2011-11-11T11:29:39-06:00 2010-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE STE 2600 INDIANAPOLIS IN 462045120 990 2010-01-01 510609967 Healthfirst Health Plan of New Jersey Inc HEAL 9734972367 1 Washington Street STE 1405 Newark NJ 071023105 MARYBETH TITA 2128016000 2011-11-11 Christopher Boggs 3176817000 2010 2016-02-24 21:20:13Z HEALTHFIRST NJ TERENCE BYRD 1 Washington Street STE 1405 Newark NJ 071023105 99029223 false X WWW.HEALTHFIRSTNJ.ORG X 2006 NJ TO PROMOTE THE HEALTH OF THE PEOPLE OF THE STATE OF NEW JERSEY BY ARRANGING FOR THE PROVISION OF HEALTH CARE SERVICES TO MEDICARE AND MEDICAID BENEFICIARIES. 19 13 0 0 0 0 0 0 39545268 98887554 119118 141669 0 0 39664386 99029223 0 0 0 0 0 0 0 0 0 40169010 98607703 40169010 98607703 -504624 421520 15102850 29112536 12484419 22002764 2618431 7109772 TO PROMOTE THE HEALTH OF THE COMMUNITY BY ARRANGING FOR THE PROVISION OF HEALTH CARE SERVICES TO MEDICARE AND MEDICAID BENEFICIARIES AND TO RELIEVE THE POOR AND DISTRESSED BY MEETING THE SPECIAL HEALTH CARE NEEDS OF MEDICARE AND MEDICAID BENEFICIARIES. false false 52062651 54206702 MEDICARE HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC. (HFNJ) PROVIDES AFFORDABLE QUALITY HEALTH PLANS TO ELIGIBLE MEDICARE RECIPIENTS. FOR 2010 THERE WERE 5,011 MEMBERS ENROLLED IN HFNJ'S MEDICARE PLANS. HFNJ'S NETWORK INCLUDES APPROXIMATELY 15 REGIONAL HOSPITALS THAT PROVIDE SERVICES TO MEMBERS. 42913580 44680852 MEDICAID/NJFAMILYCARE HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC. (HFNJ) PROVIDES AFFORDABLE QUALITY HEALTH PLANS TO ELIGIBLE MEDICAID RECIPIENTS. FOR 2010 THERE WERE 22,995 MEMBERS ENROLLED IN HFNJ'S MEDICAID/NJFAMILYCARE PLANS. HFNJ'S NETWORK INCLUDES APPROXIMATELY 15 REGIONAL HOSPITALS THAT PROVIDE SERVICES TO MEMBERS. 94976231 false false false false false false false false false false false false true true true false true false false false false false false false false false false false true false false false false false false false true false false false false false true true false false true 1856 0 true 0 false false false false false false X 19 13 false true false false true true true true true false false true true true true true true false false false X MARYBETH TITA 2128016000 100 CHURCH ST FL 18 NEW YORK NY 100072601 X GARY HORAN 1.0 X 0 0 0 WILLIAM MCDONALD 1.0 X 0 0 0 GEORGE POPKO 1.0 X 0 0 0 STEVEN SAKOVITS 1.0 X 0 490252 83479 DANIEL P MCCARTHY 1.0 X 0 632126 96413 DEBORAH E HAMMOND 1.0 X 0 338335 16343 MICHAEL H HONIG 1.0 X 0 525374 18917 MARYBETH A TITA 1.0 X X 0 444258 68986 MICHAEL D D'AGNES 1.0 X 0 0 0 ANTHONY T ORLANDO 1.0 X 0 0 0 CASWELL SAMMS 1.0 X 0 0 0 AXEL RAMOS 1.0 X 0 0 0 LESLIE D HIRSCH 1.0 X 0 0 0 MICHAEL MARON 1.0 X 0 0 0 SPIROS HAITRAS 1.0 X 0 0 0 JOHN CALANDRIELLO 1.0 X 0 0 0 JAMES DEROSA 1.0 X 0 0 0 JAMES M MAHER 1.0 X 0 0 0 TERENCE L BYRD 1.0 X X 0 273632 23846 MITCHELL BLUME 1.0 X 0 0 0 PATRICIA J WANG 1.0 X 0 1206179 217641 ELIZABETH R ST CLAIR 1.0 X 0 488527 65122 JAY A SCHECHTMAN 1.0 X 0 506688 93425 GEORGE FRAWLEY 1.0 X 0 391808 110413 SEAN M NATARO 1.0 X 0 336606 21267 ANDREA C FORINO 1.0 X 0 307963 15980 REBECCA SCHWIETZ 1.0 X 0 277725 10297 DAVID T GUTWALD 1.0 X 0 117788 0 0 6337261 842129 0 true true false ST JOSEPH REGIONAL MEDICAL CENTER 703 MAIN ST PATERSON NJ 07503 HOSPITAL/MEDICAL 6946069 NEWARK BETH ISRAEL MEDICAL CENTER 201 LYONS AVE NEWARK NJ 07112 MEDICAL/HOSPITAL 3956367 TRINITAS REGIONAL MEDICAL CENTER 225 WILLIAMSON ST ELIZABETH NJ 07202 MEDICAL/HOSPITAL 3648626 RIVERSIDE PEDIATRIC GROUP 714 10TH ST SECAUCUS NJ 07094 MEDICAL/PROFESSIONAL 3568493 JERSEY CITY MEDICAL CENTER 355 GRAND ST JERSEY CITY NJ 07302 MEDICAL/HOSPITAL 1858847 81 0 MEDICARE ADVANTAGE (PART C) 524114 48355249 48355249 MEDICARE PRESCRIPTION DRUG CVG (PART D) 524114 5851453 5851453 MEDICAID / NJFAMILYCARE 524114 44680852 44680852 98887554 141669 141669 0 0 0 0 0 0 0 99029223 98887554 0 141669 0 0 0 0 0 0 0 0 0 0 11552296 7958128 3594168 0 0 0 0 0 287 287 0 0 0 0 0 0 0 0 112894 112894 0 0 0 HEALTHCARE SERVICE COSTS 87017816 87017816 UNPAID CLAIMS PROCESSING EXP -75590 -75590 98607703 94976231 3631472 0 6618365 15258458 3796840 6243875 3689771 4619870 997874 2990333 15102850 29112536 8203614 16402989 4280805 5599775 12484419 22002764 X 2618431 7109772 2618431 7109772 15102850 29112536 X 421520 4069821 X X false true true X false OTHER RECEIVABLES 685647 RISK POOL BALANCE RECEIVABLE 2304686 2990333 0 SECURED NOTES DUE TO RELATED ORG 3898849 DUE TO AFFILIATE 155952 DUE TO CMS 990009 DUE TO STATE OF NJ 554965 5599775 99029223 98607703 421520 -17131 4086951 4069820 4491340 103099043 -17131 4086951 4069820 99029223 99029223 98607703 98607703 98607703 1 PART X, LINE 2 THE FOLLOWING IS DISCLOSED IN THE AUDITED FINANCIAL STATEMENTS OF HF MANAGEMENT SERVICES, LLC, THE PARENT COMPANY OF HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC.: It is the Companys policy to provide for uncertain tax positions and the related interest and penalties based upon managements assessment of whether a tax benefit is more likely than not to be sustained upon examination by tax authorities. At December 31, 2010, the Company believes it has appropriately accounted for any unrecognized tax benefits. To the extent the Company prevails in matters for which a liability for an unrecognized tax benefit is established or is required to pay amounts in excess of the liability, the Company's effective tax rate in a given financial statement period may be affected. 2 PART XI, LINE 8 - OTHER ADJUSTMENTS RETAINED HOSPITAL PAYMENTS: 4,086,951. 3 PART XII, LINE 2D - OTHER ADJUSTMENTS RETAINED HOSPITAL PAYMENTS: 4,086,951. X X X X X true true false false false false true false false JAY A SCHECHTMAN 0 371872 0 118701 0 16115 0 83319 0 10106 0 600113 0 0 GEORGE FRAWLEY 0 282533 0 100936 0 8339 0 104618 0 5795 0 502221 0 0 PATRICIA J WANG 0 701556 0 290769 0 213854 0 207647 0 9994 0 1423820 0 0 STEVEN SAKOVITS 0 308695 0 107716 0 73841 0 73600 0 9879 0 573731 0 0 DANIEL P MCCARTHY 0 440085 0 160111 0 31930 0 81766 0 14647 0 728539 0 0 DEBORAH E HAMMOND 0 250986 0 76491 0 10858 0 7350 0 8993 0 354678 0 0 SEAN M NATARO 0 249671 0 76634 0 10301 0 7350 0 13917 0 357873 0 0 MICHAEL H HONIG 0 309902 0 91225 0 124247 0 8923 0 9994 0 544291 0 0 MARYBETH A TITA 0 329426 0 96003 0 18829 0 54757 0 14229 0 513244 0 0 ELIZABETH R ST CLAIR 0 342296 0 111053 0 35178 0 54786 0 10336 0 553649 0 0 ANDREA C FORINO 0 236471 0 68838 0 2654 0 7350 0 8630 0 323943 0 0 DAVID T GUTWALD 0 0 0 0 0 117788 0 0 0 0 0 117788 0 0 REBECCA SCHWIETZ 0 226718 0 50822 0 185 0 6948 0 3349 0 288022 0 0 TERENCE L BYRD 0 239585 0 22596 0 11451 0 15515 0 8331 0 297478 0 0 1 SCHEDULE J, PART 1, LINE 4A THE FOLLOWING INDIVIDUALS ENTERED INTO SEVERANCE AGREEMENTS AND/OR RECEIVED SEVERANCE PAYMENTS FROM HF MANAGEMENT SERVICES, LLC - A RELATED ORGANIZATION: DAVID T. GUTWALD TOTAL OF SEVERANCE AGREEMENT IN 2009: 184,159 SEVERANCE PAID IN 2010: 122,571 STEVEN SAKOVITS TOTAL OF SEVERANCE AGREEMENT IN 2010: 487,725 SEVERANCE PAID IN 2010: -0- SEVERANCE DEFERRED TO 2011: 325,150 SEVERANCE DEFERRED TO 2012: 162,575 2 SCHEDULE J, PART 1, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE NON-QUALIFIED RETIREMENT PLAN PROVIDED BY HF MANAGEMENT SERVICES, LLC - A RELATED ORGANIZATION. THE AMOUNTS BELOW REPRESENT CONTRIBUTIONS FROM THE PLAN SPONSOR FOR 2010. Patrica J. Wang 200,297. [Col. C] Michael H. Honig 109,701. [Col. BIII] George Frawley 90,346. [Col. C] Daniel P. McCarthy 74,416. [Col. C] Jay A. Schechtman 68,600. [Col. C] Steve Sakovits 58,778. [Col. C] Elizabeth R. St Clair 47,436. [Col. C] Marybeth A. Tita 47,407. [Col. C] 3 SCHEDULE J, PART 1, LINE 6B A PORTION OF THE BONUS COMPENSATION RECEIVED BY OFFICERS OF THE ORGANIZATION IS CONTINGENT UPON THE NET EARNINGS OF HF MANAGEMENT SERVICES, LLC - A RELATED ORGANIZATION. HF MANAGEMENT SERVICES LLC SOLE CORPORATE MEMBER 3898849 SURPLUS NOTES OUTSTANDING false HF MANAGEMENT SERVICES LLC SOLE CORPORATE MEMBER 11552296 MANAGEMENT AND ADMIN SERVICES false 1 FORM 990, PART VI, SECTION A, LINE 3 HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC. CONTRACTS WITH HF MANAGEMENT SERVICES, LLC (HFMS) TO PROVIDE ALL OF ITS MANAGEMENT AND ADMINISTRATIVE SERVICES. THE NOT-FOR-PROFIT ENTITY DOES NOT MAINTAIN ITS OWN STAFF OR OFFICE SPACE, THESE ARE SUPPLIED BY HFMS. HFMS CHARGES A PERCENT OF PREMIUM ON A PER MEMBER PER MONTH BASIS OR A FLAT FEE PER MEMBER PER MONTH. THE ARRANGEMENT IS APPROVED BY RESOLUTION OF THE BOARD OF DIRECTORS. 2 FORM 990, PART VI, SECTION A, LINE 6 HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC. IS A NEW JERSEY NOT-FOR-PROFIT CORPORATION WITH ONE CORPORATE MEMBER, HF MANAGEMENT SERVICES, LLC. 3 FORM 990, PART VI, SECTION A, LINES 7A AND 7B 7A: HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC. IS A NEW JERSEY NOT FOR PROFIT CORPORATION WITH ONE CORPORATE MEMBER, HF MANAGEMENT SERVICES, LLC. THE CORPORATE MEMBER HAS THE RIGHT TO APPOINT THE BOARD OF DIRECTORS OF HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC. 7B: AMENDMENTS TO THE GOVERNING DOCUMENTS REQUIRE APPROVAL OF THE SOLE CORPORATE MEMBER, HF MANAGEMENT SERVICES, LLC. CERTAIN DECISIONS OF THE BOARD OF DIRECTORS RELATING TO PRODUCTS OFFERED, RELATED PARTY TRANSACTIONS AND REPAYMENT OF SURPLUS NOTES REQUIRE APPROVAL OF THE NEW JERSEY DEPARTMENT OF BANKING AND INSURANCE. 4 FORM 990, PART VI, SECTION A, LINE 11A THE 990 IS PREPARED BY THE HF MANAGEMENT SERVICES, LLC (HFMS) CORPORATE FINANCE DEPARTMENT STAFF AND THEN REVIEWED BY THE HFMS DIRECTOR OF TREASURY OPERATIONS. SECONDARY REVIEWS ARE ALSO PERFORMED BY THE HFMS ASSISTANT VICE PRESIDENT OF FINANCE, GENERAL COUNSEL AND CHIEF FINANCIAL OFFICER. THE DRAFT 990 IS THEN REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE DRAFT 990 IS THEN TRANSMITTED TO THE BOARD OF DIRECTORS. THE FINAL 990 IS SUBMITTED AFTER THE RETURN IS RELEASED TO THE BOARD OF DIRECTORS. 5 FORM 990, PART VI, SECTION B, LINE 12C A CONFLICT OF INTEREST DISCLOSURE STATEMENT IS COMPLETED ANNUALLY BY EACH BOARD MEMBER, OFFICER AND KEY EMPLOYEE. EACH BOARD MEMBER, OFFICER AND KEY EMPLOYEE IS GIVEN A COPY OF THE DISCLOSURE STATEMENT TO COMPLETE ON AN ANNUAL BASIS. A MEMBER WHO DOES NOT COMPLETE THE STATEMENT IS NOT ALLOWED TO ATTEND BOARD MEETINGS AND MAY BE REMOVED FROM THE BOARD. AN OFFICER OR KEY EMPLOYEE WHO DOES NOT COMPLETE THE STATEMENT WILL BE DISCIPLINED, UP TO TERMINATION FROM THE POSITION. ANY DISCLOSURE OF A CONFLICT OR POTENTIAL CONFLICT IS REVIEWED BY THE CHIEF COMPLIANCE OFFICER. CONFLICTS ARE ADDRESSED BY EXAMINING THE RELATIONSHIP OF THE INDIVIDUAL TO THE ORGANIZATION. A REPORT OF ANY CONFLICTS IS PREPARED FOR DISCUSSION WITH AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF MANAGERS OF HF MANAGEMENT SERVICES, LLC, A RELATED ORGANIZATION, AS WELL AS THE FULL BOARD OF DIRECTORS OF HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC. AS APPROPRIATE, ACTION IS TAKEN, INCLUDING BUT NOT LIMITED TO MODIFICATIONS TO BUSINESS AGREEMENTS, CHANGES IN VENDORS OR REPLACEMENT OF THE DIRECTOR, OFFICER OR KEY EMPLOYEE WITH A NON-CONFLICTED INDIVIDUAL. 6 FORM 990, PART VI, SECTION B, LINE 15 BECAUSE THE REPORTING ORGANIZATION DID NOT COMPENSATE ANY OFFICER OR EMPLOYEE, THE REPORTING ORGANIZATION HAS RESPONDED "NO." HOWEVER, THE COMPENSATION OF THE PRESIDENT, CEO, OTHER OFFICERS, AND KEY EMPLOYEES IS DETERMINED BY THE COMPENSATION COMMITTEE OF HF MANAGEMENT SERVICES, LLC (A RELATED ORGANIZATION). THE COMMITTEE CONSISTS ONLY OF INDEPENDENT DIRECTORS. THE PROCESS FOR DETERMINING COMPENSATION IS DESCRIBED IN THE COMMITTEES CHARTER. THE PROCESS INCLUDES ENGAGEMENT OF AN OUTSIDE HUMAN RESOURCES CONSULTING FIRM TO CONDUCT A COMPARABILITY ANALYSIS. THE ANALYSIS INCLUDES COMPARABLE RANGES OF EXECUTIVE COMPENSATION USING THE COMPANY'S INDUSTRY CLASSIFICATION. THE COMMITTEE MEETS PRIOR TO IMPLEMENTATION OF ANY CHANGE IN COMPENSATION. CONTEMPORANEOUS MINUTES OF EACH MEETING ARE PREPARED. 7 FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC BY PROVIDING COPIES ON REQUEST FOR INSPECTION AT ITS CORPORATE OFFICES. 8 FORM 990, PART VII, SECTION A ALL OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES WERE PAID BY, AND WORKED 40 HOURS A WEEK FOR HF MANAGEMENT SERVICES, LLC (A RELATED ORGANIZATION) WHICH PROVIDES MANAGEMENT SERVICES FOR MULTIPLE ENTITIES. NO ALLOCATION OF TIME SPENT ON INDIVIDUAL NOT FOR PROFIT ENTITIES EXISTED FOR THE PERIOD COVERED BY THIS RETURN. NONE OF THE INDIVIDUALS LISTED EARNED ANY COMPENSATION FROM THE NOT-FOR-PROFIT ENTITY. 9 FORM 990, PART XI, LINE 5 RETAINED HOSPITAL PAYMENTS: 4,086,952 CHANGE IN UNREALIZED GAINS AND LOSSES ON INVESTMENTS: -17,131 10 FORM 990, PART XII, LINE 2B The filing organization does not publish stand-alone financial statements for general disclosure and use. Stand-alone financial statements are prepared solely for the New Jersey Department of Banking and Insurance and New Jersey Department of Human Services and are restricted as to their use. Such financial statements are prepared in conformity with accounting practices prescribed or permitted by the New Jersey Department of Banking and Insurance, which is a comprehensive basis of accounting other than accounting principles generally accepted in the United States. The statutory-basis financial statements are audited by an independent accountant. For purposes of general disclosure and use, including the Form 990, the filing organization is included in the consolidated financial statements of HF Management Services, LLC, a related organization, which are prepared in accordance with US GAAP and audited by an independent accountant. Other financial information included in the consolidated financial statements contains the GAAP-Basis balance sheet and income statement of the filing organization. 11 FORM 990, PART XII, LINE 2C THE SELECTION OF THE INDEPENDENT AUDITOR IS ADMINISTERED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF MANAGERS OF HF MANAGEMENT SERVICES, LLC (A RELATED ORGANIZATION). HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STEVEN SAKOVITS TITLE:DIRECTOR HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DANIEL P. MCCARTHY TITLE:DIRECTOR HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DEBORAH E. HAMMOND TITLE:DIRECTOR HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL H. HONIG TITLE:DIRECTOR HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARYBETH A. TITA TITLE:TREASURER/CFO HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TERENCE L. BYRD TITLE:PRESIDENT HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PATRICIA J. WANG TITLE:CHIEF EXECUTIVE OFFICER HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ELIZABETH R. ST CLAIR TITLE:SECRETARY HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAY A. SCHECHTMAN TITLE:SVP, CHIEF MEDICAL OFFICER HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GEORGE FRAWLEY TITLE:SVP OPERATIONS HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SEAN M. NATARO TITLE:ASSOCIATE GENERAL COUNSEL HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ANDREA C. FORINO TITLE:SVP, HUMAN RESOURCES HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:REBECCA SCHWIETZ TITLE:VP, CLINICAL PERF. MGMT HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID T. GUTWALD TITLE:VP, OPERATIONS HOURS:40 HEALTHFIRST INC 100 CHURCH ST FL 18 NEW YORK NY 100072601 133714932 MANAGED CARE NY 501(c)(3) 11 NA MANAGED HEALTH INC 100 CHURCH ST FL 18 NEW YORK NY 100072601 113029569 MANAGED CARE NY 501(c)(4) HEALTHFIRST HEALTHFIRST PHSP INC 100 CHURCH ST FL 18 NEW YORK NY 100072601 133783732 MANAGED CARE NY 501(c)(3) 9 HEALTHFIRST SENIOR HEALTH PARTNERS INC 345 E 102ND ST STE 200 NEW YORK NY 100295611 134103882 MGD LT CARE NY 501(c)(3) 9 HF MGMT SVCS HF MANAGEMENT SERVICES LLC 100 CHURCH ST FL 18 NEW YORK NY 100072601 134069806 3RD PTY ADM SVCS NY NA NONE 0 0 false 0 false 0.00000 HF PURCHASING SERVICES INC 100 CHURCH ST FL 18 NEW YORK NY 100072601 020537865 LEASING SERVICES NY HF MGMT SVCS C CORP 0 0 0.00000 HF ADMINISTRATIVE SERVICES INC 100 CHURCH ST FL 18 NEW YORK NY 100072601 133873482 3RD PTY ADM SVCS NY MF MGMT SVCS C CORP 0 0 0.00000 false false false false false false false false false false false true false false false false false false HF MANAGEMENT SERVICES LLC L 11552296 1 FORM 990, SCHEDULE R, PART V, LINE 2 METHOD OF DETERMINING AMOUNT INVOLVED ITEM (1): THE AMOUNT REPRESENTS THE EXPENSES INCURRED AND PAID OR DUE TO THE RELATED ORGANIZATION FOR SERVICES RENDERED BASED ON CONTRACTED RATES APPROVED BY RESOLUTION OF THE ORGANIZATION'S BOARD OF DIRECTORS AND BY STATE REGULATORS.