2014-11-06T12:26:17-06:00 2013-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2013-01-01 133330672 AFFINITY HEALTH PLAN INC % Glenn A MacFarlane AFFI 7187947700 2500 Halsey Street Suite Bronx NY 10461 Glenn MacFarlane Senior VP and CFO 2014-11-05 2013 2015-11-30 17:44:51Z Bertran L Scott 2500 Halsey Street Bronx NY 10461 1304086289 false X www.affinityplan.org X 1981 NY THE MISSION OF AFFINITY HEALTH PLAN IS TO IMPROVE THE HEALTH AND WELL-BEING OF ITS MEMBERS, THEIR FAMILIES, AND THEIR COMMUNITIES IN COLLABORATION WITH PRIMARY CARE PROVIDERS. 11 7 1019 0 0 0 0 1148928908 1181375348 2259911 4107792 95422 0 1151284241 1185483140 0 0 0 0 59599892 65073711 0 0 0 1102793425 1136785583 1162393317 1201859294 -11109076 -16376154 277981903 279784162 147194218 162247765 130787685 117536397 X The mission of Affinity Health Plan is to improve the health and well-being of its Members, their families, and their communities in collaboration with primary care providers. Affinity strives to be the health plan of choice for its Members and its providers -- known for assuring access to high quality, cost-effective care; delivering the best customer experience; and contributing significantly to achieving a patient-centered health care system. false false 910417988 981285147 AFFINITY HEALTH PLAN'S MEDICAID PROGRAM IS FUNDED BY THE STATE OF NEW YORK TO MANAGE THE HEALTHCARE AND RELATED COSTS OF MEDICAID PATIENTS IN NEW YORK CITY AND THE SURROUNDING COUNTIES OF NASSAU, SUFFOLK, WESTCHESTER, ROCKLAND AND ORANGE COUNTY. 98112599 109406867 THE FAMILY HEALTH PLUS (FHP) PROGRAM PROVIDES HEALTH INSURANCE COVERAGE FOR LOW INCOME SINGLE ADULTS AND ADULTS WITH CHILDREN. THE FHP PROGRAM IS ADMINISTERED UNDER AGREEMENTS WITH THE NYS DEPARTMENT OF HEALTH. 48922892 60769222 THE MEDICARE ADVANTAGE PROGRAM IS FUNDED BY THE STATE OF NEW YORK TO MANAGE THE HEALTHCARE AND RELATED COSTS OF MEDICARE PATIENTS WHO LIVE IN ONE OF THE FIVE BOROUGHS OF NEW YORK CITY. AFFINITY'S MEDICARE ADVANTAGE PROGRAM INCLUDES AFFINITY MEDICARE ULTIMATE AND AFFINITY MEDICARE SOLUTIONS. 23660187 29914113 1081113666 true false false false false false false false false true true false false true true false true false false false false false false false false false false false false true false false false false false false false true false false false false false true false false false true 5992 0 false 1019 true false false false false false false false false false false X 11 7 false false false false false false false true true false false true true true true true true true true false NY X Glenn A MacFarlane 7187947700 2500 Halsey Street Bronx NY 10461 X Caleb DesRosiers Trustee 1.0 X Craig Keyes MD Trustee 1.0 X Robert Schiller MD Trustee 1.0 X James Hooley Trustee 1.0 X Yvette Walker Trustee 1.0 X Nanette Falkenberg Trustee 1.0 X Verona Greenland Trustee 1.0 X Paloma Hernandez Trustee 1.0 X Amy Knapp Trustee 1.0 X Lynn Sherman Trustee 1.0 X John Sardelis Trustee 1.0 X Mark Corcoran EVP & Chief Financial Officer 37.5 X 295489 0 45328 Robert Brown EVP & COO (TERM 2/13) 37.5 X 203103 0 4213 Robert Allen EVP - COO 37.5 X 291649 0 33282 Bertram Scott President - CEO 37.5 X 461519 0 28650 Dr Munish Khaneja SVP - Chief Medical Officer 37.5 X 276205 0 48029 Abenna Udochi Exec Dir -State Gov't Programs 37.5 X 236941 0 39298 Ann Van Etten VP - Human Resources 37.5 X 209623 0 41247 Caron Cullen SVP - Chief Compliance Officer 37.5 X 232250 0 37086 Joseph Karp Medical Director 37.5 X 224869 0 7715 Glenn MacFarlane SVP -Strategy, Business & Prod 37.5 X 225954 0 23073 2657602 0 307921 78 false true false TMG Health Care PO Box 200521 PITTSBURGH PA 152510521 MGMT CONSULTING 1821861 Health Integrated 10008 N Dale Mabry Hwy TAMPA FL 33618 MGMT CONSULTING 2014748 Price WaterhouseCooper LLC PO BOX 7247-8001 PHILADELPHIA PA 191708001 CONSULTING SERVICES 3515726 Transaction Application Group 2300 WEST PLANO PKWY PLANO TX 75075 CONSULTING SERVICES 1550957 Weiser Mazars LLP 135 WEST 50TH STREET NEW YORK NY 10020 CONSULTING SERVICES 1521615 5 0 0 0 Medicaid 981285146 981285146 0 0 FHP 109406867 109406867 0 0 Medicare 60769222 60769222 0 0 CHP 29503373 29503373 0 0 FEDELIS 410740 410740 0 0 1181375348 1857730 1857730 0 0 0 0 0 120853211 118603149 2250062 2250062 2250062 0 0 0 0 0 0 1185483140 1181375348 0 4107792 X 0 0 0 0 0 0 0 0 1687467 0 1687467 0 0 0 0 48843232 0 48843232 0 1816920 0 1816920 0 8456706 0 8456706 0 4269386 0 4269386 0 16398782 0 16398782 0 534882 0 534882 0 455748 0 455748 0 0 0 0 0 0 0 415631 0 415631 0 5144947 0 5144947 0 3410851 0 3410851 0 2323887 0 2323887 0 4227742 0 4227742 0 0 0 0 6795427 0 6795427 0 407577 0 407577 0 0 0 0 0 187555 0 187555 0 1629179 0 1629179 0 0 0 0 0 7538621 0 7538621 0 349420 0 349420 0 INPATIENT 299373510 299373510 0 0 OUTPATIENT 179181769 179181769 0 0 Pharmacy 210006276 210006276 0 0 PROFESSIONAL 249900847 249900847 0 0 148502932 142651264 5851668 1201859294 1081113666 120745628 0 0 0 0 78169263 95235378 0 0 107688260 72130860 0 0 0 0 0 0 0 0 0 0 61167617 32977430 25545242 28190187 41509428 55382690 0 0 0 0 0 0 25069710 28845047 277981903 279784162 144444703 159914833 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2749515 2332932 147194218 162247765 X 23405984 7757872 107381701 109778525 0 0 130787685 117536397 277981903 279784162 X -16376154 2709238 415628 X false true X true true true X false false false 107381700 2396825 109778525 94154933 13226767 107381700 105757586 -11602653 94154933 86616257 19141329 105757586 71789689 14354790 -471778 86616257 0.18000 0.82000 true false 5814122 829866 4984256 3802027 3382055 419972 51551468 28765509 22785959 28190187 Advances to Providers 26097212 Other Assest 2747835 28845047 0 Capital Lease Obligation 206987 Deferred Rent 2125945 2332932 1188192378 2709238 2709238 1185483140 1185483140 1201443666 1201443666 415628 415628 1201859294 ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 1b, column A THE PLAN MUST MAINTAIN MINIMUM LEVELS OF RESTRICTED ASSETS (CONTIGENT RESERVE) AS REQUIRED BY THE NEW YORK STATE DEPARTMENT OF HEALTH (NYSDOH). THE REQUIREMENT IS RECALCULATED ANNUALLY BASED ON STATUTORY PREMIUM REVENUE FOR THE YEAR. DURING 2013, THE NYSDOH AMENDED THE REGULATIONS GOVERNING THE CONTINGENT RESERVE. THE AMENDMENT PROVIDED SPECIAL REDUCED PERCENTAGES TO BE APPLIED TO THE REVENUES FROM THE MEDICAID MANAGE CARE, CHP AND FHP PROGRAMS OFFERED BY NEW YORK STATE. X X X X true false false false false false false false false Mark Corcoran EVP & Chief Financial Officer 294457 0 0 0 1032 0 23467 0 21861 0 340817 0 0 0 Robert Brown EVP & COO (TERM 2/13) 37611 0 0 0 165492 0 3912 0 301 0 207316 0 0 0 Robert Allen EVP - COO 290617 0 0 0 1032 0 23236 0 10046 0 324931 0 0 0 Abenna Udochi Exec Dir -State Gov't Programs 236701 0 0 0 240 0 23367 0 15931 0 276239 0 0 0 Ann Van Etten VP - Human Resources 206575 0 0 0 3048 0 34294 0 6953 0 250870 0 0 0 Caron Cullen SVP - Chief Compliance Officer 231218 0 0 0 1032 0 27677 0 9409 0 269336 0 0 0 Dr Munish Khaneja SVP - Chief Medical Officer 275965 0 0 0 240 0 26010 0 22019 0 324234 0 0 0 Joseph Karp Medical Director 223015 0 0 0 1854 0 6691 0 1024 0 232584 0 0 0 Bertram Scott President - CEO 408685 0 51250 0 1584 0 4289 0 24361 0 490169 0 0 0 Glenn MacFarlane SVP -Strategy, Business & Prod 225402 0 0 0 552 0 1054 0 22019 0 249027 0 0 0 Form 990, Schedule J, Part I-13, Line 4a Recieve a severance payment or change-of-control payment A severance payment was paid to Robert Brown when he left the organization in February, 2013 CHARLES B WANG COMMUNITY HEALTH CE SEE PART V 1234781 SEE PART V false MORRIS HEIGHTS HEALTH CENTER SEE PART V 3242573 SEE PART V false THE INSTITUTE FOR FAMILY HEALTH SEE PART V 1939847 SEE PART V false URBAN HEALTH PLAN SEE PART V 3719678 SEE PART V false SUPPLEMENTAL INFORMATION SCHEDULE L, PART IV LINE 1: NAME OF INTERESTED PERSON: CHARLES B. WANG COMMUNITY HEALTH CENTER RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION: TRUSTEE FOR AFFINITY HEALTH PLAN, LYNN SHERMAN, ALSO SERVES AS AN OFFICER FOR THE CHARLES B. WANG COMMUNITY HEALTH CENTER. AMOUNT OF TRANSACTION: $1,234,781 DESCRIPTION OF TRANSACTION: AFFINITY HEALTH PLAN PROVIDES HEALTH CARE COVERAGE FOR THE CHARLES B. WANG COMMUNITY CENTER SHARING OF ORGANIZATION'S REVENUES: NO LINE 2: NAME OF INTERESTED PERSON: MORRIS HEIGHTS HEALTH CENTER RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION: TRUSTEE FOR AFFINITY HEALTH PLAN, VERONA GREENLAND, ALSO SERVE AS OFFICERS FOR THE MORRIS HEIGHTS HEALTH CENTER. AMOUNT OF TRANSACTION: $3,242,573 DESCRIPTION OF TRANSACTION: AFFINITY HEALTH PLAN PROVIDES HEALTH CARE COVERAGE FOR THE MORRIS HEIGHTS HEALTH CENTER SHARING OF ORGANIZATION'S REVENUES: NO LINE 3: NAME OF INTERESTED PERSON: THE INSTITUTE FOR FAMILY HEALTH RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION: TRUSTEE FOR AFFINITY HEALTH PLAN, ROBERT SCHILLER, ALSO SERVES AS AN OFFICER FOR THE INSTITUTE FOR FAMILY HEALTH. AMOUNT OF TRANSACTION: $1,939,847 DESCRIPTION OF TRANSACTION: AFFINITY HEALTH PLAN PROVIDES HEALTH CARE COVERAGE FOR THE INSTITUTE FOR FAMILY HEALTH SHARING OF ORGANIZATION'S REVENUES: NO LINE 4: NAME OF INTERESTED PERSON: URBAN HEALTH PLAN RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION: TRUSTEE FOR AFFINITY HEALTH PLAN, PALOMA HERNANDEZ, ALSO SERVES AS AN OFFICER FOR THE URBAN HEALTH PLAN. AMOUNT OF TRANSACTION: $3,719,678 DESCRIPTION OF TRANSACTION: AFFINITY HEALTH PLAN PROVIDES HEALTH CARE COVERAGE FOR THE URBAN HEALTH PLAN SHARING OF ORGANIZATION'S REVENUES: NO Description of Other Program Services Form 990, Part III, Line 4d THE CHILD HEALTH PLUS (CHP) PROGRAM IS FUNDED BY THE STATE OF NEW YORK TO PROVIDE HEALTH INSURANCE COVERAGE FOR CHILDREN THAT ARE UNDER THE AGE OF 19. START UP COST FOR TWO PROGRAMS MEDICAL LONG TERM CARE AND THE QUALITY HEALTH PLAN. Describe the Process to review the Form 990 Form 990, Part VI, Line 11b THE FINANCIAL STAFF COMPILES THE FINANCIAL AND OTHER INFORMATION REQUIRED IN THE 990 RETURN. ERNST & YOUNG, LLP, PREPARES THE RETURN AND THE INFORMATION IS REVIEWED BY THE COMPANY'S CFO AND SENIOR VICE PRESIDENT, STRATEGY, BUSINESS & PRODUCT DEVELOPMENT. A FINAL COPY OF THE FORM 990 IS MADE AVAILABLE TO THE ENTIRE GOVERNING BODY BEFORE FILING. DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, QUESTION 12C 1. ACTUAL OR POTENTIAL CONFLICTS OF INTEREST MUST BE DISCLOSED TO APPROPRIATE MANAGEMENT PERSONNEL, HUMAN RESOURCES OR THE CORPORATE COMPLIANCE OFFICER. 2. EMPLOYEES MUST SEEK GUIDANCE AND APPROVAL FROM APPROPRIATE MANAGEMENT PERSONNEL PRIOR TO PURSUING ANY BUSINESS OR PERSONAL ACTIVITY THAT MAY CONSTITUTE A CONFLICT OF INTEREST. 3. MANAGEMENT, WITH PURCHASING AUTHORITY, WILL COMPLETE A RELATED PARTY QUESTIONNAIRE ANNUALLY TO IDENTIFY ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST. 4. EMPLOYEES REVIEW THE CODE OF ETHICS WHICH INCLUDES INFORMATION ON CONFLICTS OF INTEREST. IN ADDITION, EMPLOYEES ARE REQUIRED TO SIGN AN ATTESTATION THAT THEY ACKNOWLEDGE AND UNDERSTOOD THE CODE OF ETHICS. OFFICERS & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN FORM 990, PART VI, QUESTION 15A AND 15B The process for determining compensation for the CEO, CFO and COO included review and approval by a Compensation Committee (the "Committee") comprised of independent directors charged with this responsibility, consideration of comparability data and contemporaneous substantiation and documentation of the deliberation and decision. Affinity Health Plan's compensation program for these positions and other officers and key employees includes established policies for job evaluation using a point factor system; merit increases; and salary actions associated with new hires, promotions, transfers and demotions. Specifically, for: a) The CEO - Compensation for the Chief Executive officer is established by the Compensation Committee and ratified by the Board of Directors of Affinity Health Plan. The Board and the Committee has established compensation terms for the CEO considering comparability data for CEO positions in similar organizations in their deliberations and decision making. These decisions are documented in accordance with legal requirements and best practices. b) Other officers and key employees - Jobs held by other officers and jobs held by key employees are evaluated using the point factor job evaluation process applicable to all jobs at Affinity Health Plan. Based on the point factor evaluation, jobs are placed in a salary grade. Merit increases are calculated through a formulaic approach based directly on the results of a formal year end performance evaluation. This program applies to all employees including other officers and key employees. Discretionary compensation decisions applicable for other officers and key employees, including promotional salary adjustments, market/equity salary adjustments and starting salaries for newly hired officers and key employees are made after review of comparability data from published sources for similar positions in the relevant labor market. Published comparability data utilized includes industry specific data. Internal data is reviewed as well with the objective of ensuring internal equity with similarly situated staff. Discretionary compensation decisions impacting those of the foregoing positions that are also deemed to be "disqualified persons" under the Internal Revenue Code (e.g., Chief Operating Officer and Chief Financial Officer) are made by the Committee (and ratified by the Board) in accordance with "intermediate sanctions safe harbor" standards utilizing the same processes as are applied to the CEO (discussed above). Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public Form 990, Part VI, Question 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 COMMISSIONS INCLUDED IN REVENUE $415,628 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:OTHER MEDICAL TOTAL EXPENSES:XXX-XX-XXXX PROGRAM SERVICES:XXX-XX-XXXX MANAGEMENT AND GENERAL:FUNDRAISING: FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:OTHER OTPS TOTAL EXPENSES:5851668 PROGRAM SERVICES:MANAGEMENT AND GENERAL:5851668 FUNDRAISING: AHP ENTERPRISES INC MGMT SVCS DE AHP C CORP 1.00000 true false false false false false false false false false false false false false false false false false false false