Affinity Health Plan Inc.

“FORM 990, PART III, LINE 1: THE MISSION OF AFFINITY HEALTH PLAN IS TO IMPROVE THE HEALTH AND WELL-BEING OF ITS MEMBERS, THEIR FAMILIES, AND THEIR COMMUNITIES IN COLLABORATION WITH PRIMARY CARE PROVIDERS. AFFINITY STRIVES TO BE THE HEALTH PLAN OF CHOICE FOR ITS MEMBERS AND ITS PROVIDERS -- KNOWN FOR ASSURING ACCESS TO HIGH QUALITY, COST-EFFECTIVE CARE; DELIVERING THE BEST CUSTOMER EXPERIENCE; AND CONTRIBUTING SIGNIFICANTLY TO ACHIEVING A PATIENT-CENTERED HEALTH CARE SYSTEM. OTHER PROGRAM SERVICE (TWO NEW SIGNIFICANT PROGRAMS) FORM 990, PART III, LINE 2 & 4D: THE CHILD HEALTH PLUS (CHP) PROGRAM IS FUNDED BY THE STATE OF NEW YORK TO PROVIDE HEALTH INSURANCE COVERAGE FOR CHILDREN THAT ARE UNDER THE AGE OF 19. Established January 1, 2016, the Essential Plan covers essential health benefits, including inpatient and outpatient care, physician services, diagnostic services and prescription drugs among others, with no annual deductible and low out-of-pocket costs. Preventive care, such as routine office visits and recommended screenings are free. Plan members with income at or below 150% of the federal poverty level do not pay any monthly premium. Plan members with income at 200% of the federal poverty level pay a monthly premium of $20. Established July 1, 2016, HARP plans provide enhanced care management for members to help them coordinate all their physical health, behavioral health, substance use disorder and nonmedical support needs. HARP participants must be 21 or older, insured only by Medicaid and be eligible for Medicaid managed care. Individuals identified as HARP eligible must be offered care management through a Health Home designated by New York State. FORM 990 REVIEW FORM 990, PART VI, LINE 11B THE FINANCIAL STAFF COMPILES THE FINANCIAL AND OTHER INFORMATION REQUIRED IN THE 990 RETURN. KPMG, LLP, PREPARES THE RETURN AND THE INFORMATION IS REVIEWED BY THE COMPANY'S CFO AND VP of FINANCE. A FINAL COPY OF THE FORM 990 IS MADE AVAILABLE TO THE ENTIRE GOVERNING BODY BEFORE FILING WITH THE IRS. DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, QUESTION 12C 1. ACTUAL OR POTENTIAL CONFLICTS OF INTEREST MUST BE DISCLOSED TO APPROPRIATE MANAGEMENT PERSONNEL, HUMAN RESOURCES OR THE CORPORATE COMPLIANCE OFFICER. 2. EMPLOYEES MUST SEEK GUIDANCE AND APPROVAL FROM APPROPRIATE MANAGEMENT PERSONNEL PRIOR TO PURSUING ANY BUSINESS OR PERSONAL ACTIVITY THAT MAY CONSTITUTE A CONFLICT OF INTEREST. 3. MANAGEMENT, WITH PURCHASING AUTHORITY, WILL COMPLETE A RELATED PARTY QUESTIONNAIRE ANNUALLY TO IDENTIFY ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST. 4. EMPLOYEES, UPON HIRE AND ANNUALLY THEREAFTER, REVIEW THE CODE OF ETHICS WHICH INCLUDES INFORMATION ON CONFLICTS OF INTEREST. IN ADDITION, EMPLOYEES ARE REQUIRED TO SIGN AN ATTESTATION, UPON HIRE AND ANNUALLY THEREAFTER, THAT THEY ACKNOWLEDGE AND UNDERSTOOD THE CODE OF ETHICS. IF A CONFLICT OF INTEREST IS FOUND, PERSONS WITH A CONFLICT RECUSE THEMSELVES FROM DECISIONS RELATED TO THE CONFLICT.”

“Form 990, part vi, questions 15a and 15b: the process for determining compensation for the ceo, cfo and coo included review and approval by a compensation committee (the "committee") comprised of independent directors charged with this responsibility, consideration of comparability data and contemporaneous substantiation and documentation of the deliberation and decision. Affinity health plan's compensation program for these positions and other officers and key employees includes: a)the ceo - compensation for the chief executive officer is established by the compensation committee and ratified by the board of directors of affinity health plan. The board and the committee has established compensation terms for the ceo considering comparability data for ceo positions in similar organizations in their deliberations and decision making. These decisions are documented in accordance with legal requirements and best practices. B)compensation decisions applicable for other officers and key employees, including incentive bonuses, merit inceases, promotional salary adjustments, and starting salaries for newly hired officers and key employees are made after review of comparability data from published sources for similar positions in the relevant labor market. Published comparability data utilized includes industry specific data. Internal data is reviewed as well with the objective of ensuring internal equity with similarly situated staff. Compensation decisions impacting those of the foregoing positions that are also deemed to be "disqualified persons" under the internal revenue code (e.g., chief operating officer and chief financial officer) are made by the committee (and ratified by the board) in accordance with "intermediate sanctions safe harbor" standards utilizing the same processes as are applied to the ceo (discussed above). Document disclosure form 990, part vi, question 19 the organization makes its governing documents, conflict of interest policy, and financial statements available upon request.”

“Form 990, part xi, line 9 -16,137,117 write off of risk corridor receivable.”

“Description:inpatient med. Surgical hcra total expenses:21610952 program services:21610952”

“Description:emergency room claims total expenses:73775435 program services:73775435”

“Description:emergency room hcra total expenses:1736539 program services:1736539”

“Description:profession service-ibnr total expenses:15737630 program services:15737630”

“Description:outpatient claims-ibnr total expenses:7485132 program services:7485132”

“Description:other professional services - total expenses:xxx-xx-xxxx program services:xxx-xx-xxxx”

“Description:other professional svc-hcra total expenses:4278366 program services:4278366”

“Description:third party recoveries - reins total expenses:-20584020 program services:-20584020”

“Description:pharmacy lics total expenses:-10295359 program services:-10295359”

“Description:pharmacy reinsurance total expenses:-17742508 program services:-17742508”

“Description:pharmacy gov gap disc total expenses:-407221 program services:-407221”

“Description:dental claims total expenses:2937275 program services:2937275”

“Description:dental capitation total expenses:27976222 program services:27976222”

“Description:behavioral health capitation total expenses:23251966 program services:23251966”

“Description:dental hcra total expenses:211333 program services:211333”

“Description:beacon hcra total expenses:1849117 program services:1849117”

“Description:behavioral health capitation-m total expenses:24822717 program services:24822717”

“Description:diagnotic test lab & x-ray cla total expenses:68862642 program services:68862642”

“Description:radiology - capitation total expenses:52387 program services:52387”

“Description:lab capitations total expenses:7753284 program services:7753284”

“Description:lab hcra total expenses:1797224 program services:1797224”

“Description:diagnostic test lab-monte total expenses:2501785 program services:2501785”

“Description:family planning total expenses:-178231 program services:-178231”

“Description:nursing facility total expenses:2968901 program services:2968901”

“Description:transportation non-emergent total expenses:105022 program services:105022”

“Description:metro cards total expenses:-10524 program services:-10524”

“Description:vision capitation total expenses:3888913 program services:3888913”

“Description:outpatient physical therapy total expenses:423982 program services:423982”

“Description:chiropractic total expenses:460051 program services:460051”

“Description:acupuncture total expenses:37986 program services:37986”

“Description:dme, medical supplies total expenses:78759 program services:78759”

“Description:ambulatory surgery total expenses:2297993 program services:2297993”

“Description:home health care total expenses:23055 program services:23055”

“Description:other medical total expenses:906952 program services:906952”

“Description:prenatal/postpartum care total expenses:128820 program services:128820”

“Description:medicaid stop loss insurance total expenses:11990538 program services:11990538”

“Description:covered lives total expenses:7570605 program services:7570605”

“Description:premium tax total expenses:-1672182 program services:-1672182”