 PART VI SECTION A - GOVERNING BODY AND MANAGEMENT, LINE 1A NUMBER OF VOTING MEMBERS = 9. TWO OF THE TEN BOARD MEMBERS LISTED IN PART VII, SECTION A ARE FROM THE SAME ORGANIZATION AND SHARE ONE VOTE ON ALL MATTERS DISCUSSED. ALL MEMBERS PARTICIPATE IN BOARD MEETINGS AND VOTE ON ALL MATTERS, EXCEPT THOSE WHICH ASSESS A FINANCIAL CONTRIBUTION REQUIREMENT, IN WHICH CASE, ONLY BOARD MEMBERS WHO REPRESENT ORGANIZATIONS WHICH WOULD BE REQUIRED TO MAKE THE FINANCIAL CONTRIBUTION MAY VOTE.