Fallon Total Care Inc.

Form 990, Part I, Line 1

“FTC'S MISSION Fallon Total Care, Inc. ("FTC") was formed as a Massachusetts nonprofit corporation on September 20, 2013 for charitable, educational, and scientific purposes, for relief of the poor and distressed and to lessen the burdens of government within the meaning of Sections 170(c)(2)(B) and 501(c)(3) of the Internal Revenue Code of 1986. Specifically, FTC was formed to promote, facilitate, and enhance the delivery of quality, efficient, effective and economical health care and related services to individuals who are dually eligible for both Medicare and Medicaid, and to improve and enhance the health and well-being of those individuals, by providing integrated behavioral and physical health management services on a risk basis. The enrollees are generally underprivileged, underserved, low-income population with major health care needs, including many individuals who suffer from chronic physical and/or mental health conditions. Serving this population is challenging and costly for federal and state governments. Established as a Demonstration Program by the Commonwealth of Massachusetts Executive Office of Health and Human Services' Office of Medicaid and the Center for Medicare Services, participating health plans coordinate and manage integrated behavioral and physical health management services to enrollees ages 21-64 who are eligible for both Medicare and Medicaid. By combining Medicare and Medicaid funding, the Demonstration Program enables a broader menu of services to better meet the needs of Dual Eligibles in the most cost effective way and enables an unprecedented level of integration to achieve better health outcomes for this population and to provide higher quality, more cost effective, person-centered care. FTC was formed by Fallon Community Health Plan, Inc. ("FCHP"), a Section 501(c)(3) tax-exempt Massachusetts nonprofit corporation and licensed Massachusetts health maintenance organization (HMO). FCHP is dedicated to improving the health and welfare of the populations it serves through the delivery of high quality, affordable health care. FCHP formed FTC to further FCHP's charitable health care mission, and FTC's purposes explicitly include supporting, benefiting, performing certain functions of, and carrying out the charitable, educational, or scientific purposes of FCHP. Given its participation in the Demonstration Program, FTC can perform its activities which are similar to that of an HMO, even though it is not licensed as an HMO in Massachusetts. FTC's structure, the method in which it delivers care, and the specific Medicaid population it serves, allow it to meet the criteria, discussed below, required for exemption under Section 501(c)(3) of the Code even if it was not participating in the Demonstration Program and would otherwise be required to obtain licensure as an HMO. FORM 990, PART III, LINE 4 FTC's Activities As a participant in the Demonstration Program, FTC provides integrated management and coordination services of both behavioral and physical health needs of its members. FTC develops individualized and comprehensive plans of care for its Members. A Navigator works with each Member, their caregiver and their health care providers to coordinate and advocate for the Member's physical, mental and social needs. An individualized care plan and central electronic record aid the Member's Care Team in delivering high quality health care and care that improves the Member's quality of life. FTC's Program activities consist of prepaid healthcare in the Commonwealth of Massachusetts. The covered population as of December 31, 2014, was 5,795 members. Members pay no premiums, co-payments, or co-insurance while participating in the Plan. All premiums are paid by state and federal agencies to cover traditional Medicaid and Medicare services. In addition to these services, FTC provides comprehensive care management, dedicated Navigators, expanded dental and Long Term Service and Support benefits. The combina”