2013-11-07T10:28:36-06:00 2012-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 2600 INDIANAPOLIS IN 46204 990 2012-01-01 133330672 AFFINITY HEALTH PLAN INC % MARK CORCORAN AFFI 7187947700 2500 Halsey Street Suite Bronx NY 10461 Mark T Corcoran 2013-11-07 3176811000 2012 2016-03-07 17:11:31Z 1252503321 false X www.affinityplan.org X 1981 NY IMPROVE THE HEALTH OF UNDERSERVED POPULATIONS. 11 6 1000 0 0 0 0 960026373 1148928908 2878629 2259911 443960 95422 963348962 1151284241 0 0 0 0 53099979 59599892 0 0 0 909071062 1102793425 962171041 1162393317 1177921 -11109076 267641300 277981903 127385932 147194218 140255368 130787685 X MISSION OF AFFINITY HEALTH PLANS IS TO IMPROVE THE HEALTH OF UNDERSERVED POPULATIONS BY PROVIDING COMPREHENSIVE, AFFORDABLE, HIGH QUALITY HEALTH CARE COVERAGE, AND BY STRIVING, IN COLLABORATION WITH ITS PRIMARY CARE PROVIDERS, TO IMPROVE CARE SEEKING AND CARE GIVING. false false 893813733 0 948687764 AFFINITY HEALTH PLAN'S MEDICAID PROGRAM IS FUNDED BY THE STATE OF NY 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. 97614311 0 109230945 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. 45355859 0 54349358 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 SOLTIONS. 26949001 36660841 1063732903 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 false false false false true 6677 0 false 1000 true false false false false false false false false false false X 11 6 false false false false false false false true true false false true true true true true true true true false NY X MARK CORCORAN 7187947700 2500 HALSEY STREET BRONX NY 10461 X Amy Knapp 1.0 X Lynn Sherman 1.0 X Verona Greenland 1.0 X Yvette Walker MD 1.0 X Robert Schiller 1.0 X Paloma Hernandez 1.0 X Caleb DesRosiers 1.0 X Nanette Falkenberg 1.0 X Craig Keyes MD 1.0 X John Sardelis 1.0 X James Hooley 1.0 X Bertran L Scott 37.5 X 131820 0 5197 Mark T Corcoran 37.5 X 291748 0 43396 Maura Bluestone 37.5 X 420065 0 53256 Robert Brown 37.5 X 301886 0 20794 Munish Khaneja 37.5 X 272075 0 41146 Robert C Allen 37.5 X 281869 0 41304 Abenna Udochi 37.5 X 232624 0 39937 Caron Cullen 37.5 X 225125 0 37148 Ann M Van Etten 37.5 X 210032 0 33899 Joseph Karp 37.5 X 208170 0 7280 Stephanie Citerman 37.5 X 180850 0 33629 2756264 0 356986 73 false true false TMG Health Care PO Box 200521 PITTSBURGH PA 152510521 RETRO BILLING 1455620 Health Integrated 10008 N Dale Mabry Hwy TAMPA FL 15251 MGMT CONSULTING 950285 Express Script One Express Way HQ3W01 ST LOUIS MO 63121 ADMINISTRATIVE SVCS 844018 Green Key Resources 475 Park Ave S NEW YORK NY 10016 TEMP STAFFING 813892 First Choice Staffing 9 East 38th Street Suite 201 NEW YORK NY 10016 TEMP SERVICES 716506 19 0 NET PREMIUM REVENUE 524114 1148928908 1148928908 1148928908 1277082 1277082 0 0 101094 89664 11430 0 11430 11430 102112246 101129416 982830 982829 982829 0 0 0 MISCELLANEOUS REVENUE 900099 83992 83992 83992 1151284241 1149012900 2271341 0 0 0 0 1699464 1699464 0 45196349 45196349 1789911 1789911 7014528 7014528 3899640 3899640 0 436717 436717 450089 450089 0 0 331778 331778 49009 49009 1081233 1081233 1677515 1677515 121024 121024 0 6285525 6285525 311444 311444 0 235486 235486 981856 981856 0 6293104 6293104 564852 564852 OUTPATIENT 293754856 293754856 PHARMACY 205263654 205263654 PROFESSIONAL 183959168 183959168 INPATIENT 159635245 159635245 241360870 221119980 20240890 1162393317 1063732903 98660414 0 0 0 100082697 78169263 0 0 83128657 107688260 0 0 0 0 0 0 0 0 0 0 31838346 6293104 25053073 25545242 36470436 41509428 0 0 0 0 0 0 22906437 25069710 267641300 277981903 124857519 144444703 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2528413 2749515 127385932 147194218 X 46100435 23405984 94154933 107381701 0 0 140255368 130787685 267641300 277981903 -11109076 1641393 X false true X true true true X 94154933 13226248 107381181 105757586 -11602653 94154933 86616257 19141329 105757586 71789689 14354790 -471778 86616257 79076598 11787917 19074826 71789689 0.18810 0.81190 true false 6744735 940378 5804357 866228 297958 568270 24227384 5054769 19172615 25545242 Advances to Providers 22595034 Other Assets 2474676 25069710 0 CAPITAL LEASE OBLIGATIONS 2339826 Deferred Remt 409689 2749515 1152925633 1641392 1641392 1151284241 1151284241 1162393317 1162393317 1162393317 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 2012, THE NYSDOH AMENDED THE REGULATIONS GOVERNING THE CONTIGENT 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 false false false false false false false false false Mark T Corcoran 290716 0 0 0 1032 0 23000 0 20396 0 335144 0 0 0 Munish Khaneja 271835 0 0 0 240 0 20750 0 20396 0 313221 0 0 0 Robert C Allen 280837 0 0 0 1032 0 20750 0 20554 0 323173 0 0 0 Abenna Udochi 232383 0 0 0 240 0 23046 0 16891 0 272561 0 0 0 Caron Cullen 224093 0 0 0 1032 0 27257 0 9891 0 262273 0 0 0 Ann M Van Etten 206983 0 0 0 3048 0 25047 0 8852 0 243931 0 0 0 Joseph Karp 206387 0 0 0 1783 0 6192 0 1088 0 215450 0 0 0 Maura Bluestone 415621 0 0 0 4444 0 30000 0 23256 0 473321 0 0 0 Robert Brown 300853 0 0 0 1032 0 19540 0 1255 0 322681 0 0 0 Stephanie Citerman 179818 0 0 0 1032 0 11234 0 22395 0 214479 0 0 0 0 CHARLES B WANG COMMUNITY HEALTH CE SEE PART V 1309942 SEE PART V false MORRIS HEIGHTS HEALTH CENTER SEE PART V 3349744 SEE PART V false THE INSTITUTE FOR FAMILY HEALTH SEE PART V 2000659 SEE PART V false URBAN HEALTH PLAN SEE PART V 3601276 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: $1,309,942 DESCRIPTION OF TRANSACTION: CHARLES B. WANG COMMUNITY HEALTH CENTER IS CONTRACTED WITH AFFINITY HEALTH PLAN TO PROVIDE HEALTH CARE SERVICES TO AFFINITY'S MEMBERS AS PART OF AFFINITY'S PROVIDER NETWORK. SHARING OF ORGANIZATION'S REVENUES: NO LINE 2: NAME OF INTERESTED PERSON: MORRIS HEIGHTS HEALTH CENTER RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION: TRUSTEES FOR AFFINITY HEALTH PLAN, VERONA GREENLAND AND YVETTE WALKER, ALSO SERVE AS OFFICERS FOR THE MORRIS HEIGHTS HEALTH CENTER. AMOUNT OF TRANSACTION: $3,349,744 DESCRIPTION OF TRANSACTION: MORRIS HEIGHTS HEALTH CENTER IS CONTRACTED WITH AFFINITY HEALTH PLAN TO PROVIDE HEALTH CARE SERVICES TO AFFINITY'S MEMBERS AS PART OF AFFINITY'S PROVIDER NETWORK. 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: $2,000,659 DESCRIPTION OF TRANSACTION: THE INSTITUTE FOR FAMILY HEALTH IS CONTRACTED WITH AFFINITY HEALTH PLAN TO PROVIDE HEALTH CARE SERVICES TO AFFINITY'S MEMBERS AS PART OF AFFINITY'S PROVIDER NETWORK. 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: $3,601,276 DESCRIPTION OF TRANSACTION: THE URBAN HEALTH PLAN IS CONTRACTED WITH AFFINITY HEALTH PLAN TO PROVIDE HEALTH CARE SERVICES TO AFFINITY'S MEMBERS AS PART OF AFFINITY'S PROVIDER NETWORK. SHARING OF ORGANIZATION'S REVENUES: NO 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. DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, QUESTION 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 CONTROLLER. 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 EXPENSES FORM 990 PART IX DESCRIPTION:OTHER MEDICAL TOTAL EXPENSES:XXX-XX-XXXX PROGRAM SERVICES:XXX-XX-XXXX FUNDRAISING: OTHER EXPENSES FORM 990 PART IX DESCRIPTION:OTHER MISCELLANEOUS EXPENSES TOTAL EXPENSES:20240890 MANAGEMENT AND GENERAL:20240890