Affinity Health Plan Inc.

“FORM 990, PART I, LINE 1 AND 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. CEASED ACTIVITIES FORM 990, PART III, LINE 3 Affinity Health Plan (the Plan) established a Qualified Health Plan (QHP) in 2013 under Health Care Reform, which was certified by the New York State Health Insurance Marketplace (the Exchange). QHP provided essential health benefits, follows established limits on cost sharing (deductible, copayment, and out-of-pocket maximum amounts), and must maintain compliance with other provisions of the ACA. The QHP business became operational effective October 1, 2013, with the acceptance of members under the provisions of the Exchange. Coverage for QHP members began on January 1, 2014. QHP was administered under an agreement between the Plan and the NYSDOH and extended through December 31, 2017. Effective January 1, 2018, the Plan no longer offers a QHP through the Exchange. 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/CONTROLLER. 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. 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 and cfo 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) 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 have 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 increases, 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 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.”

“Description:emergency room claims total expenses:38558232 program services:38558232”

“Description:emergency room hcra total expenses:1978909 program services:1978909”

“Description:profession service-ibnr total expenses:-17133778 program services:-17133778”

“Description:share savings expense total expenses:-1994630 program services:-1994630”

“Description:outpatient claims-ibnr total expenses:-4347083 program services:-4347083”

“Description:outpatient non valuated exp total expenses:55696 program services:55696”

“Description:ils capitation total expenses:2757247 program services:2757247”

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

“Description:other professional svc-hcra total expenses:4762856 program services:4762856”

“Description:third party recoveries - reins total expenses:-22380180 program services:-22380180”

“Description:health home claims total expenses:5411529 program services:5411529”

“Description:dental capitation total expenses:28636673 program services:28636673”

“Description:behavioral health capitation total expenses:97084397 program services:97084397”

“Description:dental hcra total expenses:210621 program services:210621”

“Description:beacon hcra total expenses:1263799 program services:1263799”

“Description:diagnostic test lab & x-ray total expenses:84330896 program services:84330896”

“Description:lab capitations total expenses:-277299 program services:-277299”

“Description:lab hcra total expenses:2634664 program services:2634664”

“Description:diagnostic test lab total expenses:325075 program services:325075”

“Description:family planning total expenses:2554 program services:2554”

“Description:nursing facility total expenses:3185901 program services:3185901”

“Description:nursing facility hcra total expenses:13 program services:13”

“Description:transportation non-emergent total expenses:-87700 program services:-87700”

“Description:vision capitation total expenses:4056091 program services:4056091”

“Description:outpatient physical therapy total expenses:23887 program services:23887”

“Description:chiropractic total expenses:270341 program services:270341”

“Description:acupuncture total expenses:6500 program services:6500”

“Description:dme, medical supplies total expenses:7882 program services:7882”

“Description:ambulatory surgery total expenses:342014 program services:342014”

“Description:home health care total expenses:996 program services:996”

“Description:other medical total expenses:921362 program services:921362”

“Description:prenatal/postpartum care total expenses:21888 program services:21888”

“Description:medicaid stop loss insurance total expenses:12878634 program services:12878634”

“Description:covered lives total expenses:5985797 program services:5985797”