2011-08-11T14:45:35-05:00 2010-12-31 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2010-01-01 113153422 NEW YORK STATE CATHOLIC HEALTH PLANINC NEWY 7183936151 95-25 QUEENS BOULEVARD REGO PARK NY 11374 MARK L LANE 7183936151 2011-08-10 1 5169187000 2010 2016-02-24 21:20:13Z FIDELIS CARE NEW YORK MARK L LANE 95-25 QUEENS BOULEVARD REGO PARK NY 11374 2374828133 0 X WWW.FIDELISCARE.ORG X 1993 NY 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. 18 18 1790 0 0 0 537574 211811 1432031556 1911001018 2431508 9567496 215408 181706 1435216046 1920962031 2505994 2496644 1255838987 1703299439 95717598 102652058 0 0 0 53270927 61144552 1407333506 1869592693 27882540 51369338 490906279 585701387 287773688 320658782 203132591 265042605 X SEE SCHEDULE O 0 0 1146852843 1767988 1302393621 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. 198706125 294636 216434686 FAMILY HEALTH PLUS ("FHP") 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. 154043903 164861434 EMPLOYER PARTNERSHIP FOR FAMILY HEALTH PLUS ("FAMILY HEALTH PLUS BUY-IN") IS A PROGRAM SPONSORED BY THE STATE OF NEW YORK, WHEREBY FIDELIS PROVIDES FAMILY HEALTH PLUS STATE-MANDATED BENEFITS, SUBJECT TO SPECIFIC EXCLUSIONS, TO CERTAIN ELIGIBLE MEMBERS OF THE 1199SEIU NATIONAL BENEFIT FUND FOR HOME CARE EMPLOYEES. 1199SEIU NATIONAL BENEFIT FUND DETERMINES THE ELIGIBILITY OF ITS MEMBERS TO PARTICIPATE IN THE PROGRAM. 206193212 434020 227311277 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. 206193212 434020 227311277 1705796083 1 1 0 1 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 12010 0 1 1790 1 0 0 0 0 0 0 0 0 0 0 X 18 18 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X WILLIAM COFFIN JR 7183936151 95-25 QUEENS BLVD REGO PARK NY 11374 X KARL P ADLER MD 0.00 X 0 0 0 JACK BALINSKY 0.00 X 0 0 0 M WILLIAM BENEDETTO 0.00 X 0 0 0 SISTER PATRICIA BURKARD OSF 0.00 X X 0 0 0 JAMES M CORRIGAN CPA MHA 0.00 X X 0 0 0 REV JOHN COUGHLIN 0.00 X 0 0 0 THOMAS DESTEFANO 0.00 X 0 0 0 REV DONALD J HARRINGTON 0.00 X 0 0 0 JOHN J HURLEY 0.00 X 0 0 0 THOMAS L KELLY 0.00 X X 0 0 0 MARK L LANE 38.00 X X 1748733 0 215941 REV LEO J O'DONOVAN SJ 0.00 X 0 0 0 GINO PAZZAGLINI 0.00 X 0 0 0 REV MONSIGNOR ALAN J PLACA 0.00 X 0 0 0 JOSEPH SLAVIK 0.00 X 0 0 0 MOST REV JOSEPH M SULLIVAN 0.00 X X 0 0 0 N NOEL TESTA MD 0.00 X 0 0 0 MICHAEL J TOOLEY 0.00 X 0 0 0 JOHN A WERWAISS 0.00 X 0 0 0 THOMAS HALLORAN 38.00 X 359513 19077 47670 PATRICK J FRAWLEY 38.00 X 1480571 32554 60515 DAVID THOMAS 38.00 X 640620 0 48672 PAMELLA HASSEN 38.00 X 286935 0 35636 MARGARET M BRUBAKER 38.00 X 227532 0 7284 ROBERT HOOVER 38.00 X 128037 0 9070 SANJIV SHAH MD 38.00 X 131715 0 445 WILLIAM COFFIN JR 38.00 X 267553 0 38862 RUPERT BRADY 38.00 X 237277 0 35968 ROBERT FAZZOLARI 38.00 X 244675 0 25675 PAMELA WILKES 38.00 X 241143 0 23974 JAMES M BURNOSKY 38.00 X 186452 33446 32338 EDWARD ANSELM MD 38.00 X 217869 0 17481 PATRICK GARLAND 38.00 X 151661 0 10028 ROBERT PIGOTT 38.00 X 236113 10897 36372 6526647 95974 636416 99 1 1 0 IHT SERVICES LLC 115 PERIMETER CENTER PLACE SUITE 70 ATLANTA GA 30346 MEDICAL CLAIMS REVIEW 3187475 PCI 703 WASHINGTON STREET BUFFALO NY 142031416 IT SERVICES 3181242 HEALTH MANAGEMENT SYSTEMS INC PO BOX 27151 NEW YORK NY 100877151 COORDINATION OF BENEFITS REVIEW 2247575 EMDEON BUSINESS SERVICES 12016 COLLECTIONS CTR DR CHICAGO IL 606930120 CLAIMS PROCESSING SERVICES 1151561 HEALTHTRIO LLC 400 S COLORADO BLVD SUITE 540 DENVER CO 802461255 WEB PORTAL 968339 23 4500 13489 193822 211811 MEDICAID 524114 1302393621 1302393621 FAMILY HEALTH PLUS 524114 216434686 216434686 FHP BUY-IN 524114 164861434 164861434 CHILD HEALTH PLUS 524114 111612123 111612123 MEDICARE ADVANTAGE 524114 95682897 95682897 20016257 20016257 1911001018 6038456 6038456 457395142 453866102 3529040 3529040 3529040 PURCHASE REBATES 524298 86278 86278 EQUITY IN SALUS ADMIN. 900001 36224 36224 MISCELLANEOUS 524298 32892 32892 26312 26312 181706 1920962031 1911001018 0 9749202 2378303 2378303 118341 118341 1703299439 1703299439 6403834 6403834 75135476 75135476 2826003 2826003 12642739 12642739 5644006 5644006 1499394 1499394 644015 644015 58525 58525 547725 547725 1391718 1391718 6113864 6113864 497313 497313 3945889 3945889 4134116 4134116 2160541 2160541 281365 281365 291753 291753 5508111 5508111 589317 589317 CLAIMS PROCESSING 7698350 0 7698350 0 LICENSE FEES 4269709 0 4269709 0 PRINTING & PUBLICATIONS 3922388 0 3922388 0 POSTAGE & SHIPPING 3876097 0 3876097 0 TELEPHONE 2266859 0 2266859 0 11447503 11447503 1869592693 1705796083 163796610 0 161811605 199115341 42164251 43799357 31097901 28195560 49434415 41058051 7554357 8376364 175503464 209376373 222147 258371 17712278 16942278 54840276 79637743 490906279 585701387 30639803 44002980 803790 1016466 7500000 248830095 275639336 287773688 320658782 X 202752541 264594074 380050 448531 203132591 265042605 490906279 585701387 X 51369338 10540676 X 0 1 1 X 1 1 X 261757 185206 848235 537574 211811 2044583 599417358 669307221 996353043 1432031556 1911001018 5608110196 599679115 669492427 997201278 1432569130 1911212829 5610154779 0 0 0 5610154779 6078071 8410230 9566173 6565256 6033312 36653042 6078071 8410230 9566173 6565256 6033312 36653042 1820656 4891744 485232 189310 155394 7542336 607577842 682794401 1007252683 1439323696 1917401535 5654350157 0.99220 0.98970 0.00650 0.00850 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE A, PART III, LINE 12, EXPLANATION FOR OTHER INCOME: DESCRIPTION 2006 2007 2008 2009 2010 TOTAL MISCELLANEOUS INCOME 60,346 4,131 110,414 25,808 32,892 233,591 PURCHASE REBATES 91,135 87,295 104,727 91,355 86,278 460,790 EQUITY IN SUBS. 515,354 4,800,318 270,091 72,147 36,224 5,694,134 CLAIMS PROCESSING 60,000 0 0 0 0 60,000 INSURANCE PROCEEDS 1,093,821 0 0 0 0 1,093,821 TOTAL $1,820,656 $4,891,744 $485,232 $189,310 $155,394 $7,542,336 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 58525 58525 0 PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE C, PART II-B, LINE 1(I), OTHER LOBBYING ACTIVITIES: 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 2010, THAT PORTION IS $58,525. 3623303 3185952 437351 9431821 8154144 1277677 36379291 29717955 6661336 8376364 ASSETS WHOSE USE IS LIMITED (RESTRICTED FUNDS) 77592080 OTHER RECEIVABLES 2045663 79637743 CLAIMS PAYABLE 262231401 DUE TO NEW YORK STATE 12759453 CAPITAL LEASE PAYABLE 648482 275639336 1920962031 1869592693 51369338 10752122 -211446 10540676 61910014 1931769257 10752122 89117 10841239 1920928018 34013 34013 1920962031 1869859243 267647 267647 1869591596 1097 1097 1869592693 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: EFFECTIVE JANUARY 1, 2009, THE PLAN ADOPTED THE PROVISION OF A STATEMENT ISSUED BY THE FASB WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES IN AN ENTITY'S FINANCIAL STATEMENTS. IT PRESCRIBES AN UNCERTAINTY THRESHOLD AND MEASUREMENT ATTRIBUTES FOR FINANCIAL STATEMENT DISCLOSURE OF TAX POSITIONS TAKEN, OR EXPECTED TO BE TAKEN, ON A TAX RETURN. THE IMPACT OF ADOPTING THE STATEMENT WAS NOT MATERIAL. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED 129,841. EQUITY IN SALUS ADMINISTRATION -36,224. SALUS CONTRIBUTION TO HK ELIMINATED ON CONSOLIDATION -4,500. PART XII, LINE 4B - OTHER ADJUSTMENTS: ORDINARY INCOME FROM HPA, LLC 24,811. INTEREST INCOME FROM HPA, LLC 1,597. DIVIDEND INCOME FROM HPA, LLC 3,546. NET CAPITAL GAIN FROM HPA, LLC 2,558. NET IMPACT OF CURRENT AND PRIOR YEAR HPA, LLC RECONCILING ITEMS 1,501. PART XIII, LINE 2D - OTHER ADJUSTMENTS: EQUITY IN SALUS -36,224. SALUS CONTRIBUTION TO HK ELIMINATED ON CONSOLIDATION -4,500. NET ASSETS RELEASED 129,841. REVERSAL OF ACCRUED GRANTS NOT TO BE PAID IN THE FUTURE 178,530. PART XIII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT MANAGEMENT FEE FROM HPA, LLC 1,097. 1 AMAUS HEALTH SERVICES AT THE CATHEDRAL OF THE IMMACULATE CONCEPTION 259 E ONONDAGA STREET SYRACUSE NY 13202 611548780 501(C)(3) 8000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O CATHOLIC CHARITIES DIOCESE OF ROCHESTER 1150 BUFFALO ROAD ROCHESTER NY 14624 160743944 501(C)(3) 46000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O CATHOLIC CHARITIES NEIGHBORHOOD SERVICES 191 JORALEMON STREET BROOKLYN NY 11201 112047151 501(C)(3) 114730 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O CATHOLIC CHARITIES OF BROOKLYN & QUEENS 191 JORALEMON STREET BROOKLYN NY 11201 111633548 501(C)(3) 112290 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O CATHOLIC CHARITIES OF BUFFALO 741 DELAWARE AVENUE BUFFALO NY 14209 160743251 501(C)(3) 59700 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O CATHOLIC CHARITIES OF THE ARCHDIOCESE OF NEW YORK 1011 FIRST AVENUE NEW YORK NY 10022 135562185 501(C)(3) 505000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O CATHOLIC CHARITIES OF THE DIOCESE OF ALBANY 40 NORTH MAIN AVENUE ALBANY NY 12203 141340033 501(C)(3) 102000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O CATHOLIC CHARITIES OF THE DIOCESE OF OGDENSBURG 6866 STATE HIGHWAY 37 OGDENSBURG NY 13669 150614025 501(C)(3) 25000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O CATHOLIC CHARITIES OF THE DIOCESE OF ROCKVILLE CENTRE 90 CHERRY LANE HICKSVILLE NY 11801 111843801 501(C)(3) 98000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O CATHOLIC CHARITIES OF THE DIOCESE OF SYRACUSE 240 ONONDAGA STREET SYRACUSE NY 13202 150532085 501(C)(3) 94500 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O CATHOLIC MEDICAL MISSION BOARD 10 WEST 17TH ST NEW YORK NY 100115765 135602319 501(C)(3) 13792 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O CATHOLIC MIGRATION OFFICE 1258 65TH STREET BROOKLYN NY 11219 112634818 501(C)(3) 189980 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O COMMUNITY HEALTH CENTER OF BUFFALO INC 462 GRIDER ST BUFFALO NY 14215 161566929 501(C)(3) 12645 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O CORTLAND-CHENANGO RURAL SERVICES 2704 LOWER CINCINNATUS ROAD CINCINNATUS NY 13040 161075281 501(C)(3) 6000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O DEPT OF EDUC CATHOLIC SCHOOLS OF THE DIOCESE OF OGDENSBURG 100 ELIZABETH STREET OGDENSBURG NY 13669 150532120 501(C)(3) 31920 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O ELLIS HOSPITAL FOUNDATION 1101 NOTT STREET SCHENECTADY NY 12308 141638957 501(C)(3) 10000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O FAMILY HEALTH NETWORK OF CENTRAL NEW YORK INC 17-29 MAIN ST SUITE 302 CORTLAND NY 13045 161133983 501(C)(3) 95000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O FOUNDATION OF ST MARY'S HOSPITAL AT AMSTERDAM 427 GUY PARK AVENUE AMSTERDAM NY 12010 133254655 501(C)(3) 25000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O FRANSISCAN NORTHSIDE MINISTRIES 804 NORTH SALINA STREET SYRACUSE NY 13208 150532104 501(C)(3) 12500 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O GREATER HUDSON VALLEY FAMILY HEALTH CENTER 2570 ROUTE 9W SUITE 10 CORNWALL NY 12518 061036715 501(C)(3) 50000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O HUDSON RIVER HEALTHCARE INC 1037 MAIN ST PEEKSKILL NY 10566 132828349 501(C)(3) 10000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O IBERO-AMERICAN ACTION LEAGUE INC 911 EAST MAIN ST ROCHESTER NY 14605 160954745 501(C)(3) 7500 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O INNER-CITY SCHOLARSHIP FUND 1011 FIRST AVENUE NEW YORK NY 10022 510453629 501(C)(3) 150000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O MERCY HOSPITAL OF BUFFALO 565 ABBOTT ROAD BUFFALO NY 14220 160756336 501(C)(3) 38600 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O MONTEFIORE MEDICAL CENTER 111 EAST 210TH STREET BRONX NY 104672490 131740114 501(C)(3) 10000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O NORTH SHORE-LIJ HEALTH SYSTEM 600 COMMUNITY DRIVE SUITE 102 MANHASSET NY 11030 112163522 501(C)(3) 100000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O OFFICE OF CATHOLIC SCHOOLS DIOCESE OF SYRACUSE 240 EAST ONONDAGA ST PO BOX 511 SYRACUSE NY 132010511 222563307 501(C)(3) 49050 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O OFFICE OF THE SUPT-CATHOLIC SUPPORT SERVICES DIOCESE OF BROOKLYN 7200 DOUGLASTON PARKWAY DOUGLASTON NY 11362 111631807 501(C)(3) 90500 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O P2 COLLABORATIVE OF WESTERN NEW YORK INC 6225 SHERIDAN DRIVE SUITE 206 WILLIAMSVILLE NY 14221 421604185 501(C)(3) 30000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O QUEEN OF ALL SAINTS CHURCH 300 VANDERBILT AVENUE BROOKLYN NY 11205 111657620 170(B)(1)A(1) 25000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O ROCHESTER PARISH SUPPORT MINISTRIES 1150 BUFFALO ROAD ROCHESTER NY 14624 160755765 501(C)(3) 36000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O SETON HEALTH FOUNDATION 1300 MASSACHUSETTS AVENUE TROY NY 12181 222345416 501(C)(3) 100000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O ST JOHN'S RIVERSIDE HOSPITAL 967 N BROADWAY YONKERS NY 10701 131740126 501(C)(3) 7790 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O ST JOSEPH'S HOSPITAL HEALTH CENTER FOUNDATION 973 JAMES ST SUITE 250 SYRACUSE NY 132032502 150532254 501(C)(3) 10106 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O THE FOUNDATION OF THE ROMAN CATHOLIC DIOCESE OF BUFFALO 795 MAIN STREET BUFFALO NY 14203 161517131 501(C)(3) 36700 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O THE KINGSTON HOSPITAL FOUNDATION 396 BROADWAY KINGSTON NY 12401 222511450 501(C)(3) 10000 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O WILLIAM F RYAN COMMUNITY HEALTH CENTER 110 WEST 97TH STREET NEW YORK NY 10025 132884976 501(C)(3) 7500 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O GRANTS 5000 95-25 QUEENS BOULEVARD REGO PARK NY 11374 501(C)(3) 47500 CASH SEE PURPOSE OF GRANTS IN SCHEDULE O 23 HEALTHY KIDS FUND 20276 118341 CASH PAID N/A PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: 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. X 1 1 X X X X X X 0 1 0 0 0 0 0 1 0 MARK L LANE 1096183 0 0 0 652550 0 17244 0 198697 0 1964674 0 0 0 THOMAS HALLORAN 295389 16594 38624 2033 25500 450 16382 862 29181 1245 405076 21184 0 0 PATRICK J FRAWLEY 587249 32104 0 0 893322 450 16382 862 41525 1746 1538478 35162 0 0 DAVID THOMAS 320996 0 41323 0 278301 0 17244 0 31428 0 689292 0 0 0 PAMELLA HASSEN 227719 0 31326 0 27890 0 17244 0 18392 0 322571 0 0 0 MARGARET M BRUBAKER 194455 0 5000 0 28077 0 0 0 7284 0 234816 0 0 0 WILLIAM COFFIN JR 234588 0 25000 0 7965 0 17244 0 21618 0 306415 0 0 0 RUPERT BRADY 193240 0 28700 0 15337 0 17110 0 18858 0 273245 0 0 0 ROBERT FAZZOLARI 201459 0 26266 0 16950 0 17244 0 8431 0 270350 0 0 0 PAMELA WILKES 193823 0 23340 0 23980 0 16913 0 7061 0 265117 0 0 0 JAMES M BURNOSKY 141632 29541 22130 3905 22690 0 13332 2353 14832 1821 214616 37620 0 0 EDWARD ANSELM MD 146106 0 40990 0 30773 0 13126 0 4355 0 235350 0 0 0 PATRICK GARLAND 55800 0 0 0 95861 0 2989 0 7039 0 161689 0 0 0 ROBERT PIGOTT 152794 8885 32292 1700 51027 312 14387 783 20259 943 270759 12623 0 0 PART I, LINE 1A REFER TO LINE 4B BELOW: PART I, LINE 4B SERP COMPENSATION OF OFFICERS OR KEY EMPLOYEES: MARK L. LANE - $525,696 PATRICK J. FRAWLEY - $861,482 DAVID THOMAS - $252,366 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. SISTER PATRICIA BURKARD OFFICER 14983141 MED. CLAIMS PAYMENTS TO ST. ELIZABETH MEDICAL CENTER 0 SISTER PATRICIA BURKARD OFFICER 9732299 MED. CLAIMS PAYMENTS TO ST. JOSEPH'S HOSPITAL AND HEALTH CENTER 0 THOMAS DESTEFANO DIRECTOR 23831 MED. CLAIMS PAYMENTS TO ST. JOACHIM & ANNE RESIDENCE 0 PATRICK J FRAWLEY KEY EMPLOYEE 4422025 MED. CLAIMS PAYMENTS TO ST. VINCENT'S CATHOLIC MEDICAL CENTER 0 MARK L LANE OFFICER 4422025 MED. CLAIMS PAYMENTS TO ST. VINCENT'S CATHOLIC MEDICAL CENTER 0 MARK L LANE OFFICER 5123079 MED. CLAIMS PAYMENTS TO KINGSBROOK JEWISH MEDICAL CENTER 0 GINO J PAZZAGLINI DIRECTOR 3321616 MED. CLAIMS PAYMENTS TO SETON HEALTH SYSTEM 0 MOST REV JOSEPH M SULLIVAN CHAIRMAN OF BOARD 4422025 MED. CLAIMS PAYMENTS TO ST. VINCENT'S CATHOLIC MEDICAL CENTER 0 JOHN A WERWAISS DIRECTOR 4422025 MED. CLAIMS PAYMENTS TO ST. VINCENT'S CATHOLIC MEDICAL CENTER 0 SCHEDULE L, PART IV AS A MANAGED CARE ORGANIZATION ADMINISTERING GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS SUCH AS MEDICAID, THE ORGANIZATION ENTERS INTO CONTRACTS WITH THOUSANDS OF HEALTH CARE ENTITIES THROUGHOUT NEW YORK STATE, INCLUDING INSTITUTIONS THAT ARE TAX-EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF WHICH CERTAIN OF THE ORGANIZATION'S OFFICERS AND DIRECTORS ARE ALSO DIRECTORS, OFFICERS OR KEY EMPLOYEES. UNDER THESE CONTRACTS, THE ORGANIZATION REIMBURSES THE ENTITIES FOR HEALTH CARE SERVICES PROVIDED TO THE ORGANIZATION'S ENROLLEES. THE ORGANIZATION'S OFFICERS AND DIRECTORS DO NOT HAVE FINANCIAL-OWNERSHIP INTEREST IN SUCH ENTITIES AS THEY ARE NOT-FOR-PROFIT CORPORATIONS; THE CONTRACTS ARE NOT FINANCIALLY MATERIAL FOR EITHER PARTY; AND NO INTERESTED PARTY PLAYS ANY ROLE IN SUCH CONTRACTS CONSISTENT WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. FORM 990, PART III, LINE 1 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, 2010, THE PLAN SERVED AN ENROLLED POPULATION COMPRISED OF BENEFICIARIES OF THE MEDICAL ASSISTANCE PROGRAM ("MEDICAID"), APPROXIMATELY 478,000, THE CHILD HEALTH PLUS BENEFICIARIES, APPROXIMATELY 71,000,A PROGRAM FOR LOW INCOME UNINSURED CHILDREN, THE FAMILY HEALTH PLUS BENEFICIARIES, APPROXIMATELY 85,000, A MEDICAID PROGRAM FOR LOW INCOME UNINSURED FAMILIES; FAMILY HEALTH-PLUS BUY-IN PROGRAM, APPROXIMATELY 30,000, A PROGRAM FOR CERTAIN ELIGIBLE MEMBERS OF THE 1199SEIU NATIONAL BENEFIT FUND FOR HOME CARE EMPLOYEES, 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. 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, VICE PRESIDENT FOR FINANCE AND CHIEF LEGAL OFFICER, IN COLLABORATION WITH THE ORGANIZATION'S OUTSIDE INDEPENDENT AUDITORS. THEREAFTER, THE ORGANIZATION'S PRESIDENT AND CHIEF EXECUTIVE OFFICER AND EXECUTIVE VICE PRESIDENT & CHIEF OPERATING OFFICER REVIEW THE DRAFT FORM 990 WITH CHIEF FINANCIAL OFFICER, 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 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 BI-ANNUALLY. 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, COLUMN B 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 - 5% THOMAS HALLORAN, CHIEF FINANCIAL OFFICER - 5% ROBERT PIGOTT, FORMER CHIEF LEGAL OFFICER - 5% JAMES M. BURNOSKY, VP STRATEGIC PLANNING - 15% THIS ARRANGEMENT IS COVERED BY AN EMPLOYEE SERVICE AGREEMENT BETWEEN FIDELIS AND SALUS. FORM 990 PART IX LINE 12 & LINE 24F THE ORGANIZATION'S LINE 12, ADVERTISING AND PROMOTION EXPENSES, AND LINE 24F, ALL OTHER 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: AMERICAN RED CROSS ROME AREA CHAPTER 9,000. CATHOLIC CHARITIES OF BROOKLYN & QUEENS 25,180. THANKSGIVING CONTRIBUTION TO NEEDY 120,027. THE ALFRED E. SMITH FOUNDATION 127,000. OTHER CHARITABLE CONTRIBUTIONS LESS THAN $5,000 97,863. TOTAL 379,070. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 10,752,122. ORDINARY INCOME FROM HPA, LLC -24,811. INTEREST INCOME FROM HPA, LLC -1,597. DIVIDEND INCOME FROM HPA, LLC -3,546. NET CAPITAL GAIN FROM HPA, LLC -2,558. INVESTMENT MANAGEMENT FEE FROM HPA, LLC 1,097. NET IMPACT OF CURRENT AND PRIOR YEAR HPA, LLC RECONCILING ITEMS -1,501. REVERSAL OF ACCRUED GRANTS NOT TO BE PAID IN THE FUTURE -178,530. TOTAL TO FORM 990, PART XI, LINE 5: 10,540,676. SCHEDULE I, PART II, COLUMN 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 MAKES CHARITABLE DONATIONS TO ORGANIZATIONS CLASSIFIED AS TAX-EXEMPT NONPROFIT ORGANIZATIONS UNDER STATE AND FEDERAL LAW. NON APPLICABLE QUESTIONS FORM 990 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. SALUS ADMINISTRATIVE SERVICES INC 95-25 QUEENS BOULEVARD REGO PARK NY 11374 550878053 THIRD PARTY ADMINISTRATOR NY FIDELIS CARE NEW YORK C 931884 2301010 1.00000 0 0 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 SALUS ADMINISTRATIVE SERVICES INC N 774616 CASH SALUS ADMINISTRATIVE SERVICES INC K 2891315 CASH RELATED PARTY TRANSACTIONS SCHEDULE R, PART V 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 3RD 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 OF TOTAL HOURS SPENT PROVIDING SERVICES TO SALUS.