Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2010 and ending 12-31-2010
BCheck if applicable:
CName of organization
NEW YORK STATE CATHOLIC HEALTH PLANINC
 
Doing Business As
FIDELIS CARE NEW YORK
 
Number and street (or P.O. box if mail is not delivered to street address)
95-25 QUEENS BOULEVARD
 
Room/suite
City or town, state or country, and ZIP + 4
REGO PARK, NY11374
D Employer identification number

11-3153422
E Telephone number

G Gross receipts $ 2,374,828,133
F Name and address of principal officer:
MARK L LANE
95-25 QUEENS BOULEVARD
REGO PARK,NY11374
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.FIDELISCARE.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1993
M State of legal domicile: NY
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: 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.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 18
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 18
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 1,790
6 Total number of volunteers (estimate if necessary) .... 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 537,574 211,811
9 Program service revenue (Part VIII, line 2g) ......... 1,432,031,556 1,911,001,018
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 2,431,508 9,567,496
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 215,408 181,706
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 1,435,216,046 1,920,962,031
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 2,505,994 2,496,644
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 1,255,838,987 1,703,299,439
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 95,717,598 102,652,058
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 53,270,927 61,144,552
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 1,407,333,506 1,869,592,693
19 Revenue less expenses. Subtract line 18 from line 12...... 27,882,540 51,369,338
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 490,906,279 585,701,387
21 Total liabilities (Part X, line 26)............ 287,773,688 320,658,782
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 203,132,591 265,042,605
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: SEE SCHEDULE O
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 1,146,852,843 including grants of $ 1,767,988 ) (Revenue $ 1,302,393,621 )
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.
4b (Code:   ) (Expenses $ 198,706,125 including grants of $ 294,636 ) (Revenue $ 216,434,686 )
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.
4c (Code:   ) (Expenses $ 154,043,903 including grants of $   ) (Revenue $ 164,861,434 )
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.
(Code:   ) (Expenses $ 206,193,212 including grants of $ 434,020 ) (Revenue $ 227,311,277 )
(Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
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.
4d Other program services. (Describe in Schedule O.)
(Expenses $ 206,193,212 including grants of $ 434,020 ) (Revenue $ 227,311,277 )
4e Total program service expensesMediumBullet$ 1,705,796,083
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....
20a
 
No
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. .....
20b
 
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
12,010
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
1,790
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
18
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
18
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
WILLIAM COFFIN JR
95-25 QUEENS BLVD
REGO PARK,NY11374
(718) 393-6151
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) KARL P ADLER MD
DIRECTOR
 0.00 X           0 0 0
(2) JACK BALINSKY
DIRECTOR
 0.00 X           0 0 0
(3) M WILLIAM BENEDETTO
DIRECTOR
 0.00 X           0 0 0
(4) SISTER PATRICIA BURKARD OSF
DIRECTOR/SECRETARY
 0.00 X   X       0 0 0
(5) JAMES M CORRIGAN CPA MHA
DIRECTOR/TREASURER
 0.00 X   X       0 0 0
(6) REV JOHN COUGHLIN
DIRECTOR
 0.00 X           0 0 0
(7) THOMAS DESTEFANO
DIRECTOR
 0.00 X           0 0 0
(8) REV DONALD J HARRINGTON
DIRECTOR
 0.00 X           0 0 0
(9) JOHN J HURLEY
DIRECTOR
 0.00 X           0 0 0
(10) THOMAS L KELLY
DIRECTOR/VICE-CHAIRMAN
 0.00 X   X       0 0 0
(11) MARK L LANE
PRESIDENT & CEO
 38.00 X   X       1,748,733 0 215,941
(12) REV LEO J O'DONOVAN SJ
DIRECTOR
 0.00 X           0 0 0
(13) GINO PAZZAGLINI
DIRECTOR
 0.00 X           0 0 0
(14) REV MONSIGNOR ALAN J PLACA
DIRECTOR
 0.00 X           0 0 0
(15) JOSEPH SLAVIK
DIRECTOR
 0.00 X           0 0 0
(16) MOST REV JOSEPH M SULLIVAN
CHAIRMAN OF THE BOARD
 0.00 X   X       0 0 0
(17) N NOEL TESTA MD
DIRECTOR
 0.00 X           0 0 0
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) MICHAEL J TOOLEY
DIRECTOR
 0.00 X           0 0 0
(19) JOHN A WERWAISS
DIRECTOR
 0.00 X           0 0 0
(20) THOMAS HALLORAN
CHIEF FINANCIAL OFFICER
 38.00     X       359,513 19,077 47,670
(21) PATRICK J FRAWLEY
EVP & COO
 38.00       X     1,480,571 32,554 60,515
(22) DAVID THOMAS
SR VP & CHIEF ADM. OFF.
 38.00       X     640,620 0 48,672
(23) PAMELLA HASSEN
CHIEF MARKETING OFFICER
 38.00       X     286,935 0 35,636
(24) MARGARET M BRUBAKER
CHIEF HR OFFICER
 38.00       X     227,532 0 7,284
(25) ROBERT HOOVER
CHIEF INF. OFFICER
 38.00       X     128,037 0 9,070
(26) SANJIV SHAH MD
CHIEF MEDICAL OFFICER
 38.00       X     131,715 0 445
(27) WILLIAM COFFIN JR
VP FINANCE
 38.00         X   267,553 0 38,862
(28) RUPERT BRADY
VP MARKETING
 38.00         X   237,277 0 35,968
(29) ROBERT FAZZOLARI
VP GOV'T AFFAIRS & COM.
 38.00         X   244,675 0 25,675
(30) PAMELA WILKES
VP NETWORK DEV.
 38.00         X   241,143 0 23,974
(31) JAMES M BURNOSKY
VP STRATEGIC PLANNING
 38.00         X   186,452 33,446 32,338
(32) EDWARD ANSELM MD
CHIEF MEDICAL OFFICER
 38.00           X 217,869 0 17,481
(33) PATRICK GARLAND
CHIEF INF. OFFICER
 38.00           X 151,661 0 10,028
(34) ROBERT PIGOTT
CHIEF LEGAL OFFICER
 38.00           X 236,113 10,897 36,372
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 6,526,647 95,974 636,416
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet99
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
IHT SERVICES LLC
115 PERIMETER CENTER PLACE SUITE 70
ATLANTA,GA30346 		MEDICAL CLAIMS REVIEW 3,187,475
PCI
703 WASHINGTON STREET
BUFFALO,NY142031416 		IT SERVICES 3,181,242
HEALTH MANAGEMENT SYSTEMS INC
PO BOX 27151
NEW YORK,NY100877151 		COORDINATION OF BENEFITS REVIEW 2,247,575
EMDEON BUSINESS SERVICES
12016 COLLECTIONS CTR DR
CHICAGO,IL606930120 		CLAIMS PROCESSING SERVICES 1,151,561
HEALTHTRIO LLC
400 S COLORADO BLVD SUITE 540
DENVER,CO802461255 		WEB PORTAL 968,339
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet23
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 4,500
e Government grants (contributions)1e 13,489
f All other contributions, gifts, grants, and
similar amounts not included above1f 		193,822
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 211,811
Program Service Revenue Business Code
2a MEDICAID 524,114 1,302,393,621 1,302,393,621    
b FAMILY HEALTH PLUS 524,114 216,434,686 216,434,686    
c FHP BUY-IN 524,114 164,861,434 164,861,434    
d CHILD HEALTH PLUS 524,114 111,612,123 111,612,123    
e MEDICARE ADVANTAGE 524,114 95,682,897 95,682,897    
f All other program service revenue . 20,016,257 20,016,257    
g Total. Add lines 2a–2f........MediumBullet 1,911,001,018
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 6,038,456     6,038,456
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross Rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 457,395,142  
b Less: cost or other basis and sales expenses 453,866,102  
c Gain or (loss) 3,529,040  
d Net gain or (loss)..........MediumBullet 3,529,040     3,529,040
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a PURCHASE REBATES 524,298 86,278     86,278
b EQUITY IN SALUS ADMIN. 900,001 36,224     36,224
c MISCELLANEOUS 524,298 32,892     32,892
d All other revenue .... 26,312     26,312
e Total. Add lines 11a–11d ......MediumBullet 181,706
12 Total revenue. See Instructions....MediumBullet 1,920,962,031 1,911,001,018 0 9,749,202
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 2,378,303 2,378,303
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 118,341 118,341
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16    
4 Benefits paid to or for members 1,703,299,439 1,703,299,439
5 Compensation of current officers, directors, trustees, and key employees .... 6,403,834   6,403,834  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 75,135,476   75,135,476  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 2,826,003   2,826,003  
9 Other employee benefits ....... 12,642,739   12,642,739  
10 Payroll taxes ........... 5,644,006   5,644,006  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 1,499,394   1,499,394  
c Accounting ........... 644,015   644,015  
d Lobbying ........... 58,525   58,525  
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ...... 547,725   547,725  
g Other .......... 1,391,718   1,391,718  
12 Advertising and promotion .... 6,113,864   6,113,864  
13 Office expenses ....... 497,313   497,313  
14 Information technology ...... 3,945,889   3,945,889  
15 Royalties ..        
16 Occupancy ........... 4,134,116   4,134,116  
17 Travel ............ 2,160,541   2,160,541  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 281,365   281,365  
20 Interest ........... 291,753   291,753  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 5,508,111   5,508,111  
23 Insurance .............. 589,317   589,317  
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a CLAIMS PROCESSING 7,698,350 0 7,698,350 0
b LICENSE FEES 4,269,709 0 4,269,709 0
c PRINTING & PUBLICATIONS 3,922,388 0 3,922,388 0
d POSTAGE & SHIPPING 3,876,097 0 3,876,097 0
e TELEPHONE 2,266,859 0 2,266,859 0
f All other expenses 11,447,503   11,447,503  
25 Total functional expenses. Add lines 1 through 24f 1,869,592,693 1,705,796,083 163,796,610 0
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 161,811,605 1 199,115,341
2 Savings and temporary cash investments .......   2  
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 42,164,251 4 43,799,357
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use ..............   8  
9 Prepaid expenses and deferred charges ............ 31,097,901 9 28,195,560
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 49,434,415
b Less: accumulated depreciation. ..... 10b 41,058,051 7,554,357 10c 8,376,364
11 Investments—publicly traded securities .......... 175,503,464 11 209,376,373
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 .. 222,147 13 258,371
14 Intangible assets ......... 17,712,278 14 16,942,278
15 Other assets. See Part IV, line 11 ........... 54,840,276 15 79,637,743
16 Total assets. Add lines 1 through 15 (must equal line 34)... 490,906,279 16 585,701,387
Liabilities 17 Accounts payable and accrued expenses . 30,639,803 17 44,002,980
18 Grants payable ..........   18  
19 Deferred revenue .......... 803,790 19 1,016,466
20 Tax-exempt bond liabilities ..........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 7,500,000 23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 248,830,095 25 275,639,336
26 Total liabilities. Add lines 17 through 25..... 287,773,688 26 320,658,782
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 202,752,541 27 264,594,074
28 Temporarily restricted net assets ..... 380,050 28 448,531
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 203,132,591 33 265,042,605
34 Total liabilities and net assets/fund balances ..... 490,906,279 34 585,701,387
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
1,920,962,031
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
1,869,592,693
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
51,369,338
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
203,132,591
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
10,540,676
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
265,042,605
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
NEW YORK STATE CATHOLIC HEALTH PLANINC
 
Employer identification number

11-3153422
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . 261,757 185,206 848,235 537,574 211,811 2,044,583
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... 599,417,358 669,307,221 996,353,043 1,432,031,556 1,911,001,018 5,608,110,196
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5. 599,679,115 669,492,427 997,201,278 1,432,569,130 1,911,212,829 5,610,154,779
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...           0
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.           0
c Add lines 7a and 7b..           0
8 Public Support (Subtract line 7c from line 6.)           5,610,154,779
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6... 599,679,115 669,492,427 997,201,278 1,432,569,130 1,911,212,829 5,610,154,779
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 6,078,071 8,410,230 9,566,173 6,565,256 6,033,312 36,653,042
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b. 6,078,071 8,410,230 9,566,173 6,565,256 6,033,312 36,653,042
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) 1,820,656 4,891,744 485,232 189,310 155,394 7,542,336
13 Total support (Add lines 9, 10c, 11 and 12.). 607,577,842 682,794,401 1,007,252,683 1,439,323,696 1,917,401,535 5,654,350,157
14
Section C. Computation of Public Support Percentage
15
15
99.220 %
16
16
98.970 %
Section D. Computation of Investment Income Percentage
17
17
0.650 %
18
18
0.850 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
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
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
NEW YORK STATE CATHOLIC HEALTH PLANINC
 
Employer identification number

11-3153422
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
NEW YORK STATE CATHOLIC HEALTH PLANINC
  		Employer identification number

11-3153422
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
NEW YORK STATE CATHOLIC HEALTH PLANINC
  		Employer identification number

11-3153422
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
NEW YORK STATE CATHOLIC HEALTH PLANINC
  		Employer identification number

11-3153422
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
NEW YORK STATE CATHOLIC HEALTH PLANINC
 
Employer identification number

11-3153422
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
58,525
j
Total. lines 1c through 1i ...................................
58,525
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
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.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NEW YORK STATE CATHOLIC HEALTH PLANINC
 
Employer identification number

11-3153422
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....      
b Contributions ........      
c Investment earnings or losses ...      
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		     
f Administrative expenses ....      
g End of year balance ......      
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet  
c
Term endowment: SchDMd Bullet  
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................        
c Leasehold improvements ............ 3,623,303   3,185,952 437,351
d Equipment ................ 9,431,821   8,154,144 1,277,677
e Other ................. 36,379,291   29,717,955 6,661,336
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 8,376,364
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) ASSETS WHOSE USE IS LIMITED (RESTRICTED FUNDS) 77,592,080
(2) OTHER RECEIVABLES 2,045,663







Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 79,637,743
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  
CLAIMS PAYABLE 262,231,401
DUE TO NEW YORK STATE 12,759,453
CAPITAL LEASE PAYABLE 648,482






Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 275,639,336
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 1,920,962,031
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 1,869,592,693
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 51,369,338
4 Net unrealized gains (losses) on investments .......................... 4 10,752,122
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8 -211,446
9 Total adjustments (net). Add lines 4 - 8 ............................. 9 10,540,676
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 61,910,014
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 1,931,769,257
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a 10,752,122
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d 89,117
e Add lines 2a through 2d ..................... 2e 10,841,239
3 Subtract line 2e from line 1..................... 3 1,920,928,018
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b 34,013
c Add lines 4a and 4b....................... 4c 34,013
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5 1,920,962,031
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 1,869,859,243
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d 267,647
e Add lines 2a through 2d...................... 2e 267,647
3 Subtract line 2e from line 1..................... 3 1,869,591,596
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b 1,097
c Add lines 4a and 4b....................... 4c 1,097
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5 1,869,592,693
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
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.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
NEW YORK STATE CATHOLIC HEALTH PLANINC
 
Employer identification number
11-3153422
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) AMAUS HEALTH SERVICES AT THE CATHEDRAL OF THE IMMACULATE CONCEPTION259 E ONONDAGA STREET
SYRACUSE,NY13202 		61-1548780 501(C)(3) 8,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(2) CATHOLIC CHARITIES DIOCESE OF ROCHESTER1150 BUFFALO ROAD
ROCHESTER,NY14624 		16-0743944 501(C)(3) 46,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(3) CATHOLIC CHARITIES NEIGHBORHOOD SERVICES191 JORALEMON STREET
BROOKLYN,NY11201 		11-2047151 501(C)(3) 114,730   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(4) CATHOLIC CHARITIES OF BROOKLYN & QUEENS191 JORALEMON STREET
BROOKLYN,NY11201 		11-1633548 501(C)(3) 112,290   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(5) CATHOLIC CHARITIES OF BUFFALO741 DELAWARE AVENUE
BUFFALO,NY14209 		16-0743251 501(C)(3) 59,700   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(6) CATHOLIC CHARITIES OF THE ARCHDIOCESE OF NEW YORK1011 FIRST AVENUE
NEW YORK,NY10022 		13-5562185 501(C)(3) 505,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(7) CATHOLIC CHARITIES OF THE DIOCESE OF ALBANY40 NORTH MAIN AVENUE
ALBANY,NY12203 		14-1340033 501(C)(3) 102,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(8) CATHOLIC CHARITIES OF THE DIOCESE OF OGDENSBURG6866 STATE HIGHWAY 37
OGDENSBURG,NY13669 		15-0614025 501(C)(3) 25,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(9) CATHOLIC CHARITIES OF THE DIOCESE OF ROCKVILLE CENTRE90 CHERRY LANE
HICKSVILLE,NY11801 		11-1843801 501(C)(3) 98,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(10) CATHOLIC CHARITIES OF THE DIOCESE OF SYRACUSE240 ONONDAGA STREET
SYRACUSE,NY13202 		15-0532085 501(C)(3) 94,500   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(11) CATHOLIC MEDICAL MISSION BOARD10 WEST 17TH ST
NEW YORK,NY100115765 		13-5602319 501(C)(3) 13,792   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(12) CATHOLIC MIGRATION OFFICE1258 65TH STREET
BROOKLYN,NY11219 		11-2634818 501(C)(3) 189,980   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(13) COMMUNITY HEALTH CENTER OF BUFFALO INC462 GRIDER ST
BUFFALO,NY14215 		16-1566929 501(C)(3) 12,645   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(14) CORTLAND-CHENANGO RURAL SERVICES2704 LOWER CINCINNATUS ROAD
CINCINNATUS,NY13040 		16-1075281 501(C)(3) 6,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(15) DEPT OF EDUC CATHOLIC SCHOOLS OF THE DIOCESE OF OGDENSBURG100 ELIZABETH STREET
OGDENSBURG,NY13669 		15-0532120 501(C)(3) 31,920   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(16) ELLIS HOSPITAL FOUNDATION1101 NOTT STREET
SCHENECTADY,NY12308 		14-1638957 501(C)(3) 10,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(17) FAMILY HEALTH NETWORK OF CENTRAL NEW YORK INC17-29 MAIN ST SUITE 302
CORTLAND,NY13045 		16-1133983 501(C)(3) 95,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(18) FOUNDATION OF ST MARY'S HOSPITAL AT AMSTERDAM427 GUY PARK AVENUE
AMSTERDAM,NY12010 		13-3254655 501(C)(3) 25,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(19) FRANSISCAN NORTHSIDE MINISTRIES804 NORTH SALINA STREET
SYRACUSE,NY13208 		15-0532104 501(C)(3) 12,500   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(20) GREATER HUDSON VALLEY FAMILY HEALTH CENTER2570 ROUTE 9W SUITE 10
CORNWALL,NY12518 		06-1036715 501(C)(3) 50,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(21) HUDSON RIVER HEALTHCARE INC1037 MAIN ST
PEEKSKILL,NY10566 		13-2828349 501(C)(3) 10,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(22) IBERO-AMERICAN ACTION LEAGUE INC911 EAST MAIN ST
ROCHESTER,NY14605 		16-0954745 501(C)(3) 7,500   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(23) INNER-CITY SCHOLARSHIP FUND1011 FIRST AVENUE
NEW YORK,NY10022 		51-0453629 501(C)(3) 150,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(24) MERCY HOSPITAL OF BUFFALO565 ABBOTT ROAD
BUFFALO,NY14220 		16-0756336 501(C)(3) 38,600   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(25) MONTEFIORE MEDICAL CENTER111 EAST 210TH STREET
BRONX,NY104672490 		13-1740114 501(C)(3) 10,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(26) NORTH SHORE-LIJ HEALTH SYSTEM600 COMMUNITY DRIVE SUITE 102
MANHASSET,NY11030 		11-2163522 501(C)(3) 100,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(27) OFFICE OF CATHOLIC SCHOOLS DIOCESE OF SYRACUSE240 EAST ONONDAGA ST PO BOX 511
SYRACUSE,NY132010511 		22-2563307 501(C)(3) 49,050   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(28) OFFICE OF THE SUPT-CATHOLIC SUPPORT SERVICES DIOCESE OF BROOKLYN7200 DOUGLASTON PARKWAY
DOUGLASTON,NY11362 		11-1631807 501(C)(3) 90,500   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(29) P2 COLLABORATIVE OF WESTERN NEW YORK INC6225 SHERIDAN DRIVE SUITE 206
WILLIAMSVILLE,NY14221 		42-1604185 501(C)(3) 30,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(30) QUEEN OF ALL SAINTS CHURCH300 VANDERBILT AVENUE
BROOKLYN,NY11205 		11-1657620 170(B)(1)A(1) 25,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(31) ROCHESTER PARISH SUPPORT MINISTRIES1150 BUFFALO ROAD
ROCHESTER,NY14624 		16-0755765 501(C)(3) 36,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(32) SETON HEALTH FOUNDATION1300 MASSACHUSETTS AVENUE
TROY,NY12181 		22-2345416 501(C)(3) 100,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(33) ST JOHN'S RIVERSIDE HOSPITAL967 N BROADWAY
YONKERS,NY10701 		13-1740126 501(C)(3) 7,790   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(34) ST JOSEPH'S HOSPITAL HEALTH CENTER FOUNDATION973 JAMES ST SUITE 250
SYRACUSE,NY132032502 		15-0532254 501(C)(3) 10,106   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(35) THE FOUNDATION OF THE ROMAN CATHOLIC DIOCESE OF BUFFALO795 MAIN STREET
BUFFALO,NY14203 		16-1517131 501(C)(3) 36,700   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(36) THE KINGSTON HOSPITAL FOUNDATION396 BROADWAY
KINGSTON,NY12401 		22-2511450 501(C)(3) 10,000   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(37) WILLIAM F RYAN COMMUNITY HEALTH CENTER110 WEST 97TH STREET
NEW YORK,NY10025 		13-2884976 501(C)(3) 7,500   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
(38) GRANTS 500095-25 QUEENS BOULEVARD
REGO PARK,NY11374 		501(C)(3) 47,500   CASH   SEE PURPOSE OF GRANTS IN SCHEDULE O
2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
23
3
Enter total number of other organizations ................................ . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) HEALTHY KIDS FUND 20276 118,341   CASH PAID N/A













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
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.
Schedule I (Form 990) 2010


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NEW YORK STATE CATHOLIC HEALTH PLANINC
 
Employer identification number

11-3153422
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) MARK L LANE (i)
(ii)		 1,096,183
0 		0
0 		652,550
0 		17,244
0 		198,697
0 		1,964,674
0 		0
0
(2) THOMAS HALLORAN (i)
(ii)		 295,389
16,594 		38,624
2,033 		25,500
450 		16,382
862 		29,181
1,245 		405,076
21,184 		0
0
(3) PATRICK J FRAWLEY (i)
(ii)		 587,249
32,104 		0
0 		893,322
450 		16,382
862 		41,525
1,746 		1,538,478
35,162 		0
0
(4) DAVID THOMAS (i)
(ii)		 320,996
0 		41,323
0 		278,301
0 		17,244
0 		31,428
0 		689,292
0 		0
0
(5) PAMELLA HASSEN (i)
(ii)		 227,719
0 		31,326
0 		27,890
0 		17,244
0 		18,392
0 		322,571
0 		0
0
(6) MARGARET M BRUBAKER (i)
(ii)		 194,455
0 		5,000
0 		28,077
0 		0
0 		7,284
0 		234,816
0 		0
0
(7) WILLIAM COFFIN JR (i)
(ii)		 234,588
0 		25,000
0 		7,965
0 		17,244
0 		21,618
0 		306,415
0 		0
0
(8) RUPERT BRADY (i)
(ii)		 193,240
0 		28,700
0 		15,337
0 		17,110
0 		18,858
0 		273,245
0 		0
0
(9) ROBERT FAZZOLARI (i)
(ii)		 201,459
0 		26,266
0 		16,950
0 		17,244
0 		8,431
0 		270,350
0 		0
0
(10) PAMELA WILKES (i)
(ii)		 193,823
0 		23,340
0 		23,980
0 		16,913
0 		7,061
0 		265,117
0 		0
0
(11) JAMES M BURNOSKY (i)
(ii)		 141,632
29,541 		22,130
3,905 		22,690
0 		13,332
2,353 		14,832
1,821 		214,616
37,620 		0
0
(12) EDWARD ANSELM MD (i)
(ii)		 146,106
0 		40,990
0 		30,773
0 		13,126
0 		4,355
0 		235,350
0 		0
0
(13) PATRICK GARLAND (i)
(ii)		 55,800
0 		0
0 		95,861
0 		2,989
0 		7,039
0 		161,689
0 		0
0
(14) ROBERT PIGOTT (i)
(ii)		 152,794
8,885 		32,292
1,700 		51,027
312 		14,387
783 		20,259
943 		270,759
12,623 		0
0


Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
  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.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NEW YORK STATE CATHOLIC HEALTH PLANINC
 
Employer identification number

11-3153422
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) SISTER PATRICIA BURKARD
  		OFFICER 14,983,141 MED. CLAIMS PAYMENTS TO ST. ELIZABETH MEDICAL CENTER   No
(2) SISTER PATRICIA BURKARD
  		OFFICER 9,732,299 MED. CLAIMS PAYMENTS TO ST. JOSEPH'S HOSPITAL AND HEALTH CENTER   No
(3) THOMAS DESTEFANO
  		DIRECTOR 23,831 MED. CLAIMS PAYMENTS TO ST. JOACHIM & ANNE RESIDENCE   No
(4) PATRICK J FRAWLEY
  		KEY EMPLOYEE 4,422,025 MED. CLAIMS PAYMENTS TO ST. VINCENT'S CATHOLIC MEDICAL CENTER   No
(5) MARK L LANE
  		OFFICER 4,422,025 MED. CLAIMS PAYMENTS TO ST. VINCENT'S CATHOLIC MEDICAL CENTER   No
(6) MARK L LANE
  		OFFICER 5,123,079 MED. CLAIMS PAYMENTS TO KINGSBROOK JEWISH MEDICAL CENTER   No
(7) GINO J PAZZAGLINI
  		DIRECTOR 3,321,616 MED. CLAIMS PAYMENTS TO SETON HEALTH SYSTEM   No
(8) MOST REV JOSEPH M SULLIVAN
  		CHAIRMAN OF BOARD 4,422,025 MED. CLAIMS PAYMENTS TO ST. VINCENT'S CATHOLIC MEDICAL CENTER   No
(9) JOHN A WERWAISS
  		DIRECTOR 4,422,025 MED. CLAIMS PAYMENTS TO ST. VINCENT'S CATHOLIC MEDICAL CENTER   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
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.
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
NEW YORK STATE CATHOLIC HEALTH PLANINC
 
Employer identification number

11-3153422
Identifier Return Reference Explanation
  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.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NEW YORK STATE CATHOLIC HEALTH PLANINC
 
Employer identification number

11-3153422
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No












For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) SALUS ADMINISTRATIVE SERVICES INC
95-25 QUEENS BOULEVARD
REGO PARK,NY11374
55-0878053 		THIRD PARTY ADMINISTRATOR NY FIDELIS CARE NEW YORK
  		C 931,884 2,301,010 100.000 %












Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) SALUS ADMINISTRATIVE SERVICES INC

 N 774,616 CASH
(2) SALUS ADMINISTRATIVE SERVICES INC

 K 2,891,315 CASH
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
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.
Additional Data


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