2015-08-12T09:35:57-05:00 2014-12-31 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2014-01-01 113153422 NEW YORK STATE CATHOLIC HEALTH PLANINC NEWY 7183936403 95-25 QUEENS BOULEVARD REGO PARK NY 113744510 PATRICK J FRAWLEY PRESIDENT & CEO 7183936403 2015-08-11 1 CHRISTINE KAWECKI P00743140 5169187000 2015-08-11 2014 2016-02-25 16:41:14Z FIDELIS CARE NEW YORK PATRICK J FRAWLEY 95-25 QUEENS BOULEVARD REGO PARK NY 113744510 6167950744 0 X WWW.FIDELISCARE.ORG X 1993 NY SEE SCHEDULE O. 18 18 2734 0 0 0 353245 196215 4086015198 5282714979 15018260 21647808 153519 201752 4101540222 5304760754 3492936 3565309 3533028969 4758014894 131937126 169288472 0 0 0 77335242 102149659 3745794273 5033018334 355745949 271742420 1622426424 2199606728 667496483 979578494 954929941 1220028234 X SEE SCHEDULE O 1 0 3606196232 2735123 4077863264 MEDICAID MANAGED CARE PROGRAM IS A NEW YORK STATE PROGRAM ADMINISTERED BY FIDELIS THAT PROVIDES FREE COMPREHENSIVE HEALTH COVERAGE FOR ELIGIBLE INDIVIDUALS AND FAMILIES WHO ARE RESIDENTS OF NEW YORK STATE AND HAVE LOW INCOME AND LIMITED RESOURCES. THE NEW YORK STATE DEPARTMENT OF HEALTH ESTABLISHES ELIGIBILITY CRITERIA WITH REGARD TO INCOME (IN RELATION TO A PERCENTAGE OF THE FEDERAL POVERTY LEVEL), RESIDENCY, RESOURCES, AGE, AND IMMIGRATION STATUS, AMONG OTHER FACTORS, AND ELIGIBILITY FOR THE PROGRAM IS DETERMINED BASED ON INCOME, RESOURCES, AND FAMILY SIZE. 440999762 26664 417093255 FIDELIS CARE AT HOME IS A MEDICAID LONG-TERM CARE CAPITATED PROGRAM WITH THE NEW YORK STATE DEPARTMENT OF HEALTH WHICH PROVIDES AN ARRAY OF HOME, COMMUNITY, AND INSTITUTIONALLY BASED, LONG-TERM CARE SERVICES TO PERSONS WHO ARE ELIGIBLE FOR MEDICAID AND WHO HAVE BEEN CERTIFIED AS APPROPRIATE CANDIDATES FOR NURSING HOME PLACEMENT. 273442093 62611 269071404 MEDICARE ADVANTAGE PROGRAM IS A PROGRAM AVAILABLE TO ADULTS AGED 65 AND OVER WHO ARE ELIGIBLE UNDER MEDICARE. BENEFICIARIES MAY CHOOSE TO USE PRIVATE PAY OPTIONS, ESTABLISH MEDICAL SAVINGS ACCOUNTS, USE MANAGED CARE PLANS SUCH AS FIDELIS, OR JOIN PROVIDER-SPONSORED PLAN. 440942116 740911 518888808 OTHER PROGRAMS ADMINISTERED BY THE PLAN INCLUDE THE CHILD HEALTH PLUS PROGRAM, FAMILY HEALTH PLUS PROGRAM, MEDICARE/MEDICAID DUAL ADVANTAGE PROGRAM, MEDICAID ADVANTAGE PLUS PROGRAM AND HEALTH BENEFIT EXCHANGE PROGRAM. CHILD HEALTH PLUS PROGRAM IS A PROGRAM THAT COVERS UNINSURED CHILDREN UNDER THE AGE OF 19, WHO ARE RESIDENTS OF NEW YORK STATE AND ARE NOT ELIGIBLE FOR MEDICAID. FAMILY HEALTH PLUS PROGRAM IS A PROGRAM FOR UNINSURED ADULTS, AGES 19-64, WHO ARE RESIDENTS OF NEW YORK STATE AND ARE NOT ELIGIBLE FOR MEDICAID. MEDICARE/MEDICAID DUAL ADVANTAGE IS A PROGRAM FOR THOSE WHO MEET ELIGIBILITY REQUIREMENTS FOR BOTH MEDICARE AND MEDICAID AND ARE ENROLLED IN BOTH PROGRAMS. MEDICAID ADVANTAGE PLUS IS A FULL-RISK MANAGED LONG-TERM CARE PROGRAM FOR INDIVIDUALS 18 YEARS OF AGE AND OLDER WITH MEDICARE AND MEDICAID COVERAGE WHO HAVE A CHRONIC ILLNESS OR DISABILITY. MEMBERS MUST BE IN NEED OF LONG-TERM CARE SERVICES AND MAY NEED CARE TYPICALLY GIVEN IN A NURSING HOME. HEALTH BENEFIT EXCHANGE IS A PROGRAM PROVIDING HEALTH COVERAGE TO INDIVIDUALS UNDER THE HEALTH CARE REFORM ACT. 440942116 740911 518888808 4761580203 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 14733 0 1 2734 1 0 0 0 0 0 0 0 0 0 0 0 X 18 18 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X ANNE C KONTOPOULOS 7183936403 95-25 QUEENS BLVD REGO PARK NY 113744510 X KARL P ADLER MD DIRECTOR 1.00 X 0 0 0 JACK BALINSKY DIRECTOR 1.00 X 0 0 0 M WILLIAM BENEDETTO DIRECTOR 1.00 X 0 0 0 SISTER PATRICIA BURKARD OSF DIRECTOR/SECRETARY 1.00 X X 0 0 0 JAMES M CORRIGAN CPA MHA DIRECTOR 1.00 X 0 0 0 REV JOHN COUGHLIN DIRECTOR 1.00 X 0 0 0 THOMAS DESTEFANO DIRECTOR THROUGH SEP '14 1.00 X 0 0 0 THOMAS F DOODIAN DIRECTOR 1.00 X 0 0 0 REV DONALD J HARRINGTON CM CHAIRMAN OF THE BOARD 1.00 X X 0 0 0 JOHN J HURLEY DIRECTOR 1.00 X 0 0 0 THOMAS L KELLY DIRECTOR 1.00 X 0 0 0 REV LEO J O'DONOVAN SJ DIRECTOR 1.00 X 0 0 0 GINO J PAZZAGLINI DIRECTOR/VICE CHAIRMAN 1.00 X X 0 0 0 REV MONSIGNOR ALAN J PLACA DIRECTOR 1.00 X 0 0 0 JOHN J RYDZEWSKI DIRECTOR 1.00 X 0 0 0 JOSEPH SLAVIK DIRECTOR 1.00 X 0 0 0 MARY THOMPSON DIRECTOR 1.00 X 0 0 0 MICHAEL J TOOLEY DIRECTOR 1.00 X 0 0 0 JOHN A WERWAISS DIRECTOR/TREASURER 1.00 X X 0 0 0 PATRICK J FRAWLEY PRESIDENT & CEO 37.50 X 2706367 0 109808 THOMAS HALLORAN CHIEF FINANCIAL OFFICER 33.70 3.80 X 510748 57910 309731 DAVID THOMAS EVP & COO 34.70 2.80 X 1146656 51404 65208 SANJIV SHAH MD CHIEF MEDICAL OFFICER 32.80 4.70 X 407678 58655 176192 PAMELA HASSEN CHIEF MARKETING OFFICER 37.50 X 389091 0 244916 MARTIN KREBS CHIEF INF. OFFICER 37.50 X 405232 0 163360 SANTO RUSSO CHIEF LEGAL OFFICER 33.70 3.80 X 344186 39296 162709 THOMAS BROWN CHIEF ADMIN OFFICER 37.50 X 411954 0 95764 HALINA RUP SR MEDICARE SALES REP 37.50 X 337470 0 40983 ROBERT FAZZOLARI VP GOV'T REL & CORP COMP 37.50 X 327544 0 27333 BEVERLY MAISON VP FINANCE 37.50 X 292569 0 38847 PAMELA WILKES VP NETWORK DEVELOPMENT 30.00 7.50 X 240865 60004 26613 ROBERT WICKS VP MEDICAL DIRECTOR 37.50 X 295664 0 20054 7816024 267269 1481518 185 0 1 0 IHT SERVICES LLC 115 PERIMETER CENTER PLACE ATLANTA GA 303460000 MEDICAL CLAIMS REVIEW 6659554 PERSONAL COMPUTERS INC 703 WASHINGTON STREET BUFFALO NY 142030000 IT SERVICES 3460945 HEALTH MANAGEMENT SYSTEMS INC PO BOX 27151 NEW YORK NY 100870000 COORDINATION OF BENEFITS REVIEW 3359248 EMDEON BUSINESS SERVICES PO BOX 572490 MURRAY UT 841572490 CLAIMS PROCESSING 1820757 SYSTEMS PERSONNEL INC 968 B UNION ROAD WEST SENECA NY 142240000 TEMPORARY STAFFING 1313687 52 9000 187215 196215 MEDICAID 524114 4077863264 4077863264 FIDELIS CARE AT HOME 524114 417093255 417093255 MEDICARE ADVANTAGE 524114 269071404 269071404 FAMILY HEALTH PLUS 524114 229265845 229265845 CHILD HEALTH PLUS 524114 133514024 133514024 155907187 155907187 5282714979 18001330 18001330 866828802 7666 863189990 0 3638812 7666 3646478 3646478 PURCH.REBATES/DISCOUNT 524298 417131 417131 MISCELLANEOUS 524298 24028 24028 EQUITY IN SALUS ADMINI 900001 -239407 -239407 201752 5304760754 5282916731 0 21647808 3340000 3340000 225309 225309 4758014894 4758014894 8041501 8041501 130618146 130618146 4182826 4182826 16624547 16624547 9821452 9821452 166032 166032 788998 788998 69962 69962 875612 875612 7634095 7634095 10803841 10803841 2404869 2404869 13484738 13484738 7011528 7011528 3097873 3097873 556209 556209 267800 267800 12175989 12175989 762545 762545 CLAIMS PROCESSING 12768930 0 12768930 0 POSTAGE & SHIPPING 6196345 0 6196345 0 PRINTING & PUBLICATIONS 4598603 0 4598603 0 TELEPHONE EXPENSES 3481112 0 3481112 0 15004578 15004578 5033018334 4761580203 271438131 0 41316700 41167982 806361520 907141291 78687794 243776681 54343523 74508175 105824697 71491516 17280905 34333181 408902367 527869989 30899686 131276298 486334 412046 16252278 16022278 167895317 223098807 1622426424 2199606728 60039588 131979295 18361843 6693172 589095052 840906027 667496483 979578494 X 954253573 1219380960 676368 647274 0 954929941 1220028234 1622426424 2199606728 X 271742420 -6644128 1 X 0 1 X 1 1 1 X 211811 537543 270351 353245 196215 1569165 1911001018 2401477190 3273848371 4086015198 5282714979 16955056756 1911212829 2402014733 3274118722 4086368443 5282911194 16956625921 0 0 0 16956625921 6033312 7022612 9356791 11866741 18001330 52280786 6033312 7022612 9356791 11866741 18001330 52280786 155394 296626 239217 153519 209418 1054174 1917401535 2409333971 3283714730 4098388703 5301121942 17009960881 0.99690 0.99680 0.00310 0.00310 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 69962 69962 0 PART II-B, LINE 1: FIDELIS IS A MEMBER OF CERTAIN ASSOCIATIONS, TO WHICH IT PAYS ANNUAL DUES A PORTION OF THOSE DUES ARE DETERMINED TO BE EXPENDITURES FOR LOBBYING PURPOSES. IN 2014, THAT PORTION WAS $69,962. 6535693 5476863 1058830 12103271 11314332 788939 87185733 54700321 32485412 34333181 FIXED INCOME FUNDS 36020093 F LONG TERM CERTIFICATES OF DEPOSIT 95256205 F 131276298 ASSETS WHOSE USE IS LIMITED (RESTRICTED FUNDS)-CURRENT 245929 ASSETS WHOSE USE IS LIMITED (RESTRICTED FUNDS) 183739606 OTHER RECEIVABLES 39113270 ROUNDING 2 223098807 CLAIMS PAYABLE 756190321 DUE TO THIRD PARTIES 83872959 CAPITAL LEASE PAYABLE 842747 840906027 5298351258 -6644128 234632 -6409496 5304760754 0 5304760754 5033252965 234631 234631 5033018334 0 5033018334 PART XI, LINE 2D - OTHER ADJUSTMENTS: EQUITY INVESTMENT IN SALUS ADMINISTRATIVE SERVICES, INC ("SALUS") 239,408. SALUS CONTRIBUTIONS ELIMINATED IN CONSOLIDATION -9,000. SALUS INTEREST INCOME ELIMINATED IN CONSOLIDATION 4,224. PART XII, LINE 2D - OTHER ADJUSTMENTS: EQUITY INVESTMENT IN SALUS ADMINISTRATIVE SERVICES, INC ("SALUS") 239,408. SALUS CONTRIBUTIONS ELIMINATED IN CONSOLIDATION -9,000. SALUS INTEREST INCOME ELIMINATED IN CONSOLIDATION 4,224. ROUNDING -1. 1 AMAUS HEALTH SERVICES AT THE CATHEDRAL OF IMMACULATE CONCEPTION 259 E ONONDAGA SREET SYRACUSE NY 132020000 611548780 501(C)(3) 14000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. ARCHCARE 205 LEXINGTON AVE - 3RD FLOOR NEW YORK NY 100160000 134054158 501(C)(3) 383500 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. ARCHDIOCESE OF NEW YORK 1011 FIRST AVENUE NEW YORK NY 100220000 510453629 501(C)(3) 90000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. BASSETT HEALTHCARE NETWORK ONE ATWELL ROAD COOPERSTOWN NY 133260000 237041610 501(C)(3) 10000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. CATHOLIC CHARITIES COMMUNITY SERVICES 1011 FIRST AVENUE NEW YORK NY 100220000 135562185 501(C)(3) 383500 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. CATHOLIC CHARITIES NEIGHBORHOOD SERVICES 191 JORALEMON STREET 9TH FLOOR BROOKLYN NY 112010000 112047151 501(C)(3) 230608 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. CATHOLIC CHARITIES OF BROOKLYN & QUEENS 191 JORALEMON STREET 7TH FLOOR BROOKLYN NY 112010000 111633548 501(C)(3) 228886 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. CATHOLIC CHARITIES OF FULTON & MONTGOMERY COUNTIES 55 EAST MAIN ST SUITE 100 JOHNSTOWN NY 120950000 141340033 501(C)(3) 5500 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. CATHOLIC CHARITIES OF THE DIOCESE OF FINGER LAKES 94 EXCHANGE STREET GENEVA NY 144560000 142005241 501(C)(3) 15000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. CATHOLIC CHARITIES OF STEUBEN COUNTY 23 LIBERTY STREET BATH NY 148100000 300553416 501(C)(3) 21500 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. CATHOLIC CHARITIES OF THE DIOCESE OF ALBANY 40 NORTH MAIN AVENUE ALBANY NY 122030000 141340033 501(C)(3) 186000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. CATHOLIC CHARITIES OF THE DIOCESE OF OGDENSBURG 6866 STATE HIGHWAY 37 OGDENSBURG NY 136690000 150614025 501(C)(3) 71000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. CATHOLIC CHARITIES OF THE DIOCESE OF ROCHESTER 1150 BUFFALO ROAD ROCHESTER NY 146240000 160743944 501(C)(3) 48000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. CATHOLIC CHARITIES OF THE DIOCESE OF ROCKVILLE CENTRE 90 CHERRY LANE HICKSVILLE NY 118016299 111843801 501(C)(3) 196000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. CATHOLIC CHARITIES OF THE DIOCESE OF SYRACUSE 240 EAST ONONDAGA STREET SYRACUSE NY 132020000 150532085 501(C)(3) 160000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. CATHOLIC MEDICAL MISSION BOARD 10 WEST 17TH STREET NEW YORK NY 100110000 135602319 501(C)(3) 10000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. CATHOLIC MIGRATION SERVICES 191 JORALEMON STREET 9TH FLOOR BROOKLYN NY 112010000 112634818 501(C)(3) 238506 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. CHARLES B WANG COMMUNITY HEALTH CENTER 268 CANAL STREET NEW YORK NY 100130000 132739694 501(C)(3) 7500 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. CORTLAND-CHENANGO RURAL SERVICES 2704 LOWER CINCINNATUS ROAD PO BOX 57 CINCINNATUS NY 130400000 455599324 501(C)(3) 11950 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. CRISTO REY BROOKLYN HIGH SCHOOL 710 E 37TH STREET BROOKLYN NY 112030000 262433224 501(C)(3) 10000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. DEPARTMENT OF EDUCATION - CATHOLIC SCHOOLS 100 ELIZABETH STREET OGDENSBURG NY 136690000 150532120 501(C)(3) 60000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. DIOCESE OF ALBANY CATHOLIC SCHOOLS 40 NORTH MAIN AVENUE ALBANY NY 122030000 141605502 501(C)(3) 36724 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. DIOCESE OF BROOKLYN OFFICE OF THE SUPERINTENDENT CATHOLIC SCHOOL SUPPORT SE 310 PROSPECT PARK WEST BROOKLYN NY 112150000 111631807 501(C)(3) 90000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. DIOCESE OF BUFFALO CATHOLIC SCHOOLS 795 MAIN STREET BUFFALO NY 142031250 160743984 501(C)(3) 60000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. DIOCESE OF ROCHESTER - DEPARTMENT OF CATHOLIC SCHOOLS 1150 BUFFALO ROAD ROCHESTER NY 146240000 160755765 501(C)(3) 60000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. DIOCESE OF ROCKVILLE CENTRE - EDUCATION DEPARTMENT 50 NORTH PARK AVENUE PO BOX 9023 ROCKVILLE CENTRE NY 115719023 111837437 501(C)(3) 60000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. ELLIS HOSPITAL FOUNDATION 1101 NOTT STREET SCHENECTADY NY 123080000 141338428 501(C)(3) 7500 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. EZRAS CHOILIM HEALTH CENTER 49 FOREST AVENUE MONROE NY 109500000 133595755 501(C)(3) 25000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. FRANSISCAN NORTHSIDE MINISTRIES 804 NORTH SALINA STREET SYRACUSE NY 132080000 150532104 501(C)(3) 19050 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. MATERNITY AND EARLY CHILDHOOD FOUNDATION INC 40 N MAIN STREET ALBANY NY 122030000 141650131 501(C)(3) 25000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. PARISH AND CLERGY SERVICES DIOCESE OF ROCHESTER 1150 BUFFALO ROAD ROCHESTER NY 146240000 530196617 501(C)(3) 84500 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. ROMAN CATHOLIC DIOCESE OF SYRACUSE - CATHOLIC SCHOOL OFFICE 240 EAST ONONDAGA STREET SYRACUSE NY 132020000 150625353 501(C)(3) 60000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. TELECARE 1200 GLEN CURTIS BLVD UNIONDALE NY 115533705 113045547 501(C)(3) 75000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. THE ALFRED E SMITH MEMORIAL FOUNDATION 1011 FIRST AVENUE SUITE 1400 NEW YORK NY 100224112 131553263 501(C)(3) 130000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. THE FOUNDATION OF THE ROMAN CATHOLIC DIOCESE OF BUFFALO 795 MAIN STREET BUFFALO NY 142030000 530169917 501(C)(3) 208000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. WILLIAM F RYAN COMMUNITY HEALTH CENTER 110 W 97TH STREET NEW YORK NY 100250000 132884976 501(C)(3) 15000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. GRANTS 5000 95-25 QUEENS BOULEVARD REGO PARK NY 11374-4570 501(C)(3) 2776 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O. 37 0 HEALTHY KIDS FUND 25316 225309 CASH PAID N/A PART I, LINE 2: RECIPIENTS OF GRANT AWARDS UNDER THE COMMUNITY GRANT FUND ARE REQUIRED TO PROVIDE PERIODIC UPDATES ON THE ACCOMPLISHMENTS OF THE GRANT AND DISBURSEMENTS. IT IS THE RESPONSIBILITY OF THE GRANT RECIPIENT TO ENSURE THAT THE GRANT IS USED FOR THE PURPOSE(S) STATED IN THE ORIGINAL APPLICATION. FIDELIS MONITORS GRANT USAGE BY CORRESPONDENCE, TELEPHONE OR SITE VISITS. AN EVALUATION OF THE PROJECT IS REQUIRED UPON THE GRANTEE'S COMPLETION. NON-COMPLIANCE WITH THESE GUIDELINES MAY RESULT IN A REQUEST FOR RETURN OF THE FUNDS IN QUESTION OR INELIGIBILITY OF THE ORGANIZATION FOR FUTURE GRANTS FROM FIDELIS. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 PATRICK J FRAWLEY PRESIDENT & CEO 973784 0 0 0 1732583 0 18135 0 91673 0 2816175 0 0 0 THOMAS HALLORAN CHIEF FINANCIAL OFFICER 399280 47519 91337 10149 20131 242 266017 1814 38831 3069 815596 62793 0 0 DAVID THOMAS EVP & COO 495442 42473 107901 8749 543313 182 16775 1360 43938 3135 1207369 55899 0 0 SANJIV SHAH MD CHIEF MEDICAL OFFICER 312461 48437 69407 9915 25810 303 144203 2267 26557 3165 578438 64087 0 0 PAMELA HASSEN CHIEF MARKETING OFFICER 293288 0 69990 0 25813 0 220735 0 24181 0 634007 0 0 0 MARTIN KREBS CHIEF INF. OFFICER 315099 0 69990 0 20143 0 126739 0 36621 0 568592 0 0 0 SANTO RUSSO CHIEF LEGAL OFFICER 277411 32288 60891 6766 5884 242 119624 1814 38181 3090 501991 44200 0 0 THOMAS BROWN CHIEF ADMIN OFFICER 324003 0 60548 0 27403 0 94269 0 1495 0 507718 0 0 0 HALINA RUP SR MEDICARE SALES REP 78333 0 258925 0 212 0 18135 0 22848 0 378453 0 0 0 ROBERT FAZZOLARI VP GOV'T REL & CORP COMP 258589 0 45265 0 23690 0 18135 0 9198 0 354877 0 0 0 BEVERLY MAISON VP FINANCE 238829 0 29450 0 24290 0 14396 0 24451 0 331416 0 0 0 PAMELA WILKES VP NETWORK DEVELOPMENT 179888 51462 34167 8542 26810 0 14508 3627 7374 1104 262747 64735 0 0 ROBERT WICKS VP MEDICAL DIRECTOR 221483 0 45000 0 29181 0 18135 0 1919 0 315718 0 0 0 PART I, LINE 4B SERP COMPENSATION OF OFFICERS OR KEY EMPLOYEES: PATRICK J. FRAWLEY - $1,704,280*; DAVID THOMAS - $523,122* THOMAS HALLORAN - $249,696**; PAMELA HASSEN - $202,600**; SANJIV SHAH - $128,335**; MARTIN KREBS - $108,604**; SANTO RUSSO - $103,302**; THOMAS BROWN - $76,134** *THE ABOVE AMOUNTS INCLUDE GROSS-UP TAXES PAID ON BEHALF OF THE PARTICIPANTS. (LINE 1A) **THESE REPRESENT NON-VESTED SERP BENEFITS PART I, LINE 7 PERFORMANCE-BASED INCENTIVES ARE PAID AS PART OF THE PLAN'S ANNUAL INCENTIVE PROGRAM. THE PRESIDENT & CHIEF EXECUTIVE OFFICER DOES NOT PARTICIPATE IN ANY INCENTIVE PROGRAM. FORM 990, PART I, LINE 1 DESCRIPTION OF ORGANIZATION MISSION: TO PROMOTE HEALTH THROUGH QUALITY, ACCESSIBLE CARE AND SERVICES TO THE COMMUNITY, ESPECIALLY TO THE POOR AND UNDERSERVED; TO PROMOTE HEALTH EDUCATION AND PREVENTATIVE MEDICINE. FORM 990, PART III, LINE 1 DESCRIPTION OF ORGANIZATION MISSION: THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC. ("FIDELIS" OR THE "PLAN") STRIVES TO PROMOTE HEALTH THROUGH QUALITY, ACCESSIBLE CARE AND SERVICES FOR ALL; TO JOIN IN PARTNERSHIP WITH HEALTH PROFESSIONALS TO ASSIST THEM IN THEIR HEALING WORK; TO ACT AS A FACILITATOR TO BUILD LINKAGES AND SYSTEMS FOR THE COORDINATION OF CARE AND SERVICES AMONG HEALTHCARE, BEHAVIORAL AND SOCIAL SERVICES, AS WELL AS EDUCATORS AND RELIGIOUS LEADERS, TO ADDRESS THE SPIRITUAL, EMOTIONAL AND PHYSICAL NEEDS OF THOSE WE SERVE; TO ADVOCATE FOR A HEALTH POLICY THAT ACCORDS TRUE DIGNITY AND RESPECT FOR ALL HUMAN PERSONS, ESPECIALLY THE POOR AND UNDERSERVED. AS OF DECEMBER 31, 2014, THE PLAN SERVED AN ENROLLED POPULATION COMPRISED OF BENEFICIARIES OF THE MEDICAL ASSISTANCE PROGRAM ("MEDICAID"), APPROXIMATELY 1,017,000, THE CHILD HEALTH PLUS BENEFICIARIES, APPROXIMATELY 72,100, A PROGRAM FOR LOW INCOME UNINSURED CHILDREN, THE FAMILY HEALTH PLUS BENEFICIARIES, APPROXIMATELY 7,700, A MEDICAID PROGRAM FOR LOW INCOME, UNINSURED FAMILIES, MEDICARE/DUAL ADVANTAGE PROGRAM BENEFICIARIES, APPROXIMATELY 27,800, A PROGRAM FOR THE ELDERLY, FIDELIS CARE AT HOME MANAGED LONG-TERM CARE PROGRAM BENEFICIARIES, APPROXIMATELY 9,700, A PROGRAM FOR RESIDENTS WHO NEED LONG-TERM CARE SERVICES AND ARE ELIGIBLE FOR MEDICAID AND THE NEW YORK HEALTH BENEFIT EXCHANGE PROGRAM ("HEALTH BENEFIT EXCHANGE") BENEFICIARIES, APPROXIMATELY 46,200, A PROGRAM THAT BEGAN ON JANUARY 1, 2014 WHICH PROVIDES HEALTH COVERAGE TO INDIVIDUAL MEMBERS UNDER THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AND THE HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010 ("HEALTH CARE REFORM ACT"). FORM 990, PART III, LINE 2 EFFECTIVE JANUARY 1, 2014, FIDELIS PROVIDED HEALTH COVERAGE TO INDIVIDUAL MEMBERS THROUGH THE HEALTH BENEFIT EXCHANGE UNDER THE HEALTH CARE REFORM ACT. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS. THE MEMBERSHIP OF THE ORGANIZATION SHALL BE LIMITED TO THE DIOCESAN BISHOPS OF THE STATE AND THE ECCLESIASTICAL PROVINCE OF NEW YORK. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION IS A MEMBERSHIP CORPORATION UNDER THE NEW YORK NOT-FOR-PROFIT CORPORATION LAW (THE "N-PCL") THE ORGANIZATION'S MEMBERS ELECT ITS BOARD OF DIRECTORS AND, AS MEMBERS OF A NEW YORK NOT-FOR-PROFIT CORPORATION, POSSESS CERTAIN OTHER POWERS UNDER THE N-PCL. FURTHERMORE, THE ORGANIZATION'S BY-LAWS, WHICH ARE FILED WITH THE NEW YORK STATE DEPARTMENT OF HEALTH ("NYSDOH"), DEFINE THE FOLLOWING RESERVED POWERS OF THE MEMBERS: (I) THE INTERPRETATION OF THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH CARE SERVICES TO WHICH THE ORGANIZATION, AS A FAITH-BASED ORGANIZATION, IS SUBJECT; (II) APPROVAL OF THE MISSION STATEMENT; (III) STANDING TO ENSURE THE ORGANIZATION'S COMPLIANCE WITH ITS PHILOSOPHY AND MISSION STATEMENT; (IV) APPROVAL OF AMENDMENTS TO THE ORGANIZATION'S CERTIFICATE OF INCORPORATION AND BY-LAWS; (V) APPROVAL OF TRANSACTIONS INVOLVING REAL PROPERTY; (VI) APPROVAL OF CERTAIN ACTIONS BY THE ORGANIZATION WHEN ACTING AS A SHAREHOLDER OR MEMBER OF ANOTHER ENTITY; (VII) APPROVAL OF THE ACCEPTANCE AND ISSUANCE OF SUBVENTIONS; (VIII) APPROVAL OF ANY MERGER, DISSOLUTION OR CONSOLIDATION, (IX) REMOVAL OF DIRECTORS AND CERTAIN OFFICERS OF THE CORPORATION; (X) APPROVAL OF THE ELECTION OF THE PRESIDENT & CHIEF EXECUTIVE OFFICER, AND (XI) REVIEW OF THE AUDITED FINANCIAL STATEMENTS. CERTAIN OF THESE POWERS ALREADY EXIST BY VIRTUE OF THE N-PCL (E.G., THE POWER TO APPROVE ANY MERGER, DISSOLUTION OR CONSOLIDATION UNDER N-PCL 903(A)(2) & 1002(A)). FORM 990, PART VI, SECTION A, LINE 7B PLEASE SEE LINE 11 NARRATIVE. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF THE FORM 990 PREPARED BY THE ORGANIZATION'S FINANCE DEPARTMENT IS REVIEWED BY THE ORGANIZATION'S CHIEF FINANCIAL OFFICER, ASSISTANT VICE PRESIDENT FOR FINANCE AND CHIEF LEGAL OFFICER, IN COLLABORATION WITH THE ORGANIZATION'S OUTSIDE INDEPENDENT TAX ADVISORS. THEREAFTER, THE ORGANIZATION'S PRESIDENT & CHIEF EXECUTIVE OFFICER AND EXECUTIVE VICE PRESIDENT & CHIEF OPERATING OFFICER REVIEW THE DRAFT FORM 990 WITH CHIEF FINANCIAL OFFICER, ASSISTANT VICE PRESIDENT FOR FINANCE AND CHIEF LEGAL OFFICER. THE ORGANIZATION'S BOARD OF DIRECTORS HAS AUTHORIZED THE EXECUTIVE COMMITTEE OF THE BOARD TO REVIEW AND ACCEPT THE DRAFT FORM 990 BEFORE ITS FILING WITH THE IRS. ACCORDINGLY, AFTER THE ORGANIZATION'S MANAGEMENT HAS COMPLETED ITS REVIEW OF THE DRAFT FORM 990, IT IS CIRCULATED IN DRAFT FOR REVIEW, COMMENT AND APPROVAL TO THE MEMBERS OF THE EXECUTIVE COMMITTEE. ONCE ANY COMMENTS HAVE BEEN INCORPORATED AND THE FORM 990 HAS BEEN ACCEPTED BY THE EXECUTIVE COMMITTEE, A COPY OF THE FORM 990 IS PROVIDED TO EACH MEMBER OF THE BOARD OF DIRECTORS PRIOR TO ITS FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE ORGANIZATION'S OFFICERS, DIRECTORS AND SENIOR EXECUTIVES ARE PROVIDED WITH A COPY OF THE CONFLICTS OF INTEREST POLICY AND AN ACKNOWLEDGEMENT FORM. THESE INDIVIDUALS ARE INSTRUCTED TO SIGN AND RETURN THE FORM, (A) TO ACKNOWLEDGE THAT THEY HAVE REVIEWED THE POLICY AND (B) TO DISCLOSE ANY CONFLICTS OR POTENTIAL CONFLICTS. THE CONFLICTS OF INTEREST POLICY DEFINES "DISCLOSABLE INTERESTS", I.E., THOSE INTERESTS THAT AN INDIVIDUAL COVERED BY THE POLICY MUST HAVE IN ANOTHER ENTITY IN ORDER FOR A TRANSACTION BETWEEN THE ORGANIZATION AND THAT ENTITY TO BE COVERED BY THE POLICY. THE POLICY ALSO DEFINES THE TYPES OF TRANSACTIONS BETWEEN THE ORGANIZATION AND ANOTHER ENTITY INVOLVING AN INDIVIDUAL COVERED BY THE POLICY THAT IS SUBJECT TO BY THE POLICY. THE POLICY REQUIRES DISCLOSURE TO THE BOARD OF DIRECTORS AND/OR THE EXECUTIVE COMMITTEE BY ANY PERSON WITH A DISCLOSABLE INTEREST IN A TRANSACTION AS DEFINED IN THE POLICY OF ALL CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST. INITIALLY, AFTER THE INTERESTED INDIVIDUAL HAS RECUSED HIMSELF, THE ORGANIZATION'S BOARD OF DIRECTORS OR EXECUTIVE COMMITTEE DETERMINES WHETHER A POTENTIAL CONFLICT OF INTEREST EXISTS. IF A CONFLICT OF INTEREST IS FOUND TO EXIST, THE BOARD OF DIRECTORS OR THE EXECUTIVE COMMITTEE DECIDES WHETHER TO ENTER INTO THE TRANSACTION BASED ON ITS DETERMINATION OF WHETHER (A) A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, (B) THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND (C) THE TRANSACTION IS FAIR AND REASONABLE TO THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 OUTSIDE COUNSEL FOR THE ORGANIZATION, A NATIONAL LAW FIRM WITH EXPERTISE IN ADVISING TAX-EXEMPT ORGANIZATIONS ON EXCESS BENEFIT TRANSACTIONS LAW, HAS ADVISED FIDELIS AS TO WHICH EMPLOYEES ARE DISQUALIFIED PERSONS WITHIN THE MEANING OF SECTION 4958 OF THE INTERNAL REVENUE CODE. THE ORGANIZATION EMPLOYS A COMPENSATION CONSULTANT FIRM, A NATIONAL HUMAN RESOURCES CONSULTING FIRM WITH EXPERTISE IN ADVISING TAX-EXEMPT ORGANIZATIONS ON EXCESS BENEFIT TRANSACTIONS LAW, TO PREPARE ANNUALLY A DETAILED REPORT ON THE PROPOSED COMPENSATION FOR THE ORGANIZATION'S DISQUALIFIED PERSONS THAT INCLUDES DATA AS TO COMPARABLE COMPENSATION FOR SIMILAR QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY-SITUATED ORGANIZATIONS. THE EXECUTIVE COMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS, WHICH HAS BEEN AUTHORIZED BY THE BOARD TO REVIEW AND APPROVE ALL MATTERS CONCERNING EXECUTIVE COMPENSATION, IS PROVIDED WITH THE COMPENSATION CONSULTANT'S DETAILED EXECUTIVE COMPENSATION REPORT. THE REVIEW AND APPROVAL OF THE COMPENSATION OF THE ORGANIZATION'S DISQUALIFIED PERSONS IS ACCOMPLISHED IN TWO PHASES: FIRST WITH RESPECT TO THE PRESIDENT & CHIEF EXECUTIVE OFFICER AND THEN WITH RESPECT TO ALL OTHER DISQUALIFIED PERSONS, NAMELY, (I) THE EXECUTIVE VICE PRESIDENT & CHIEF OPERATING OFFICER, (II) THE CHIEF FINANCIAL OFFICER, (III) THE CHIEF LEGAL OFFICER, (IV) THE CHIEF MEDICAL OFFICER, (V) CHIEF MARKETING OFFICER, (VI) CHIEF INFORMATION OFFICER AND (VII) CHIEF ADMINISTRATIVE OFFICER. FIRST, THE AFOREMENTIONED OUTSIDE COUNSEL AND HUMAN RESOURCES CONSULTING FIRM, AT THE INVITATION OF THE EXECUTIVE COMMITTEE, REVIEW WITH THE COMMITTEE THE DETAILED EXECUTIVE COMPENSATION REPORT WITH RESPECT TO THE PRESIDENT & CHIEF EXECUTIVE OFFICER. THE EXECUTIVE COMMITTEE ALSO RETAINS THE SERVICES OF A SECOND HUMAN RESOURCES CONSULTING FIRM TO ASSIST IN ITS EVALUATION OF THE PERFORMANCE OF THE PRESIDENT & CHIEF EXECUTIVE OFFICER. THE FULL REVIEW OF THE COMPENSATION AND PERFORMANCE OF THE PRESIDENT & CHIEF EXECUTIVE OFFICER IS PERFORMED BY THE EXECUTIVE COMMITTEE AT LEAST BI-ANNUALLY. AFTER ESTABLISHING THE COMPENSATION OF THE PRESIDENT & CHIEF EXECUTIVE OFFICER, THE EXECUTIVE COMMITTEE REPORTS ON ITS DELIBERATIONS AND DETERMINATIONS TO THE ORGANIZATION'S BOARD OF DIRECTORS. SECOND, THE EXECUTIVE COMMITTEE REVIEWS THE DETAILED EXECUTIVE COMPENSATION REPORT WITH RESPECT TO THE ORGANIZATION'S OTHER DISQUALIFIED PERSONS WITH THE ASSISTANCE OF THE SAME OUTSIDE COUNSEL AND COMPENSATION CONSULTANTS PARTICIPATING IN THE REVIEW OF THE COMPENSATION OF THE PRESIDENT & CHIEF EXECUTIVE OFFICER. THE EXECUTIVE COMMITTEE DETERMINES WHETHER TO APPROVE THE COMPENSATION ANALYSIS AND CONCLUSIONS CONTAINED IN THE COMPENSATION REPORT WITH RESPECT TO THE ORGANIZATION'S OTHER DISQUALIFIED PERSONS. AFTER CONSULTING WITH OUTSIDE COUNSEL, THE EXECUTIVE COMMITTEE HAS DESIGNATED THE PRESIDENT & CHIEF EXECUTIVE OFFICER TO SERVE AS AN "AUTHORIZED BODY" AS CONTEMPLATED BY THE EXCESS BENEFIT TRANSACTION REGULATIONS FOR THE PURPOSE OF SETTING THE COMPENSATION OF THOSE DISQUALIFIED PERSONS WITHIN AN APPROVED RANGE. THE ORGANIZATION MAINTAINS CONTEMPORANEOUS DOCUMENTATION AND RECORD KEEPING WITH RESPECT TO THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS FOR ALL DISQUALIFIED PERSONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION IS A NEW YORK NOT-FOR-PROFIT CORPORATION. ITS CERTIFICATE OF INCORPORATION IS READILY AVAILABLE TO THE GENERAL PUBLIC FROM THE NEW YORK STATE DEPARTMENT OF STATE UNDER THE NEW YORK FREEDOM OF INFORMATION LAW ("FOIL"). ITS CERTIFICATE OF INCORPORATION AND BY-LAWS ARE ALSO ON FILE WITH THE NYSDOH AND LIKEWISE AVAILABLE TO THE GENERAL PUBLIC UNDER FOIL. THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE TO ENROLLEES IN ITS MEDICAID AND FAMILY HEALTH PLUS PROGRAMS AND TO INDIVIDUALS CONSIDERING BECOMING ENROLLEES BY INCLUDING IN THE MEMBER HANDBOOKS FOR BOTH PROGRAMS, WHICH ARE PROVIDED TO ENROLLEES AND ARE ACCESSIBLE ON THE ORGANIZATION'S WEB SITE, A STATEMENT THAT THE FINANCIAL STATEMENTS (AS WELL AS OTHER INFORMATION DESCRIBED IN THE HANDBOOKS) ARE AVAILABLE UPON REQUEST BY CALLING A TOLL-FREE NUMBER PROVIDED IN THE HANDBOOKS. FORM 990, PART VII: AVG. HOURS DEVOTED TO RELATED ORG(S) WHEN RELATED COMP IS REPORTED: THE FOLLOWING INDIVIDUALS DEVOTE A PERCENTAGE OF THEIR TIME TO SALUS ADMINISTRATIVE SERVICES, INC. ("SALUS"), A RELATED ORGANIZATION, AS DETAILED BELOW: DAVID THOMAS, EVP & COO - 7.5% THOMAS HALLORAN, CHIEF FINANCIAL OFFICER - 10% SANJIV SHAH, MD, CHIEF MEDICAL OFFICER - 12.5% SANTO RUSSO, CHIEF LEGAL OFFICER - 10% PAMELA WILKES, VP NETWORK DEVELOPMENT - 20% THIS ARRANGEMENT IS COVERED BY AN EMPLOYEE SERVICE AGREEMENT BETWEEN FIDELIS AND SALUS. FORM 990, PART IX, LINE 12 THE ORGANIZATION'S LINE 12, ADVERTISING AND PROMOTION EXPENSES INCLUDE PAYMENTS TO OTHER EXEMPT ORGANIZATIONS IN SUPPORT OF THEIR CHARITABLE PURPOSES, TO BENEFIT THE COMMUNITY, OR IN SPONSORSHIP OF THEIR FUNDRAISING EVENTS. THE EXPENDITURES INCLUDE THE AMOUNTS PAID TO THE FOLLOWING: THANKSGIVING CONTRIBUTION TO NEEDY: $152,799 OTHER CHARITABLE CONTRIBUTION LESS THAN $5,000: $2,081 FORM 990, PART XI, LINE 9: ROUNDING 1. FORM 990 SCHEDULE I, PART II COL H: SINCE 2004 THE PURPOSE OF THE FIDELIS CARE COMMUNITY GRANT FUND IS TO OFFER SUPPORT ANNUALLY THROUGH CHARITABLE CONTRIBUTIONS TO SELECTED TAX-EXEMPT NONPROFIT ORGANIZATIONS THAT SHARE SIMILAR MISSIONS AND VALUES OF SERVICE TO LOW-INCOME VULNERABLE INDIVIDUALS. PROPOSALS ARE EVALUATED ON THEIR RELEVANCE TO FIDELIS' MISSION OF CARING FOR THE NEEDS AND CONCERNS OF THE POOR AND MEDICALLY UNDERSERVED IN CONSULTATION WITH FIDELIS' MEMBERS. THE TOTAL AMOUNT TO BE DISTRIBUTED EACH YEAR IS APPROVED BY THE BOARD OF DIRECTORS AND DISTRIBUTED IN ACCORDANCE WITH THE APPROVED BOARD POLICY. IN ADDITION TO THE GRANTS MADE THROUGH ITS COMMUNITY GRANT FUND, FIDELIS PROVIDES SUPPORT THROUGH CHARITABLE CONTRIBUTIONS THROUGH ITS CATHOLIC SCHOOLS GRANT INITIATIVE TO SELECTED CATHOLIC SCHOOLS OR DIOCESAN SCHOOL SYSTEMS IN THEIR EFFORT TO IMPROVE THE HEALTH STATUS OF CHILDREN AND THEIR FAMILIES. LASTLY, FIDELIS MAKES CHARITABLE DONATIONS TO ORGANIZATIONS CLASSIFIED AS TAX-EXEMPT NONPROFIT ORGANIZATIONS UNDER STATE AND FEDERAL LAW THAT WORK WITH FIDELIS TO SUPPORT THE PLAN'S MISSION. NOT APPLICABLE QUESTIONS: TO THE EXTENT THAT A QUESTION ON THE FORM 990 HAS BEEN LEFT BLANK, THE RESPONSE TO THIS QUESTION SHOULD BE NOT APPLICABLE. DUE TO SOFTWARE LIMITATIONS, FIDELIS COULD NOT PROPERLY RESPOND TO THE RESPECTIVE QUESTION AS N/A. SALUS ADMINISTRATIVE SERVICES INC 95-25 QUEENS BOULEVARD REGO PARK NY 11374 550878053 THIRD PARTY ADMINISTRATOR NY FIDELIS CARE NEW YORK C 5391416 47183089 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 SALUS ADMINISTRATIVE SERVICES INC L 5391416 CASH SALUS ADMINISTRATIVE SERVICES INC N 386800 CASH SALUS ADMINISTRATIVE SERVICES INC O 5180440 CASH SCHEDULE R, PART V SCHEDULE R, PART V RELATED PARTY TRANSACTIONS: FIDELIS REPORTS CERTAIN RELATED PARTY TRANSACTIONS BETWEEN ITSELF AND SALUS ADMINISTRATIVE SERVICES, INC. ("SALUS"), A RELATED PARTY, ON SCHEDULE R, PART V. THE METHODS USED FOR DETERMINING THE AMOUNTS REPORTED DIFFER BASED ON THE TYPE OF TRANSACTION BUT ARE ALL CONTAINED IN WRITTEN CONTRACTS BETWEEN THE TWO PARTIES. SALUS REPORTS A PERFORMANCE OF SERVICES TO FIDELIS. THE WRITTEN AGREEMENT SPECIFIES A FIXED DISPENSING FEE PER PHARMACY CLAIM PROCESSED. THE FEE IS AN ESTIMATE DESIGNED TO COVER DIRECT AND INDIRECT COSTS AS WELL AS A MODEST AMOUNT OF PROFIT. THE AMOUNT IS DEEMED CONSISTENT WITH AN INDEPENDENT THIRD PARTY TRANSACTION. FIDELIS REPORTS A SHARING OF FACILITIES, EQUIPMENT, AND OTHER ASSETS. THE OVERHEAD AND ADMINISTRATIVE COSTS ARE ALLOCATED BASED ON THE SHARE OF FACILITIES AND ASSETS SALUS IS DEEMED TO USE. FIDELIS SHARES PAID EMPLOYEES WITH SALUS. FIDELIS ALLOCATES SALARIES FOR EACH EMPLOYEE BASED ON THE PERCENTAGE OF TOTAL HOURS SPENT PROVIDING SERVICES TO SALUS.