FALLON TOTAL CARE INC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
FALLON TOTAL CARE INC (EIN 45-5591420)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-11-14
IRS object ID
201623199349306967
Schema version
2015v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2016-11-14T13:32:00-06:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PricewaterhouseCoopers LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1101 SEAPORT BOULEVARDAddressLine1Txt
CityBOSTONCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02210ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN455591420EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FALLON TOTAL CARE INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% R SCOTT WALKERInCareOfNm
Business Name ControlFALLBusinessNameControlTxt
Phone5087992100PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1C/O FCHP 10 CHESTNUT STREETAddressLine1Txt
CityWORCESTERCityNm
State AbbreviationMAStateAbbreviationCd
ZIP01608ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonR SCOTT WALKERPersonNm
Person TitleDIRECTOR/TREASURERPersonTitleTxt
Phone5087992100PhoneNum
Signature2016-11-14SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonERIN COUTUREPreparerPersonNm
PTINP01390592PTIN
Phone6175305000PhoneNum
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerRICHARD P BURKEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line110 Chestnut StreetAddressLine1Txt
CityWorcesterCityNm
State AbbreviationMAStateAbbreviationCd
ZIP01608ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$86,641,385GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.fchp.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2013FormationYr
Legal Domicile StateMALegalDomicileStateCd
Activity Or MissionSEE SCHEDULE OActivityOrMissionDesc
Voting Members Governing Body3VotingMembersGoverningBodyCnt
Voting Members Independent0VotingMembersIndependentCnt
Total Employee110TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$94,515,910PYProgramServiceRevenueAmt
CY Program Service Revenue$86,376,610CYProgramServiceRevenueAmt
PY Investment Income$10,596PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$94,526,506PYTotalRevenueAmt
CY Total Revenue$86,376,610CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$90,110,341PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$79,859,382CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$9,379,113PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$5,415,896CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$4,439,677PYOtherExpensesAmt
CY Other Expenses$3,958,395CYOtherExpensesAmt
PY Total Expenses$103,929,131PYTotalExpensesAmt
CY Total Expenses$89,233,673CYTotalExpensesAmt
PY Revenues Less Expenses-$9,402,625PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$2,857,063CYRevenuesLessExpensesAmt
Total Assets BOY$11,272,176TotalAssetsBOYAmt
Total Assets EOY$20,671,949TotalAssetsEOYAmt
Total Liabilities BOY$20,486,128TotalLiabilitiesBOYAmt
Total Liabilities EOY$12,092,964TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$9,213,952NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$8,578,985NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionMAKE A POSITIVE DIFFERENCE BY IMPROVING THE HEALTH AND WELLNESS OF OUR COMMUNITIES THROUGH THE DELIVERY OF HIGH QUALITY, ECONOMICAL HEALTHCARE SERVICES TO BOTH MEDICARE AND MEDICAID ELIGIBLE POPULATION FROM 21 TO 64 YEARS OF AGE.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangeYes (true)SignificantChangeInd
Expense$79,859,382ExpenseAmt
Revenue$86,376,610RevenueAmt
DescSEE SCHEDULE ODesc
Total Program Service Expenses$79,859,382TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document1083IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee110EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members3GoverningBodyVotingMembersCnt
Independent Voting Member0IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldMAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd
OtherYes (X)OtherInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonR SCOTT WALKERPersonNm
Phone5087992100PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line110 CHESTNUT STREETAddressLine1Txt
CityWORCESTERCityNm
State AbbreviationMAStateAbbreviationCd
ZIP01608ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Richard P Burke
Chairman2.055.0Yes (X)Yes (X)$0$448,049$64,782
CHRISTINE CASSIDY
Director/Clerk1.050.0Yes (X)Yes (X)$0$252,703$39,241
R Scott Walker
Director/Treasurer1.047.0Yes (X)Yes (X)$0$458,106$59,331
SARIKA AGGARWAL
DIRECTOR, ENDED 9/155.050.0Yes (X)$0$320,111$36,904
SONJA BREHM
VP, Health Care Services50.00.0$46,394$157,598$17,729Yes (X)
Dan Rome
Medical Director UNTIL 9/1520.00.0$222,297$0$23,267Yes (X)
Lisa Price-Stevens
Medical Director, UNTIL 7/1530.010.25$210,978$132,459$29,230Yes (X)
MICHAEL NICKEY
EXECUTIVE DIRECTOR FTC & MH10.040.0$0$228,022$26,093Yes (X)
Jo Ann Savage
Director, Clinical Operations42.08.0$104,714$20,911$3,802Yes (X)
JILL BENOIT
CLINICAL PHARMACIST UNTIL 9/1550.00.0$104,417$0$24,521Yes (X)
MATTHEW COLLINS
DIRECTOR/CLERK UNTIL 11/140.050.0$0$173,350$10,658Yes (X)
MARY RITTER
PRESIDENT & CEO, UNTIL 12/130.050.0$0$185,030$4,326Yes (X)
Judith Roark-Mackey
Dir. MKTG&outreach until 12/130.050.0$0$114,181$18,538Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$688,800TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,490,520TotReportableCompRltdOrgAmt
Total Other Compensation$358,422TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K4IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
UMASS MEMORIAL MEDICAL CENTER
PO BOX 415353BOSTONMA02241MEDICAL SERVICES$9,575,353
BAYSTATE MEDICAL CENTER
759 CHESTNUT STSPRINGFIELDMA01199MEDICAL SERVICES$5,430,609
STAVROS CENTER FOR INDEPENDENT LIVI
PO BOX 2130AMHERSTMA01004COUNSELING SERVICES$3,691,131
FALLON COMMUNITY HEALTH PLAN INC
10 CHESTNUT STWORCESTERMA01608MANAGEMENT FEES$3,022,601
CEREBRAL PALSY OF MASSACHUSETTS INC
600 TECHNOLOGY CENTER DRSTOUGHTONMA02072MEDICAL SERVICES$2,849,678
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K102CntrctRcvdGreaterThan100KCnt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PREMIUM REVENUE524114$86,366,610$86,366,610
FTC ONE CARE PROGRAM STUDY REVENUE524114$10,000$10,000
FieldValueIRS element (for citing)
Total Program Service Revenue$86,376,610TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$264,775RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$264,775RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$86,376,610TotalRevenueColumnAmt
Related Or Exempt Func Income$86,376,610RelatedOrExemptFuncIncomeAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$79,859,382TotalAmt
Program Services$79,859,382ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$524,415TotalAmt
Management And General$524,415ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$3,786,418TotalAmt
Management And General$3,786,418ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$152,970TotalAmt
Management And General$152,970ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$565,931TotalAmt
Management And General$565,931ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$386,162TotalAmt
Management And General$386,162ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$3,022,601TotalAmt
Management And General$3,022,601ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$128,500TotalAmt
Management And General$128,500ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$1,525TotalAmt
Management And General$1,525ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$160,562TotalAmt
Management And General$160,562ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$11,790TotalAmt
Management And General$11,790ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$57,875TotalAmt
Management And General$57,875ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$10,389TotalAmt
Management And General$10,389ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$478,045TotalAmt
Management And General$478,045ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$6,004TotalAmt
Management And General$6,004ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$33,478TotalAmt
Management And General$33,478ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$46,521TotalAmt
Management And General$46,521ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescDUES & SUBSCRIPTIONSDesc
Total$1,105TotalAmt
Management And General$1,105ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$89,233,673TotalAmt
Program Services$79,859,382ProgramServicesAmt
Management And General$9,374,291ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,973,640BOYAmt
EOY$400,328EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$9,165,975BOYAmt
EOY$20,269,121EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$38,729BOYAmt
EOY$2,500EOYAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$93,832BOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$11,272,176BOYAmt
EOY$20,671,949EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$20,181,460BOYAmt
EOY$11,958,433EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$304,668BOYAmt
EOY$134,531EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$20,486,128BOYAmt
EOY$12,092,964EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$9,213,952BOYAmt
EOY$8,578,985EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$9,213,952BOYAmt
EOY$8,578,985EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$11,272,176BOYAmt
EOY$20,671,949EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$2,857,063ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$20,650,000OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$0TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years$1,551,981CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$94,515,910CurrentTaxYearMinus1YearAmt
Current Tax Year$86,376,610CurrentTaxYearAmt
Total$182,444,501TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl509 GovtFurnSrvcFcltsVl509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,551,981CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$94,515,910CurrentTaxYearMinus1YearAmt
Current Tax Year$86,376,610CurrentTaxYearAmt
Total$182,444,501TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$182,444,501PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year$184,145CurrentTaxYearMinus1YearAmt
Current Tax Year$264,775CurrentTaxYearAmt
Total$448,920TotalAmt

Post1975 UBTI Post1975UBTIGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year$184,145CurrentTaxYearMinus1YearAmt
Current Tax Year$264,775CurrentTaxYearAmt
Total$448,920TotalAmt

Net Income From Other UBI NetIncomeFromOtherUBIGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,551,981CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$94,700,055CurrentTaxYearMinus1YearAmt
Current Tax Year$86,641,385CurrentTaxYearAmt
Total$182,893,421TotalAmt
FieldValueIRS element (for citing)
First5 Years509Yes (X)First5Years509Ind
Public Support CY5090.00000PublicSupportCY509Pct

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp
LandLandGrp
BuildingsBuildingsGrp
Leasehold ImprovementsLeaseholdImprovementsGrp
EquipmentEquipmentGrp
Other Land BuildingsOtherLandBuildingsGrp
Total Rev Etc Audited Fincl Stmt$86,375,000TotalRevEtcAuditedFinclStmtAmt
Revenue Subtotal$86,375,000RevenueSubtotalAmt
Other Revenues Not Included$1,610OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$1,610RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$86,376,610TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$89,232,000TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$89,232,000ExpensesSubtotalAmt
Other Expenses Not Included$1,673OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$1,673ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$89,233,673TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE D, PART XI, LINE 4bFormAndLineReferenceDesc
ExplanationINVESTMENT FEE RECLASS TO EXPENSE 1,525 FINANCIAL STATEMENT ROUNDING 85 ------------------ TOTAL ON FORM 990, NOT ON FINANCIALS 1,610 SCHEDULE D, PART XII, LINE 4B INVESTMENT FEE RECLASS TO EXPENSE 1,525 FINANCIAL STATEMENT ROUNDING 148 ------------ TOTAL ON FORM 990, NOT ON FINANCIALS 1,673ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Richard P Burke
Chairman$0$357,164$0$81,678$0$9,207$0$38,005$0$26,777$0$512,831$0$31,678
CHRISTINE CASSIDY
Director/Clerk$0$224,697$0$15,625$0$12,381$0$18,330$0$20,911$0$291,944$0$15,625
R Scott Walker
Director/Treasurer$0$370,963$0$80,634$0$6,509$0$34,098$0$25,233$0$517,437$0$30,634
SONJA BREHM
VP, Health Care Services$28,775$124,732$0$32,673$17,619$193$2,125$4,808$2,105$8,691$50,624$171,097$0$26,171
Dan Rome
Medical Director UNTIL 9/15$142,304$0$39,383$0$40,610$0$8,669$0$14,598$0$245,564$0$39,383$0
Lisa Price-Stevens
Medical Director, UNTIL 7/15$163,389$132,071$37,141$0$10,448$388$6,375$4,007$10,874$7,974$228,227$144,440$37,141$0
Judith Roark-Mackey
Dir. MKTG&outreach until 12/13$0$101,765$0$8,497$0$3,919$0$4,224$0$14,314$0$132,719$0$8,497
MARY RITTER
PRESIDENT & CEO, UNTIL 12/13$0$39,065$0$0$0$145,965$0$1,532$0$2,794$0$189,356$0$0
SARIKA AGGARWAL
DIRECTOR, ENDED 9/15$0$208,951$0$26,950$0$84,210$0$11,441$0$25,463$0$357,015$0$26,950
MICHAEL NICKEY
EXECUTIVE DIRECTOR FTC & MH$0$197,879$0$29,606$0$537$0$8,176$17,917$0$254,115$0$25,806
MATTHEW COLLINS
DIRECTOR/CLERK UNTIL 11/14$129,441$37,863$6,046$7,918$2,740$184,008$37,863

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceFORM 990 SCHEDULE J:FormAndLineReferenceDesc
ExplanationPART I, LINE 4A SEVERANCE PAYMENT FALLON TOTAL CARE, INC. (FTC), PAID SEVERANCE PAYMENTS TO THE FOLLOWING INDIVIDUALS: DAN ROME, MEDICAL DIRECTOR, WAS PAID $31,508 FOR 10 WEEKS OF SEVERANCE PAY. JILL BENOIT, CLINICAL PHARMACIST, WAS PAID $23,981 FOR 12 WEEKS OF SEVERANCE PAY. FALLON COMMUNITY HEALTH PLAN, INC. (FCHP), THE PARENT ORGANIZATION, PAID SEVERANCE PAYMENTS TO MARY RITTER, FORMER FTC PRESIDENT & CEO, A LUMP SUM PAYMENT OF $136,154 FOR 24 WEEKS OF SEVERANCE PAY. PART I, LINE 4B SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN OF FCHP FCHP, THE PARENT ORGANIZATION OF FTC, HAS A SUPPLEMENTAL EXECUTIVE RETIREMENT 457(F) PLAN THAT COVERS CERTAIN EXECUTIVES OF FCHP, WHO ARE ALSO DIRECTORS OF FTC. UNDER THE TERMS OF THE PLAN, INDIVIDUALS VEST AS PROVIDED, DEPENDING ON THE DATE OF ELIGIBILITY TO PARTICIPATE IN THE PLAN. FOR INDIVIDUALS LISTED WHO WERE ELIGIBLE ON OR BEFORE MARCH 1, 2007, 50% OF THE YEARLY CONTRIBUTION VESTS IMMEDIATELY WITH THE REMAINING CONTRIBUTION SUBJECT TO VESTING UPON NORMAL RETIREMENT AGE, OR IF EARLIER, UPON DEATH, DISABILITY, OR INVOLUNTARY SEPARATION FROM SERVICE FOR A REASON OTHER THAN CAUSE, INCLUDING INVOLUNTARY SEPARATION FROM SERVICE FOR A REASON OTHER THAN CAUSE FOLLOWING A CHANGE IN CONTROL. FOR INDIVIDUALS LISTED WHO WERE ELIGIBLE ON OR BEFORE DECEMBER 31, 2012, 50% OF THE YEARLY CONTRIBUTION VESTS IMMEDIATELY IF THE PARTICIPANT HAS BEEN COVERED FOR AT LEAST 36 MONTHS, WITH THE REMAINING CONTRIBUTION SUBJECT TO VESTING UPON NORMAL RETIREMENT AGE, OR IF EARLIER, UPON DEATH, DISABILITY, OR INVOLUNTARY SEPARATION FROM SERVICE FOR A REASON OTHER THAN CAUSE, INCLUDING INVOLUNTARY SEPARATION FROM SERVICE FOR A REASON OTHER THAN CAUSE FOLLOWING A CHANGE IN CONTROL. FOR INDIVIDUALS WHO FIRST BECOME ELIGIBLE FOR A PLAN YEAR THAT BEGINS IN 2013 OR 2014, 50% OF THE YEARLY CONTRIBUTIONS VEST IMMEDIATELY IF THE PARTICIPANT HAS BEEN COVERED FOR AT LEAST 60 MONTHS, WITH THE REMAINING CONTRIBUTIONS SUBJECT TO VESTING UPON THE EARLIEST OF NORMAL RETIREMENT AGE, DEATH, DISABILITY OR INVOLUNTARY SEPARATION FROM SERVICE FOR A REASON OTHER THAN CAUSE, INCLUDING INVOLUNTARY SEPARATION FROM SERVICE FOR A REASON OTHER THAN CAUSE FOLLOWING A CHANGE IN CONTROL. Effective January 1, 2015, SERP contributions may be made on behalf of an employee who is the President and Chief Executive Officer, the Division President, Senior Care Services, an Executive Vice President or a Senior Vice President. In addition, contributions may be made on behalf of an employee who is designated as eligible for a plan year by the Board at its discretion. The SERP contribution made for an employee for the 2015 plan year or a later plan year will vest 20% EACH YEAR BEGINNING IN THE YEAR OF THE CONTRIBUTION AND ENDING ON THE LAST DAY OF THE FIFTH PLAN YEAR. If a participant separates from service for any reason, prior to the last day of the fifth year for which the contribution is credited, he or she will forfeit the non-vested portion of the contribution that has been credited, except that a participant automatically becomes vested upon death, disability or attainment of normal retirement age. IN 2015, THE FOLLOWING INDIVIDUALS LISTED IN SCHEDULE J, PART II PARTICIPATED IN THE PLAN. AMOUNTS VESTED AND PAID UNDER THE PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B) (III). AMOUNTS DEFERRED ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). CONTRIBUTIONS THAT WERE PREVIOUSLY REPORTED ON A PRIOR FORM 990, AND ARE PAID OUT IN THE CURRENT YEAR ARE REPORTED IN SCHEDULE J, PART II, COLUMN (F). OFFICER AMOUNT PAID AMOUNT DEFERRED RICHARD P. BURKE $6,520 $26,080 R. SCOTT WALKER $5,543 $22,173 CHRISTINE CASSIDY $2,220 $8,880 PART I, LINE 7 THE FCHP BOARD HAS THE AUTHORITY AND DISCRETION TO DETERMINE COMPENSATION OF THE SENIOR EXECUTIVES AND EXECUTIVE INCENTIVES. THE DISCRETION IS TYPICALLY EXERCISED THROUGH THE BOARD'S EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE, WHICH HAS THE AUTHORITY TO DISCHARGE THE BOARD'S RESPONSIBILITIES FOR COMPENSATION AND EXECUTIVE INCENTIVES. HOWEVER, THE DISCRETIONARY COMPENSATION/INCENTIVES RECOMMENDED MUST BE WITHIN THE PARAMETERS OF THE STANDARDS THAT THE COMMITTEE HAS ESTABLISHED AND NEEDS TO BE CONSISTENT WITH THE IRS STANDARDS OF REASONABLENESS FOR SUCH INCENTIVES PROVIDED TO NONPROFIT EXECUTIVES.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART I, LINE 1FTC'S MISSION Fallon Total Care, Inc. ("FTC") was formed as a Massachusetts nonprofit corporation on September 20, 2013 for charitable, educational, and scientific purposes, for relief of the poor and distressed and to lessen the burdens of government within the meaning of Sections 170(c)(2)(B) and 501(c)(3) of the Internal Revenue Code of 1986. Specifically, FTC was formed to promote, facilitate, and enhance the delivery of quality, efficient, effective and economical health care and related services to individuals who are dually eligible for both Medicare and Medicaid, and to improve and enhance the health and well-being of those individuals, by providing integrated behavioral and physical health management services on a risk basis. The enrollees are generally underprivileged, underserved, low-income population with major health care needs, including many individuals who suffer from chronic physical and/or mental health conditions. Serving this population is challenging and costly for federal and state governments. Established as a Demonstration Program by the Commonwealth of Massachusetts Executive Office of Health and Human Services' Office of Medicaid and the Center for Medicare Services, participating health plans coordinate and manage integrated behavioral and physical health management services to enrollees ages 21-64 who are eligible for both Medicare and Medicaid. By combining Medicare and Medicaid funding, the Demonstration Program enables a broader menu of services to better meet the needs of Dual Eligibles in the most cost effective way and enables an unprecedented level of integration to achieve better health outcomes for this population and to provide higher quality, more cost effective, person-centered care. FTC was formed by Fallon Community Health Plan, Inc. ("FCHP"), a Section 501(c)(3) tax-exempt Massachusetts nonprofit corporation and licensed Massachusetts health maintenance organization (HMO). FCHP is dedicated to improving the health and welfare of the populations it serves through the delivery of high quality, affordable health care. FCHP formed FTC to further FCHP's charitable health care mission, and FTC's purposes explicitly include supporting, benefiting, performing certain functions of, and carrying out the charitable, educational, or scientific purposes of FCHP. FORM 990, PART III, LINE 3 After careful consideration, FCHP, THE PARENT COMPANY, decided to reluctantly end its participation in the Commonwealth of Massachusetts One Care demonstration program effective September 30, 2015. This decision was reached after exploring alternatives with Medicare and Medicaid but ultimately we determined that our continued participation was not economically sustainable. FCHP worked with Medicare and Medicaid officials throughout the wind down process. We notified each member by mail in advance of the effective date that their coverage would end. This letter also explained the member's options for coverage after September 30 and included telephone numbers to call with any questions. FCHP held informational meetings in two Massachusetts locations to answer questions and help members' understand their choices. FCHP also notified all providers in its network prior to the effective date. FORM 990, PART III, LINE 4 FTC's Program activities consist of prepaid healthcare in the Commonwealth of Massachusetts. The covered population as of September 30, 2015, was 4,684 members. Members pay no premiums, co-payments, or co-insurance while participating in the Plan. All premiums are paid by state and federal agencies to cover traditional Medicaid and Medicare services. In addition to these services, FTC provides comprehensive care management, dedicated Navigators, expanded dental and Long Term Service and Support benefits. FORM 990, PART VI, SECTION A, LINE 1B NONE OF THE VOTING MEMBERS ARE INDEPENDENT BECAUSE THE MEMBERS ARE EMPLOYEES OF THE PARENT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS - THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY AN ORGANIZATION, (OTHER THAN THE FILING ORGANIZATION), FOR WHICH ANOTHER PERSON LISTED SERVES AS AN OFFICER - RICHARD P. BURKE, CHRISTINE CASSIDY, R. SCOTT WALKER, AND SARIKA AGGARWAL. FORM 990, PART VI, SECTION A, LINE 6 ORGANIZATION'S MEMBERS OR STOCKHOLDERS THE ORGANIZATION'S MEMBER IS FALLON COMMUNITY HEALTH PLAN, INC. (FCHP), THE PARENT COMPANY. FORM 990, PART VI, SECTION A, LINE 7A MEMBER'S POWER TO ELECT THE GOVERNING BODY THE PARENT COMPANY CAN ELECT THE MEMBERS OF THE GOVERNING BODY OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B GOVERNANCE DECISIONS OF THE ORGANIZATION RESERVED TO MEMBERS OTHER THAN THE GOVERNING BODY FCHP MAY APPROVE THE DECISIONS OF THE ORGANIZATION'S GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B PROCESS USED BY MANAGEMENT AND GOVERNING BODY TO REVIEW 990 A DRAFT OF THE FORM 990 IS PREPARED BY FCHP AND REVIEWED BY ITS TAX CONSULTING FIRM. THE FINAL VERSION OF THE FORM 990 IS PROVIDED TO BOARD MEMBERS FOR REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C DESCRIBE THE PROCESS TO MONITOR CONFLICTS OF INTEREST FTC'S PROCESS OF MONITORING CONFLICTS OF INTEREST IS SAME AS ITS PARENT ORGANIZATION, FCHP. FTC'S BYLAWS REQUIRE ALL DIRECTORS AND OFFICERS TO DISCLOSE ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AS DEFINED IN THE ORGANIZATION'S CONFLICT OF INTEREST POLICY RELATING TO DIRECTORS, OFFICERS AND MEMBERS OF A COMMITTEE WITH BOARD-DELEGATED POWERS. THIS IS ENFORCED BY THE REQUIREMENT THAT SUCH INDIVIDUALS ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. EACH YEAR THE COMPLETED CONFLICT OF INTEREST DISCLOSURE STATEMENTS ARE REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF THE PARENT ORGANIZATION, FALLON COMMUNITY HEALTH PLAN, WHICH REPORTS ANY ACTUAL OR POTENTIAL CONFLICTS TO THE FULL BOARD OF THE PARENT. ANY BOARD MEMBER OR OFFICER WITH A CONFLICT OF INTEREST IS PROHIBITED FROM PARTICIPATING IN ANY DISCUSSION OF, OR VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. TWO INDEPENDENT BOARD MEMBERS OF THE PARENT ALSO CONDUCT AN ANNUAL REVIEW OF ANY BUSINESS TRANSACTIONS INVOLVING THE ORGANIZATION THAT COULD POTENTIALLY BENEFIT A BOARD MEMBER OR OFFICER, TO ENSURE THAT THE TRANSACTIONS DO NOT INVOLVE ANY UNDUE INFLUENCE, ARE AT FAIR MARKET VALUE, AND ARE IN THE ORGANIZATION'S BEST INTEREST. THE REVIEWING BOARD MEMBERS REPORT THEIR FINDINGS TO THE FULL BOARD. FURTHERMORE, AT BOARD MEETINGS, INDIVIDUAL BOARD MEMBERS ARE ASKED TO IDENTIFY, AND RECUSE THEMSELVES FROM ANY DISCUSSION AND VOTE ON ANY MATTER BEFORE THE BOARD IN WHICH THEY MAY HAVE A CONFLICT. FTC ALSO REQUIRES ALL DIRECTORS, OFFICERS, AND KEY EMPLOYEES TO COMPLETE A WRITTEN DISCLOSURE STATEMENT DESIGNED TO IDENTIFY POTENTIAL CONFLICTS. FTC ALSO HAS GENERAL CORPORATE-WIDE CONFLICT OF INTEREST POLICIES THAT REQUIRE REPORTING OF POTENTIAL CONFLICTS AND MANAGEMENT APPROVAL OF CERTAIN TRANSACTIONS, AND PROHIBITS CERTAIN SPECIFIC TRANSACTIONS. THESE POLICIES ARE ENFORCED BY SENIOR MANAGEMENT, INCLUDING THE CHIEF COMPLIANCE OFFICER OF THE PARENT.
FORM 990, PART VI, SECTION B, LINE 15A AND 15BTHE PROCESS FOR DETERMINING CEO AND OTHER OFFICERS' COMPENSATION THE CEO POSITION WAS NOT FILLED IN 2015. THE COMPENSATION FOR THE CEO AND OTHER OFFICERS OF FTC WERE DETERMINED BY THE PARENT ORGANIZATION, FCHP, PURSUANT TO FCHP'S PROCESS FOR DETERMINING COMPENSATION FOR SUCH INDIVIDUALS AS FOLLOWS: FCHP HAS ESTABLISHED AN EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE (THE "COMMITTEE") OF THE BOARD OF DIRECTORS THAT ESTABLISHES POLICIES AND THE COMPENSATION STRUCTURE OF CERTAIN FTC AND FCHP EXECUTIVE OFFICERS. THIS COMMITTEE IS RESPONSIBLE FOR ASSURING THAT THE TOTAL COMPENSATION PROVIDED TO THESE EXECUTIVE OFFICERS IS DETERMINED BY A FAIR AND EQUITABLE PROCESS, INFORMED BY CURRENT AND CREDIBLE MARKET PRACTICE INFORMATION, AND COMPLIANT WITH APPLICABLE LEGAL AND REGULATORY GUIDELINES. IN 2015, THE COMMITTEE CONSISTED OF FOUR MEMBERS OF FCHP'S BOARD OF DIRECTORS WHO ARE NOT EMPLOYED BY THE ORGANIZATION. FCHP'S CEO SERVED AS AN EX OFFICIO MEMBER OF THE COMMITTEE WITHOUT A VOTING RIGHT. THE EXECUTIVE OFFICERS OVER WHOSE COMPENSATION THE COMMITTEE IS RESPONSIBLE ARE COMPRISED OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER ("CEO"), AND THE PRESIDENT, EXECUTIVE VICE PRESIDENT, AND SENIOR VICE PRESIDENT POSITIONS THAT REPORT DIRECTLY TO THE CEO ("EXECUTIVE GROUP"). IN 2015, TO DETERMINE THE COMPENSATION STRUCTURE OF THE EXECUTIVE GROUP, THE COMMITTEE RELIED ON A WRITTEN COMPENSATION SURVEY PRODUCED IN 2014 BY AN INDEPENDENT CONSULTING FIRM THAT ASSESSES EXECUTIVE COMPENSATION AND BENEFITS AND REFRESHED IN 2015 BY FALLON HEALTHs COMPENSATION DEPARTMENT. THE COMMITTEE MET TO REVIEW THE COMPENSATION STRUCTURE OF THE EXECUTIVE GROUP AND REVIEWED THE COMPENSATION SURVEY PREPARED BY THE INDEPENDENT CONSULTING FIRM and updated by Fallon Health. THE COMMITTEE THEN VOTED TO APPROVE THE COMPENSATION OF THE EXECUTIVE GROUP (OTHER THAN THE CEO). FOR THE CEO'S COMPENSATION THE COMMITTEE (MEETING WITHOUT THE CEO) RECOMMENDED A COMPENSATION STRUCTURE THAT WAS PRESENTED TO THE FCHP'S BOARD OF DIRECTORS. THE BOARD OF DIRECTORS (WITHOUT THE CEO PRESENT), VOTED TO APPROVE THE COMMITTEE'S RECOMMENDATION. ALL THESE DELIBERATIONS WERE CONTEMPORANEOUSLY DOCUMENTED IN THE MINUTES OF THE COMMITTEE AND BOARD OF DIRECTORS. THE PROCESS WAS USED TO ESTABLISH THE COMPENSATION FOR THE EXECUTIVE GROUP IN 2015. THIS PROCESS WAS NOT USED TO ESTABLISH COMPENSATION FOR THE "KEY EMPLOYEES" LISTED IN SCHEDULE J. FORM 990, PART VI, LINES 18 AND 19 FTC'S FORM 990 AND ANNUAL AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE GENERAL PUBLIC ON THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE. FTC'S FORM 990, FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY, ARE ALSO PROVIDED UPON REQUEST. FORM 990, PART XI, LINE 9 CAPITAL CONTRIBUTION FROM PARENT: $20,650,000

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
FALLON COMMUNITY HEALTH PLAN INC
10 CHESTNUT STREETWORCESTERMA01608237442369HEALTH CAREMA501(C)(3)9N/Afalse
SUMMIT LIVING INC
10 CHESTNUT STREETWORCESTERMA01608261836279ASST LIVINGMA501(C)(3)11AYes (true)FCHP
FALLON HEALTH WEINBERG INC
2700 NORTH FOREST RDGETZVILLENY14068161580245HEALTH CARENY501(C)(3)9Yes (true)FCHP

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
FALLON HEALTH & LIFE ASSURANCE COMPANY
10 CHESTNUT STREETWORCESTERMA01608043169246HEALTH & LIFEMANAC CORPYes (true)
ULTRABENEFITS INC
29 EAST MOUNTAIN STREETWORCESTERMA016080435257523RD PARTY ADMMAC CORPYes (true)N/A
GROUP INSURANCE SERVICE CENTER INC
20 WINTER STREET 1PEMBROKEMA023590432713043RD PARTY ADMMANAC CORPYes (true)
GISC INSURANCE AGENCY INC
20 WINTER STREET 1PEMBROKEMA02359043273688INSURANCE AGENCYMANAC CORPYes (true)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (true)LoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgYes (true)AssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

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