TIN:
SCHEDULE O
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
(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 990-EZ or to provide any additional information.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Inspection
Name of the organization
TUFTS HEALTH PUBLIC PLANS INC
Employer identification number
80-0721489
80-0721489
| Return Reference | Explanation |
|---|---|
| FORM 990, PART I, LINE 1 | THE PURPOSE OF TUFTS HEALTH PUBLIC PLANS, INC. ("THPP", OR THE "ORGANIZATION") IS TO IMPROVE THE HEALTH AND WELLNESS OF THE DIVERSE COMMUNITIES IT SERVES BY ARRANGING FOR THE PROVISION OF COMPREHENSIVE HEALTH CARE SERVICES, INCLUDING PROVIDING COMMUNITY OUTREACH AND EDUCATION TO THE COMMUNITY IT SERVES. THE ORGANIZATION AIMS TO IMPROVE THE LIVES OF MASSACHUSETTS RESIDENTS AND RHODE ISLAND RESIDENTS BY PROVIDING ACCESS TO HIGH-QUALITY, AFFORDABLE HEALTH CARE, PRIMARILY THROUGH MANAGED CARE PROGRAMS DIRECTED AT LOW TO MODERATE INCOME RESIDENTS OF THE COMMONWEALTH OF MASSACHUSETTS AND STATE OF RHODE ISLAND. ACCESS IS PROVIDED THROUGH PROGRAMS SUCH AS, BUT NOT LIMITED TO, MASSHEALTH AND THE COMMONWEALTH OF MASSACHUSETTS MEDICAID MANAGED CARE ORGANIZATION (MCO) AND ACCOUNTABLE CARE ORGANIZATION (ACO) PLANS AND PROVIDING COVERAGE TO MASSACHUSETTS RESIDENTS ELIGIBLE FOR MEDICAID OR THE CHILDREN'S HEALTH INSURANCE PROGRAM. THE ORGANIZATION ALSO OFFERS COVERAGE TO RHODE ISLAND rESIDENTS THROUGH A MEDICAID MANAGED CARE ORGANIZATION PLAN. THE ORGANIZATION ALSO OFFERS SUBSIDIZED HEALTH PLANS TO LOW AND MIDDLE INCOME INDIVIDUALS THROUGH THE COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY (THE MASSACHUSETTS STATE RUN EXCHANGE), AS WELL AS THE ONECARE PROGRAM FOR MASSACHUSETTS RESIDENTS WHO ARE UNDER 65 YEARS OLD AND ELIGIBLE FOR BOTH MEDICARE AND MEDICAID WITH INTEGRATED, COORDINATED MEDICAL AND BEHAVIORAL HEALTHCARE. |
| FORM 990, PART III, LINE 1 | ORGANIZATION'S MISSION STATEMENT THE PURPOSE OF TUFTS HEALTH PUBLIC PLANS, INC. ("THPP", OR THE "ORGANIZATION") IS TO IMPROVE THE HEALTH AND WELLESS OF THE DIVERSE COMMUNITIES IT SERVES BY ARRANGING FOR THE PROVISION OF COMPREHENSIVE HEALTH CARE SERVICES, INCLUDING PROVIDING COMMUNITY OUTREACH AND EDUCATION TO THE COMMUNITY IT SERVES. THE ORGANIZATION AIMS TO IMPROVE THE LIVES OF MASSACHUSETTS AND RHODE ISLAND RESIDENTS BY PROVIDING ACCESS TO HIGH-QUALITY, AFFORDABLE HEALTH CARE, PRIMARILY THROUGH MANAGED CARE PROGRAMS DIRECTED AT LOW TO MODERATE INCOME RESIDENTS OF THE COMMONWEALTH OF MASSACHUSETTS AND STATE OF RHODE ISLAND. ACCESS IS PROVIDED THROUGH PROGRAMS SUCH AS, BUT NOT LIMITED TO, MASSHEALTH AND THE COMMONWEALTH OF MASSACHUSETTS MEDICAID MANAGED CARE ORGANIZATION (MCO), PROVIDING COVERAGE TO MASSACHUSETTS RESIDENTS ELIGIBLE FOR MEDICAID OR THE CHILDREN'S HEALTH INSURANCE PROGRAM. THE ORGANIZATION ALSO OFFERS SUBSIDIZED HEALTH PLANS TO LOW AND MIDDLE INCOME INDIVIDUALS THROUGH THE COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY THE MASSACHUSETTS STATE RUN EXCHANGE), AS WELL AS THE ONECARE PROGRAM FOR MEMBERS WHO ARE UNDER 65 YEARS OLD AND ELIGIBLE FOR BOTH MEDICARE AND MEDICAID WITH INTEGRATED, COORDINATED MEDICAL AND BEHAVIORAL HEALTH CARE. THE ORGANIZATION ALSO OFFERS COVERAGE TO RHODE ISLAND RESIDENTS THROUGH A MEDICAID MANAGED CARE ORGANIZATION PLAN. THPP'S PRIMARY ACTIVITY IS TO PROVIDE HEALTH COVERAGE AND EDUCATION ABOUT BENEFITS TO LOW AND MODERATE INCOME RESIDENTS OF MASSACHUSETTS AND RHODE ISLAND THROUGH CONTRACTS WITH THE MASSACHUSETTS' COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY AND THE MASSACHUSETTS AND RHODE ISLAND EXECUTIVE OFFICES OF HEALTH AND HUMAN SERVICES. THE ORGANIZATION OFFERS FULLY INTEGRATED, IN-HOUSE CARE MANAGEMENT, PROVIDING A TEAM OF MEDICAL,BEHAVIORAL HEALTH, SOCIAL CARE AND PHARMACY PROFESSIONALS WHO COORDINATE MEMBER CARE. THE ORGANIZATION CONTRACTS WITH THOUSANDS OF PRIMARY CARE PHYSICIANS, SPECIALISTS, HOSPITALS AND COMMUNITY ORGANIZATIONS IN MASSACHUSETTS AND RHODE ISLAND. THE ORGANIZATION ENROLLS A SUBSTANTIAL NUMBER OF PERSONS WHO MAY OTHERWISE BE UNABLE TO OBTAIN AFFORDABLE HEALTH CARE SERVICES AS WELL AS THOSE POPULATIONS WHO HAVE SPECIAL HEALTH CARE NEEDS, SUCH AS DISABLED INDIVIDUALS BETWEEN 21-64 YEARS OLD ELIGIBLE FOR THE ORGANIZATION'S ONECARE DEMONSTRATION PROGRAM IN MASSACHUSETTS, AND THOSE INDIVIDUALS ELIGIBLE FOR THE ORGANIZATION'S MEDICAID PROGRAMS. THE ORGANIZATION PROVIDES ACCESS TO HEALTH CARE STATEWIDE, IN OVER 400 CITIES AND TOWNS IN MASSACHUSETTS AND OVER 50 CITIES AND TOWNS IN RHODE ISLAND THROUGH ITS EXTENSIVE PROVIDER NETWORK. THE ORGANIZATION'S ACTIVITIES FURTHER ITS EXEMPT PURPOSE OF PROVIDING COMPREHENSIVE HEALTH CARE SERVICES, OUTREACH, AND EDUCATION TO RESIDENTS OF MASSACHUSETTS AND RHODE ISLAND, MOST OF WHOM ARE LOW AND MODERATE INCOME. THE ORGANIZATION PROVIDES COMMUNITY AND PUBLIC BENEFITS BY ENSURING ACCESS TO NEEDED HEALTH CARE SERVICES BY LOW TO MODERATE INCOME, HIGH-RISK, AND MEDICALLY UNDERSERVED POPULATIONS THROUGH ITS PARTICIPATION IN MEDICARE-MEDICAID (DUAL ELIGIBLES) AND OTHER STATE PROGRAMS WHOSE PURPOSE IS TO SERVE SUCH POPULATIONS. THE ORGANIZATION OPERATES EXCLUSIVELY FOR THE PROMOTION OF SOCIAL WELFARE BY PRIMARILY ENGAGING IN ACTIVITIES THAT PROMOTE THE COMMON GOOD, GENERAL WELFARE, AND EDUCATION OF THE MASSACHUSETTS AND RHODE ISLAND COMMUNITIES. THE ORGANIZATION DOES THIS BY PROVIDING AND ENCOURAGING PREVENTIVE CARE TO THOSE WHO MIGHT OTHERWISE NOT RECEIVE SUCH CARE AND THE ABILITY TO SEEK HEALTH CARE SERVICES WHEN NEEDED TO THOSE WHO MIGHT NOT OTHERWISE BE ABLE TO AFFORD IT. AS PART OF THE ORGANIZATION'S EFFORTS TO EDUCATE AND ASSIST THE MULTICULTURAL POPULATION IT SERVES, THE ORGANIZATION ALSO MAINTAINS ONGOING EDUCATIONAL OUTREACH EFFORTS. THESE EFFORTS INCLUDE: 1) COMMUNITY OUTREACH REPRESENTATIVES WORKING WITH MEMBERS TO ENSURE ENGAGEMENT AND EDUCATION ON HEALTH CARE ACCESS AS WELL AS POTENTIAL ACCESS TO OTHER SOCIAL SERVICE PROGRAMS. 2) BUILDING RELATIONSHIPS WITH COMMUNITY-BASED ORGANIZATIONS THAT SERVE THPP'S AUDIENCES, INCLUDING SMALL BUSINESSES THAT OFFER A WIDE RANGE OF SERVICES TO IMMIGRANT POPULATIONS. 3) PARTNERING WITH FINANCIAL COUNSELORS AT LOCAL HEALTH CENTERS TO OFFER ASSISTANCE WITH MEDICAID. 4) PARTNERING WITH LOCAL SOCIAL SERVICE, ADVOCACY ORGANIZATIONS TO GIVE PRESENTATIONS REGARDING HEALTH CARE ACCESS, AVAILABLE BENEFITS, AND PLAN OFFERINGS. 5) PARTNERING WITH LOCAL RELIGIOUS ORGANIZATIONS TO COORDINATE HEALTH AND WELLNESS EVENTS FOR THEIR DIVERSE CONGREGATIONS. 6) COMMUNITY OUTREACH REPRESENTATIVES SERVING AS CULTURAL EXPERTS FOR MEMBER OUTREACH EFFORTS, LOCAL MEDIA PRESENTATIONS, AND SPEAKING ENGAGEMENTS TO PROVIDE UP TO DATE INFORMATION ON HEALTH ACCESS AND THPP OFFERINGS IN A CULTURALLY COMPETENT MANNER. 7) PROVIDING IN-KIND, MONETARY, AND VOLUNTEER SUPPORT TO LOCAL COMMUNITY BASED ORGANIZATIONS, INCLUDING PRESENTING ON AND LEADING ACTIVITIES RELATED TO HEALTH AND WELLNESS. 8) PROVIDING IN-KIND AND VOLUNTEER SUPPORT TO OTHER LOCAL COMMUNITY INSTITUTIONS, SUCH AS FOOD PANTRIES AND HOMELESS SHELTERS. |
| FORM 990, PART III, LINE 4A | MASSACHUSETTS MEDICAID COVERAGE THE ORGANIZATION PROVIDES ACCESS TO AFFORDABLE HEALTH CARE THROUGH A MEDICAID MANAGED CARE ORGANIZATION CONTRACT WITH THE MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES FOR QUALIFIED RESIDENTS AND THEIR FAMILIES WHO MEET INCOME AND OTHER ELIGIBILITY REQUIREMENTS. IN MARCH 2018, THPP WAS ALSO AWARDED FOUR (4) MEDICAID ACCOUNTABLE CARE ORGANIZATION CONTRACTS BY EOHHS IN ADDITION TO THE MANAGED CARE ORGANIZATION CONTRACT. THROUGH CONTRACTS WITH FOUR MASSACHUSETTS-BASED PROVIDER SYSTEMS, THPP PROVIDES MEDICAID MANAGED CARE CLOSELY ALIGNED WITH PRIMARY CARE PHYSICIANS AND COMMUNITY PARTNERS. TUFTS HEALTH TOGETHER IS THE NAME OF THPP'S MASSACHUSETTS MEDICAID MCO AND ACO PLANS THAT PROVIDE ACCESS TO AFFORDABLE HEALTH CARE FOR QUALIFIED RESIDENTS AND THEIR FAMILIES WHO MEET INCOME AND OTHER ELIGIBILITY REQUIREMENTS. MASSHEALTH IS THE NAME OF THE MASSACHUSETTS MEDICAID PROGRAM FUNDED BY THE FEDERAL GOVERNMENT AND THE STATE. MASSHEALTH HELPS PEOPLE WITH LIMITED INCOMES AND RESOURCES PAY FOR MEDICAL AND SUPPORT SERVICES. IT ALSO COVERS EXTRA SERVICES AND DRUGS NOT COVERED BY MEDICARE. TO BE ELIGIBLE FOR MASSHEALTH, YOU MUST BE A MASSACHUSETTS RESIDENT WITH LOW TO MODERATE INCOME. THE INCOME LIMITS DEPEND ON FAMILY SIZE, CATEGORY OF ELIGIBILITY, AND THE TYPE OF MASSHEALTH COVERAGE FOR WHICH AN INDIVIDUAL IS ELIGIBLE. FINANCIAL ELIGIBILITY IS BASED ON THE MODIFIED ADJUSTED GROSS INCOME ("MAGI"), WHICH IS COMPARED TO THE FPL. DIFFERENT MASSHEALTH CATEGORIES USE DIFFERENT PERCENTAGES OF THE FEDERAL POVERTY LEVEL ("FPL") AS THE THRESHOLD FOR FINANCIAL ELIGIBILITY. A FAMILY'S MAGI MUST BE NO GREATER THAN THE AMOUNT SHOWN IN THE FPL TABLES FOR THE INDIVIDUAL OR FAMILY'S CATEGORY AND FAMILY SIZE. TUFTS HEALTH TOGETHER PROVIDES LOW TO MODERATE INCOME INDIVIDUALS WITH ACCESS TO THOUSANDS OF HIGH QUALITY DOCTORS AND SPECIALISTS ACROSS THE STATE, SUPPORTIVE SERVICE REPRESENTATIVES, INFORMATION IN A NUMBER OF LANGUAGES, AS WELL AS PREVENTIVE MEASURES SUCH AS BIKE HELMETS AND HOME SAFETY KITS AT NO COST, INCENTIVES FOR HEALTHY BEHAVIORS, FITNESS REIMBURSEMENTS, AND OTHER IMPORTANT TOOLS TO PROMOTE HEALTH AND WELLNESS. TUFTS HEALTH TOGETHER HAS EARNED "EXCELLENT" HEALTH PLAN ACCREDITATION STATUS BY THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE, WHICH IS THE COMMITTEE'S HIGHEST ACCREDITATION RATING. IN 2014-2015, TUFTS HEALTH TOGETHER RECEIVED A RANKING OF NO. 1 IN THE COUNTRY BY NCQA'S HEALTH INSURANCE PLAN RANKINGS BASED ON THE ORGANIZATION'S EXCEPTIONAL CLINICAL PERFORMANCE, MEMBER SATISFACTION, AND QUALITY PROCESSES. IN 2015, NCQA INTRODUCED A NEW SCORING METHODOLOGY FOR ITS HEALTH INSURANCE PLAN RATINGS, ASSIGNING AN OVERALL RATING TO EACH HEALTH PLAN BASED ON A SCALE OF 1 TO 5, WHERE FIVE IS THE HIGHEST SCORE. IN OCTOBER 2018, THPP RECEIVED A RATING OF 4.5 OUT OF 5 BASED ON THIS SCORING METHODOLOGY FOR THE FOURTH YEAR IN A ROW. THE ORGANIZATION IN ITS PREDECESSOR FORMS (NETWORK HEALTH,LLC. AND NETWORK HEALTH,INC.) ALSO WON THE DORLAND HEALTH CASE IN POINT PLATINUM AWARD FOR "BEST SOCIAL CARE MANAGEMENT PROGRAM" IN 2013, "BEST INTEGRATED CASE MANAGEMENT PROGRAM" IN 2012, AND "BEST OVERALL CASE/CARE MANAGEMENT PROGRAM" IN 2010. IN 2012, THE ORGANIZATION WAS AMONG TEN NATIONALLY AND THE FIRST IN NEW ENGLAND TO EARN THE NCQA MULTICULTURAL HEALTH CARE DISTINCTION. AS OF THE END OF 2018, THE ORGANIZATION HAD OVER 272,428 ENROLLEES IN TUFTS HEALTH TOGETHER. |
| FORM 990, PART III, LINE 4B | MASSACHUSETTS QUALIFIED HEALTH PLAN COVERAGE TUFTS HEALTH DIRECT IS AN INDIVIDUAL AND SMALL GROUP QUALIFIED HEALTH PLAN (QHP) ESTABLISHED BY THE ORGANIZATION AFTER THE ENACTMENT OF THE AFFORDABLE CARE ACT TO PROVIDE ACCESS TO AFFORDABLE HEALTH CARE FOR INDIVIDUALS AND FAMILIES WHO ARE NOT ELIGIBLE FOR AFFORDABLE EMPLOYER-SPONSORED INSURANCE, AND SMALL EMPLOYER GROUPS WITH 1-50 EMPLOYEES. THESE PLANS ARE SOLD PRIMARILY THROUGH THE MASSACHUSETTS HEALTH CONNECTOR, THE MASSACHUSETTS STATE MARKETPLACE. TUFTS HEALTH DIRECT IS ACCREDITED BY THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE. AS OF DECEMBER 31, 2018, THE ORGANIZATION SERVED CLOSE TO 94,470 CONNECTORCARE MEMBERS (A SUBSET OF TUFTS HEALTH DIRECT MEMBERS WHO RECEIVE BOTH STATE AND FEDERAL SUBSIDIES), WHICH ACCOUNTED FOR ROUGHLY 49% OF THE TOTAL MARKET SHARE. ALSO AS OF DECEMBER 31, 2018, THPP SERVED AN ADDITIONAL 58,273 TUFTS HEALTH DIRECT MEMBERS, 14% OF WHOM RECEIVED FEDERAL SUBSIDIES ONLY IN THE FORM OF ADVANCED PREMIUM TAX CREDITS TO PURCHASE INSURANCE. |
| FORM 990, PART III, LINE 4C | TUFTS HEALTH UNIFY IS A MEDICARE-MEDICAID PLAN FOR INDIVIDUALS AGE 21-64 WHO ARE ELIGIBLE FOR BOTH MEDICARE AND MEDICAID. TUFTS HEALTH UNIFY IS ONE OF TWO MASSACHUSETTS ONECARE PLANS PARTICIPATING IN THE FINANCIAL ALIGNMENT INITIATIVE ("DUALS DEMONSTRATION") TO INTEGRATE BENEFITS AND CARE FOR MEDICARE-MEDICAID ENROLLEES. THE PLAN CONTRACTS WITH THE CENTER FOR MEDICARE AND MEDICAID SERVICES AND MASSHEALTH TO PROVIDE THE BENEFITS OF BOTH PROGRAMS TO LOW AND MODERATE INCOME INDIVIDUALS WITH DISABILITIES. THE PLAN INCLUDES AN EXPANDED BENEFITS PACKAGE AND COMMUNITY-BASED, LONG-TERM SERVICES AND SUPPORT, SUCH AS HOME CARE SERVICES, HOMEMAKER SERVICES, RESPITE CARE, ADULT FOSTER CARE, DAY HABILITATION AND OTHER TYPES OF SUPPORT, COUNSELING AND NAVIGATION. EACH TUFTS HEALTH UNIFY ENROLLEE IS ASSIGNED A CARE MANAGER, WHO DEVELOPS A PERSONALIZED CARE PLAN TO MEET ALL OF THE ENROLLEE'S PHYSICAL, MENTAL, AND SOCIAL CARE NEEDS. THE GOAL OF THIS INNOVATIVE MODEL IS TO IMPROVE THE QUALITY OF CARE, WHILE IMPROVING HEALTH AND PROVIDING MORE COST EFFECTIVE CARE. AS OF THE END OF 2018, THE ORGANIZATION HAD OVER 2,977 ENROLLEES IN TUFTS HEALTH UNIFY. |
| FORM 990, PART III, LINE 4D | RHODE ISLAND MEDICAID COVERAGE THE ORGANIZATION ALSO OFFERS MEDICAID COVERAGE TO RHODE ISLAND RESIDENTS THROUGH A MEDICAID MANAGED CARE ORGANIZATION PLAN. THE ORGANIZATION'S COVERAGE IS CALLED TUFTS HEALTH RI TOGETHER, AND IS SIMILAR TO THE MEDICAID COVERAGE OFFERED IN MASSACHUSETTS. AS OF THE END OF 2018, THE ORGANIZATION HAD APPROXIMATELY 9,351 ENROLLEES IN TUFTS HEALTH RI TOGETHER. |
| FORM 990, PART VI, LINE 1 | THE INDEPENDENCE AND COMMUNITY RESPONSIVENESS OF THE ORGANIZATION'S BOARD IS ENSURED BY THE ULTIMATE CONTROL AND OVERSIGHT OF THE MAJORITY COMMUNITY BOARD OF THE ORGANIZATION'S SOLE MEMBER, TUFTS HEALTH PLAN, INC. ("THPI"). THPI APPOINTS AND HAS THE AUTHORITY TO REMOVE AND REPLACE THE ORGANIZATION'S BOARD OF DIRECTORS AND TO APPROVE THE CREATION OF ANY COMMITTEE OF THE ORGANIZATION'S BOARD. IN ADDITION, CERTAIN SIGNIFICANT ACTIONS CANNOT BE TAKEN BY THE ORGANIZATION'S BOARD WITHOUT THPI'S APPROVAL, INCLUDING (1) EXECUTION OF ANY CONTRACT OR ENGAGEMENT IN ANY TRANSACTION PROVIDING FOR THE SALE, LEASE, EXCHANGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ORGANIZATION'S PROPERTY; (2) FILING OR ACQUIESCENCE IN THE FILING OF ANY VOLUNTARY OR INVOLUNTARY BANKRUPTCY OR INSOLVENCY PROCEEDINGS UNDER ANY FEDERAL OR STATE INSOLVENCY OR BANKRUPTCY LAWS OR THE MAKING OF AN ASSIGNMENT FOR THE BENEFIT OF CREDITORS; (3) ADOPTION OF A PLAN OF OR AUTHORIZATION OF A PETITION FOR LIQUIDATION AND/OR DISSOLUTION OF THE ORGANIZATION; (4) ADOPTION OR AUTHORIZATION OF A PLAN AND/OR AGREEMENT OF MERGER OR SHARE EXCHANGE WITH ANY OTHER FOREIGN OR DOMESTIC CORPORATION; (5) AMENDMENT, ALTERATION OR REPEAL OF THE ORGANIZATION'S ARTICLES OF ORGANIZATION; AND (6)AMENDMENT, ALTERATION OR REPEAL OF THE ORGANIZATION'S BYLAWS, EXCEPT FOR ALTERATION, AMENDMENT OR REPEAL BY A VOTE OF A MAJORITY OF DIRECTORS PENDING NOTIFICATION OF THE MEMBER. |
| FORM 990, PART VI, LINE 2 | THE FOLLOWING PEOPLE SERVED AS A BOARD MEMBER AND/OR OFFICER FOR TUFTS HEALTH PLAN, INC: THOMAS CROSWELL MARY MAHONEY UMESH KURPAD ROLAND PRICE Jean Yang January 8, 2018 through June 5, 2018 Tracey Carter As of June 6, 2018 Maurice Hebert As of June 6, 2018 THE FOLLOWING INDIVIDUALS SERVED AS A BOARD MEMBER AND/OR OFFICER FOR TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION, INC: THOMAS CROSWELL MARY MAHONEY UMESH KURPAD ROLAND PRICE MARC SPOONER - Through June 5, 2018 Tracey Carter As of June 6, 2018 Maurice Hebert June 6, 2018 through September 14, 2018 THE FOLLOWING PEOPLE SERVED AS A BOARD MEMBER AND/OR OFFICER FOR TUFTS HEALTH PLAN FOUNDATION, INC: THOMAS CROSWELL MARY MAHONEY UMESH KURPAD ROLAND PRICE THE FOLLOWING PEOPLE SERVED AS A BOARD MEMBER AND/OR OFFICER FOR TUFTS ASSOCIATED HEALTH PLANS, INC: THOMAS CROSWELL MARY MAHONEY UMESH KURPAD ROLAND PRICE MARC SPOONER Through June 5, 2018 Jean Yang January 8, 2018 through June 5, 2018 THE FOLLOWING PEOPLE SERVED AS A BOARD MEMBER AND/OR OFFICER FOR TOTAL HEALTH PLAN, INC: THOMAS CROSWELL UMESH KURPAD MARY MAHONEY ROLAND PRICE THE FOLLOWING PEOPLE SERVED AS A BOARD MEMBER AND/OR OFFICER FOR TUFTS INSURANCE COMPANY: THOMAS CROSWELL MARY MAHONEY UMESH KURPAD ROLAND PRICE Tracey Carter As of June 5, 2018 Maurice Hebert June 5, 2018 through September 14, 2018 THE FOLLOWING PEOPLE SERVED AS A BOARD MEMBER AND/OR OFFICER FOR TUFTS BENEFIT ADMINISTRATORS, INC: THOMAS CROSWELL MARY MAHONEY UMESH KURPAD ROLAND PRICE THE FOLLOWING PEOPLE SERVED AS A BOARD MEMBER OR OFFICER FOR TAHP BROKERAGE CORPORATION THOMAS CROSWELL UMESH KURPAD MARY MAHONEY ROLAND PRICE THE FOLLOWING PEOPLE SERVED AS A BOARD MEMBER FOR INTEGRA PARTNERS HOLDINGS, INC.: THOMAS CROSWELL UMESH KURPAD |
| FORM 990, PART VI, LINE 3 | DELEGATION OF CONTROL OF MANAGEMENT DUTIES THE ORGANIZATION'S SOLE MEMBER IS TUFTS HEALTH PLAN, INC. ("THPI"). TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION, INC. (TAHMO),PREVIOUSLY THPP'S SOLE CORPORATE MEMBER, IS ALSO A SUBSIDIARY OF THPI. TAHMO'S WHOLLY-OWNED SUBSIDIARY, TUFTS ASSOCIATED HEALTH PLANS, INC.,PERFORMS CERTAIN MANAGEMENT, ADMINISTRATIVE, AND MARKETING SERVICES FOR THPP,INCLUDING EMPLOYEE DECISIONS AND SUPERVISING AND PLANNING AND EXECUTING BUDGETS AND FINANCIAL OPERATIONS. MANY OF THE OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES LISTED IN PART VII, SECTION A ARE EMPLOYEES OF TAHP. THEIR COMPENSATION IS LISTED IN PART VII,SECTION A AND SCHEDULE J. |
| MEMBERS OR STOCKHOLDERS | FORM 990, PART VI, LINE 6 TUFTS HEALTH PLAN, INC.(THPI) IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. POWER TO ELECT OR APPOINT MEMBERS FORM 990, PART VI, LINE 7A TUFTS HEALTH PLAN, INC.(THPI), AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, ELECTS THE MEMBERS OF THE ORGANIZATION'S GOVERNING BODY. DECISIONS RESERVED TO MEMBERS OR STOCKHOLDERS FORM 990, PART VI, LINE 7B THPI, AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, HAD THE RIGHT TO MAKE CERTAIN DECISIONS REGARDING THE ORGANIZATION, AND IS REQUIRED TO APPROVE ANY CHANGES TO THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, LINE 8B FOR MAJORITY OF THE TIME, THE ORGANIZATION CONTEMPORANEOUSLY DOCUMENTS MEETINGS HELD AND WRITTEN ACTIONS UNDERTAKEN BY ITS COMMITTEES. HOWEVER,ON LIMITED OCCASIONS, A COMMITTEE MAY HAVE A SERIES OF CONFERENCE CALLS AND MINUTES FOR THOSE CALLS ARE NOT APPROVED UNTIL THE NEXT IN-PERSON MEETING, WHICH MAY BE MORE THAN SIXTY DAYS LATER. |
| PROCESS USED TO REVIEW THE FORM 990 | FORM 990, PART VI, LINE 11B THE FORM 990 IS PREPARED IN OUR FINANCE DEPARTMENT, WITH ASSISTANCE FROM OUR EXTERNAL ACCOUNTANTS, ERNST & YOUNG. INFORMATION IS PROVIDED BY OUR FINANCE DEPARTMENT, HUMAN RESOURCES DEPARTMENT, GOVERNANCE MANAGER, COMPLIANCE & PRIVACY OFFICER, AND INTERNAL LEGAL COUNSEL. CERTAIN SECTIONS OF THE FORM ARE REVIEWED BY A NUMBER OF SENIOR MANAGERS; OUR CHIEF FINANCIAL OFFICER REVIEWS THE FORM IN ITS ENTIRETY. ONCE THE FORM IS COMPLETE, IN NOVEMBER 2019, IT IS FORWARDED ON TO OUR BOARD OF DIRECTORS AND IT IS THEN SUBMITTED FOR FILING. MONITORING AND ENFORCEMENT OF COMPLIANCE WITH CONFLICT OF INTEREST POLICY FORM 990, PART VI, LINE 12C THE TUFTS HEALTH PLAN (THP) CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY AND REVISED AS NEEDED. THE POLICY REQUIRES MANAGERS, ALL DIRECTORS, AVPS, VPS, SVPS, EVPS, THE PRESIDENT AND CEO, AND THE BOARD OF DIRECTORS TO ATTEST ANNUALLY THAT THEY WILL ABIDE BY THE POLICY. IT ALSO REQUIRES THEM TO SUBMIT AN ANNUAL DISCLOSURE STATEMENT TO THE CORPORATE COMPLIANCE OFFICER, LISTING ANY OUTSIDE RELATIONSHIPS, INCLUDING FINANCIAL AND/OR BOARD RELATIONSHIPS, THAT THEY OR A FAMILY MEMBER HAVE WITH THP'S SUPPLIERS, PURCHASERS, PROVIDERS AND/OR COMPETITORS. THERE IS A PROTOCOL TO REVIEW ANY DISCLOSURE THAT MIGHT BE A POTENTIAL CONFLICT OF INTEREST. ALSO, ALL EMPLOYEES ARE REQUIRED TO REPORT THE OFFER BY AN OUTSIDE ENTITY OF GIFTS OVER $100, HONORARIA OR COVERAGE OF BUSINESS EXPENSES TO THE CORPORATE COMPLIANCE OFFICER AND A SENIOR LEADER. BOTH MUST APPROVE BEFORE ACCEPTANCE IS ALLOWED. THE LEVELS OF REVIEW ARE: - FOR BOARD MEMBERS, THE BOARD CHAIR, CEO, AND BOARD AUDIT & COMPLIANCE COMMITTEE CHAIR - ONCE DISCLOSURES ARE REVIEWED AND APPROVED, THEY ARE COMMUNICATED TO THE GOVERNANCE MANAGER AND TO THE CORPORATE COMPLIANCE OFFICER. - FOR TUFTS HEALTH PLAN MANAGEMENT, THE SENIOR MANAGER, CORPORATE COMPLIANCE OFFICER,CHIEF COMPLIANCE & ETHICS OFFICER, AND CHIEF LEGAL OFFICER. DISCLOSURES THAT NEED FURTHER REVIEW ARE BROUGHT TO THE BOARD AUDIT & COMPLIANCE COMMITTEE CHAIR. IF A CONFLICT OF INTEREST DOES EXIST, A TRANSACTION WITH THE ENTITY WITH WHICH THERE IS A CONFLICT MAY BE UNDERTAKEN ONLY IF ALL OF THE FOLLOWING ARE OBSERVED: 1. THE CONFLICTING INTEREST IS FULLY DISCLOSED; 2. THE PERSON WITH THE CONFLICT OF INTEREST MAY PRESENT INFORMATION, BUT THEN SHALL BE EXCUSED FROM FURTHER DISCUSSION AND FROM THE DECISION REGARDING APPROVING SUCH TRANSACTION; 3. IF PRACTICAL, A COMPETITIVE BID OR COMPARABLE VALUATION EXISTS; AND 4. THE BOARD (OR A DULY CONSTITUTED COMMITTEE THEREOF OR BOARD APPOINTEE) OR THE CHIEF COMPLIANCE & ETHICS OFFICER HAS DETERMINED THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION. ALL NEW HIRES, AND ALL EMPLOYEES ON AN ANNUAL BASIS, COMPLETE COMPLIANCE TRAINING THAT ADDRESSES CONFLICT OF INTEREST AND REQUIRES THE EMPLOYEE TO ATTEST THAT THEY DO NOT HAVE ANY POTENTIAL CONFLICTING RELATIONSHIPS THAT THEY HAVE NOT DISCLOSED TO THE PROPER LEVEL OF MANAGEMENT AND TO THE CORPORATE COMPLIANCE OFFICER. |
| PROCESS FOR DETERMINING COMPENSATION | FORM 990, PART VI, LINE 15 THE COMPENSATION COMMITTEE (THE "COMMITTEE") OF THE BOARD OF DIRECTORS (THE "BOARD") OF TUFTS HEALTH PLAN, INC. (TUFTS HP OR THE "COMPANY") REVIEWS AND ADMINISTERS TOTAL REMUNERATION OPPORTUNITIES, POLICIES, PROGRAMS, AND MAJOR CHANGES IN TUFTS HP'S BENEFIT PLANS THAT ARE APPLICABLE TO THE OFFICERS AND EXECUTIVES OF THE COMPANY (THE "EXECUTIVES" - THESE INCLUDE THE CEO AND ALL SENIOR VICE PRESIDENTS), AS WELL AS TO THE GENERAL AUDITOR, CHIEF COMPLIANCE & ETHICS OFFICER, AND ANY OTHER INDIVIDUAL OR GROUPS THE COMMITTEE DEEMS APPROPRIATE BASED ON ITS INTERPRETATION OF THE DEFINITION OF "DISQUALIFIED PERSONS" IN SECTION 4958 OF THE INTERNAL REVENUE CODE OF 1986. THE COMMITTEE IS COMPRISED OF INDEPENDENT DIRECTORS OF THE COMPANY. THE COMMITTEE REPORTS TO THE FULL BOARD OF DIRECTORS. FOR CEO COMPENSATION, THE COMMITTEE REVIEWS THE INFORMATION DESCRIBED BELOW AND RECOMMENDS THE CEO'S COMPENSATION TO THE FULL BOARD FOR ITS APPROVAL. THE COMMITTEE REVIEWS AND APPROVES COMPENSATION RECOMMENDATIONS FROM THE CEO FOR OTHER EXECUTIVES, AND PROVIDES A REPORT TO THE FULL BOARD ON THIS INFORMATION. IT IS THE BOARD'S INTENTION THAT THE COMMITTEE WILL PERFORM ITS DUTIES IN A MANNER THAT WILL ESTABLISH A PRESUMPTION THAT THE TOTAL REMUNERATION OFFERED TO EXECUTIVES AND OTHER "DISQUALIFIED PERSONS" ARE REASONABLE. COMPARABILITY DATA AND REASONABLENESS THE TOTAL REMUNERATION OPPORTUNITIES PROVIDED TO EXECUTIVES OF THE COMPANY ARE INTENDED TO BE COMPETITIVE WITH, AND IN REASONABLE COMPARISON TO, THOSE OPPORTUNITIES PROVIDED BY ORGANIZATIONS IN THOSE BUSINESS SECTORS WITH WHICH THE COMPANY COMPETES FOR EXECUTIVE TALENT. THE BOARD BELIEVES THAT SUCH COMPETITORS ARE NOT LIMITED TO OTHER HEALTHCARE INSTITUTIONS AND THAT COMPARISONS SHOULD BE MADE TO THE COMPENSATION PRACTICES OF A CROSS-SECTION OF BUSINESS SECTORS IN BOTH FOR-PROFIT AND NOT-FOR-PROFIT ORGANIZATIONS, WHEN APPROPRIATE. THE COMMITTEE RETAINS INDEPENDENT COMPENSATION CONSULTANTS TO PROVIDE DATA AS NECESSARY, AND ALSO USES AVAILABLE SOURCES OF INDEPENDENT DATA ON COMPENSATION. PEER ORGANIZATIONS AND PUBLISHED SURVEY SOURCES WILL BE APPROVED BY THE COMMITTEE BASED ON ITS REASONABLE DETERMINATION. THE COMMITTEE MAY ALSO RELY ON MEMBERS OF MANAGEMENT AND OUTSIDE ADVISORS, CONSULTANTS, AND COUNSEL TO PROVIDE MARKET DATA REPORTS, ANALYSIS, AND OPINIONS WITH RESPECT TO COMPENSATION-RELATED MATTERS. THE DATA REVIEWED CONSISTS OF COMPARABLE, RELEVANT MARKET DATA FOR THE COMPANY'S POSITIONS FROM PUBLISHED SURVEYS, AND OTHER AVAILABLE SOURCES, OF HEALTH AND MANAGED CARE INSTITUTIONS AND THE GENERAL INDUSTRY. OTHER SURVEYS OF SPECIALIZED SKILL SETS OR EMPLOYEE ATTRIBUTES CRITICAL TO THE SUCCESS OF THE COMPANY, E.G., ACTUARIAL, LEGAL, ETC., ARE ALSO INCORPORATED AS NEEDED, ALONG WITH GEOGRAPHIC REFERENCES TO THE BOSTON AND NEW ENGLAND LABOR MARKETS. THE COMMITTEE WILL RELY ON THIS MARKET DATA TO ASSESS, DETERMINE, AND VALIDATE COMPENSATION LEVELS FOR THE COMPANY'S EXECUTIVES. THE COMMITTEE USES THIS DATA IN ITS REVIEW OF: - SETTING BASE SALARIES - IN LIGHT OF MARKET DATA AND THE INDIVIDUAL'S PERFORMANCE, BACKGROUND, EXPERIENCES, AND PERSONAL SKILLS. BASE SALARY WILL BE SET SO THAT THE TARGETED POSITIONING OF AN EXECUTIVE IS AT THE 50TH PERCENTILE FOR EACH POSITION. ACTUAL BASE SALARY MAY VARY BASED ON SKILLS, BACKGROUND, AND EXPERIENCE. - ANNUAL INCENTIVE COMPENSATION - THE COMPANY'S GOAL IS TO PROVIDE COMPETITIVE AND REASONABLE OPPORTUNITIES UNDER THE TERMS OF AN EXECUTIVE ANNUAL INCENTIVE PLAN FOR THE SELECTED POSITIONS WHICH ARE RESPONSIBLE FOR ACHIEVING PERFORMANCE GOALS THAT REFLECT THE OVERALL MISSION OF THE COMPANY, AND THE STRATEGIC DIRECTION OF THE COMPANY FOR THE PERFORMANCE YEAR. THE COMMITTEE MAKES EVERY EFFORT TO ESTABLISH A PRESUMPTION THAT THE TOTAL REMUNERATION OPPORTUNITIES PROVIDED TO EXECUTIVES ARE REASONABLE; AS SUCH PRESUMPTION IS CONTEMPLATED IN SECTION 4958 OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED FROM TIME TO TIME. IN ESTABLISHING THE PRESUMPTION OF REASONABLENESS, THE COMMITTEE MAY ENGAGE THE PROFESSIONAL SERVICES OF INDEPENDENT LEGAL COUNSEL, COMPENSATION EXPERTS, ACCOUNTANTS,AND OTHER EXPERTS AND ADVISORS. TIMING EXECUTIVE BENCHMARKING IS COMPLETED EVERY TWO YEARS FOR THOSE INDIVIDUALS UNDER THE COMPENSATION COMMITTEE'S PURVIEW BY THE EXTERNAL CONSULTANT ENGAGED BY THE COMPENSATION COMMITTEE. TO COMPLETE THE ANALYSIS, THE CONSULTANT: - COLLECTED RELEVANT INFORMATION REGARDING THE COMPANY'S OPERATIONS, COMPLEXITY, STRUCTURE, SIZE, AND SCOPE, AS WELL AS RELEVANT BACKGROUND ON THE EXECUTIVES' DUTIES AND SCOPE OF RESPONSIBILITIES; - DETERMINED THE SURVEY SOURCES TO USE IN THE ANALYSIS, BASED ON THE COMPANY'S COMPETITIVE MARKET FOR EXECUTIVE POSITIONS (AS DESCRIBED ABOVE); - MATCHED THE COMPANY'S EXECUTIVE POSITIONS IN THE SURVEYS BASED ON THE COMPANY'S SIZE COMPLEXITY, AND SCOPE, AS WELL AS ACCORDING TO SPECIFIC POSITION RESPONSIBILITIES AND REPORTING RELATIONSHIPS; - VALIDATED THE SURVEY SOURCES AND MARKET MATCHES WITH THE INTERNAL COMPENSATION TEAM TO ENSURE CONSISTENCY; - REVIEWED, COMPILED, AND SUMMARIZED THE DATA IN REPORT FORM. THE REPORT SUMMARIZING THE RESULTS OF THE ANALYSIS WAS PRESENTED TO THE COMPENSATION COMMITTEE FOR DISCUSSION AND DELIBERATION. DOCUMENTATION A SUMMARY OF THE DISCUSSIONS AND DELIBERATIONS OF THE COMMITTEE ARE DOCUMENTED IN THE MEETING MINUTES, WHICH ARE REVIEWED AND APPROVED BY THE COMMITTEE. COPIES OF ALL MEETING MATERIALS DISTRIBUTED PRIOR TO AND DURING THE MEETING ARE MAINTAINED IN THE CORPORATE RECORDS ALONG WITH MEETING MINUTES. |
| PROCESS FOR MAKING DOCUMENTS AVAILABLE TO THE PUBLIC | FORM 990, PART VI, LINE 19 THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS OF THE ORGANIZATION ARE AVAILABLE AT ITS HEADQUARTERS IN WATERTOWN, MA. ALL REQUESTS CAN BE MADE TO THE CORPORATE COMMUNICATIONS OR FINANCE DEPARTMENTS. |
| OTHER CHANGE IN NET ASSETS | FORM 990, PART XI, LINE 9 Non-Admitted Assets (8,189,050) Capital Contributions 25,000,000 TOTAL 16,810,950 |
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2018
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