2015-11-05T13:37:23-06:00 2014-12-31 420714325 RSM US LLP 1185 AVENUE OF THE AMERICAS NEW YORK NY 100362602 990 2014-01-01 134154068 AMIDA CARE INC AMID 6467577000 14 PENN PLAZA NO 2ND FL NEW YORK NY 10122 DOUGLAS WIRTH CEO 6467577000 2015-11-05 1 MARTIN GREIF P00029738 2123721000 2014 2016-03-07 17:11:31Z X DOUGLAS WIRTH 14 PENN PLAZA NO 2ND FL NEW YORK NY 10122 309240719 0 X WWW.AMIDACARENY.ORG X 2000 NY AMIDA CARE INC. IS A HEALTH MAINTENANCE ORGANIZATION FORMED TO OBTAIN A COMPREHENSIVE HIV SPECIAL NEEDS CERTIFICATE OF AUTHORITY IN ORDER TO PROVIDE OR ARRANGE FOR ALL MEDICAL ASSISTANCE SERVICES TO PERSONS ENROLLED IN THE PLAN AND FOR ASSISTING ENROLLEES IN THE PRUDENT SELECTION OF SERVICES. 9 9 277 10 0 0 920185 1240607 263795280 307993102 3867 7010 -8411 -9726 264710921 309230993 0 0 0 0 10523261 17307006 0 0 0 247408311 293376865 257931572 310683871 6779349 -1452878 53708290 56527742 30193358 34465688 23514932 22062054 X AMIDA CARE INC. IS A MEDICAID HIV SPECIAL NEEDS MANAGED CARE PLAN THAT PROVIDES ASSISTANCE AND/OR ARRANGES FOR MEDICAL CARE AND NON-MEDICAL SUPPORT FOR PERSONS ENROLLED IN THE PLAN. IN 2014, THE PLAN EXPANDED ITS SERVICES INTO THE MEDICARE ADVANTAGE PROGRAM. STAFF ALSO ASSISTS ENROLLEES IN THE PRUDENT SELECTION OF SERVICES. 1 0 275164690 306466525 AMIDA CARE IS A MEDICAID MANAGED CARE PLAN THAT PROVIDES ASSISTANCE AND/OR ARRANGES FOR MEDICAL CARE AND NON-MEDICAL SUPPORT FOR PERSONS ENROLLED IN THE PLAN. STAFF ALSO ASSISTS ENROLLEES IN THE PRUDENT SELECTION OF SERVICES. THE PLAN COVERED 72,125 MEMBER MONTHS IN 2014. 1554614 1526577 EFFECTIVE JANUARY 1, 2014, THE PLAN BEGAN PROVIDING SERVICES THROUGH ITS CONTRACT WITH THE CENTERS FOR MEDICARE AND MEDICAID (CMS) TO RECIPIENTS ELIGIBLE TO PARTICIPATE IN ONE OF THE PLAN'S THREE MEDICARE ADVANTAGE PRODUCTS. THE PRODUCTS INCLUDE MEDICARE ADVANTAGE PRESCRIPTION DRUG PLAN, MEDICARE ADVANTAGE PRESCRIPTION DRUG CHRONIC CONDITION SPECIAL NEEDS PLAN, AND MEDICARE ADVANTAGE PRESCRIPTION DRUG DUAL ELIGIBLE SPECIAL NEED PLAN. STAFF ALSO ASSISTS ENROLLEES IN THE PRUDENT SELECTION OF SERVICES. THE PLAN COVERED 898 MEMBER MONTHS FOR MEDICARE IN 2014. 276719304 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 747 0 1 277 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 NY X DOUGLAS WIRTH CEO 6467577000 14 PENN PLAZA 2ND FLOOR NEW YORK NY 10122 PAUL VITALE CHAIRPERSON 0.50 X X 0 0 0 EMMA DEVITO VICE CHAIR 0.50 X X 0 0 0 STEVEN BUSSEY SECRETARY 0.50 X X 0 0 0 TOMAS DEL RIO TREASURER 0.50 X X 0 0 0 HOLLY ARGENT-TARIQ BOARD MEMBER 0.50 X 0 0 0 CHARLES KING BOARD MEMBER 0.50 X 0 0 0 PAM MATTEL BOARD MEMBER 0.50 X 0 0 0 DR MATTHEW WEISSMAN BOARD MEMBER - FROM SEPT. 2014 0.50 X 0 0 0 SABRINA JOHNSON BOARD MEMBER 0.50 X 0 0 0 ROMANO JOHNSON BOARD MEMBER - FROM JAN. 2014 0.50 X 0 0 0 ROSLYN GILL BOARD MEMBER - THRU JAN. 2014 0.50 X 0 0 0 DOUGLAS WIRTH PRESIDENT & CEO 40.00 X 495855 0 59997 JAMES CRAMER CHIEF OPERATING OFFICER 40.00 X 184756 0 21788 JEROME A ERNST MD CHIEF MEDICAL OFFICER 40.00 X 281874 0 35866 FELICE KUSSOY CHIEF FINANCIAL OFFICER 40.00 X 241118 0 25310 MAURA MCGRATH CHIEF COMPLIANCE & PRIVACY OFFICER 40.00 X 171180 0 11504 LISA ELLEN KEEHN VP OF MEDICARE OPERATION 40.00 X 204250 0 27748 STEPHANE HOWZE OMBUDSMAN 40.00 X 163209 0 31083 KATHY FRANK-KLEIN VP OF VENDOR MANAGEMENT 40.00 X 167898 0 21259 MARIA DASILVA VP OF RISK & NETWORK MGMT 40.00 X 162515 0 19195 VIRPI RANTA DIRECTOR OF CQI 40.00 X 136956 0 17414 STEPHANIE VELUZ SR DIR OF MEDICAL INFORMATICS 40.00 X 132106 0 38461 ALEXANDRA SHUSS SENIOR DIRECTOR OF IS 40.00 X 134708 0 12017 KEVIN STEFFENS SR DIR OF HEALTH SERVICES OPERATIONS 40.00 X 127943 0 25887 TERRY LEACH VP OF PHARMACY 40.00 X 120513 0 10624 2724881 0 358153 21 0 1 0 ROYAL HEALTH CARE 810 SEVENTH AVENUE STE 801 NEW YORK NY 10019 MANAGEMENT SERVICES 2355086 STAR ADMINISTRATORS LLC 272 SW LANGELIER DRIVE FORT WHITE FL 32038 MANAGEMENT SERVICES 1276712 ROPES & GRAY LLP 800 BOYLSTON STREET SUITE 3600 BOSTON MA 021993600 LEGAL SERVICES 709953 BEACON HEALTH STRATEGIES LLC 200 STATE STREET SUITE 302 BOSTON MA 02109 MANAGEMENT SERVICES 342000 WEISERMAZARS LLP 135 WEST 50TH STREET NEW YORK NY 10020 CONSULTING SERVICES 202151 10 160775 1079832 1240607 MEDICAID PAYMENTS 900099 306466525 306466525 MEDICARE PAYMENTS 900099 1526577 1526577 307993102 7010 7010 0 160775 9726 -9726 -9726 309230993 307993102 0 -2716 2263056 2263056 12061475 12061475 203926 203926 1596200 1596200 1182349 1182349 2640275 2640275 637399 637399 105301 105301 4182956 4182956 102257 102257 1515125 1515125 163526 163526 1701680 1701680 97407 97407 166931 166931 377988 377988 498919 498919 168415 168415 PHARMACY COSTS 191279555 190823682 455873 MEDICAL SERVICES 81585207 81585207 HEALTH ASSESSMENTS & SU 4310415 4310415 UTILIZATION MANAGEMENT 1470763 1470763 2372746 2372746 310683871 276719304 33964567 0 849447 1432874 27330567 15553616 9586 121313 23579034 35162637 377535 204402 3919929 968805 665563 2951124 896558 1101776 53708290 56527742 22709706 25607036 5250000 5625000 2233652 3233652 30193358 34465688 X 23514932 22062054 23514932 22062054 53708290 56527742 -1452878 0 X 0 1 X 1 0 X 358185 804111 758965 920185 1240607 4082053 29875365 88329851 218214600 263795280 307993102 908208198 30233550 89133962 218973565 264715465 309233709 912290251 0 0 0 912290251 92379 81306 7413 3867 7010 191975 92379 81306 7413 3867 7010 191975 30325929 89215268 218980978 264719332 309240719 912482226 0.99980 0.99960 0.00020 0.00040 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 865662 73587 792075 1535555 777740 757815 1518712 117478 1401234 2951124 SUBVENTION PAYABLE TO 501(C) ORG 3233652 3233652 X 309240719 0 309240719 -9726 -9726 309230993 310693597 9726 9726 310683871 0 310683871 PART X, LINE 2: THE PLAN WAS INCORPORATED AS A NOT-FOR-PROFIT CORPORATION UNDER THE LAWS OF THE STATE OF NEW YORK AND IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THEREFORE, THERE IS NO PROVISION FOR INCOME TAXES INCLUDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. IN ADDITION, MANAGEMENT HAS ASSESSED WHETHER THERE WERE ANY UNCERTAIN TAX POSITIONS WHICH MAY GIVE RISE TO INCOME TAX LIABILITIES AND DETERMINED THAT THERE WERE NO SUCH MATTERS REQUIRING RECOGNITION IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE PLAN FILES INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION. THE PLAN IS NO LONGER SUBJECT TO U.S. FEDERAL INCOME TAX EXAMINATIONS BY TAXING AUTHORITIES FOR YEARS BEFORE DECEMBER 31, 2011. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED AGAINST FUNDRAISING REVENUE -9,726. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED AGAINST FUNDRAISING REVENUE 9,726. LIVE YOUR LIFE FUNDRAISER 160775 160775 9726 160775 160775 9726 9726 -9726 X X 0 0 0 0 0 0 0 1 0 DOUGLAS WIRTH PRESIDENT & CEO 395481 0 100000 0 374 0 34859 0 25138 0 555852 0 0 0 JAMES CRAMER CHIEF OPERATING OFFICER 179744 0 4000 0 1012 0 9427 0 12361 0 206544 0 0 0 JEROME A ERNST MD CHIEF MEDICAL OFFICER 254691 0 22500 0 4683 0 11668 0 24198 0 317740 0 0 0 FELICE KUSSOY CHIEF FINANCIAL OFFICER 219147 0 21500 0 471 0 12305 0 13005 0 266428 0 0 0 MAURA MCGRATH CHIEF COMPLIANCE & PRIVACY OFFICER 165612 0 5000 0 568 0 6415 0 5089 0 182684 0 0 0 LISA ELLEN KEEHN VP OF MEDICARE OPERATION 201552 0 2500 0 198 0 413 0 27335 0 231998 0 0 0 STEPHANE HOWZE OMBUDSMAN 157997 0 5000 0 212 0 4397 0 26686 0 194292 0 0 0 KATHY FRANK-KLEIN VP OF VENDOR MANAGEMENT 167678 0 0 0 220 0 346 0 20913 0 189157 0 0 0 MARIA DASILVA VP OF RISK & NETWORK MGMT 156899 0 5000 0 616 0 0 0 19195 0 181710 0 0 0 VIRPI RANTA DIRECTOR OF CQI 136263 0 0 0 693 0 6961 0 10453 0 154370 0 0 0 STEPHANIE VELUZ SR DIR OF MEDICAL INFORMATICS 131999 0 0 0 107 0 7067 0 31394 0 170567 0 0 0 KEVIN STEFFENS SR DIR OF HEALTH SERVICES OPERATIONS 127795 0 0 0 148 0 3423 0 22464 0 153830 0 0 0 PART I, LINE 7 THE FOLLOWING INDIVIDUALS, LISTED ON PART VII, RECEIVED A NON-FIXED PAYMENT IN THE FORM OF A BONUS DURING 2014: DOUGLAS WIRTH - $100,000 JAMES CRAMER - $4,000 JEROME A. ERNST, M.D. - $22,500 FELICE KUSSOY - $21,500 MAURA MCGRATH - $5,000 STEPHANE HOWZE - $5,000 MARIA DASILVA - $5,000 LISA ELLEN KEEHN - $2,500 FORM 990, PART III, LINE 2 PLEASE REFER TO FORM 990, PART III, LINE 4B FOR NEW PROGRAM DESCRIPTION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 FOR 2014 IS REVIEWED IN DETAIL BY THE ORGANIZATION'S CFO. ANY QUESTIONS ARISING FROM THAT REVIEW WILL BE DISCUSSED WITH THE PREPARER OF THE RETURN. SUBSEQUENT TO THE DETAILED CFO REVIEW, THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S CEO. ANY QUESTIONS ARISING FROM THAT REVIEW WILL BE DISCUSSED WITH THE CFO AND THE PREPARER OF THE RETURN, AS NEEDED. FOLLOWING CFO AND CEO REVIEW, THE FORM 990 IS REVIEWED BY THE BOARD OF DIRECTORS AT A REGULARLY SCHEDULED BOARD MEETING. THE CEO AND CFO WILL RESPOND TO ANY QUESTIONS RAISED BY THE BOARD MEMBERS. ONCE ALL QUESTIONS HAVE BEEN ANSWERED, THE BOARD, CEO AND CFO WILL APPROVE THE FINALIZATION AND FILING OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE REQUIRED ANNUALLY TO COMPLETE AND SIGN A DETAILED CONFLICT OF INTEREST DISCLOSURE STATEMENT. EMPLOYEES ARE REQUIRED TO PROMPTLY DISCLOSE ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST TO HIS OR HER SUPERVISOR (OR IN THE CASE OF THE CEO TO THE CHAIR OF THE BOARD OF DIRECTORS). MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED TO PROMPTLY DISCLOSE ANY REAL OR POTENTIAL CONFLICTS OF INTEREST TO THE CHAIR OF THE BOARD OF DIRECTORS (OR IN THE CASE THE CONFLICT IS REPORTABLE BY THE CHAIR THEN TO THE VICE CHAIR). THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY THE CHIEF COMPLIANCE & PRIVACY OFFICER WHO RECORDS ANY POTENTIAL CONFLICTS AND MONITORS BUSINESS RELATIONSHIPS BETWEEN AMIDA CARE AND THE INDIVIDUAL REPORTING A POTENTIAL CONFLICT OR ANY ORGANIZATION THAT INDIVIDUAL MAY BE AFFILIATED WITH THAT DOES BUSINESS WITH AMIDA CARE. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION'S BOARD OF DIRECTORS COMMISSIONED A CEO COMPENSATION STUDY TO ESTABLISH COMPENSATION PACKAGES FOR THE CEO. THE BOARD OF DIRECTORS CHAIR COMPLETES AN ANNUAL PERFORMANCE EVALUATION ON THE CEO AND RECOMMENDS ANY COMPENSATION ADJUSTMENTS TO THE BOARD FOR APPROVAL. THE ORGANIZATION'S CEO UTILIZES THE ASSOCIATION FOR COMMUNITY AFFILIATED PLAN ("ACAP") COMPENSATION STUDY TO ESTABLISH THE COMPENSATION OF THE MEDICAL DIRECTOR, CFO, COO AND CHIEF COMPLIANCE & PRIVACY OFFICER ("CCPO"). ACAP IS AN ASSOCIATION OF NONPROFIT MEDICAID AND MEDICARE HEALTH PLAN ORGANIZATIONS. THE ORGANIZATION'S CEO COMPLETES AN ANNUAL PERFORMANCE EVALUATION OF THE CMO, CFO, COO AND CCPO. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC, BASED UPON WRITTEN REQUEST. FORM 990 PART VI SECTION A - GOVERNING BODY AND MANAGEMENT, LINE 1A NUMBER OF VOTING MEMBERS = 9. 6 MEMBERS ARE THE DIRECTORS OF THE 6 NOT-FOR-PROFIT ORGANIZATIONS WHICH FOUNDED AMIDA CARE INC. AND 2 ARE ENROLLED MEMBERS OF THE ORGANIZATION. IN 2014, ANOTHER NON-PROFIT ORGANIZATION BECAME A MEMBER OF THE BOARD. ALL MEMBERS PARTICIPATE IN BOARD MEETINGS AND VOTE ON ALL MATTERS, EXCEPT THOSE WHICH ASSESS A FINANCIAL CONTRIBUTION REQUIREMENT, IN WHICH CASE, ONLY BOARD MEMBERS WHO REPRESENT ORGANIZATIONS WHICH WOULD BE REQUIRED TO MAKE THE FINANCIAL CONTRIBUTION MAY VOTE.