NEW YORK STATE CATHOLIC HEALTH PLAN INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- NEW YORK STATE CATHOLIC HEALTH PLAN INC (EIN 11-3153422)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-08-10
- IRS object ID
- 201212239349300346
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-08-10T10:01:58-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 861065772 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | TWO JERICHO PLAZA | AddressLine1 |
| City | JERICHO | City |
| State | NY | State |
| ZIP Code | 11753 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 113153422 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NEW YORK STATE CATHOLIC HEALTH PLANINC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | NEWY | NameControl |
| Phone | 7183936403 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 95-25 QUEENS BOULEVARD | AddressLine1 |
| City | REGO PARK | City |
| State | NY | State |
| ZIP Code | 113744510 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | PATRICK J FRAWLEY | Name |
| Title | INTERIM CEO | Title |
| Phone | 7183936403 | Phone |
| Date Signed | 2012-08-10 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| PTIN | P00743140 | PTIN |
| Phone | 5169187000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FIDELIS CARE NEW YORK | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | PATRICK J FRAWLEY | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 95-25 QUEENS BOULEVARD | AddressLine1 |
| City | REGO PARK | City |
| State | NY | State |
| ZIP Code | 113744510 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 2974548847 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.FIDELISCARE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1993 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | SEE SCHEDULE O. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 19 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 19 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1990 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 211811 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 537543 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 1911001018 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 2401477190 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 9567496 | InvestmentIncomePriorYear |
| Investment Income Current Year | 10773904 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 181706 | OtherRevenuePriorYear |
| Other Revenue Current Year | 296626 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1920962031 | TotalRevenuePriorYear |
| Total Revenue Current Year | 2413085263 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 2496644 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 2287302 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 1703299439 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 2164074037 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 102652058 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 106503453 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 61144552 | OtherExpensePriorYear |
| Other Expenses Current Year | 63383796 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 1869592693 | TotalExpensesPriorYear |
| Total Expenses Current Year | 2336248588 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 51369338 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 76836675 | RevenuesLessExpensesCY |
| Total Assets BOY | 585701387 | TotalAssetsBOY |
| Total Assets EOY | 745086008 | TotalAssetsEOY |
| Total Liabilities BOY | 320658782 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 411835560 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 265042605 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 333250448 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SEE SCHEDULE O | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 1 | SignificantChange |
| Expense | 1558842732 | Expense |
| Grants | 1611818 | Grants |
| Revenue | 1717102388 | Revenue |
| Description | MEDICAID MANAGED CARE PROGRAM IS A NEW YORK STATE PROGRAM ADMINISTERED BY FIDELIS THAT PROVIDES FREE COMPREHENSIVE HEALTH COVERAGE FOR ELIGIBLE INDIVIDUALS AND FAMILIES WHO ARE RESIDENTS OF NEW YORK STATE AND HAVE LOW INCOME AND LIMITED RESOURCES. THE NEW YORK STATE DEPARTMENT OF HEALTH ESTABLISHES ELIGIBILITY CRITERIA WITH REGARD TO INCOME (IN RELATION TO A PERCENTAGE OF THE FEDERAL POVERTY LEVEL), RESIDENCY, RESOURCES, AGE, AND IMMIGRATION STATUS, AMONG OTHER FACTORS, AND ELIGIBILITY FOR THE PROGRAM IS DETERMINED BASED ON INCOME, RESOURCES, AND FAMILY SIZE. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 274354094 | Expense |
| Grants | 266563 | Grants |
| Revenue | 283975726 | Revenue |
| Description | FAMILY HEALTH PLUS IS PART OF NEW YORK STATE'S FAMILY HEALTH PLUS PROGRAM ADMINISTERED BY FIDELIS FOR UNINSURED ADULTS, AGES 19-64, WHO ARE RESIDENTS OF NEW YORK STATE AND ARE NOT ELIGIBLE FOR MEDICAID. FAMILY HEALTH PLUS PROVIDES COMPREHENSIVE COVERAGE, INCLUDING PREVENTION, PRIMARY CARE, HOSPITALIZATION, AND OTHER SERVICES.THE NEW YORK STATE DEPARTMENT OF HEALTH ESTABLISHES ELIGIBILITY CRITERIA WITH REGARD TO INCOME (IN RELATION TO A PERCENTAGE OF THE FEDERAL POVERTY LEVEL), RESIDENCY, RESOURCES, AGE, AND IMMIGRATION STATUS, AMONG OTHER FACTORS, AND ELIGIBILITY FOR THE PROGRAM IS DETERMINED BASED ON INCOME, RESOURCES, AND FAMILY SIZE. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 114866035 | Expense |
| Revenue | 142669791 | Revenue |
| Description | EMPLOYER PARTNERSHIP FOR FAMILY HEALTH PLUS ("FAMILY HEALTH PLUS BUY-IN") WAS A PROGRAM SPONSORED BY THE STATE OF NEW YORK, WHEREBY FIDELIS PROVIDED FAMILY HEALTH PLUS STATE-MANDATED BENEFITS, SUBJECT TO SPECIFIC EXCLUSIONS, TO CERTAIN ELIGIBLE MEMBERS OF THE 1199SEIU BENEFIT FUND FOR HOME CARE EMPLOYEES. THE 1199SEIU BENEFIT FUND DETERMINED THE ELIGIBILITY OF ITS MEMBERS TO PARTICIPATE IN THE PROGRAM. THE 1199SEIU BENEFIT FUND, WITH NEW YORK STATE'S APPROVAL, ELECTED TO TERMINATE ITS AGREEMENT WITH FIDELIS EFFECTIVE OCTOBER 31, 2011. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 218298478 | Expense |
| Grants | 408921 | Grants |
| Revenue | 257729285 | Revenue |
| Description | OTHER PROGRAMS ADMINISTERED BY THE PLAN INCLUDE THE CHILD HEALTH PLUS PROGRAM, MEDICARE ADVANTAGE PROGRAM, MEDICARE/MEDICAID DUAL ADVANTAGE PROGRAM, FIDELIS CARE AT HOME, AND MEDICAID ADVANTAGE PLUS PROGRAM. THE CHILD HEALTH PLUS PROGRAM COVERS UNINSURED CHILDREN UNDER THE AGE OF 19, WHO ARE RESIDENTS OF NEW YORK STATE AND ARE NOT ELIGIBLE FOR MEDICAID. THE PROGRAM PROVIDES COMPREHENSIVE COVERAGE, INCLUDING PREVENTION, PRIMARY CARE, HOSPITALIZATION, PRESCRIPTIONS AND OTHER SERVICES.MEDICARE ADVANTAGE PROGRAM IS A PROGRAM AVAILABLE TO ADULTS AGED 65 AND OVER WHO ARE ELIGIBLE UNDER MEDICARE. BENEFICIARIES MAY CHOOSE TO USE PRIVATE PAY OPTIONS, ESTABLISH MEDICAL SAVINGS ACCOUNTS, USE MANAGED CARE PLANS SUCH AS FIDELIS, OR JOIN PROVIDER-SPONSORED PLANS. MEDICARE/MEDICAID DUAL ADVANTAGE IS A PROGRAM FOR THOSE WHO MEET ELIGIBILITY REQUIREMENTS FOR BOTH MEDICARE AND MEDICAID AND ARE ENROLLED IN BOTH PROGRAMS.FIDELIS CARE AT HOME IS A MANAGED LONG-TERM CARE PROGRAM FOR RESIDENTS OF ORANGE AND ROCKLAND COUNTIES, 18 YEARS OF AGE AND OLDER, WHO NEED LONG-TERM CARE SERVICES AND ARE ELIGIBLE FOR MEDICAID. MEMBERS HAVE THEIR OWN CARE MANAGER, RECEIVE INDIVIDUAL ATTENTION, AND HAVE THE SUPPORT AND RESOURCES THEY NEED TO HELP THEM LIVE INDEPENDENTLY IN THEIR OWN HOMES AND COMMUNITIES. MEDICAID ADVANTAGE PLUS IS A FULL-RISK MANAGED LONG-TERM CARE PROGRAM FOR INDIVIDUALS 18 YEARS OF AGE AND OLDER WITH MEDICARE AND MEDICAID COVERAGE WHO HAVE A CHRONIC ILLNESS OR DISABILITY. MEMBERS MUST BE IN NEED OF LONG-TERM CARE SERVICES AND MAY NEED CARE TYPICALLY GIVEN IN A NURSING HOME. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 218298478 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 408921 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 257729285 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 2166361339 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 13501 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1990 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 19 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 19 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANNE KONTOPOULOS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7183936403 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 95-25 QUEENS BLVD | AddressLine1 |
| City | REGO PARK | City |
| State | NY | State |
| ZIP Code | 11374 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (33 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| KARL P ADLER MD | |||||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||||
| JACK BALINSKY | |||||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||||
| M WILLIAM BENEDETTO | |||||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||||
| SISTER PATRICIA BURKARD OSF | |||||||||
| DIRECTOR/SECRETARY | 0.00 | X | 0 | 0 | 0 | X | |||
| JAMES M CORRIGAN CPA MHA | |||||||||
| DIRECTOR/TREASURER | 0.00 | X | 0 | 0 | 0 | X | |||
| REV JOHN COUGHLIN | |||||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||||
| THOMAS DESTEFANO | |||||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||||
| THOMAS F DOODIAN | |||||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||||
| REV DONALD J HARRINGTON CM | |||||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||||
| JOHN J HURLEY | |||||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||||
| THOMAS L KELLY | |||||||||
| DIRECTOR/VICE-CHAIRMAN | 0.00 | X | 0 | 0 | 0 | X | |||
| REV LEO J O'DONOVAN SJ | |||||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||||
| GINO PAZZAGLINI | |||||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||||
| REV MONSIGNOR ALAN J PLACA | |||||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||||
| JOHN J RYDZEWSKI | |||||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||||
| JOSEPH SLAVIK | |||||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||||
| MOST REV JOSEPH M SULLIVAN | |||||||||
| CHAIRMAN OF THE BOARD | 0.00 | X | 0 | 0 | 0 | X | |||
| MICHAEL J TOOLEY | |||||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||||
| JOHN A WERWAISS | |||||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | ||||
| MARK L LANE | |||||||||
| PRESIDENT & CEO | 38.00 | 2214846 | 0 | 213444 | X | ||||
| THOMAS HALLORAN | |||||||||
| CHIEF FINANCIAL OFFICER | 38.00 | 385736 | 22790 | 240876 | X | ||||
| PATRICK J FRAWLEY | |||||||||
| EVP & COO | 38.00 | 1632570 | 37468 | 73587 | X | ||||
| DAVID THOMAS | |||||||||
| SR. VP & CHIEF ADM. OFF. | 38.00 | 759237 | 0 | 54167 | X | ||||
| SANJIV SHAH MD | |||||||||
| CHIEF MEDICAL OFFICER | 38.00 | 361353 | 5836 | 9506 | X | ||||
| PAMELA HASSEN | |||||||||
| CHIEF MARKETING OFFICER | 38.00 | 298447 | 0 | 182692 | X | ||||
| MARGARET M BRUBAKER | |||||||||
| CHIEF HR OFFICER | 38.00 | 286767 | 0 | 32241 | X | ||||
| WILLIAM COFFIN JR | |||||||||
| VP FINANCE | 38.00 | 277097 | 0 | 38399 | X | ||||
| PAMELA WILKES | |||||||||
| VP NETWORK DEVELOPMENT | 38.00 | 264544 | 0 | 24238 | X | ||||
| ROBERT FAZZOLARI | |||||||||
| VP GOV'T REL & CORP COMP | 38.00 | 263109 | 0 | 25608 | X | ||||
| RUPERT BRADY | |||||||||
| VP MARKETING | 38.00 | 245308 | 0 | 36449 | X | ||||
| JAMES M BURNOSKY | |||||||||
| VP STRATEGIC PLANNING | 38.00 | 190217 | 37031 | 33036 | X | ||||
| ROBERT HOOVER | |||||||||
| CHIEF INF. OFFICER | 38.00 | 282516 | 0 | 24964 | X | ||||
| CHRISTINE TESTAVERDE | |||||||||
| CHIEF LEGAL OFFICER | 38.00 | 151954 | 9048 | 1039 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 7613701 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 112173 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 990246 | TotalOtherCompensation |
| Number Individuals GT100 K | 103 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| AARETE LLC | |||||
| DEPARTMENT 4972 | CAROL STREAM | IL | 601220000 | VENDOR CONTRACTS REVIEW | 4361980 |
| IHT SERVICES LLC | |||||
| 115 PERIMETER CENTER PLACE | ATLANTA | GA | 303460000 | MEDICAL CLAIMS REVIEW | 4281721 |
| PCI | |||||
| 703 WASHINGTON STREET | BUFFALO | NY | 142030000 | IT SERVICES | 4120695 |
| HEALTH MANAGEMENT SYSTEMS INC | |||||
| PO BOX 27151 | NEW YORK | NY | 100870000 | COORDINATION OF BENEFITS REVIEW | 3876952 |
| HEALTHTRIO LLC | |||||
| 400 S COLORADO BLVD | DENVER | CO | 802461255 | WEB PORTAL | 1127098 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 21 | NumberOfContractorsGT100K |
| Related Organizations | 28000 | RelatedOrganizations |
| Government Grants | 25099 | GovernmentGrants |
| All Other Contributions | 484444 | AllOtherContributions |
| Total Contributions | 537543 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MEDICAID | 524114 | 1717102388 | 1717102388 |
| FAMILY HEALTH PLUS | 524114 | 283975726 | 283975726 |
| FAMILY HEALTH PLUS BUY | 524114 | 142669791 | 142669791 |
| CHILD HEALTH PLUS | 524114 | 122461702 | 122461702 |
| MEDICARE ADVANTAGE | 524114 | 101861582 | 101861582 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 33406001 | TotalRevenueColumn |
| Related Or Exempt Function Income | 33406001 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 2401477190 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7022612 | TotalRevenueColumn |
| Exclusion | $7,022,612 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 565214876 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 561463584 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3751292 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3751292 | TotalRevenueColumn |
| Exclusion | $3,751,292 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| EQUITY IN SALUS ADMINI | 900001 | 145900 | $145,900 |
| PURCHASE REBATES | 524298 | 72472 | $72,472 |
| MISCELLANEOUS | 524298 | 56010 | $56,010 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 22244 | TotalRevenueColumn |
| Exclusion | $22,244 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 296626 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2413085263 | TotalRevenueColumn |
| Related Or Exempt Function Income | 2401477190 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $11,070,530 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2125309 | Total |
| Program Services | 2125309 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 161993 | Total |
| Program Services | 161993 | ProgramServices |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2164074037 | Total |
| Program Services | 2164074037 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6933036 | Total |
| Management And General | 6933036 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78823866 | Total |
| Management And General | 78823866 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2783325 | Total |
| Management And General | 2783325 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11986999 | Total |
| Management And General | 11986999 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5976227 | Total |
| Management And General | 5976227 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1117202 | Total |
| Management And General | 1117202 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 572000 | Total |
| Management And General | 572000 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 62675 | Total |
| Management And General | 62675 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 482479 | Total |
| Management And General | 482479 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6839084 | Total |
| Management And General | 6839084 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4122039 | Total |
| Management And General | 4122039 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1456655 | Total |
| Management And General | 1456655 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3298610 | Total |
| Management And General | 3298610 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5762442 | Total |
| Management And General | 5762442 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2229579 | Total |
| Management And General | 2229579 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 390432 | Total |
| Management And General | 390432 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 286569 | Total |
| Management And General | 286569 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5808702 | Total |
| Management And General | 5808702 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 603052 | Total |
| Management And General | 603052 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| CLAIMS PROCESSING | 10216166 | 0 | 10216166 | 0 |
| LICENSE FEES | 4367327 | 0 | 4367327 | 0 |
| POSTAGE & SHIPPING | 4087530 | 0 | 4087530 | 0 |
| PRINTING & PUBLICATIONS | 3424908 | 0 | 3424908 | 0 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8256345 | Total |
| Management And General | 8256345 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2336248588 | Total |
| Program Services | 2166361339 | ProgramServices |
| Management And General | 169887249 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 199115341 | BOY |
| EOY | 275555612 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43799357 | BOY |
| EOY | 61574999 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28195560 | BOY |
| EOY | 24106013 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 55999405 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 46636753 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8376364 | BOY |
| EOY | 9362652 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 209376373 | BOY |
| EOY | 244514611 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 258371 | BOY |
| EOY | 404271 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16942278 | BOY |
| EOY | 16712278 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 79637743 | BOY |
| EOY | 112855572 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 585701387 | BOY |
| EOY | 745086008 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44002980 | BOY |
| EOY | 51027459 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1016466 | BOY |
| EOY | 1971993 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 275639336 | BOY |
| EOY | 358836108 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 320658782 | BOY |
| EOY | 411835560 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 264594074 | BOY |
| EOY | 332556465 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 448531 | BOY |
| EOY | 693982 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 265042605 | BOY |
| EOY | 333250448 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 585701387 | BOY |
| EOY | 745086008 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 76836675 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -8628832 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 185206 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 848235 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 537574 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 211811 | CurrentTaxYearMinus1Year |
| Current Tax Year | 537543 | CurrentTaxYear |
| Total | 2320369 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 669307221 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 996353043 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1432031556 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1911001018 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2401477190 | CurrentTaxYear |
| Total | 7410170028 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 669492427 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 997201278 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1432569130 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1911212829 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2402014733 | CurrentTaxYear |
| Total | 7412490397 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 7412490397 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 8410230 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 9566173 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6565256 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 6033312 | CurrentTaxYearMinus1Year |
| Current Tax Year | 7022612 | CurrentTaxYear |
| Total | 37597583 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 8410230 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 9566173 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6565256 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 6033312 | CurrentTaxYearMinus1Year |
| Current Tax Year | 7022612 | CurrentTaxYear |
| Total | 37597583 | Total |
Other Income509 OtherIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 4891744 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 485232 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 189310 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 155394 | CurrentTaxYearMinus1Year |
| Current Tax Year | 296626 | CurrentTaxYear |
| Total | 6018306 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 682794401 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1007252683 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1439323696 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1917401535 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2409333971 | CurrentTaxYear |
| Total | 7456106286 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.99420 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.99220 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00500 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.00650 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
| General Explanation | SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE A, PART III, LINE 12, EXPLANATION FOR OTHER INCOME: DESCRIPTION 2007 2008 2009 2010 2011 TOTAL MISCELLANEOUS INCOME $4,131 $110,414 $25,808 $32,892 $78,254 $251,499 PURCHASE REBATES $87,295 $104,727 $91,355 $86,278 $72,472 $442,127 EQUITY IN SUBSIDIARIES $4,800,318 $270,091 $72,147 $36,224 $145,900 $5,324,680 TOTAL $4,891,744 $485,232 $189,310 $155,394 $296,626 $6,018,306 | GeneralExplanation |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $62,675 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 62675 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | ReturnReference |
| Explanation | FIDELIS IS A MEMBER OF CERTAIN ASSOCIATIONS, TO WHICH IT PAYS ANNUAL DUES. A PORTION OF THOSE DUES ARE DETERMINED TO BE EXPENDITURES FOR LOBBYING PURPOSES. IN 2011, THAT PORTION IS $62,675. | Explanation |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 4556270 | InvestmentCostOrOtherBasis |
| Depreciation | 3585852 | Depreciation |
| Book Value | 970418 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 10641395 | InvestmentCostOrOtherBasis |
| Depreciation | 9210436 | Depreciation |
| Book Value | 1430959 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 40801740 | InvestmentCostOrOtherBasis |
| Depreciation | 33840465 | Depreciation |
| Book Value | 6961275 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 9362652 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| ASSETS WHOSE USE IS LIMITED (RESTRICTED FUNDS) | 99574100 |
| OTHER RECEIVABLES | 13281472 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 112855572 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| CLAIMS PAYABLE | $343,761,925 |
| DUE TO NEW YORK STATE | $14,148,063 |
| CAPITAL LEASE PAYABLE | $926,120 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 358836108 | TotalOfAmounts |
| Total Revenue | 2413085263 | TotalRevenue |
| Total Expenses | 2336248588 | TotalExpenses |
| Excess Or Deficit For Year | 76836675 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -8495449 | NetUnrealizedGLOnInvestments |
| Other | -$125,645 | OtherAmount |
| Total Adjustments | -8621094 | TotalAdjustments |
| Excess Or Deficit Per FS | 68215581 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 2404656558 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -8495449 | NetUnrealizedGainsInvestments |
| Other Revenues | 93093 | OtherRevenues |
| Revenue Not Rptd F990 | -8402356 | RevenueNotRptdF990 |
| Revenue Subtotal | 2413058914 | RevenueSubtotal |
| Other Revenues Not Included | 26349 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 26349 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 2413085263 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 2336440977 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 193560 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 193560 | ExpensesNotRptdF990 |
| Expenses Subtotal | 2336247417 | ExpensesSubtotal |
| Other Expenses Not Included | 1171 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 1171 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 2336248588 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | ORDINARY INCOME FROM HPA, LLC -22,244. INTEREST INCOME FROM HPA, LLC -1,732. DIVIDEND INCOME FROM HPA, LLC -4,131. NET CAPITAL LOSS FROM HPA, LLC 1,758. INVESTMENT MANAGEMENT FEE FROM HPA, LLC 1,171. REVERSAL OF ACCRUED GRANTS NOT TO BE PAID IN THE FUTURE -100,467. TOTAL TO SCHEDULE D, PART XI, LINE 8: -125,645. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | NET ASSETS RELEASED 266,993. EQUITY IN SALUS ADMINISTRATIVE SERVICES, INC. ("SALUS") -145,900. SALUS CONTRIBUTION TO HEALTHY KIDS ("HK") ELIMINATED IN CONSOLIDATION -28,000. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | ORDINARY INCOME FROM HPA, LLC 22,244. INTEREST INCOME FROM HPA, LLC 1,732. DIVIDEND INCOME FROM HPA, LLC 4,131. NET CAPITAL LOSS FROM HPA, LLC -1,758. |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | EQUITY IN SALUS -145,900. SALUS CONTRIBUTION TO HK ELIMINATED IN CONSOLIDATION -28,000. NET ASSETS RELEASED 266,993. REVERSAL OF ACCRUED GRANTS NOT TO BE PAID IN THE FUTURE 100,467. |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | INVESTMENT MANAGEMENT FEE FROM HPA, LLC 1,171. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (37 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Method Of ValuationMethodOfValuation | Purpose Of GrantPurposeOfGrant | Address Line2AddressUS/AddressLine2 |
|---|---|---|---|---|---|---|---|---|---|
| ALBANY MEDICAL CENTER | |||||||||
| 43 NEW SCOTLAND AVENUE | ALBANY | NY | 122080000 | 146023119 | 501(C)(3) | 5000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| BASSETT HEALTHCARE NETWORK | |||||||||
| 1 ATWELL ROAD | COOPERSTOWN | NY | 133260000 | 135596796 | 501(C)(3) | 10000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| CATHOLIC CHARITIES DIOCESE OF ROCHESTER | |||||||||
| 1150 BUFFALO ROAD | ROCHESTER | NY | 146240000 | 160743944 | 501(C)(3) | 55000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| CATHOLIC CHARITIES NEIGHBORHOOD SERVICES | |||||||||
| 191 JORALEMON STREET 9TH FLOOR | BROOKLYN | NY | 112010000 | 112047151 | 501(C)(3) | 115730 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| CATHOLIC CHARITIES OF BROOKLYN & QUEENS | |||||||||
| 191 JORALEMON STREET 7TH FLOOR | BROOKLYN | NY | 112010000 | 111633548 | 501(C)(3) | 113290 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| CATHOLIC CHARITIES OF FULTON & MONTGOMERY | |||||||||
| 4 NICHOLAS STREET | JOHNSTOWN | NY | 120950000 | 141340033 | 501(C)(3) | 5000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| CATHOLIC CHARITIES OF THE ARCHDIOCESE OF NEW YORK | |||||||||
| 1011 FIRST AVENUE | NEW YORK | NY | 100220000 | 135562185 | 501(C)(3) | 510000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| CATHOLIC CHARITIES OF THE DIOCESE OF BUFFALO | |||||||||
| 741 DELAWARE AVENUE | BUFFALO | NY | 142090000 | 160743251 | 501(C)(3) | 70000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| CATHOLIC CHARITIES OF THE DIOCESE OF OGDENSBURG | |||||||||
| 6866 STATE HIGHWAY 37 | OGDENSBURG | NY | 136690000 | 150614025 | 501(C)(3) | 30000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| CATHOLIC CHARITIES OF THE DIOCESE OF ROCKVILLE CENTRE | |||||||||
| 90 CHERRY LANE | HICKSVILLE | NY | 118010000 | 111843801 | 501(C)(3) | 104000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| CATHOLIC CHARITIES OF THE DIOCESE OF SYRACUSE | |||||||||
| 240 ONONDAGA STREET | SYRACUSE | NY | 132020511 | 150532085 | 501(C)(3) | 100000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| CATHOLIC HEALTH SYSTEM | |||||||||
| 2121 MAIN STREET | BUFFALO | NY | 142140000 | 222565278 | 501(C)(3) | 38000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| CATHOLIC MIGRATION OFFICE | |||||||||
| 1258 65TH STREET | BROOKLYN | NY | 112190000 | 112634818 | 501(C)(3) | 190980 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| CHARLES B WANG COMMUNITY HEALTH CENTER | |||||||||
| 268 CANAL STREET | NEW YORK | NY | 100130000 | 132739694 | 501(C)(3) | 12500 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| CHINATOWN YMCA | |||||||||
| 273 BOWERY | NEW YORK | NY | 100020000 | 131624228 | 501(C)(3) | 5000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| CORTLAND-CHENANGO RURAL SERVICES | |||||||||
| 2704 LOWER CINCINNATUS ROAD | CINCINNATUS | NY | 130400000 | 150532085 | 501(C)(3) | 6000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| DIOCESE OF BUFFALO - CATHOLIC SCHOOLS | |||||||||
| 795 MAIN STREET | BUFFALO | NY | 142030000 | 160743984 | 501(C)(3) | 63500 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| DIOCESE OF OGDENSBURG | |||||||||
| 622 WASHINGTON STREET | OGDENSBURG | NY | 136690000 | 150532120 | 501(C)(3) | 15000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| DIOCESE OF OGDENSBURG - DEPARTMENT OF EDUCATION - CATHOLIC SCHOOLS | |||||||||
| 100 ELIZABETH STREET PO BOX 369 | OGDENSBURG | NY | 136690000 | 150532120 | 501(C)(3) | 32435 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| DIOCESE OF ROCHESTER | |||||||||
| 1150 BUFFALO ROAD | ROCHESTER | NY | 146240000 | 160755765 | 501(C)(3) | 40000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| DIOCESE OF ROCHESTER - DEPARTMENT OF CATHOLIC SCHOOLS | |||||||||
| 1150 BUFFALO ROAD | ROCHESTER | NY | 146240000 | 160755765 | 501(C)(3) | 50000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| ELLIS MEDICINE | |||||||||
| 1101 NOTT STREET | SCHENECTADY | NY | 123080000 | 141338428 | 501(C)(3) | 10000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| FRANCISCAN NORTHSIDE MINISTRIES | |||||||||
| 804 NORTH SALINA STREET | SYRACUSE | NY | 132080000 | 150532104 | 501(C)(3) | 10000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| GREATER HUDSON VALLEY FAMILY HEALTH CENTER | |||||||||
| 2570 ROUTE 9W SUITE 10 | CORNWALL | NY | 125180000 | 061036715 | 501(C)(3) | 50000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| KINGSBROOK JEWISH MEDICAL CENTER | |||||||||
| 585 SCHENECTADY AVENUE | BROOKLYN | NY | 112031891 | 111631759 | 501(C)(3) | 12500 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| MORRIS HEIGHTS HEALTH CENTER | |||||||||
| 85 WEST BURNSIDE AVE | BRONX | NY | 104530000 | 061081232 | 501(C)(3) | 5000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| MOUNT ST MARY'S NIAGARA FALLS | |||||||||
| MOUNT ST MARYS HOSPITAL 5300 | LEWISTON | NY | 140920000 | 161523353 | 501(C)(3) | 48187 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | MILITARY ROAD |
| OFFICE OF THE SUPERINTENDENT CATHOLIC SCHOOL SUPPORT SERVICES RC DIOCESE | |||||||||
| 310 PROSPECT PARK WEST | BROOKLYN | NY | 112150000 | 111631807 | 501(C)(3) | 98900 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| OFFICE OF THE SUPERINTENDENT OF SCHOOLS ARCHDIOCESE OF NEW YORK | |||||||||
| 1011 FIRST AVENUE | NEW YORK | NY | 100220000 | 510453629 | 501(C)(3) | 150000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| QUEEN OF ALL SAINTS CHURCH | |||||||||
| 300 VANDERBILT AVENUE | BROOKLYN | NY | 112050000 | 111657620 | 170(B)(1)A(1) | 10000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| ROMAN CATHOLIC DIOCESE OF SYRACUSE | |||||||||
| 240 EAST ONONDAGA STREET | SYRACUSE | NY | 132020000 | 150532085 | 501(C)(3) | 15000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| ROMAN CATHOLIC DIOCESE OF SYRACUSE - CATHOLIC SCHOOL OFFICE | |||||||||
| 240 EAST ONONDAGA STREET | SYRACUSE | NY | 132022608 | 204325029 | 501(C)(3) | 40550 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| SCHOOLS OF THE ROMAN CATHOLIC DIOCESE OF ALBANY | |||||||||
| 40 NORTH MAIN AVENUE | ALBANY | NY | 122030000 | 141605502 | 501(C)(3) | 5000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| ST ELIZABETH MEDICAL CENTER FOUNDATION | |||||||||
| 2209 GENESEE STREET | UTICA | NY | 135010000 | 222562170 | 501(C)(3) | 43819 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| ST JOHN'S RIVERSIDE HOSPITAL | |||||||||
| 967 N BROADWAY | YONKERS | NY | 107010000 | 131740126 | 501(C)(3) | 14918 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| THE FOUNDATION OF THE ROMAN CATHOLIC DICOCESE OF BUFFALO | |||||||||
| 795 MAIN STREET | BUFFALO | NY | 142030000 | 161517131 | 501(C)(3) | 36000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | |
| GRANTS 5000 | |||||||||
| 95-25 QUEENS BOULEVARD | REGO PARK | NY | 113744510 | 501(C)(3) | 4000 | CASH | SEE PURPOSE OF GRANTS IN SCHEDULE O. | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 26 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | HEALTHY KIDS FUND | TypeOfGrant |
| Number Of Recipients | 18402 | NumberOfRecipients |
| Amount Of Cash Grant | 161993 | AmountOfCashGrant |
| Amount Of Non Cash Assistance | 0 | AmountOfNonCashAssistance |
| Method Of Valuation | CASH PAID | MethodOfValuation |
| Description Of Non Cash Assistance | N/A | DescriptionOfNonCashAssistance |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: RECIPIENTS OF GRANT AWARDS UNDER THE COMMUNITY GRANT FUND ARE REQUIRED TO PROVIDE PERIODIC UPDATES ON THE ACCOMPLISHMENTS OF THE GRANT AND DISBURSEMENTS. IT IS THE RESPONSIBILITY OF THE GRANT RECIPIENT TO ENSURE THAT THE GRANT IS USED FOR THE PURPOSE(S) STATED IN THE ORIGINAL APPLICATION. FIDELIS MONITORS GRANT USAGE BY CORRESPONDENCE, TELEPHONE OR SITE VISITS. AN EVALUATION OF THE PROJECT IS REQUIRED UPON THE GRANTEE'S COMPLETION. NON-COMPLIANCE WITH THESE GUIDELINES MAY RESULT IN A REQUEST FOR RETURN OF THE FUNDS IN QUESTION OR INELIGIBILITY OF THE ORGANIZATION FOR FUTURE GRANTS FROM FIDELIS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (14 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARK L LANE | |||||||||||||
| 1123661 | 0 | 0 | 0 | 1091185 | 0 | 17244 | 0 | 196200 | 0 | 2428290 | 0 | 0 | 0 |
| THOMAS HALLORAN | |||||||||||||
| 315332 | 19922 | 44956 | 2366 | 25448 | 502 | 207707 | 862 | 30750 | 1557 | 624193 | 25209 | 0 | 0 |
| PATRICK J FRAWLEY | |||||||||||||
| 603156 | 36966 | 0 | 0 | 1029414 | 502 | 16382 | 862 | 53556 | 2787 | 1702508 | 41117 | 0 | 0 |
| DAVID THOMAS | |||||||||||||
| 344864 | 0 | 48655 | 0 | 365718 | 0 | 17244 | 0 | 36923 | 0 | 813404 | 0 | 0 | 0 |
| SANJIV SHAH MD | |||||||||||||
| 294564 | 5679 | 40995 | 0 | 25794 | 157 | 6324 | 259 | 2899 | 24 | 370576 | 6119 | 0 | 0 |
| PAMELA HASSEN | |||||||||||||
| 234915 | 0 | 33992 | 0 | 29540 | 0 | 163061 | 0 | 19631 | 0 | 481139 | 0 | 0 | 0 |
| MARGARET M BRUBAKER | |||||||||||||
| 226706 | 0 | 27771 | 0 | 32290 | 0 | 17244 | 0 | 14997 | 0 | 319008 | 0 | 0 | 0 |
| WILLIAM COFFIN JR | |||||||||||||
| 242467 | 0 | 19875 | 0 | 14755 | 0 | 17244 | 0 | 21155 | 0 | 315496 | 0 | 0 | 0 |
| PAMELA WILKES | |||||||||||||
| 205746 | 0 | 32988 | 0 | 25810 | 0 | 17244 | 0 | 6994 | 0 | 288782 | 0 | 0 | 0 |
| ROBERT FAZZOLARI | |||||||||||||
| 205338 | 0 | 35081 | 0 | 22690 | 0 | 17244 | 0 | 8364 | 0 | 288717 | 0 | 0 | 0 |
| RUPERT BRADY | |||||||||||||
| 198082 | 0 | 31526 | 0 | 15700 | 0 | 17244 | 0 | 19205 | 0 | 281757 | 0 | 0 | 0 |
| JAMES M BURNOSKY | |||||||||||||
| 144299 | 32932 | 23228 | 4099 | 22690 | 0 | 13683 | 2680 | 14725 | 1948 | 218625 | 41659 | 0 | 0 |
| ROBERT HOOVER | |||||||||||||
| 222538 | 0 | 17662 | 0 | 42316 | 0 | 4268 | 0 | 20696 | 0 | 307480 | 0 | 0 | 0 |
| CHRISTINE TESTAVERDE | |||||||||||||
| 136158 | 7691 | 0 | 0 | 15796 | 1357 | 0 | 0 | 1002 | 37 | 152956 | 9085 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | REFER TO LINE 4B BELOW: |
| PART I, LINE 4B | SERP COMPENSATION OF OFFICERS OR KEY EMPLOYEES: MARK LANE - $963,404* PATRICK J. FRAWLEY - $997,626* DAVID THOMAS - $339,784* THOMAS HALLORAN - $191,325 PAMELA HASSEN - $145,817 *THE ABOVE AMOUNTS INCLUDE GROSS-UP TAXES PAID ON BEHALF OF THE PARTICIPANTS. |
| PART I, LINE 7 | PERFORMANCE-BASED INCENTIVES ARE PAID AS PART OF THE PLAN'S ANNUAL INCENTIVE PROGRAM. THE PRESIDENT & CHIEF EXECUTIVE OFFICER AND THE EXECUTIVE VICE PRESIDENT & CHIEF OPERATING OFFICER DO NOT PARTICIPATE IN ANY INCENTIVE PROGRAM. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (9 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| SISTER PATRICIA BURKARD | |||
| OFFICER | 16052575 | MED. CLAIMS | 0 |
| SISTER PATRICIA BURKARD | |||
| OFFICER | 10806010 | MED. CLAIMS | 0 |
| THOMAS DESTEFANO | |||
| DIRECTOR | 27258 | MED. CLAIMS | 0 |
| PATRICK J FRAWLEY | |||
| DIRECTOR | 27258 | MED. CLAIMS | 0 |
| PATRICK J FRAWLEY | |||
| DIRECTOR | 21126 | MED. CLAIMS | 0 |
| MARK L LANE | |||
| OFFICER | 5693209 | MED. CLAIMS | 0 |
| MARK L LANE | |||
| OFFICER | 21126 | MED. CLAIMS | 0 |
| MOST REV JOSEPH M SULLIVAN | |||
| CHAIRMAN OF BOARD | 21126 | MED. CLAIMS | 0 |
| JOHN A WERWAISS | |||
| DIRECTOR | 21126 | MED. CLAIMS | 0 |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE L, PART IV | Identifier |
| Explanation | DESCRIPTION OF TRANSACTION: MED. CLAIMS PAYMENTS TO THE FOLLOWING: 1.) ST. ELIZABETH MEDICAL CENTER 2.) ST. JOSEPH'S HOSPITAL & HEALTH CENTER 3.) STS. JOACHIM & ANNE NURSING AND REHABILITATION CENTER 4.) STS. JOACHIM & ANNE NURSING AND REHABILITATION CENTER 5.) ST. VINCENT'S CATHOLIC MEDICAL CENTER6.) KINGSBROOK JEWISH MEDICAL CENTER7.) ST. VINCENT'S CATHOLIC MEDICAL CENTER8.) ST. VINCENT'S CATHOLIC MEDICAL CENTER9.) ST. VINCENT'S CATHOLIC MEDICAL CENTER | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (15 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION MISSION STATEMENT | FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: | TO PROMOTE HEALTH THROUGH QUALITY, ACCESSIBLE CARE AND SERVICES TO THE COMMUNITY, ESPECIALLY TO THE POOR AND UNDERSERVED; TO PROMOTE HEALTH EDUCATION AND PREVENTATIVE MEDICINE. |
| ORGANIZATION MISSION STATEMENT | FORM 990, PART III, LINE 1 DESCRIPTION OF ORGANIZATION MISSION | THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC. ("FIDELIS" OR "THE PLAN") STRIVES TO PROMOTE HEALTH THROUGH QUALITY, ACCESSIBLE CARE AND SERVICES FOR ALL; TO JOIN IN PARTNERSHIP WITH HEALTH PROFESSIONALS TO ASSIST THEM IN THEIR HEALING WORK; TO ACT AS A FACILITATOR TO BUILD LINKAGES AND SYSTEMS FOR THE COORDINATION OF CARE AND SERVICES AMONG HEALTHCARE, BEHAVIORAL AND SOCIAL SERVICES, AS WELL AS EDUCATORS AND RELIGIOUS LEADERS, TO ADDRESS THE SPIRITUAL, EMOTIONAL AND PHYSICAL NEEDS OF THOSE WE SERVE; TO ADVOCATE FOR A HEALTH POLICY THAT ACCORDS TRUE DIGNITY AND RESPECT FOR ALL HUMAN PERSONS, ESPECIALLY THE POOR AND UNDERSERVED. AS OF DECEMBER 31, 2011, THE PLAN SERVED AN ENROLLED POPULATION COMPRISED OF BENEFICIARIES OF THE MEDICAL ASSISTANCE PROGRAM ("MEDICAID"), APPROXIMATELY 544,000; THE CHILD HEALTH PLUS BENEFICIARIES, APPROXIMATELY 75,000, A PROGRAM FOR LOW INCOME UNINSURED CHILDREN; THE FAMILY HEALTH PLUS BENEFICIARIES, APPROXIMATELY 95,000, A MEDICAID PROGRAM FOR LOW INCOME UNINSURED FAMILIES; MEDICARE/DUAL ADVANTAGE PROGRAM, APPROXIMATELY 9,000, A PROGRAM FOR THE ELDERLY; AND FIDELIS CARE AT HOME MANAGED LONG-TERM CARE PROGRAM, APPROXIMATELY 400, A PROGRAM FOR RESIDENTS OF ORANGE AND ROCKLAND COUNTIES WHO NEED LONG-TERM CARE SERVICES AND ARE ELIGIBLE FOR MEDICAID. |
| CHANGES IN PROGRAM SERVICES | FORM 990, PART III, LINE 3 | THE 1199SEIU BENEFIT FUND, WITH NEW YORK STATE'S APPROVAL, ELECTED TO TERMINATE ITS FAMILY HEALTH PLUS BUY-IN PROGRAM WITH FIDELIS EFFECTIVE OCTOBER 31, 2011. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS MEMBERS. THE MEMBERSHIP OF THE ORGANIZATION SHALL BE LIMITED TO THE DIOCESAN BISHOPS OF THE STATE AND THE ECCLESIASTICAL PROVINCE OF NEW YORK. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE ORGANIZATION IS A MEMBERSHIP CORPORATION UNDER THE NEW YORK NOT-FOR-PROFIT CORPORATION LAW (THE "N-PCL"). THE ORGANIZATION'S MEMBERS ELECT ITS BOARD OF DIRECTORS AND, AS MEMBERS OF A NEW YORK NOT-FOR-PROFIT CORPORATION, POSSESS CERTAIN OTHER POWERS UNDER THE N-PCL. FURTHERMORE, THE ORGANIZATION'S BY-LAWS, WHICH ARE FILED WITH THE NEW YORK STATE DEPARTMENT OF HEALTH ("NYSDOH"), DEFINE THE FOLLOWING RESERVED POWERS OF THE MEMBERS: (I) THE INTERPRETATION OF THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH CARE SERVICES TO WHICH THE ORGANIZATION, AS A FAITH-BASED ORGANIZATION, IS SUBJECT; (II) APPROVAL OF THE MISSION STATEMENT; (III) STANDING TO ENSURE THE ORGANIZATION'S COMPLIANCE WITH ITS PHILOSOPHY AND MISSION STATEMENT; (IV) APPROVAL OF AMENDMENTS TO THE ORGANIZATION'S CERTIFICATE OF INCORPORATION AND BY-LAWS; (V) APPROVAL OF TRANSACTIONS INVOLVING REAL PROPERTY; (VI) APPROVAL OF CERTAIN ACTIONS BY THE ORGANIZATION WHEN ACTING AS A SHAREHOLDER OR MEMBER OF ANOTHER ENTITY; (VII) APPROVAL OF THE ACCEPTANCE AND ISSUANCE OF SUBVENTIONS; (VIII) APPROVAL OF ANY MERGER, DISSOLUTION OR CONSOLIDATION, (IX) REMOVAL OF DIRECTORS AND CERTAIN OFFICERS OF THE CORPORATION; (X) APPROVAL OF THE ELECTION OF THE PRESIDENT & CHIEF EXECUTIVE OFFICER, AND (XI) REVIEW OF THE AUDITED FINANCIAL STATEMENTS. CERTAIN OF THESE POWERS ALREADY EXIST BY VIRTUE OF THE N-PCL (E.G., THE POWER TO APPROVE ANY MERGER, DISSOLUTION OR CONSOLIDATION UNDER N-PCL 903(A)(2) & 1002(A)). | |
| FORM 990, PART VI, SECTION A, LINE 7B | PLEASE SEE LINE 11 NARRATIVE. | |
| FORM 990, PART VI, SECTION B, LINE 11 | A DRAFT OF THE FORM 990 PREPARED BY THE ORGANIZATION'S FINANCE DEPARTMENT, IS REVIEWED BY THE ORGANIZATION'S CHIEF FINANCIAL OFFICER, ASSISTANT VICE PRESIDENT FOR FINANCE AND CHIEF LEGAL OFFICER, IN COLLABORATION WITH THE ORGANIZATION'S OUTSIDE INDEPENDENT TAX ADVISORS. THEREAFTER, THE ORGANIZATION'S PRESIDENT & CHIEF EXECUTIVE OFFICER AND EXECUTIVE VICE PRESIDENT & CHIEF OPERATING OFFICER REVIEW THE DRAFT FORM 990 WITH CHIEF FINANCIAL OFFICER, ASSISTANT VICE PRESIDENT FOR FINANCE AND CHIEF LEGAL OFFICER. THE ORGANIZATION'S BOARD OF DIRECTORS HAS AUTHORIZED THE EXECUTIVE COMMITTEE OF THE BOARD TO REVIEW AND ACCEPT THE DRAFT FORM 990 BEFORE ITS FILING WITH THE IRS. ACCORDINGLY, AFTER THE ORGANIZATION'S MANAGEMENT HAS COMPLETED ITS REVIEW OF THE DRAFT FORM 990, IT IS CIRCULATED IN DRAFT FOR REVIEW, COMMENT AND APPROVAL TO THE MEMBERS OF THE EXECUTIVE COMMITTEE. ONCE ANY COMMENTS HAVE BEEN INCORPORATED AND THE FORM 990 HAS BEEN ACCEPTED BY THE EXECUTIVE COMMITTEE, A COPY OF THE FORM 990 IS PROVIDED TO EACH MEMBER OF THE BOARD OF DIRECTORS PRIOR TO ITS FILING WITH THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY, THE ORGANIZATION'S OFFICERS, DIRECTORS AND SENIOR EXECUTIVES ARE PROVIDED WITH A COPY OF THE CONFLICTS OF INTEREST POLICY AND AN ACKNOWLEDGEMENT FORM. THESE INDIVIDUALS ARE INSTRUCTED TO SIGN AND RETURN THE FORM, (A) TO ACKNOWLEDGE THAT THEY HAVE REVIEWED THE POLICY AND (B) TO DISCLOSE ANY CONFLICTS OR POTENTIAL CONFLICTS. THE CONFLICTS OF INTEREST POLICY DEFINES "DISCLOSABLE INTERESTS," I.E., THOSE INTERESTS THAT AN INDIVIDUAL COVERED BY THE POLICY MUST HAVE IN ANOTHER ENTITY IN ORDER FOR A TRANSACTION BETWEEN THE ORGANIZATION AND THAT ENTITY TO BE COVERED BY THE POLICY. THE POLICY ALSO DEFINES THE TYPES OF TRANSACTIONS BETWEEN THE ORGANIZATION AND ANOTHER ENTITY INVOLVING AN INDIVIDUAL COVERED BY THE POLICY THAT ARE SUBJECT TO BY THE POLICY. THE POLICY REQUIRES DISCLOSURE TO BOARD OF DIRECTORS AND/OR THE EXECUTIVE COMMITTEE BY ANY PERSON WITH A DISCLOSABLE INTEREST IN A TRANSACTION AS DEFINED IN THE POLICY OF ALL CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST. INITIALLY, AFTER THE INTERESTED INDIVIDUAL HAS RECUSED HIMSELF, THE ORGANIZATION'S BOARD OF DIRECTORS OR EXECUTIVE COMMITTEE DETERMINES WHETHER A POTENTIAL CONFLICT OF INTEREST EXISTS. IF A CONFLICT OF INTEREST IS FOUND TO EXIST, THE BOARD OF DIRECTORS OR THE EXECUTIVE COMMITTEE DECIDES WHETHER TO ENTER INTO THE TRANSACTION BASED ON ITS DETERMINATION OF WHETHER, (A) A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, (B) THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND (C) THE TRANSACTION IS FAIR AND REASONABLE TO THE ORGANIZATION. | |
| FORM 990, PART VI, SECTION B, LINE 15 | OUTSIDE COUNSEL FOR THE ORGANIZATION, A NATIONAL LAW FIRM WITH EXPERTISE IN ADVISING TAX-EXEMPT ORGANIZATIONS ON EXCESS BENEFIT TRANSACTIONS LAW, HAS ADVISED FIDELIS AS TO WHICH EMPLOYEES ARE DISQUALIFIED PERSONS WITHIN THE MEANING OF SECTION 4958 OF THE INTERNAL REVENUE CODE. THE ORGANIZATION EMPLOYS A COMPENSATION CONSULTANT FIRM, A NATIONAL HUMAN RESOURCES CONSULTING FIRM WITH EXPERTISE IN ADVISING EXEMPT ORGANIZATIONS ON EXCESS BENEFIT TRANSACTIONS LAW, TO PREPARE ANNUALLY A DETAILED REPORT ON THE PROPOSED COMPENSATION FOR THE ORGANIZATION'S DISQUALIFIED PERSONS THAT INCLUDES DATA AS TO COMPARABLE COMPENSATION FOR SIMILAR QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY-SITUATED ORGANIZATIONS. THE EXECUTIVE COMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS, WHICH HAS BEEN AUTHORIZED BY THE BOARD TO REVIEW AND APPROVE ALL MATTERS CONCERNING EXECUTIVE COMPENSATION, IS PROVIDED WITH THE COMPENSATION CONSULTANT'S DETAILED EXECUTIVE COMPENSATION REPORT. THE REVIEW AND APPROVAL OF THE COMPENSATION OF THE ORGANIZATION'S DISQUALIFIED PERSONS IS ACCOMPLISHED IN TWO PHASES: FIRST WITH RESPECT TO THE PRESIDENT & CHIEF EXECUTIVE OFFICER AND THEN WITH RESPECT TO ALL OTHER DISQUALIFIED PERSONS, NAMELY, (I) THE EXECUTIVE VICE PRESIDENT & CHIEF OPERATING OFFICER, (II) THE CHIEF FINANCIAL OFFICER, (III) THE SENIOR VICE PRESIDENT & CHIEF ADMINISTRATIVE OFFICER, (IV) THE CHIEF LEGAL OFFICER AND (V) THE CHIEF MEDICAL OFFICER. FIRST, THE AFOREMENTIONED OUTSIDE COUNSEL AND HUMAN RESOURCES CONSULTING FIRM, AT THE INVITATION OF THE EXECUTIVE COMMITTEE, REVIEW WITH THE COMMITTEE THE DETAILED EXECUTIVE COMPENSATION REPORT WITH RESPECT TO THE PRESIDENT & CHIEF EXECUTIVE OFFICER. THE EXECUTIVE COMMITTEE ALSO RETAINS THE SERVICES OF A SECOND HUMAN RESOURCES CONSULTING FIRM TO ASSIST IN ITS EVALUATION OF THE PERFORMANCE OF THE PRESIDENT & CHIEF EXECUTIVE OFFICER. THE FULL REVIEW OF THE COMPENSATION AND PERFORMANCE OF THE PRESIDENT & CHIEF EXECUTIVE OFFICER IS PERFORMED BY THE EXECUTIVE COMMITTEE BIANNUALLY. AFTER ESTABLISHING THE COMPENSATION OF THE PRESIDENT & CHIEF EXECUTIVE OFFICER, THE EXECUTIVE COMMITTEE REPORTS ON ITS DELIBERATIONS AND DETERMINATIONS TO THE ORGANIZATION'S BOARD OF DIRECTORS. SECOND, THE EXECUTIVE COMMITTEE REVIEWS THE DETAILED EXECUTIVE COMPENSATION REPORT WITH RESPECT TO THE ORGANIZATION'S OTHER DISQUALIFIED PERSONS WITH THE ASSISTANCE OF THE SAME OUTSIDE COUNSEL AND COMPENSATION CONSULTANTS PARTICIPATING IN THE REVIEW OF THE COMPENSATION OF THE PRESIDENT & CHIEF EXECUTIVE OFFICER. THE EXECUTIVE COMMITTEE DETERMINES WHETHER TO APPROVE THE COMPENSATION ANALYSIS AND CONCLUSIONS CONTAINED IN THE COMPENSATION REPORT WITH RESPECT TO THE ORGANIZATION'S OTHER DISQUALIFIED PERSONS. AFTER CONSULTING WITH OUTSIDE COUNSEL, THE EXECUTIVE COMMITTEE HAS DESIGNATED THE PRESIDENT & CHIEF EXECUTIVE OFFICER TO SERVE AS AN "AUTHORIZED BODY" AS CONTEMPLATED BY THE EXCESS BENEFIT TRANSACTION REGULATIONS FOR THE PURPOSE OF SETTING THE COMPENSATION OF THOSE DISQUALIFIED PERSONS WITHIN AN APPROVED RANGE. THE ORGANIZATION MAINTAINS CONTEMPORANEOUS DOCUMENTATION AND RECORD KEEPING WITH RESPECT TO THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS FOR ALL DISQUALIFIED PERSONS. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION IS A NEW YORK NOT-FOR-PROFIT CORPORATION. ITS CERTIFICATE OF INCORPORATION IS READILY AVAILABLE TO THE GENERAL PUBLIC FROM THE NEW YORK STATE DEPARTMENT OF STATE UNDER THE NEW YORK FREEDOM OF INFORMATION LAW ("FOIL"). ITS CERTIFICATE OF INCORPORATION AND BY-LAWS ARE ALSO ON FILE WITH THE NEW YORK STATE DEPARTMENT OF HEALTH AND LIKEWISE AVAILABLE TO THE GENERAL PUBLIC UNDER FOIL. THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE TO ENROLLEES IN ITS MEDICAID AND FAMILY HEALTH PLUS PROGRAMS AND TO INDIVIDUALS CONSIDERING BECOMING ENROLLEES BY INCLUDING IN THE MEMBER HANDBOOKS FOR BOTH PROGRAMS, WHICH ARE PROVIDED TO ENROLLEES AND ARE ACCESSIBLE ON THE ORGANIZATION'S WEB SITE, A STATEMENT THAT THE FINANCIAL STATEMENTS (AS WELL AS OTHER INFORMATION DESCRIBED IN THE HANDBOOKS) ARE AVAILABLE UPON REQUEST BY CALLING A TOLL-FREE NUMBER PROVIDED IN THE HANDBOOKS. | |
| FORM 990, PART VII, SECTION A, COLUMB B | AVERAGE HOURS DEVOTED TO RELATED ORGANIZATION(S) WHEN RELATED COMPENSATION IS REPORTED: THE FOLLOWING INDIVIDUALS DEVOTE A PERCENTAGE OF THEIR TIME TO SALUS ADMINISTRATIVE SERVICES, INC. ("SALUS"), A RELATED ORGANIZATION, AS DETAILED BELOW: PATRICK J. FRAWLEY, EVP & COO - 7.5% THOMAS HALLORAN, CHIEF FINANCIAL OFFICER - 7.5% SANJIV SHAH, MD, CHIEF MEDICAL OFFICER - 7.5% JAMES M. BURNOSKY, VP STRATEGIC PLANNING & DEVELOPMENT - 20% THIS ARRANGEMENT IS COVERED BY AN EMPLOYEE SERVICE AGREEMENT BETWEEN FIDELIS AND SALUS. | |
| FORM 990 PART IX LINE 12 | THE ORGANIZATION'S LINE 12, ADVERTISING AND PROMOTION EXPENSES INCLUDE PAYMENTS TO OTHER EXEMPT ORGANIZATIONS IN SUPPORT OF THEIR CHARITABLE PURPOSES, TO BENEFIT THE COMMUNITY, OR IN SPONSORSHIP OF THEIR FUNDRAISING EVENTS. THE EXPENDITURES INCLUDE THE FOLLOWING AMOUNTS PAID TO THE FOLLOWING EXEMPT ORGANIZATIONS: THANKSGIVING CONTRIBUTION TO NEEDY: $119,832 THE ALFRED E. SMITH FOUNDATION: $127,000 OTHER CHARITABLE CONTRIBUTIONS LESS THAN $5,000: $ 44,985 TOTAL $291,817 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -8,495,449. NET IMPACT OF PRIOR YEAR HPA, LLC RECONCILING ITEMS: -32,916. REVERSAL OF ACCRUED GRANTS NOT TO BE PAID IN THE FUTURE -100,467. TOTAL TO FORM 990, PART XI, LINE 5: -8,628,832. |
| SCHEDULE I PART II COL H | SINCE 2004, THE PURPOSE OF THE FIDELIS CARE COMMUNITY GRANT FUND IS TO OFFER SUPPORT ANNUALLY THROUGH CHARITABLE CONTRIBUTIONS TO SELECTED TAX-EXEMPT NONPROFIT ORGANIZATIONS THAT SHARE SIMILAR MISSIONS AND VALUES OF SERVICE TO LOW-INCOME VULNERABLE INDIVIDUALS. PROPOSALS ARE EVALUATED ON THEIR RELEVANCE TO FIDELIS' MISSION OF CARING FOR THE NEEDS AND CONCERNS OF THE POOR AND MEDICALLY UNDERSERVED IN CONSULTATION WITH FIDELIS' MEMBERS. THE TOTAL AMOUNT TO BE DISTRIBUTED EACH YEAR IS APPROVED BY THE BOARD OF DIRECTORS, AND DISTRIBUTED IN ACCORDANCE WITH THE APPROVED BOARD POLICY. IN ADDITION TO THE GRANTS MADE THROUGH ITS COMMUNITY GRANT FUND, FIDELIS PROVIDES SUPPORT THROUGH CHARITABLE CONTRIBUTIONS THROUGH ITS CATHOLIC SCHOOLS GRANT INITIATIVE TO SELECTED CATHOLIC SCHOOLS OR DIOCESAN SCHOOL SYSTEMS IN THEIR EFFORT TO ASSIST ALL CHILDREN WITH OBTAINING AND KEEPING HEALTH COVERAGE. LASTLY, FIDELIS MAKES CHARITABLE DONATIONS TO ORGANIZATIONS CLASSIFIED AS TAX-EXEMPT NONPROFIT ORGANIZATIONS UNDER STATE AND FEDERAL LAW THAT WORK WITH FIDELIS TO SUPPORT THE PLAN'S MISSION. | |
| NON APPLICABLE QUESTIONS: | TO THE EXTENT THAT A QUESTION ON THE FORM 990 HAS BEEN LEFT BLANK, THE RESPONSE TO THIS QUESTION SHOULD BE NOT APPLICABLE. DUE TO SOFTWARE LIMITATIONS, FIDELIS COULD NOT PROPERLY RESPOND TO THE RESPECTIVE QUESTIONS AS N/A. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SALUS ADMINISTRATIVE SERVICES INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 95-25 QUEENS BOULEVARD | AddressLine1 |
| City | REGO PARK | City |
| State | NY | State |
| ZIP Code | 11374 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550878053 | EIN |
| Primary Activity | THIRD PARTY ADMINISTRATOR | PrimaryActivity |
| Legal Domicile State | NY | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FIDELIS CARE NEW YORK | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 1884317 | ShareOfTotalIncome |
| Share Of EOY Assets | 25408309 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| SALUS ADMINISTRATIVE SERVICES INC | ||
| K | 6577357 | CASH |
| SALUS ADMINISTRATIVE SERVICES INC | ||
| M | 68855 | CASH |
| SALUS ADMINISTRATIVE SERVICES INC | ||
| N | 1498067 | CASH |
Form990 Schedule R Part VII Form990ScheduleRPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | SCHEDULE R, PART V | ReturnReference |
| Explanation | SCHEDULE R, PART V RELATED PARTY TRANSACTIONS: FIDELIS REPORTS CERTAIN RELATED PARTY TRANSACTIONS BETWEEN ITSELF AND SALUS ADMINISTRATIVE SERVICES, INC. ("SALUS"), A RELATED PARTY, ON SCHEDULE R, PART V. THE METHODS USED FOR DETERMINING THE AMOUNTS REPORTED DIFFER BASED ON THE TYPE OF TRANSACTION BUT ARE ALL CONTAINED IN WRITTEN CONTRACTS BETWEEN THE TWO PARTIES. SALUS REPORTS A PERFORMANCE OF SERVICES TO FIDELIS. THE WRITTEN AGREEMENT SPECIFIES A FIXED DISPENSING FEE PER PHARMACY CLAIM PROCESSED. THE FEE IS AN ESTIMATE DESIGNED TO COVER DIRECT AND INDIRECT COSTS AS WELL AS A MODEST AMOUNT OF PROFIT. THE AMOUNT IS DEEMED CONSISTENT WITH AN INDEPENDENT THIRD PARTY TRANSACTION. FIDELIS REPORTS A SHARING OF FACILITIES, EQUIPMENT, AND OTHER ASSETS. THE OVERHEAD AND ADMINISTRATIVE COSTS ARE ALLOCATED BASED ON THE SHARE OF FACILITIES AND ASSETS SALUS IS DEEMED TO USE. FIDELIS SHARES PAID EMPLOYEES WITH SALUS. FIDELIS ALLOCATES SALARIES FOR EACH EMPLOYEE BASED ON THE PERCENTAGE OT TOTAL HOURS SPENT PROVIDING SERVICES TO SALUS. | Explanation |
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