2015-11-13T17:10:41-06:00 2014-12-31 PricewaterhouseCoopers LLP 101 SEAPORT BOULEVARD Boston MA 02210 990 2014-01-01 237442369 Fallon Community Health Plan Inc % CHANDRAKANT MODHA FALL 5087992100 10 Chestnut Street Worcester MA 01608 R SCOTT WALKER CFO 5087992100 2015-11-11 true ERIN COUTURE P01390592 6175305000 2014 2016-03-07 17:11:31Z W Patrick Hughes 10 Chestnut Street Worcester MA 01608 1263749519 false X www.fchp.org X 1975 MA SEE SCHEDULE O 10 7 1321 323 167006 137023 138959 1195381487 1103651702 19234427 14793347 -14894944 -22753834 1199857993 1095830174 630523 850620 1058839167 952355355 82285522 86217217 0 0 0 44863213 52853933 1186618425 1092277125 13239568 3553049 433899893 426331585 222514100 210179455 211385793 216152130 X FALLON COMMUNITY HEALTH PLAN'S MISSION IS MAKING OUR COMMUNITIES HEALTHY. FCHP IS COMMITTED TO IMPROVING THE HEALTH AND WELLNESS OF OUR COMMUNITIES THROUGH THE DELIVERY OF HIGH QUALITY, AFFORDABLE CARE. false false 966685333 850620 1103651702 SEE SCHEDULE O 966685333 true true false true false false false false false false true false false false false false true true false false false false false false true false false true false true false false false false false false true true false false false false true true true true false false true 5175 0 true 1321 true true true false false false false true true false false false false X 10 7 true false false false false false false true true false false true true true true true true true true false MA X X CHANDRAKANT MODHA 5087992100 10 CHESTNUT STREET WORCESTER MA 01608 X David W Hillis Chairman 9.5 0.5 X 28500 0 0 Christian W McCarthy Treasurer/Clerk, ended 6/14 7.0 0.0 X 6500 0 0 Lynda M Young MD Vice Chair 6.5 0.5 X 21500 0 0 W Patrick Hughes President & CEO 49.0 1.0 X X 1016519 0 107512 FREDERICK MISILO ESQ CLERK 6.5 0.5 X 25500 0 0 Joseph N Stolberg Director 4.0 0.0 X 18000 0 0 Ann K Tripp TREASURER 6.5 0.5 X 22500 0 0 KARIN LANDRY DIRECTOR 4.0 0.0 X 18000 0 0 JAMES BUONOMO DIRECTOR 4.0 0.0 X 21500 0 0 B JOHN DILL DIRECTOR, EFF. 6/14 4.0 0.0 X 16500 0 0 ALAN J GAYER DIRECTOR, ended 1/14 4.0 0.0 X 2000 0 0 DAVID R GRENON DIRECTOR, ended 6/14 4.0 0.0 X 6500 0 0 W THOMAS SPENCER DIRECTOR, EFF. 6/14 4.0 0.0 X 18500 0 0 Richard P Burke Pres. Sr. Care Svc. & Gov PROG 48.0 2.0 X 465247 0 102523 LINDA ST JOHN Chief Human Resources Officer 50.0 0.0 X 281620 0 40684 R Scott Walker EVP, Chief Financial Officer 48.0 2.0 X 469925 0 93563 Richard Commander COO, ENDED 8/14 49.0 1.0 X 535134 0 15022 David Przesiek SVP, CHIEF SALES OFFICER 50.0 0.0 X 431395 0 85014 Mary Ritter EVP, COO EFFECTIVE 8/14 50.0 0.0 X 348500 0 35245 SARIKA AGGARWAL MD EVP, CHIEF MEDICAL OFFICER 49.0 1.0 X 358709 0 116415 CHRISTINE CASSIDY CHIEF COMM. OFFICER 49.0 1.0 X 229730 0 47040 FRANK BARRESI SVP, CHIEF INFORMATION OFFICER 50.0 0.0 X 357509 0 39155 Todd Bailey VP, Senior Care Services 50.0 0.0 X 291695 0 75522 Eric Hall VP, Network Development & Mgmt 50.0 0.0 X 280560 0 60777 Kevin McGovern VP, Treasurer & CAPITAL MGMT. 50.0 0.0 X 262497 0 75546 Janis Liepins VP, Marketing 50.0 0.0 X 284966 0 72205 Kevin Grozio VP, Underwriting & Actuarial 50.0 0.0 X 338676 0 93542 MATTHEW COLLINS SR. MEDICAL DIRECTOR 49.0 1.0 X 266487 0 54363 Glenn Randall MD Physician 50.0 0.0 X 280966 0 49675 David Wilner MD VP & Medical Director 50.0 0.0 X 348364 0 82769 ANN MARIE SCIAMMACCO VP, CLINICAL OPERATIONS 50.0 0.0 X 307963 0 24205 ELIZABETH HELENIUS VP, EMERGING MARKETS 50.0 0.0 X 290334 0 62631 Karen Longo VP,Exec. Dir,SE,ENDED 1/14 0.0 0.0 X 130061 0 5432 7782357 0 1338840 201 true true false UMASS MEMORIAL MEDICAL CENTER 306 BELMONT STREET WORCESTER MA 01604 HOSPITAL SERVICES 90709024 VHS ACQUISITION SUBSIDIARY P O BOX 3385 BOSTON MA 02241 HOSPITAL SERVICES 68842573 RELIANT MEDICAL GROUP 630 PLANTATION STREET WORCESTER MA 01605 MEDICAL SERVICES 60754371 BEACON HEALTH STRATEGIES LLC 200 STATE ST SUITE 302 BOSTON MA 02109 MENTAL HEALTH SVC. 27644452 UMASS MEMORIAL MEDICAL GROUP INC 306 BELMONT STREET WORCESTER MA 01604 MEDICAL SERVICES 20689842 688 138959 0 679 138959 PREMIUM 524114 1103492602 1103492602 ASO PREMIUM (INOVA) 524292 159100 159100 1103651702 10685701 10685701 0 0 79693 83307 -3614 0 -3614 -3614 171881814 167774168 4107646 4107646 4107646 64270 138959 61870 2400 2400 0 0 SUBSIDIARY LOSS 524130 -23381179 -23381179 MINORITY INTEREST 900099 620653 620653 CONSULTING & HOME STAFF 900099 7906 7906 -22752620 1095830174 1103492602 167006 -7968393 850620 850620 0 0 952355355 952355355 7217946 7217946 140493 140493 62212298 155307 62056991 2604807 2604807 8613959 37274 8576685 5427714 5427714 0 1157143 1157143 1072777 1072777 223146 223146 0 957497 957497 6682514 6682514 4085674 4085674 6487439 6487439 3079326 3079326 0 4385132 4385132 218622 218622 0 236619 236619 61748 61748 0 9623629 9623629 625643 625643 ACA TAXES 7202006 7202006 TRANSITIONAL REINSURANCE 5861625 5861625 DUES/SUBSCRIPTIONS 893393 893393 1092277125 966685333 125591792 0 0 0 14872946 7978499 0 0 18166576 12948528 0 0 0 0 0 0 0 0 1429627 1378216 81176070 42380351 43283827 38795719 346052770 366475931 0 0 0 0 0 0 10094147 -1245308 433899893 426331585 203584777 202818067 0 0 8929323 7361388 0 0 0 0 0 0 10000000 0 0 0 0 0 222514100 210179455 X 211385793 216152130 0 0 0 0 211385793 216152130 433899893 426331585 X 3553049 -3741622 4954910 X false true X true false X 181640 207375 158338 137023 138959 823335 1090378600 1096296327 1107494266 1195287317 1103492602 5592949112 0 0 0 1090560240 1096503702 1107652604 1195424340 1103631561 5593772447 1848092 1931238 2214255 2285754 2255901 10535240 54568904 59229698 68710847 70563830 89388243 342461522 56416996 61160936 70925102 72849584 91644144 352996762 5240775685 10161702 11179115 9289583 8084103 10765394 49479897 0 10161702 11179115 9289583 8084103 10765394 49479897 0 62895 64270 127165 1100721942 1107682817 1116942187 1203571338 1114461225 5643379509 0.92866 0.93511 0.00877 0.00883 X SUPPORT TEST FORM 990, SCHEDULE A, PART III RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false true false false false false true 329298 false false 329298 false Direct Lobbying Expense FORM 990, SCHEDULE C, PART IV SUPPLEMENTAL INFORMATION FCHP PAID A TOTAL OF $329,298 LOBBYING EXPENSES AS FOLLOWS: AHIP DUES (AMERICA'S HEALTH INS. PLANS) 39,595 ALLIANCE OF COMMUNITY HEALTH PLANS DUES 49,020 MAHP DUES (MASS ASSOC OF HEALTH PLANS) 83,171 NATIONAL PACE ASSOCIATION 3,360 SPILLANE & SPILLANE, LLP 48,000 _______ SUBTOTAL NON-EMPLOYEES 223,146 STAFF SALARIES ASSOCIATED WITH LOBBYING 106,152 _______ TOTAL OF ALL LOBBYING EXPENSES PAID 329,298 KEY LEGISLATIVE AND REGULATORY ISSUES IN 2014: AMERICA'S HEALTH INSURANCE PLANS (AHIP) AND ALLIANCE OF COMMUNITY HEALTH PLANS (ACHP) - LEGISLATIVE ACTIVITY IN THE HOUSE AND THE SENATE AFTER THE ENACTMENT OF THE AFFORDABLE CARE ACT (ACA) IN MARCH 2010. - REGULATORY ACTIVITY ADDRESSING IMPLEMENTATION OF NUMEROUS ACA PROVISIONS, INCLUDING INSURANCE MARKET REFORMS, RISK ADJUSTMENT, MEDICAL LOSS RATIO REQUIREMENTS, PREMIUM REVIEW, HEALTH INSURANCE EXCHANGES, DELIVERY SYSTEM REFORMS, ADMINISTRATIVE SIMPLIFICATION, HEALTH INFORMATION TECHNOLOGY, ACCOUNTABLE CARE ORGANIZATIONS (ACOS), AND THE COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS (CLASS) PROGRAM. - PUBLIC PROGRAM ISSUES AFFECTING MEDICARE ADVANTAGE, DUAL PROGRAMS, MEDICARE PART D, AND MEDICAID. - HEALTH ISSUES OUTSIDE OF THE HEALTH REFORM DEBATE INCLUDING ANTITRUST LEGISLATION, COBRA CONTINUATION COVERAGE, DATA SECURITY, MEDICAL LIABILITY REFORM, MEDICARE PHYSICIAN PAYMENT, AND THE ANNUAL APPROPRIATIONS PROCESS. SPILLANE & SPILLANE, LLP AND MASSACHUSETTS ASSOCIATION OF HEALTH PLANS (MAHP) - ANY NEW POLICIES IMPLEMENTED BY DIVISION OF INSURANCE THAT AFFECT FCHP - OTHER REGULATORY HEARINGS AND LEGISLATIVE MEETINGS THAT AFFECT HEALTHCARE POLICIES AND GUIDELINES - LEGISLATIVE MEETINGS AND INTERNAL MEETINGS ON NEW LEGISLATION THAT WILL REFORM HEALTH CARE PAYMENTS AND QUALITY - MEETINGS WITH MASSHEALTH AND MEDICAID OFFICIALS ON DUALS PROGRAMS, MMP/ONE CARE PROGRAM, INCREASING MCO MEMBERSHIP, CHANGING PAYMENT MODELS, AND BETTER MANAGING OF MEMBERS. DURING 2014, FCHP WORKED WITH THESE REGULATORY AGENCIES: DEPARTMENT OF PUBLIC HEALTH - EARLY INTERVENTION PROGRAM - INSURANCE COORDINATORS MEETINGS - CHANGES TO HOSPITAL GUIDELINES - OFFICE OF PATIENT PROTECTION - OPEN ENROLLMENT WAIVER REGULATIONS HEALTHCARE POLICY COMMISSION - COST TRENDS - TOTAL MEDICAL EXPENSES & RELATIVE PRICES TECHNICAL ADVISORY GROUP MEETINGS, CONSULTATIVE SESSIONS & REGULATIONS - HOSPITAL FINANCIAL REPORTS - TECHNICAL ADVISORY GROUP MEETINGS, - CONSULTATIVE SESSIONS & REGULATIONS DIVISION OF INSURANCE SPECIAL SESSIONS AND OTHER - GROUP PURCHASING COOPERATIVES - MEDICAL LOSS RATIO - SESSIONS AND REGULATIONS - FINANCIAL REPORTING - LIMITED & TIERED NETWORKS - OPEN ENROLLMENT - PLAN TERMINATION - RATING FACTORS - PROVIDER DIRECTORIES - PROVIDER CONTRACTING - SMALL GROUP RATE REVIEWS - CREDENTIALING - ONE-TIME SUPPLEMENTAL FUNDING PAYMENTS - TRANSPARENCY INFORMATIONAL HEARING - ADMINISTRATIVE SIMPLIFICATION PROVISIONS IN CHAPTER 288 (LEGISLATIVE AND REGULATORY ISSUE) - CODING COMMISSION EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES - WORKED WITH MASSHEALTH ON MCO ISSUES, ONE CARE PROGRAM, PACE PROGRAMS ATTORNEY GENERAL'S OFFICE - DISCUSSIONS WITH THE AG'S OFFICE ON RECOMMENDATIONS TO ADDRESS HEALTHCARE COST INCREASES 4230596 2410188 1820408 9474305 6789732 2684573 67471169 33180431 34290738 38795719 1275637000 180902068 180902068 1094734932 957497 137745 1095242 1095830174 1272084000 180902117 180902117 1091181883 957497 137745 1095242 1092277125 SCHEDULE D, PART XI, LINE 2D SUBSIDIARY ACTIVITIES & ELIMINATIONS $180,902,155 ROUNDING ON FINANCIALS ($87) --------------- TOTAL $180,902,068 SCHEDULE D, PART XI, LINE 4B CONTRA EXPENSE RECLASS TO FUNDRAISING REV $141,359 SUBLEASE LOSS RECLASS RENT EXP TO REV ($3,614) --------------- TOTAL $137,745 SCHEDULE D, PART XII, LINE 2D SUBSIDIARY ACTIVITIES & ELIMINATIONS $180,902,155 ROUNDING ON FINANCIALS ($38) --------------- TOTAL $180,902,117 SCHEDULE D, PART XII, LINE 4B CONTRA EXPENSE RECLASS TO FUNDRAISING REV $141,359 SUBLEASE LOSS RECLASS RENT EXP TO REV ($3,614) --------------- TOTAL $137,745 MA Golf Event 203229 138959 64270 679 27085 16993 17113 0 0 0 203229 138959 64270 679 27085 16993 17113 61870 2400 true Worcester Regional Chamber of Commerce 446 Main St Worcester MA 01608 041988780 501(c)(6) 67000 GENERAL SUPPORT Reliant Medical Group 100 Front St 14th fl Worcester MA 01608 222912515 501(c)(3) 15500 GENERAL SUPPORT Square One 1095 Main St fl 2 Springfield MA 01103 042103855 501(c)(3) 25550 GENERAL SUPPORT YWCA OF CENTRAL MASS INC 3 Salem Square Worcester MA 01608 042105873 501(c)(3) 8205 GENERAL SUPPORT Old Sturbridge VillAGE 1 Old Sturbridge Rd Sturbridge MA 01566 042104809 501(c)(3) 10000 GENERAL SUPPORT Worcester Regional Research Bureau 500 Salisbury Street Worcester MA 01609 042901298 501(c)(3) 5200 GENERAL SUPPORT WORCESTER COUNTY FOOD BANK INC 474 Boston Tpk Rd Shrewsbury MA 01545 043071457 501(c)(3) 7000 GENERAL SUPPORT Hanover Theatre 2 Southbridge Street Worcester MA 01608 050521735 501(c)(3) 15580 GENERAL SUPPORT Worcester Hibernian Cultural Centre 19 Temple Street Worcester MA 01604 202148447 501(c)(3) 11250 GENERAL SUPPORT Be Like Brit 24 Pommogusett Road Rutland MA 01543 271857525 501(c)(3) 5400 GENERAL SUPPORT Boys and Girls Club of Worcester 65 Tainter Street Worcester MA 01610 042105851 501(c)(3) 8457 GENERAL SUPPORT United Way of Central MA 484 Main Street Worcester MA 01608 042104017 501(C)(3) 9624 GENERAL SUPPORT Harrington Memorial Hospital 100 South Street Southbridge MA 01550 042103577 501(C)(3) 10000 GENERAL SUPPORT March of Dimes 112 Tpke Rd Ste 102 Westborough MA 01581 131846366 501(C)(3) 10250 GENERAL SUPPORT Alternatives Unlimited 50 Douglas Road Whitinsville MA 01588 042587863 501(C)(3) 7500 GENERAL SUPPORT AMERICAN HEALTH RESOURCES INC 130 Liberty Street Brockton MA 02301 200753360 501(C)(3) 23657 GENERAL SUPPORT PROVIDENCE MINISTRIES FOR THE NEEDY 51 Hamilton Street Holyoke MA 01040 042898893 501(C)(3) 20000 GENERAL SUPPORT BECKER COLLEGE 042108346 501(C)(3) 25000 GENERAL SUPPORT BERKSHIRE COUNTY ARC 395 South Street Pittsfield MA 01201 042218928 501(c)(3) 20000 GENERAL SUPPORT Mill City Grows co YWCA of Lowell 97 Central St 302 Lowell MA 01852 042105876 501(c)(3) 20000 GENERAL SUPPORT BOTTOM LINE 500 Armory ST 3 Jamaica Plain MA 02130 043351427 501(c)(3) 17500 GENERAL SUPPORT UMASS MEMORIAL FOUNDATION 333 South Street Shrewsbury MA 01545 043108190 501(c)(3) 16125 GENERAL SUPPORT WORCESTER ART MUSEUM 55 Salisbury St Worcester MA 01609 041988530 501(c)(3) 15000 GENERAL SUPPORT STEPPINGSTONE INC 522 North Main Street Fall River MA 02720 043086666 501(c)(3) 14500 GENERAL SUPPORT MARY IMMACULATE HEALTHCARE SERVICES 172 Lawrence Street Lawrence MA 01841 042857794 501(c)(3) 12500 GENERAL SUPPORT GREATER LAWRENCE COMMUNITY ACTION COUNCIL 305 Essex Street Lawrence MA 01840 042397449 501(c)(3) 11000 GENERAL SUPPORT HOLY CROSS COLLEGE One College Street Worcester MA 01610 042103558 501(c)(3) 11000 GENERAL SUPPORT QUINSIGAMOND COMMUNITY COLLEGE 670 West Boylston St Worcester MA 01606 042897624 501(c)(3) 10250 GENERAL SUPPORT NEW ENGLAND PUBLIC RADIO FOUNDATION 131 County Cir Amherst MA 01103 046130523 501(C)(3) 10000 GENERAL SUPPORT SPRINGFIELD BOYS & GIRLS CLUB 481 Carew Street Springfield MA 01104 041858620 501(C)(3) 10000 GENERAL SUPPORT STUDENTS HELPING CHILDREN ACROSS THE BORDERS Springfield Worcester MA 01610 300707429 501(C)(3) 10000 GENERAL SUPPORT DISMAS HOUSE OF MASSACHUSETTS 30 Richards Street WORCESTER MA 01603 542075825 501(C)(3) 10000 GENERAL SUPPORT WORCESTER YOUTH CENTER 326 Chandler Street WORCESTER MA 01602 043245867 501(C)(3) 10000 GENERAL SUPPORT NEW ENGLAND COUNCIL 98 N Washington St 201 BOSTON MA 02114 041661090 501(C)(6) 9500 GENERAL SUPPORT WILBRAHAM & MONSON ACADEMY 423 Main Street Wilbraham MA 01095 042105838 501(C)(3) 7800 GENERAL SUPPORT BOSTON TERRIERS FOOTBALL CORP PO Box 15187 BOSTON MA 02215 043400556 501(C)(3) 7500 GENERAL SUPPORT ABBY'S HOUSE 52 High Street WORCESTER MA 01609 042648411 501(C)(3) 7000 GENERAL SUPPORT GIRLS INC OF WORCESTER 042123666 501(C)(3) 5500 GENERAL SUPPORT CHILDRENS FRIEND INC 21 Cedar Street WORCESTER MA 01609 042105856 501(C)(3) 5250 GENERAL SUPPORT Sargent & Associates 20 Chelmsford Street Chelmsford MA 01824 043373537 501(C)(3) 5116 GENERAL SUPPORT 38 2 Form 990, Schedule I, PART I, LINE 2 Description of Organization's Procedures for Monitoring the Use of Grants FCHP GRANTS ARE CLASSIFIED EITHER AS A COMMUNITY BENEFIT GRANT OR A COMMUNITY RELATIONS GRANT. THE COMMUNITY BENEFIT GRANTS ARE VERIFIED TO ENSURE THAT EACH RECIPIENT IS A 501(C)(3) ORGANIZATION. THE COMMUNITY RELATIONS GRANTS ARE VERIFIED TO ENSURE THAT THE RECIPIENT ORGANIZATION'S IRS STATUS IS LISTED AS A TAX-EXEMPT ORGANIZATION IN THE INTERNAL REVENUE CODE SECTION 501(C). EACH RECIPIENT OF A FCHP GRANT HAS SPECIFIC INSTRUCTIONS TO BE FOLLOWED AS TO THE USE OF THE GRANT, AND THAT THE GRANT IS TO BE EXPENDED WITHIN 1 YEAR FROM THE AWARD. FOR ANY GRANTS IN EXCESS OF $10,000, fchp REQUESTS A GRANT REPORT DETAILING THE GRANT USES. THESE REPORTS ARE REVIEWED AND KEPT ON FILE AT FCHP. X true true X X X X true true false false false false false true true true MATTHEW COLLINS SR. MEDICAL DIRECTOR 229109 0 36478 900 50863 0 3500 0 320850 0 36478 0 W Patrick Hughes President & CEO 603059 0 229440 184020 88000 0 19512 0 1124031 0 229440 0 Richard P Burke Pres. Sr. Care Svc. & Gov PROG 333157 0 96910 35180 77278 0 25245 0 567770 0 96910 0 LINDA ST JOHN Chief Human Resources Officer 226938 0 53440 1242 30469 0 10215 0 322304 0 53440 0 R Scott Walker EVP, Chief Financial Officer 349412 0 93715 26798 69891 0 23672 0 563488 0 93715 0 Richard Commander COO, ENDED 8/14 165132 0 76480 293522 13000 0 2022 550156 0 76480 0 David Przesiek SVP, CHIEF SALES OFFICER 279995 0 99776 51624 59719 0 25295 0 516409 0 136331 0 Mary Ritter EVP, COO EFFECTIVE 8/14 281963 0 65129 1408 13000 0 22245 0 383745 0 65129 0 Todd Bailey VP, Senior Care Services 231946 0 54151 5598 52011 0 23511 0 367217 0 54151 0 Eric Hall VP, Network Development & Mgmt 223943 0 50837 5780 59681 0 1096 0 341337 0 50837 0 Karen Longo VP,Exec. Dir,SE,ENDED 1/14 23579 0 106482 2353 0 3079 0 135493 0 83610 0 Kevin McGovern VP, Treasurer & CAPITAL MGMT. 214335 0 41593 6569 53805 0 21741 0 338043 0 41593 0 Janis Liepins VP, Marketing 226589 0 51596 6781 55844 0 16361 0 357171 0 51596 0 Glenn Randall MD Physician 254664 0 22263 4039 29198 0 20477 0 330641 0 22263 0 David Wilner MD VP & Medical Director 295406 0 43527 9431 58393 0 24376 0 431133 0 43527 0 Kevin Grozio VP, Underwriting & Actuarial 251728 0 55279 31669 63632 0 29910 0 432218 0 55279 0 SARIKA AGGARWAL MD EVP, CHIEF MEDICAL OFFICER 307363 0 50056 1290 86150 0 30265 0 475124 0 50056 0 CHRISTINE CASSIDY CHIEF COMM. OFFICER 189842 0 38646 1242 24058 0 22982 0 276770 0 38646 0 FRANK BARRESI SVP, CHIEF INFORMATION OFFICER 289813 0 61048 6648 33160 0 5995 0 396664 0 61048 0 ANN MARIE SCIAMMACCO VP, CLINICAL OPERATIONS 144377 0 40434 123152 9802 0 14403 0 332168 0 40434 0 ELIZABETH HELENIUS VP, EMERGING MARKETS 174481 0 111628 4225 36866 0 25765 0 352965 0 0 0 FORM 990, Schedule J PART I, LINE 1 & 2 HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES. PURSUANT TO A POLICY ADOPTED AND APPROVED BY THE EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE (EECC) OF THE BOARD OF DIRECTORS, A PORTION OF THE DUES AND FEES FOR THE BUSINESS USE OF THE WORCESTER CLUB ARE PAID BY THE ORGANIZATION FOR THE FOLLOWING INDIVIDUALS: PRESIDENT & CEO, PRESIDENT OF SENIOR CARE SERVICES & GOVERNMENT PROGRAMS/CCO, EVP AND CFO, AND SENIOR VP, CHIEF SALES OFFICER. EACH EXECUTIVE IS REQUIRED TO PAY FOR HIS OR HER OWN PERSONAL USE EXPENSES, AS WELL AS A PERSONAL USE PORTION OF THE MEMBERSHIP DUES AND FEES AS DETERMINED BY THE EECC. SOCIAL CLUB DUES ARE NOT REPORTED AS TAXABLE COMPENSATION TO THE LISTED PERSONS SINCE FALLON COMMUNITY HEALTH PLAN ONLY PAYS FOR THE PORTION USED FOR BUSINESS PURPOSES. PART I, LINE 4A SEVERANCE PAYMENT FCHP PAID SEVERANCE PAYMENTS TO THE FOLLOWING INDIVIDUALS: KAREN LONGO, A FORMER KEY EMPLOYEE WAS PAID $83,610 FOR 24 WEEKS OF SEVERANCE PAY. THIS WAS PAID OVER 12 BIWEEKLY PAY PERIODS. RICHARD COMMANDER, AN OFFICER, WAS PAID A LUMP SUM PAYMENT OF $147,692 FOR 24 WEEKS OF SEVERANCE PAY. ANNMARIE SCIAMMACCO, ONE OF THE HIGHEST PAID EMPLOYEES, WAS PAID A LUMP SUM PAYMENT OF $112,563 FOR 30 WEEKS OF SEVERANCE PAY. PART I, LINE 4B SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN THE ORGANIZATION HAS A SUPPLEMENTAL EXECUTIVE RETIREMENT 457(F) PLAN THAT COVERS CERTAIN EXECUTIVES OF THE ORGANIZATION. 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. FOR 2014, 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 W. PATRICK HUGHES $176,400 NONE RICHARD P. BURKE $32,600 $32,600 DAVID PRZESIEK $50,658 $14,104 R. SCOTT WALKER $26,258 $26,258 SARIKA AGGARWAL NONE $46,200 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. SCHEDULE J, PART III, LINE 8 FCHP ENTERED INTO EMPLOYMENT CONTRACT WITH FRANK BARRESI ON AUGUST 18, 2014. THE TERMS OF HIS CONTRACT INCLUDE BASE SALARY, INCENTIVE PROGRAM, RESTRICTED ACTIVITIES OUTSIDE WORK, CONFIDENTIALITY, AND SEVERANCE PROVISION. ADCARE HOSPITAL OWNERSHIP BY DIRECTOR 2046993 SEE PART V false FAMILY MEMBER OF KEY EMPLOYEE EMPLOYEE 95794 SEE PART V false COLEBROOK REALTY SERVICES OWNERSHIP BY DIRECTOR 231571 SEE PART V false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 1140331 SEE PART V false BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS (1) NAME: ADCARE HOSPITAL RELATIONSHIP: ENTITY OWNED BY FCHP DIRECTOR, DAVID W. HILLIS, AND FAMILY MEMBERS. MR. HILLIS IS PRESIDENT, CEO AND HOLDS MAJORITY INTEREST IN ADCARE HOSPITAL OF WORCESTER, INC., A SUBSTANCE ABUSE HOSPITAL THAT PROVIDES HEALTH CARE SERVICES TO FCHP PLAN MEMBERS. MR. HILLIS ALSO HAS FAMILY MEMBERS WHO HOLD OWNERSHIP IN ADCARE HOSPITAL. FCHP PAID $22,663 TO ADCARE FOR SERVICES. ADCARE PAID $2,024,330 TO FCHP FOR HEALTH INSURANCE PREMIUMS. (2) NAME: LAURIE MCGOVERN RELATIONSHIP: FCHP EMPLOYEE WHO IS A FAMILY MEMBER OF FCHP KEY EMPLOYEE, KEVIN MCGOVERN. TOTAL COMPENSATION PAID DURING 2014 TO THE FAMILY MEMBER BY THE ORGANIZATION WAS $95,794. (3) NAME: COLEBROOK REALTY SERVICES, INC. RELATIONSHIP: B. JOHN DILL, FCHP DIRECTOR, IS PRESIDENT AND CEO OF COLEBROOK REALTY SERVICES. HE HOLDS 80% INTEREST IN THE ORGANIZATION, AND COLEBROOK PURCHASED $231,571 OF HEALTH INSURANCE FROM FCHP IN 2014. (4) RELATIONSHIP: SUBSTANTIAL CONTRIBUTOR THE COMPANY PROVIDES LEGAL AND CONSULTING SERVICES TO FCHP. TOTAL PAYMENT WAS $1,140,331. ORGANIZATION MISSION AND PROGRAM ACTIVITIES FORM 990, PART I, LINE 1 FALLON HEALTH'S MISSION IS MAKING OUR COMMUNITIES HEALTHY. FALLON HEALTH IS COMMITTED TO IMPROVING THE HEALTH AND WELLNESS OF OUR COMMUNITIES THROUGH THE DELIVERY OF HIGH QUALITY, AFFORDABLE CARE. PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A FALLON HEALTH'S PROGRAM ACTIVITIES CONSIST OF PREPAID HEALTHCARE IN THE COMMONWEALTH OF MASSACHUSETTS. THE COVERED POPULATION AT DECEMBER 31, 2014 WAS 225,830. FALLON COMMUNITY HEALTH PLAN MADE OVER $1,442,889 AVAILABLE TO PROGRAMS THAT MAKE OUR COMMUNITIES HEALTHY. THIS WAS ACCOMPLISHED THROUGH THE DISTRIBUTION OF GRANTS, CHARITABLE DONATIONS, COMMUNITY BENEFIT PROGRAMS, FUNDRAISING EVENTS, AND EMPLOYEE VOLUNTEERISM. FALLON COMMUNITY HEALTH PLAN 2014 Community Benefits Report Summary Narratives Community Benefits Mission Statement Fallon Health is committed to the vision of creating healthier lives. Since its inception in 1977, Fallon has worked to improve the quality of life and the health status of individuals by offering access to high-quality, affordable medical care and services. Fallon Health will work cooperatively with health care and community service organizations, as well as state and federal agencies, to lead the creation of innovative health care solutions, to seek healthy outcomes, and to improve access to health care services. Fallon will make resources available to community organizations as appropriate in pursuit of these goals. Program Organization and Management In accordance with the Attorney General's Community Benefits Guidelines for Health Maintenance Organizations, Fallon's Board of Directors and its President and CEO appointed Fallon staff and community representatives to serve a three-year term on the Community Benefits Committee to oversee the continued development and implementation of the Community Benefits Program. The Committee is managed by the Director of Community Relations, and reports to the Senior Vice President and Chief Communications Officer. All grant applications are reviewed by the Committee and given final approval by the President and CEO before funds are distributed. This ensures regular evaluation and oversight of the program. Community Health Needs Assessment In 2013, Fallon undertook a review of its Community Benefits Program, assessing both its goals and its grant-making methods. Using community health data and other leading health indicator studies, Fallon convened a Needs Assessment committee to review this data, and data provided by other community agencies, to gain an understanding of the most critical issues affecting communities across Massachusetts and the populations that are most in need. In response to the information gathered during this process, the Community Benefits Program adopted two new areas of focus, which are: 1. Promoting opportunities for at-risk/proven risk youth and young adults between the ages of 12 to 21 with a specific emphasis on youth preparing to age-out of the system and lose services. 2. Providing services to support individuals with behavioral and/or mental health issues with a specific emphasis on addressing the needs of the most vulnerable groups by their ethnicity, age, demographics and risk-factors. Fallon Health's Community Benefits Committee has adopted the following funding priorities for the next three years from 2013 - 2016 : (1) Good nutrition and physical activity; (2) Good health for seniors;(3) Promoting opportunities for at-risk/proven risk youth and young adults between the ages of 12-21 with a specific emphasis on youth preparing to age-out of the system and lose services; (4) Providing services to support individuals with behavioral and/or mental health issues with a specific emphasis on addressing the needs of the most vulnerable groups by their ethnicity, age, demographics and risk factors. Community Benefits Plan The Community Benefits Committee meets two times per year and reviews grant applications once per year. A Request for Proposals for the Community Benefits Grants is mailed to organizations that have applied in previous years, a release is sent to all media outlets and it is also posted on the Fallon Health website. Fallon Health's Community Benefits Committee reviews all grants and selects those programs that align best and focus on at least one of the identified funding priorities to receive grants and support from the available funds. Key Accomplishments of the Reporting Year In 2014, Fallon Health made $1,442,889 available to programs that met the goals of Fallon's Community Benefits Program's areas of focus. This was accomplished through the distribution of over $780,000 in support of the Community Benefit program's area of focus that involved direct expenses, leveraged expenses, staff and volunteer time. We also supported other philanthropic initiatives totaling approximately $699,000 in community sponsorships. In 2014, Fallon Health hosted the ninth annual Golf & Gather FORE a Cause. This fundraising event raised approximately $203,229 in gross receipts, with net revenues exceeding $138,959 which were distributed to more than 100 food pantries, food banks and hunger relief programs throughout Massachusetts. An additional $10,000 was distributed directly through CVS Caremark Foundation resulting from their indirect support of the golf event. Plans for Next Reporting Year Fallon Health is committed to an ongoing re-evaluation of its funding priorities and assessment of the health needs across our service area. In 2016, we will re-conduct another full community needs assessment to determine any future health issues and/or new focuses for our Funding priorities that support our mission of making communities healthy. FORM 990, PART VI, LINE 2 FAMILY OR BUSINESS RELATIONSHIP BETWEEN OFFICERS, DIRECTORS, AND KEY EMPLOYEES. HOME STAFF LLC IS A JOINT VENTURE OF FCHP AND THE VNA CARE NETWORK & HOSPICE. THE FOLLOWING FCHP BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES SERVED ON THE HOME STAFF BOARD OF DIRECTORS DURING 2014: W. PATRICK HUGHES, RICHARD P. BURKE, AND TODD BAILY. FALLON HEALTH & LIFE ASSURANCE COMPANY, INC. (FHLAC), IS A WHOLLY-OWNED SUBSIDIARY OF FCHP. THE FOLLOWING FCHP BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES SERVED ON THE FHLAC BOARD OF DIRECTORS IN 2014: DAVID HILLIS, LYNDA YOUNG, ANN TRIPP, FREDERICK MISILO, W. PATRICK HUGHES, AND R. SCOTT WALKER. ULTRABENEFITS, INC. (UBI) IS A WHOLLY-OWNED SUBSIDIARY OF FHLAC. THE FOLLOWING FCHP BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES SERVED ON THE UBI BOARD OF DIRECTORS IN 2014: W. PATRICK HUGHES, R. SCOTT WALKER, AND DAVID PRZESIEK. PART VI, LINE 11B THE PROCESS USED BY MANAGEMENT AND GOVERNING BODY TO REVIEW FORM 990. A DRAFT OF THE FORM 990 WAS PREPARED BY FCHP'S PAID PREPARER USING INFORMATION PROVIDED BY THE ORGANIZATION. THIS DRAFT WAS REVIEWED BY FCHP'S VICE PRESIDENT OF ACCOUNTING OPERATIONS & FINANCIAL PLANNING ANALYSIS, AND SENIOR MANAGEMENT, INCLUDING THE CHIEF FINANCIAL OFFICER, CHIEF COMPLIANCE OFFICER, CHIEF HUMAN RESOURCES OFFICER, AND CHIEF EXECUTIVE OFFICER. AFTER THIS REVIEW A FINAL FORM 990 WAS PREPARED, AND THE FINAL VERSION OF THE FORM 990 WAS PROVIDED TO EACH BOARD MEMBER FOR HIS OR HER REVIEW BEFORE THE FORM 990 WAS FILED WITH THE IRS. FORM 990, PART VI, LINE 12C THE PROCESS USED TO MONITOR CONFLICTS OF INTEREST. FCHP'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 WHICH REPORTS ANY ACTUAL OR POTENTIAL CONFLICTS TO THE FULL BOARD. 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 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. FCHP ALSO REQUIRES ALL DIRECTORS, OFFICERS, AND KEY EMPLOYEES TO COMPLETE A WRITTEN DISCLOSURE STATEMENT DESIGNED TO IDENTIFY POTENTIAL CONFLICTS. FCHP 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. FORM 990, PART VI, LINES 15A & 15b PROCESS OF DETERMINING COMPENSATION FOR CEO, TOP MANAGEMENT OFFICIALS, OFFICERS, AND KEY EMPLOYEES. 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 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 2014, THE COMMITTEE CONSISTED OF THREE 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 2014, TO DETERMINE THE COMPENSATION STRUCTURE OF THE EXECUTIVE GROUP, THE COMMITTEE RELIED ON A WRITTEN COMPENSATION SURVEY PRODUCED BY AN INDEPENDENT CONSULTING FIRM THAT ASSESSES EXECUTIVE COMPENSATION AND BENEFITS. THE COMMITTEE MET TO REVIEW THE COMPENSATION STRUCTURE OF THE EXECUTIVE GROUP AND REVIEWED THE COMPENSATION SURVEY PREPARED BY THE INDEPENDENT CONSULTING FIRM. 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 2014. THIS PROCESS WAS NOT USED TO ESTABLISH COMPENSATION FOR THE "KEY EMPLOYEES" LISTED IN SCHEDULE J. FORM 990, PART VI, LINES 18 AND 19 HOW DOCUMENTS ARE MADE AVAILABLE TO PUBLIC. FCHP'S FORM 990 AND ANNUAL AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE GENERAL PUBLIC ON THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE. FCHP'S ANNUAL REPORT IS AVAILABLE ON ITS OWN WEBSITE. FCHP'S 990, FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND ANNUAL REPORT ARE ALSO PROVIDED UPON REQUEST. FORM 990, PART XI, LINE 9 ADJUSTMENT TO NET ASSETS: ADJUSTMENT TO FHW BEGINNING BALANCE $5,575,559 NONCONTROLLING INTEREST FHW $(620,653) SYSTEM ROUNDING $4 __________ TOTAL ADJUSTMENT TO NET ASSETS $4,954,910 ***FALLON HEALTH WEINBERG, INC. (FHW) IS A JOINT VENTURE BETWEEN FCHP, its SUBSIDIARY, FCHP NEW YORK, LLC AND MENORAH CAMPUS, INC., ANOTHER TAX EXEMPT ORGANIZATION. FCHP NEW YORK LLC 10 CHESTNUT ST WORCESTER MA 01608 464193932 HEALTH CARE NY 0 0 FCHP SUMMIT LIVING INC 10 CHESTNUT STREET WORCESTER MA 01608 261836279 ASST LIVING MA 501(C)(3) 11A fchp true FALLON TOTAL CARE INC 10 CHESTNUT STREET WORCESTER MA 01608 455591420 HEALTH CARE MA 501(C)(3) 9 FCHP true FALLON HEALTH WEINBERG INC 2700 NORTH FOREST RD GETZVILLE NY 14068 161580245 HEALTH CARE NY 501(C)(3) 9 FCHP true FALLON HEALTH & LIFE ASSURANCE COMPANY 10 CHESTNUT STREET WORCESTER MA 01608 043169246 HLTH & LIFE MA FCHP C CORP 48698975 32420813 1.00000 true ULTRABENEFITS INC 29 EAST MOUNTAIN STREET WORCESTER MA 01606 043525752 3RD PARTY ADM MA FHLAC C CORP 11967300 1758063 1.00000 true true true false true true false true false false true true true true true true false false true false ULTRABENEFITS INC A IV 65000 CASH FALLON HEALTH & LIFE ASSURANCE CO INC B 12950000 CASH FALLON HEALTH WEINBERG INC B 2200000 CASH FALLON TOTAL CARE INC E 7000000 CASH FALLON TOTAL CARE INC G 894804 CASH ULTRABENEFITS INC J 65000 CASH FALLON TOTAL CARE INC K 173549 CASH ULTRABENEFITS INC L 198300 CASH FALLON HEALTH WEINBERG INC L 1362701 CASH ULTRABENEFITS INC M 278794 CASH FALLON HEALTH & LIFE ASSURANCE CO INC N 3876459 CASH FALLON HEALTH & LIFE ASSURANCE CO INC O 5814688 CASH FALLON TOTAL CARE INC O 3307903 CASH Schedule R, Part V LINE 1D FALLON COMMUNITY HEALTH PLAN, INC., (FCHP) IS THE GUARANTOR OF FALLON TOTAL CARE INC., (FTC). THE AGREEMENT WAS COMPLETED IN ORDER TO MEET THE FINANCIAL SOLVENCY REQUIREMENT OF FTC, WHICH WAS REQUIRED BY THE COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES (EOHHS) AS PART OF THE FTC DEMONSTRATION PROGRAM APPLICATION PROCESS. FCHP UNCONDITIONALLY GUARANTEES THE UNMET FINANCIAL OBLIGATIONS, AND NO DOLLAR AMOUNTS ARE SPECIFIED.