2013-01-21T14:52:13-06:00 2011-12-31 GRANT THORNTON LLP 666 THIRD AVENUE NEW YORK NY 100174057 990 2011-01-01 131828429 Health Insurance Plan of Greater New York % ARTHUR BYRD HEAL 6464475000 55 WATER STREET NEW YORK NY 10041 craig wiley 2013-01-18 true 2125990100 2011 2016-02-25 16:41:14Z ANTHONY L WATSON 55 WATER STREET NEW YORK NY 10041 4796043325 false X WWW.EMBLEMHEALTH.COM X 1944 NY HEALTH INSURANCE PLAN OF GREATER NEW YORK IS COMMITTED TO PROVIDING AFFORDABLE, QUALITY HEALTH COVERAGE IN WAYS THAT RESPECT AND RESPOND TO PEOPLE'S FUNDAMENTAL NEEDS AT PRICES THEY CAN AFFORD. 12 10 412 0 3013931 0 0 4903335816 4729574904 43200127 60567125 8814884 3143523 4955350827 4793285552 0 0 0 0 248850948 243042998 0 0 0 4467262403 4343475853 4716113351 4586518851 239237476 206766701 1807356420 1987023881 711491170 715560436 1095865250 1271463445 X HEALTH INSURANCE PLAN OF GREATER NEW YORK IS COMMITTED TO PROVIDING AFFORDABLE, QUALITY HEALTH COVERAGE IN WAYS THAT RESPECT AND RESPOND TO PEOPLE'S FUNDAMENTAL NEEDS. HIP PURSUES ITS MISSION BY PROVIDING A CHOICE OF PRODUCTS AND NETWORKS SO MEMBERS HAVE ACCESS TO THE MEDICAL CARE THEY NEED AT PRICES THEY CAN AFFORD. THE ORGANIZATION DOES THIS BY IMPROVING THE HEALTH OF MEMBERS THROUGH WELLNESS PROGRAMS THAT FOSTER PREVENTION AND HEALTHIER LIVING AND BY USING TECHNOLOGY TO EASE ACCESS TO INFORMATION AND SERVICES. false false 1500215681 1800150098 MEDICARE - HIP SERVED APPROXIMATELY 113,000 MEDICARE MEMBERS THROUGH its MEDICARE RISK AND COST CONTRACT PROGRAMS. 700323582 818315660 MEDICAID - HIP SERVED APPROXIMATELY 200,000 MEDICAID MEMBERS. HIP HAS BEEN SERVICING THE MEDICAID POPULATION SINCE 1967 (WITH THE PASSAGE OF FEDERAL LEGISLATION AUTHORIZING THIS PROGRAM) AND HAS AN EXTENSIVE PROGRAM IN PLACE TO ENCOURAGE PREVENTIVE MEDICAL CARE. 1719818704 1962218382 SUBSCRIBER BENEFITS - HIP OF GREATER NEW YORK IS A NOT-FOR-PROFIT CORPORATION THAT ARRANGES FOR THE PROVISION OF COMPREHENSIVE MEDICAL AND HEALTH CARE SERVICES FOR ITS SUBSCRIBERS/MEMBERS (INCLUDING HEALTH CARE SERVICES TO MEDICARE AND MEDICAID MEMBERS) WHICH IS AN EXEMPT FUNCTION. 31540948 35042736 CHIPS (See Schedule O) 88609833 102004092 FAMILY HEALTH PLUS (See Schedule O) 12827354 12838855 HEALTHY NEW YORK (See Schedule O) 5442752 -644887 Other Program Service Activities 138420887 149240796 4058778854 false false true false false false false false false true false false true true true false true false false true false false false false false false false false true false false false false false true true false false false false false false true true true false true 868 0 true 412 true true true false false false false false X 12 10 true false false false true false false true true false false true true true true true true true true true true NY X ARTHUR BYRD 6464475000 55 WATER STREET NEW YORK NY 10041 X ROBERT W BROKAW 2.0 X 26668 0 0 David J Cooper 2.0 X 0 0 0 KAREN J DAVIS 2.0 X 11946 0 0 Gregory E Floyd 2.0 X 0 0 0 ELAINE FRIEDMAN 2.0 X 6144 0 0 PAUL E GIBSON 2.0 X 40790 121963 0 Oliver J Gray 2.0 X 0 0 0 RONALD C JONES 2.0 X 5802 0 0 YUNGMAN F LEE 2.0 X 42113 0 0 Carmelo Mallia 2.0 X 0 0 0 JOHN J O'CONNOR 2.0 X 26668 0 0 Margaret T Pan-Loo 2.0 X 0 0 0 CHARLES P WANG 2.0 X 19136 113213 0 Anthony L Watson 35.0 X X 0 4726111 4120384 David M Weiss 2.0 X David S Abernethy 35.0 X 0 712160 597948 Rachel A Amalfitano 35.0 X 0 525665 4335 George Babitsch 35.0 X 0 576266 484975 Lynn M Balducci 35.0 X 0 313708 226869 Frank J Branchini 35.0 X 0 3903143 2310882 Robert Branchini 35.0 X 0 436566 262262 Arthur Byrd 35.0 X 0 459888 230552 Daniel Byrne 35.0 X 0 254899 102598 Jeffrey D Chansler 35.0 X 0 650447 561962 Sunny P Chiu 35.0 X 0 371599 290635 Michael Della Iacono 35.0 X 0 391911 146545 Marilyn DeQuatro 35.0 X 0 560543 664172 Kerry S DeWitt 35.0 X 0 301625 121681 Mohamed Diab 35.0 X 0 348679 117788 Jose R Diaz 35.0 X 0 317779 217644 Mariann E Drohan 35.0 X 0 401953 180761 William T Dunne 35.0 X 0 173649 1712 Thomas K Dwyer 35.0 X 0 716215 868432 Daniel P Finke 35.0 X 0 1204602 958464 Shawn M Fitzgibbon 35.0 X 0 488874 280515 Michael D Fullwood 35.0 X 0 1872337 2661006 Raymond Gannon Jr 35.0 X 0 475480 88821 Michael R Giaquinto 35.0 X 0 114926 41344 William A Gillespie 35.0 X 0 603748 364214 Philip J Gillich 35.0 X 0 333869 139437 Jefferson C Grahling 35.0 X 0 405212 79809 James Greenidge 35.0 X 0 408664 257881 Richard R Gross 35.0 X 0 324659 154736 Vincent A Hartmann 35.0 X 0 313758 162249 Nicholas P Kambolis 35.0 X 0 417613 255117 John A Kennedy 35.0 X 0 337802 116655 Erhard V Krause 35.0 X 0 261115 533473 William C Lamoreaux 35.0 X 0 676402 387639 Stuart Lefkowich 35.0 X 0 340432 144256 Williams Lewis 35.0 X 0 394213 231299 Dennis B Liotta MD 35.0 X 0 388900 206043 Carl A Lund 35.0 X 0 317496 140155 Katherine Magill 35.0 X 0 326739 112654 John D Mahder 35.0 X 0 192346 54561 Charlene A Maher 35.0 X 0 438814 190827 Edward Mailander 35.0 X 0 448786 181444 Ilene D Margolin 35.0 X 0 640288 553222 Ernesto Marrero Jr 35.0 X 0 31972 741 David Mascia 35.0 X 0 448880 68989 William Mastrogiacomo 35.0 X 0 585087 500537 Peter S Moore 35.0 X 0 284511 204800 David J Morin 35.0 X 0 292827 229271 Chester E Moskal 35.0 X 0 296333 273237 Thomas A Nemeth 35.0 X 0 544337 493468 Michael Palmateer 35.0 X 0 681679 1498150 Michelle Podolak 35.0 X 0 237712 111818 Michele A Powers 35.0 X 0 347037 168860 Valerie A Reardon 35.0 X 0 567201 476747 David Reimer 35.0 X 0 553590 72121 Robert Ronda 35.0 X 0 438043 396235 Joan Ruby 35.0 X 0 386187 237611 Sharon J Schmerzler 35.0 X 0 599608 132824 Jill A Serin 35.0 X 0 271657 10768 Karen Smith-Hagman 35.0 X 0 363281 147641 Mary Ellen Soul 35.0 X 0 88278 31424 John H Steber 35.0 X 0 1427811 2217398 Jennifer L Truscott 35.0 X 0 175467 78018 Pedro J Villalba 35.0 X 0 676332 648001 Wanda Wareham 35.0 X 0 333080 289102 John White 35.0 X 0 249627 158966 Craig M Willey 35.0 X 0 404120 202926 William Yurkowski 35.0 X 0 378043 168857 Joseph Zeitlin 35.0 X 0 385906 149426 Stephen A Zeng 35.0 X 0 387044 233007 Eliza Ng 35.0 X 0 330713 130372 Eleanor M Sorrentino 35.0 X 0 314516 115211 Bruce Sosler 35.0 X 0 330284 113586 Raymond P Vacca 35.0 X 0 421230 191076 David Yokell 35.0 X 0 350205 131539 179267 41287655 29690685 5 false true false OmniClaim 300 Unicorn Park WOBURN MA 01801 Construction 962987 Strategic Products Services 501 Fashion Avenue NEW YORK NY 10018 Consulting 216678 The Premier Group 274 Madison Avenue NEW YORK NY 10016 Legal 207007 Bio-Bright LLC 71 South Central Avenue VALLEY STREAM NY 11580 Audit 170448 HUDSON GLOBAL RESOURCE MANAGEMENT 560 LEXINGTON AVENUE 4TH FLOOR NEW YORK NY 10022 CONSULTING 110892 7 0 PREMIUM REVENUE 900099 4727924042 4727920146 3896 GROUP SERVICES & ADMIN FEE INCOME 900099 1650862 1650862 4729574904 27612672 2400000 25212672 0 0 3367808 2757773 610035 610035 610035 32952188 5207 32952188 5207 32954453 32954453 0 0 0 PHARMACY BENEFIT MANAGER INCOME 900099 1630435 1630435 MISCELLANEOUS REVENUE 900099 903053 903053 2533488 4793285552 4731201443 3013931 59070178 0 0 0 0 39540707 39540707 0 143745848 143745848 16147777 16147777 30294630 30294630 13314036 13314036 0 6795360 6795360 3544074 3544074 508494 508494 0 2781564 2781564 65806730 65806730 13341170 13341170 9112493 9112493 0 0 24311693 24311693 4447491 4447491 0 0 3670920 3670920 0 18749929 18749929 2945609 2945609 SUBSCRIBER BENEFITS 4043315948 4043315948 EQUIPMENT EXPENSE 32215671 32215671 OUTSOURCED SERVICES 24331958 24331958 BROKERS COMMISSIONS 23193582 23193582 64403167 15462906 48940261 4586518851 0 527739997 0 1476588 1100621 163425394 367335042 0 0 221006321 198994911 0 0 0 0 115000000 125000000 1193082 1123935 3304228 4019382 584637504 369292035 238763270 215345469 891228122 879135495 39950636 0 0 0 0 0 132008779 194969026 1807356420 1987023881 516296880 481310510 0 0 13450801 11476568 0 0 0 0 0 0 0 0 0 0 181743489 222773358 711491170 715560436 X 1095865250 1271463445 0 0 0 0 1095865250 1271463445 1807356420 1987023881 X 206766701 -31168506 X false true true X false 0 false EmblemHealth New York PAC 55 Water Street New York NY 10041 320150872 0 8500 Schedule C - Political Activities Health Insurance Plan of Greater New York does not undertake any political activities; in 2011, the organization was allocated $8,500 in PAC Fund contributions made by a related party, EmblemHealth Services, LLC. 7023614 7023614 147013446 67108783 79904663 201491078 99065281 102425797 96881694 77314242 19567452 132227672 125803729 6423943 215345469 OTHER RECEIVABLES 1296381 DEFERRED RENT 2549613 INTEREST/DIVIDENDS RECEIVABLE 6044492 OTHER CURRENT ASSETS 5894398 HEALTHCARE RECEIVABLES 63472619 INTERCOMPANY RECEIVABLES 106715988 POOLED RECEIVABLES 8995535 194969026 0 SUBLEASE LOSS (34TH STREET) 1290247 PENSION LIABILITY 138082478 WORLD TRADE CENTER DISASTER RECOVERY 871119 DEFERRED RENT 73960358 OTHER LONG TERM LIABILITIES 8569156 222773358 FIN 48 DISCLOSURE SCHEDULE D, PART X The organization's consolidated audited financial statements contain a modified version of the original Fin-48 footnote included when it initially adopted FIN-48: In July 2006, the Financial Accounting Standards Board (FASB) issued Interpretation No. 48, Accounting for Uncertainty in Income Taxes, an Interpretation of SFAS Statement No. 109 (FIN No. 48). Among other things, FIN No. 48 creates a model to address uncertainty in tax positions and clarifies the accounting for income taxes by prescribing minimum recognition thresholds which all income tax positions must achieve before being recognized in the financial statements. In addition, FIN No. 48 requires expanded annual disclosures, including a reconciliation of the beginning and ending aggregate unrecognized tax benefits as well as specific detail related to tax uncertainties for which it is reasonably possible the amount of unrecognized tax benefit will significantly increase or decrease within 12 months. Any tax differences between the amounts recognized in the statements of financial position prior to the adoption of FIN No. 48 and the amounts reported after adoption are generally accounted for as a cumulative-effect adjustment recorded to the beginning balance of retained earnings. Effective January 1, 2007, the Company adopted FIN No. 48, which did not have any impact on the Company's consolidated financial statements. The Company does not have any unrecognized tax benefits as of or for the year ended December 31, 2011. Europe (Including Iceland and Greenland) Investments 35707207 East Asia and the Pacific Investments 3518968 North America Investments 13481155 Central America and the Caribbean Investments 1972974 54680304 54680304 false false false false false false Schedule F, Part 1 HIP-NY does not conduct any activities outside the United States. In accordance with the instructions to the Form 990, the organization is reporting the market value of non-U.S. investments. X X X X true true X X X X X true true false false false true false false false PAUL E GIBSON 40790 121963 0 0 0 0 0 0 0 0 40790 121963 0 0 David S Abernethy 0 314768 0 367710 0 29682 0 594716 0 3232 0 1310108 0 0 Rachel A Amalfitano 0 59939 0 188363 0 277363 0 3640 0 695 0 530000 0 0 George Babitsch 0 255069 0 297413 0 23784 0 481544 0 3431 0 1061241 0 0 Lynn M Balducci 0 209217 0 88920 0 15571 0 221766 0 5103 0 540577 0 0 Frank J Branchini 0 926914 0 2415850 0 560379 0 2309796 0 1086 0 6214025 0 0 Robert Branchini 0 238869 0 169195 0 28502 0 257631 0 4631 0 698828 0 0 Arthur Byrd 0 265368 0 177036 0 17484 0 222420 0 8132 0 690440 0 0 Daniel Byrne 0 176211 0 78165 0 523 0 92517 0 10081 0 357497 0 0 Jeffrey D Chansler 0 283592 0 335265 0 31590 0 557554 0 4408 0 1212409 0 0 Sunny P Chiu 0 199583 0 143206 0 28810 0 282218 0 8417 0 662234 0 0 Michael Della Iacono 0 237000 0 149673 0 5238 0 146545 0 0 0 538456 0 0 Marilyn DeQuatro 0 236914 0 281190 0 42439 0 663086 0 1086 0 1224715 0 0 Kerry S DeWitt 0 136572 0 123643 0 41410 0 118996 0 2685 0 423306 0 0 Mohamed Diab 0 231442 0 99450 0 17787 0 110730 0 7058 0 466467 0 0 Jose R Diaz 0 163792 0 118638 0 35349 0 214916 0 2728 0 535423 0 0 Mariann E Drohan 0 215272 0 156180 0 30501 0 178033 0 2728 0 582714 0 0 William T Dunne 0 160261 0 0 0 13388 0 0 0 1712 0 175361 0 0 Thomas K Dwyer 0 310622 0 367710 0 37883 0 861054 0 7378 0 1584647 0 0 Daniel P Finke 0 455069 0 724755 0 24778 0 955033 0 3431 0 2163066 0 0 Shawn M Fitzgibbon 0 285518 0 173600 0 29756 0 278033 0 2482 0 769389 0 0 Michael D Fullwood 0 539514 0 1286150 0 46673 0 2659623 0 1383 0 4533343 0 0 Raymond Gannon Jr 0 85421 0 197505 0 192554 0 84335 0 4486 0 564301 0 0 Michael R Giaquinto 0 89335 0 20000 0 5591 0 39914 0 1430 0 156270 0 0 William A Gillespie 0 355272 0 212800 0 35676 0 361486 0 2728 0 967962 0 0 Philip J Gillich 0 181183 0 130151 0 22535 0 137118 0 2319 0 473306 0 0 Jefferson C Grahling 0 155286 0 96267 0 153659 0 71595 0 8214 0 485021 0 0 James Greenidge 0 216489 0 154840 0 37335 0 257881 0 0 0 666545 0 0 Richard R Gross 0 245887 0 47769 0 31003 0 149408 0 5328 0 479395 0 0 Vincent A Hartmann 0 161494 0 122563 0 29701 0 157441 0 4808 0 476007 0 0 Nicholas P Kambolis 0 237118 0 162688 0 17807 0 249985 0 5132 0 672730 0 0 John A Kennedy 0 267668 0 45683 0 24451 0 114173 0 2482 0 454457 0 0 Erhard V Krause 0 185044 0 47457 0 28614 0 530745 0 2728 0 794588 0 0 William C Lamoreaux 0 404755 0 238000 0 33647 0 383895 0 3744 0 1064041 0 0 Stuart Lefkowich 0 180431 0 133518 0 26483 0 141528 0 2728 0 484688 0 0 Williams Lewis 0 214184 0 156180 0 23849 0 227483 0 3816 0 625512 0 0 Dennis B Liotta MD 0 253624 0 109200 0 26076 0 201667 0 4376 0 594943 0 0 Carl A Lund 0 200977 0 87750 0 28769 0 138132 0 2023 0 457651 0 0 Katherine Magill 0 214947 0 93600 0 18192 0 103873 0 8781 0 439393 0 0 John D Mahder 0 95912 0 75000 0 21434 0 52581 0 1980 0 246907 0 0 Charlene A Maher 0 300272 0 106167 0 32375 0 188099 0 2728 0 629641 0 0 Edward Mailander 0 292222 0 150000 0 6564 0 176031 0 5413 0 630230 0 0 Ilene D Margolin 0 267272 0 309733 0 63283 0 545494 0 7728 0 1193510 0 0 David Mascia 0 381139 0 45683 0 22058 0 62908 0 6081 0 517869 0 0 William Mastrogiacomo 0 254001 0 302821 0 28265 0 496536 0 4001 0 1085624 0 0 Peter S Moore 0 147205 0 112729 0 24577 0 200755 0 4045 0 489311 0 0 David J Morin 0 152569 0 112228 0 28030 0 225840 0 3431 0 522098 0 0 Chester E Moskal 0 157289 0 113192 0 25852 0 272151 0 1086 0 569570 0 0 Thomas A Nemeth 0 236764 0 270375 0 37198 0 484732 0 8736 0 1037805 0 0 Michael Palmateer 0 300592 0 351488 0 29599 0 1495742 0 2408 0 2179829 0 0 Michelle Podolak 0 120272 0 94411 0 23029 0 109090 0 2728 0 349530 0 0 Michele A Powers 0 231814 0 97500 0 17723 0 167174 0 1686 0 515897 0 0 Valerie A Reardon 0 256360 0 281190 0 29651 0 471773 0 4974 0 1043948 0 0 David Reimer 0 132819 0 234255 0 186516 0 65417 0 6704 0 625711 0 0 Robert Ronda 0 194376 0 208984 0 34683 0 391611 0 4624 0 834278 0 0 Joan Ruby 0 209868 0 150965 0 25354 0 229479 0 8132 0 623798 0 0 Sharon J Schmerzler 0 118679 0 197575 0 283354 0 127344 0 5480 0 732432 0 0 Jill A Serin 0 225313 0 40000 0 6344 0 8195 0 2573 0 282425 0 0 Karen Smith-Hagman 0 201817 0 136948 0 24516 0 141458 0 6183 0 510922 0 0 John H Steber 0 451027 0 938840 0 37944 0 2215424 0 1974 0 3645209 0 0 Jennifer L Truscott 0 160848 0 0 0 14619 0 76932 0 1086 0 253485 0 0 Pedro J Villalba 0 295518 0 351488 0 29326 0 640519 0 7482 0 1324333 0 0 Wanda Wareham 0 177984 0 130150 0 24946 0 282086 0 7016 0 622182 0 0 Anthony L Watson 0 995518 0 3621770 0 108823 0 4112902 0 7482 0 8846495 0 0 John White 0 124567 0 100918 0 24142 0 150533 0 8433 0 408593 0 0 Craig M Willey 0 225146 0 156180 0 22794 0 196405 0 6521 0 607046 0 0 William Yurkowski 0 203068 0 149673 0 25302 0 163926 0 4931 0 546900 0 0 Joseph Zeitlin 0 272518 0 107250 0 6138 0 146944 0 2482 0 535332 0 0 Stephen A Zeng 0 218775 0 150965 0 17304 0 228282 0 4725 0 620051 0 0 Eliza Ng 0 214478 0 99225 0 17010 0 123343 7029 7029 7029 461085 0 0 Eleanor M Sorrentino 0 185654 0 105088 0 23774 0 112690 0 2521 0 429727 0 0 Bruce Sosler 0 226412 0 100643 0 3229 0 111316 0 2270 0 443870 0 0 Raymond P Vacca 0 221067 0 171366 0 28797 0 186602 0 4474 0 612306 0 0 David Yokell 0 264613 0 78216 0 7376 0 12556 0 1976 0 364737 0 0 Schedule J, Line 1A Per the company's Travel and Business Expense Policy, the Chairman and Chief Executive Officer, the President and Chief Operating Officer, the President of EmblemHealth Services, and the Executive Vice Presidents may travel first class and can request staff traveling on business with them to travel first class on accompanied segments of the trip. Any such expenses are reimbursed upon presentation of comprehensive and accurate receipts. Per the company's Travel and Business Expense Policy, approved Spousal/Guest travel and related lodging, meal expenditures and other appropriate related costs will be reimbursed when the travel is required by EmblemHealth for a legitimate business purpose. Spousal/Guest travel that is not approved in advance is referred to the Senior Vice President for Compliance for review. Mr. Branchini receives a tax gross up for amounts paid into the secular Trust. Officer parking allowances are paid on a grossed-up basis. Severance Payment Schedule J, Line 4a The following officers received severance in 2011: Rachel Amalfitano, VP/Controller (terminated employment on April 20, 2011) received $248,000. Raymond Gannon Jr, Vice President of Marketing and Development, (terminated employment on 07/01/2011) received $170,586. Jefferson Grahling, Vice President of Commercial Business Development, (terminated employment on 10/02/2011) received $120,000. David Reimer, Vice President of Actuarial, (terminated employment on 10/02/2011) received $154,345. Sharon Joy Schmerzler, Vice President of Data Analytics, (terminated employment on 10/02/2011) received @254,475. Non-Qualified Retirement Plan Schedule J, Line 4b Emblem Health Services, LLC sponsors nonqualified retirement plans that the officers of HIPNY participate in, Officers with the titles of executive vice president and above, with the exception of Frank Branchini, participate in the supplemental executive retirement plan for emblemhealth services company, llc ("SERP"). The SERP provides a retirement benefit calculated on the basis of 50% of final average pay, offset by benefits under any qualified benefit plan, such as The emblemhealth services company, llc employees' retirement plan. Participants require the approval of the board of directors to retire under the serp between the ages of 55 and 60. Participants who retire prior to age 65 have their serp benefits reduced by early retirement factors. Mr. branchini participates in the GHI supplemental retirement plan ("Secular trust") which provides a retirement benefit calculated to provide the retirement benefits that would otherwise be payable under the local 153-ghi pension plan and the ghi cash balance plan (qualified plans), but for funding and contributions limits imposed by the IRS regulations. Senior vice presidents and above, hired before june 1, 2009, participate in the supplemental retirement plan ii for emblemhealth services company, llc (SERP II"). The SERP II provides a retirement beneft calculated on the basis of 30% of final average pay after 5 years of service, and increasing to 50% of final average pay after 15 years of service, offset by benefits under any qualified benefit plan, such as the emblemhealth services company, llc employees' retirement plan. Participants require the approval of the board of directors to retire under the SERP II between the ages of 55 and 60. Participants who retire prior to age 65 have their SERP II benefits reduced by early retirement factors. Bonus Payments Schedule J, Line 6a HIP and EmblemHealth Services provide annual incentive awards based upon the achievement of performance metrics and percentage target awards. The compensation committees approve the performance metrics and targets and the ultimate payout to participants based upon the performance achieved under the Annual Incentive Plan (AIP). All management, non-union employees may be eligible to participate in the AIP. For the most senior executives of the company, the annual incentive awards are entirely based upon the successful achievement of objective performance goals. In the 2011 AIP, the two equally weighted performance metrics were Operating Income and Administrative Per Member Per Month (PM PM) savings. Operating Income was defined as premiums earned and administrative service fee revenue, less subscriber benefits, depreciation and amortization, interest and general administrative expenses, as reported in the annual financial statements, and exluding certain specified and extraordinary items. Administrative PM PM was defined as the depreciation and amortization, interest and general administrative expenses as reported in the annual audited financials associated with the administration of the company's insured commercial managed care, Medicare and State sponsored programs expressed on a per member per month basis, and excluding certain specified and extraodinary items. HIP and EmblemHealth Services also have a long term incentive plan based upon longer term performance over three year performance cycles and a limited supplemental incentive plan with payment triggered by threshold performance under the AIP. The compensation committees approve the performance metrics, targets and payouts based upon achievement of performance under these plans as well. Officers and key employees are generally eligible to participate in the long term incentive plan. A very limited number of senior officers are eligible to participate in the supplemental incentive plan, which will expire in 2011. Schedule J, Part III, Column C Deferred Compensation Health Insurance Plan of Greater New York reports the change in the actuarial value of the pension plan as deferred compensation (as required by the expanded disclosures in the form 990). A large percentage of the compensation reported in Schedule J, Part III, Column C represents this change in value. Present values are calculated based on the SEC Proxy Summary Compensation Table methodology and assumptions, as the discounted present value of normal retirement benefits earned to the measurement date payable at the later of current age or age 65, without regard to projected service, projected salary increases, pre-retirement mortality or other decrements. Displayed change in total pension value during 2010 above reflects all defined benefit plans the participants are entitled to. William White Director/HR Department 178837 See Schedule L Narrative false Paul Gibson Trustee 600000 See Schedule L Narrative false Form 990, Schedule L Vice President of Integrative Wellness, John White, has a family member who is, likewise, employed by EmblemHealth Services Company, LLC. William White is employed by EmblemHealth Services Company, LLC. as a Director in the Human Resources Department; his W-2 wages for the year ending 12/31/2011 are $178,837. Board of Trustees Member, Paul Gibson, is a limited partner in a medical practice that treats patients with insurance coverage from Connecticare, Inc. (a for-profit subsidiary of Health Insurance Plan of Greater New York). HIP-NY does not believe it has any other business transactions or relationships between itself and an officer, director, or key employee of the organization that rise to the monetary threshold required for disclosure on Schedule L of the Form 990. The organization takes its responsibilities of monitoring potential conflicts of interest very seriously (please see disclosure on Part VI, Line 12). HIP-NY compiles a lengthy Summary report of all potential business transactions between the individuals reported on Part VII of the Form 990 and HIP-NY or one of its affiliated organizations. This report discloses all potential business transactions regardless of monetary value. The organization's due diligence efforts reported no transactions that meet the 990's threshold for dislcosure. Additional information is available upon request. Form 990, Part I, Line 5 & Part V, Line 2a On March 6, 2007, Emblemhealth Services Company, LLC was formed as a joint venture by Health Insurance Plan of Greater New York (HIP) and Group Health Incorporated (GHI). On January 1, 2008, HIP and GHI transferred vendor agreements and management employees to EmblemHealth Services Company, LLC. To that end, all officers and directors (and most employees) of HIP receive their Forms W-2 from Emblemhealth Services Company, LLC. The number of employees (412) reported on Part 1, Line 5 and Part V, Line 2a represents only those unionized employees who still receive their Forms W-2 from HIP. As of January 1, 2012, all employees have been transferred to EmblemHealth Services Company, LLC. Part V, Line 1a and Part VII, Independent Contractors. HIP-NY transferred most of its vendor agreements to Emblemhealth Services Company, LLC; accordingly, most independent contractors are paid by a related party rather than HIP-NY itself. To the extent HIP-NY is still under contract with certain vendors (e.g. rent etc), those 1099s are still issued by HIP-NY. Form 990, Part III, Line 4d - Other Program Service Accomplishments 1. CHIPS (Children's Health Insurance Program) - HIP SERVED APPROXIMATELY 15,000 MEMBERS. HIP HAS BEEN SERVING THE CHIPS POPULATION SINCE THE INCEPTION OF THE STATE DEMONSTRATION PROGRAM FOR UNISURED CHILDREN UNDER 19, IN 1991 AND CONTINUED WITH THE PASSAGE OF The Childrens Health Insurance Program (CHIP) in 1997. CHIPS is a partnership between the federal government and the states to extend health coverage to uninsured children and pregnant women in families who cannot afford to purchase private health insurance but have incomes too high to qualify for Medicaid. 2. Family Health Plus Program - HIP SERVED APPROXIMATELY 28,000 MEMBERS. HIP BEGAN TO SERVE FHPLUS MEMBERS AT THE START OF THE PROGRM IN THE NY DOWNSTATE AREA IN OCTOBER OF 2001. THE BENEFIT PACKAGE FOR THE PROGAM PROVIDES a comprehensive set of medically needed health care benefits and services to the ADULT UNINSURED and low-income wage earners. 3. Healthy New York Program - HIP SERVED APPROXIMATELY 4500 MEMBERS. HIP HAS BEEN SERVING HEALTHY NY MEMBERS SINCE THE PROGRAM'S INCEPTION JANUARY 2001. THE NYS HEALTH CARE REFORM ACT OF 2000 CREATED THIS PROGRAM OF COMPREHENSIVE HEALTH INSURANCE COVERAGE FOR NY's UNINSURED WORKERS AND THEIR FAMILIES. Healthy NY is a program designed to help promote comprehensive and quality health care for small business owners and their employee's. The Healthy NY program also helps sole proprietors and those whose employers do not provide health insurance for them. Healthy NY includes benefits that cover essential health needs including inpatient and outpatient hospital services, physician services, maternity care, preventative health services, diagnostic and x-ray services, and emergency services. 4. Other Program Service Activities - the allocation of program service expenditures reported on Part III of the Form 990 is derived from HIP-NY's Statutory Financial Statements (STAT) The Form 990 is prepared in accordance with Generally Accepted Accounting Principles (GAAP). Form 990, Part VI, Line 1 The organization has 12 board members at the end of the year, 10 of which are independent for purposes of the Form 990. Chairman and CEO, Anthony Watson, is not independent by virtue of his having received compensation from a related party, EmblemHealth Services, LLC for services rendered to HIP-NY. Board of Trustees Member, Paul Gibson, is not independent by virtue of the transaction that has been dislcosed on Schedule L of the Form 990. Several of HIP-NY's Board Members do receive payment for services rendered in their capacity as Board Members. Such amounts represent reasonable compensation for services rendered (as a Board Member) and do not impair their independence. Form 990, Part VI, Line 2 Frank Branchini, President and Chief Operating Officer, has a family relationship with Robert Branchini, VP Information Technology. In the interests of full disclosure, the organization notes that various Officers and/or trustees, may serve on the Board of Directors of related for-profit organizations (e.g. - those disclosed in Schedule R of the Form 990). No individual is compensated for board service to the related for-profit organization. Form 990, Part VI, Line 6 EmblemHealth, Inc., a New York not-for-profit corporation, is the sole member of Health Insurance Plan of Greater New York. EmblemHealth (EIN 13-3941542) is exempt from federal taxation pursuant to IRC 501(c)(3). Form 990, Part VI, Line 11 The taxpayer's Form 990 for the year ending December 31, 2011 was provided to each member of the organization's governing body before it was filed. A detailed review of the Form 990 was undertaken by the Organization's Tax Director, by the Organization's Vice President, Total Rewards, by the Organization's Senior Vice President, Chief Financial Officer and by the organization's senior Vice President and General Counsel. Form 990, Part VI, Line 12 To determine if an employee's personal interests, activities or relationships constitute a conflict of interest or the appearance of a conflict of interest, certain employees, based upon functionality, as determined by the Senior Vice President for Compliance, Internal Audit and Internal controls are required to fully disclose, on an annual basis, any reportable situations on the company's conflict of interest disclosure. All employees, at the time of employment, are required to fully disclose any personal interest, activities or relationships that constitute a conflict of interest or the appearance of a conflict of interest. Disclosures are reviewed by the Senior Vice President for Compliance, Internal Audit and Internal Controls and by the Executive Vice President, Chief Financial Officer and General Counsel. Any Employee, who violates the conflict of interest policy, fails to make a required report or fails to comply with any remedial action required by the company, is subject to disciplinary action, up to and including termination of employment. Form 990, Part VI, Line 15 To determine the compensation of the CEO and all other officers of the company, HIP and EmblemHealth Services engage an outside compensation consultant to provide guidance and the comparable market data on the compensation of similarly situated executive positions in the organizations' competitive peer group comprised of profit and not for profit entities. The compensation consultant presents the comparable market data to the compensation committee of the board of directors of each of HIP and EmblemHealth Services. The compensation committees are composed entirely of outside, independent, disinterested directors. The compensation committees review and approve the proposed compensation arrangements and the deliberations and actions of the compensation committees are documented in the minutes of each meeting. Thereafter, the actions of the compensation committees are reported to the full boards in a timely manner. The CEO, or any other officer, is excused from the compensation committee meeting while the committee deliberates and approves any action related to the compensation arrangement of the CEO or other officer. Form 990, Part VI, Line 16 On March 6, 2007, EmblemHealth Services Company, LLC ("EHS") was formed as a joint venture between Health Insurance Plan of Greater New York and its sister company, Group Health Incorporated, a New York not-for-profit corporation, in order to integrate certain common administrative operations of these two entities, among other purposes. EmblemHealth, Inc., a New York not-for-profit corporation, is the sole member of both Health Insurance Plan of Greater New York and Group Health Incorporated. EmblemHealth, Inc. (EIN 13-3941542) is exempt from federal taxation pursuant to IRC 501(c)(3). In January 2008, EHS began performing those administrative operations for the organizations. The Limited Liability Agreement requires that EHS be managed at all times in a manner that furthers the tax-exempt purposes of Health Insurance Plan of Greater New York. Form 990, Part VI, Line 19 The taxpayer makes its Form 990 and Form 1023 available to the public by retaining a copy of each at its head offices at 55 Water Street, New York, New York. Any individual requesting a copy of these documents is provided that copy on the same business day. The organization's Form 990 is also available for public inspection on www.guidestar.com. The taxpayer's financial statements are available for public inspection on the organization's website, www.emblemhealth.com. The organization's governing documents and conflict of interest policy are not available to the public. Form 990, Part VII - Hours Served for Related Party The compensated individuals reported in Part VII of the Form 990 may provide services to a variety of entities within the Health Insurance Plan of Greater New York network. Allocating those hours between the many entities presents a challenge; accordingly, the hours represented on Part VII represent the hours worked by the individual in their capacity as an employee for the entire HIP network. Form 990, Part VIII, Rental Income Health Insurance Plan of Greater New York generates rental revenue from medical groups who lease a combination of personal and real property. HIP does not book this revenue in its general ledger as rental income, but rather offsets payments due to the health provider/facilities as monthly settlements are made. These transactions result in a net out-flow of cash as HIP finalizes its monthly settlements. For the most part, the rental income generated by HIP is for space rental and incidental personal property rental (i.e. 10% or less of the total rents received under the lease are from personal property). To the extent that the rental income is attributable to a mixed lease (i.e. where personal property is 11% to 50% of the total rents), HIP reports this revenue as unrelated business income and specifically reports this revenue on Part VIII, Lines 6a and 6b and on its Form 990-T. Quantifying total rental income received across all medical groups would be labor intensive and since this revenue is passive revenue that does not implicate unrelated business income, HIP has opted to continue reporting this revenue as an offset to its facilities expenditures (which are quantified on Part IX, Schedule of Functional Expenses). Form 990, Part IX, Functional Expenses Amounts reported on Part IX, Line 5, as compensation paid to officers, directors and key-employees of HIP-NY represent those salary costs reported on Form 990, Part VII, Line 1(d) that are allocated from the related party, EmblemHealth Services, LLC. Form 990, Part XI, Line 5 A difference of -31,168,506 is reported on part XI of the Reconciliation of Net Assets. This difference is attributable to changes in unrealized gains and losses on investments, book to tax adjustments on investments as well as Statutory-to-GAAP financial statement adjustments. EMBLEMHEALTH INC 55 WATER STREET NEW YORK NY 10041 133941542 support svcs NY 501(c)(3) 11e na false EmblemHealth Services Company 55 Water Street New York NY 10041 261330097 Support Services NY na Related -13950553 128783673 false 0 false 0.50000 Group Health Incorporated 55 Water Street New York NY 10041 135511997 Insurance NY NA C Corp 3533527911 927382840 1.00000 HIP Holdings Inc & Subsidiaries 55 Water Street New York NY 10041 133819759 Insurance NY NA C Corp. 1374963989 1135405916 1.00000 true true false true false true false false false false true true true true true true true true EmblemHealth Inc C, L, 2705724 Cost EmblemHealth Inc M 57873 Cost EmblemHealth Inc N 2099837 Cost Group Health Incorporated A 2400000 Market Rate Group Health Incorporated D 125000000 Loan Value Hip Holdings Inc & Subsidiaries (HIPA) L 27700000 COST Hip Holdings Inc & Subsidiaries (HIPA) K 2100000 COST Hip Holdings Inc & Subsidiaries (HIPIC) L 153500000 COST Hip Holdings Inc & Subsidiaries (HIPIC) K 145500000 COST Hip Holdings Inc & Subsidiaries (HIPIC) K, P 21100000 cost Hip Holdings Inc & Subsidiaries (HIP-IPA) l 23100000 cost Hip Holdings Inc & Subsidiaries (HIP-IPA) k 200000 cost Schedule R, Part V, Line 2 TRANSACTIONS with Emblem Health, Inc. EMBLEMHEALTH, INC. IS THE PARENT ORGANIZATION OF HEALTH INSURANCE PLAN OF NEW YORK (HIP-NY), A 501(C)(4) TAX-EXEMPT ORGANIZATION THAT DELIVERS QUALITY, AFFORDABLE HEALTH INSURANCE TO MILLIONS OF MEMBERS AND PROVIDES EMPLOYERS AND INDIVIDUALS WITH A RANGE OF PLAN CHOICES AND ATTRACTIVE BENEFIT OPTIONS DESIGNED TO MEET THE INDIVIDUAL NEED OF TODAY'S HEALTHCARE CONSUMERS. AS THE PARENT ORGANIZATION, EMBLEMHEALTH, INC. RUNS HIP-NY'S INTEGRATIVE WELLNESS PROGRAM, AN INNOVATIVE EVIDENCE-BASED PROGRAM THAT PROMOTES HEALTHY LIVING AND ENHANCES INDIVIDUALS' QUALITY OF LIFE. EMBLEMHEALTH,INC. DOES NOT GENERATE ANY REVENUE. THE EXPENSES IT INCURS IN RUNNING THE INTEGRATIVE WELLNESS PROGRAM FOR HIP-NY ARE PAID AT COST BY HIP-NY VIA A MANAGEMENT FEE. THESE AMOUNTS ARE REPRESENTED IN SCHEDULE R, PART V, TRANSACTION TYPE K. SINCE HIP-NY'S PAYMENT REPRESENTS A REIMBURSEMENT OF ALL EXPENSES INCURRED, THIS TRANSACTION IS ALSO REPRESENTED IN SCHEDULE R, PART V, TRANSACTION TYPE P. EMBLEMHEALTH, INC. SHARES AN OFFICE SPACE WITH HIP-NY AT 55 WATER STREET. TO THAT END, ITS ALLOCATION OF RENTAL EXPENSE IS REPORTED IN SCHEDULE R, PART V, TRANSACTION TYPE M. Transactions with Group health Incorporated, HIP-NY advanced $115 million to GHI in accordance with Section 1307 of the Insurance Law of the State of New York with interest accruing at 2% per annum. As provided in Section 1307, the payment of principal and interest thereon amounting to approximately $500,000, shall only be made out of free and disposable surplus, subject to prior approval of the Superintendent. As of December 31, 2011, no payments were made to HIP. Transactions with HIP Holdings, Inc. & Subs (HIPIC) HIPIC (a member of HIP Holdings, Inc. & Subs) provides the indemnity health insurance portion of dual option products offered by HIP and HIP administers the collection of premiums and pays claims on behalf of HIPIC. Premiums collected on behalf of HIPIC were approximately $153,500,000 million for the year ended December 31, 2011. HIP paid out-of-network claims on behalf of HIPIC of million in 2011. Under the terms of a service agreement, HIP allocated costs associated with administering the premiums and claims of approximately $21,100,000 million to HIPIC for the year ended December 31, 2011. Transactions with HIP Holdings, Inc. (HIP-IPA) HIP pays HIP IPA (another subsidiary in the HIP Holdings, Inc. & Subsidiaries consolidated group) a monthly per-member-per-month capitation rate for members enrolled in HIP IPA as well as a monthly fee for data collection services. For the year ended December 31, 2011, HIP incurred approximately $22,400,000 million for capitation and $700,000for data collection services. In addition, HIP provides certain administrative and support services to HIP IPA, which are reimbursed by HIP IPA. For the year ended December 31, 2011, amounts charged by HIP to HIP IPA for these services was approximately $200,000. Transactions with HIP HOldings, Inc. & Subsidiaries (HIPA) HIPA (another subsidiary in the HIP Holdings, Inc. & Subsidiaries consolidated group) provides claims processing and certain member services for HIPs members. For the year ended December 31, 2011, HIPA charged HIP approximately $27,700,000 million for these services. HIP-NY provides administrative and management services to HIPA; amounts paid in 2011 were approximately $2,100,000 million. Transactions with EmblemHealth Services, LLC EmblemHealth Services, LLC (EHS) was formed as a limited liability company under the laws of the state of Delaware as a joint venture of HIP and GHI, in which both HIP and GHI each contributed $100 for equal ownership rights and are the sole corporate partners of EHS. Effective January 1, 2008, HIP and GHI entered into a management services agreement with EHS, for the purpose of providing administrative services to the companies. HIP and GHI entered into a guaranty agreement as of January 1, 2008 with EHS. In conjunction with this guaranty agreement, HIP and GHI transferred all of their respective non-union employees to EHS. EHS assumed all of the associated benefit and compensation related liabilities of the transferred employees. EHS became the plan sponsor of the related pension and postretirement plans it assumed. The transfer was accounted for as a non-economic transaction between related parties, and as such, no consideration was exchanged and no gains or losses were recorded. Under this guaranty arrangement HIP and GHI are jointly and severally liable for: (i) guaranteed obligations earned by transferred employees who were employed by HIP and GHI prior to the effective date of the agreement; and (ii) a pro rata share of guaranteed obligations earned by transferred employees after the effective date of this agreement, based on the allocation of costs under the services agreement. For the year ending December 31, 2011, HIP is disclosing in Schedule R its share of EmblemHealth Services Company, LLC's income as disclosed on the Federal Form K-1 - ($13,950,553). This loss has, likewise, been reported on Form 990, Part VIII, Line 3.