2013-11-07T14:33:13-06:00 2012-12-31 420714325 MCGLADREY LLP 1185 AVENUE OF THE AMERICAS NEW YORK NY 100362602 990 2012-01-01 134154068 AMIDA CARE INC AMID 6467861800 248 WEST 35TH STREET NO 7TH FL NEW YORK NY 10001 DOUGLAS WIRTH 6467861800 2013-11-07 1 MARTIN GREIF P00029738 2123721000 2012 2016-02-24 21:20:13Z DOUGLAS WIRTH 248 WEST 35TH STREET NO 7TH FL NEW YORK NY 10001 218980978 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 9 145 9 0 0 804111 758965 88329851 218214600 81306 7413 -3352 -5183 89211916 218975795 16490 0 0 0 4944866 7179939 0 0 0 74293232 208028983 79254588 215208922 9957328 3766873 34127344 36115749 21158634 19380166 12968710 16735583 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. STAFF ALSO ASSISTS ENROLLEES IN THE PRUDENT SELECTION OF SERVICES. 0 0 198140229 218214600 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 63,958 MEMBER MONTHS IN 2012. 198140229 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 1 675 0 1 145 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 6467861800 248 WEST 35TH STREET 7TH FLOOR NEW YORK NY 10001 PAUL VITALE 0.50 X X 0 0 0 EMMA DEVITO 0.50 X X 0 0 0 STEVEN BUSSEY 0.50 X X 0 0 0 TOMAS DEL RIO 0.50 X X 0 0 0 HOLLY ARGENT-TARIQ 0.50 X 0 0 0 CHARLES KING 0.50 X 0 0 0 PAM MATTEL 0.50 X 0 0 0 ALLEN COX 0.50 X 0 0 0 LORENA BISE 0.50 X 0 0 0 DOUGLAS WIRTH 40.00 X 412727 0 49673 JEROME ERNST MD 40.00 X 192766 0 31256 FELICE KUSSOY 40.00 X 190318 0 21092 JAMES CRAMER 40.00 X 160535 0 17627 STEPHANE HOWZE 40.00 X 93892 0 11516 VIRPI RANTA 40.00 X 142345 0 21177 1192583 0 152341 5 0 1 0 ROYAL HEALTH CARE 521 5TH AVENUE NEW YORK NY 10175 MANAGEMENT SERVICES 2199356 DEBRA FRIEDMAN 10900 FOREST RIDGE TERRACE NORTH POTOMAC MD 20878 STRATEGIC PLANNING CONSULTANT 199810 ROPES & GRAY LLP ONE INTERNATIONAL PLACE BOSTON MA 02110 LEGAL SERVICES 191752 MILLIMAN 3000 BAYPORT DR SUITE 1050 TEMPE FL 33607 FINANCIAL CONSULTANT 143824 ENRICHMENT RESOURCE GROUP 410 LAUREL LAKE DRIVE VENICE FL 34292 CONSULTING SERVICES 100150 5 52600 706365 758965 MEDICAID PAYMENTS 900099 218214600 218214600 218214600 7413 7413 0 52600 5183 -5183 -5183 218975795 218214600 0 2230 1158480 1158480 4849754 4849754 87872 87872 611533 611533 472300 472300 1445968 1445968 247491 247491 65500 65500 2799126 2799126 897032 897032 126674 126674 1003865 1003865 142575 142575 50235 50235 205525 205525 53555 53555 PHARMACY COSTS 141579928 141069248 510680 MEDICAL SERVICES 54074845 54074845 HEALTH ASSESSMENTS & SU 2996136 2996136 UTILIZATION MANAGEMENT 1059330 1059330 1281198 1281198 215208922 198140229 17068693 0 1044 1183 31497364 28288994 135929 1723113 6553583 313339 274897 1089804 491514 339568 598290 252916 262873 34127344 36115749 18924982 17146514 2233652 2233652 21158634 19380166 X 12968710 16735583 12968710 16735583 34127344 36115749 3766873 0 X 0 1 X 1 0 X 253625 49111 358185 804111 758965 2223997 10519473 24162232 29875365 88329851 218214600 371101521 10773098 24211343 30233550 89133962 218973565 373325518 0 0 0 373325518 13740 77579 92379 81306 7413 272417 13740 77579 92379 81306 7413 272417 10786838 24288922 30325929 89215268 218980978 373597935 0.99930 0.99820 0.00070 0.00180 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 182682 46396 136286 633891 384490 249401 273231 60628 212603 598290 SUBVENTION PAYABLE TO 501(C) ORG 2233652 2233652 X 218980978 0 218980978 -5183 -5183 218975795 215214105 5183 5183 215208922 0 215208922 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2009. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EVENTS EXPENSE NETTED AGAINST FUNDRAISING EVENTS REVENUE -5,183. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENTS EXPENSE NETTED AGAINST FUNDRAISING EVENTS REVENUE 5,183. LIVE YOUR LIFE FUNDRAISER 52600 52600 5183 52600 52600 5183 5183 -5183 X X 0 0 0 0 0 0 0 1 0 DOUGLAS WIRTH 347367 0 65000 0 360 0 28866 0 20807 0 462400 0 0 0 JEROME ERNST MD 190363 0 0 0 2403 0 9942 0 21314 0 224022 0 0 0 FELICE KUSSOY 185067 0 5000 0 251 0 9457 0 11635 0 211410 0 0 0 JAMES CRAMER 159703 0 0 0 832 0 5567 0 12060 0 178162 0 0 0 VIRPI RANTA 141678 0 0 0 667 0 7240 0 13937 0 163522 0 0 0 PART I, LINE 7 PART I, LINE 7: THE FOLLOWING INDIVIDUALS, LISTED ON PART VII, RECEIVED A NON-FIXED PAYMENT IN THE FORM OF A BONUS DURING 2012: DOUGLAS WIRTH - $65,000 FELLICE KUSSOY - $5,000 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 FOR 2012 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 CORPORATE COMPLIANCE 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 INTERIM COMPLIANCE OFFICER. ACAP IS AN ASSOCIATION OF NONPROFIT MEDICAID AND MEDICARE HEALTH PLAN ORGANIZATIONS. THE ORGANIZATION'S CEO COMPLETES AN ANNUAL PERFORMANCE EVALUATION OF THE MEDICAL DIRECTOR, CFO, COO AND INTERIM COMPLIANCE OFFICER. 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. 7 MEMBERS ARE THE DIRECTORS OF THE 7 NOT-FOR-PROFIT ORGANIZATIONS WHICH FOUNDED AMIDA CARE INC. AND 2 ARE ENROLLED MEMBERS OF THE ORGANIZATION. 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.