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Nonprofiteer
← AFFINITY HEALTH PLAN INC

Form 990 for tax year 2022

Filed by AFFINITY HEALTH PLAN INC.

Totals

Total revenue
$1,879,919
Total expenses
$6,745,121
Contributions and grants received
$0
Grants paid
$5,000,000
Program service revenue
$0
Investment income
$356,942
Other revenue
$1,522,977
Total assets, end of year
$104,244,580
Total liabilities, end of year
$437,739
Net assets or fund balances, end of year
$103,806,841
Program services expenses (Part IX)
$5,000,000
Management and general expenses
$1,745,121
Fundraising expenses
$0
Program service expenses (Part III)
$5,000,000

Program services were 74.1% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 3 · Investment income

    total $864,182 · excluded $864,182

  • 7a · Gross sales of assets other than inventory

    securities $29,603,126

  • 7b · Less cost or other basis and sales expenses

    securities $30,110,366

  • 7c · Gain or loss

    securities -$507,240

  • 7d · Net gain or loss

    total -$507,240 · excluded -$507,240

  • 11a · Other revenue: PHARMACY REBATES

    total $675,184 · related or exempt $675,184

  • 11b · Other revenue: OTHER REVENUE

    total $569,441 · related or exempt $569,441

  • 11c · Other revenue: PREMIUM AMORTIZATION I

    total $278,352 · excluded $278,352

  • 11e · Other revenue, total

    $1,522,977

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $5,000,000 · program services $5,000,000

  • 5 · Compensation of officers, directors and key employees

    total $797,414 · management and general $797,414

  • 9 · Other employee benefits

    total -$142,196 · management and general -$142,196

  • 11b · Fees: legal

    total $410,209 · management and general $410,209

  • 11c · Fees: accounting

    total -$43,137 · management and general -$43,137

  • 11f · Fees: investment management

    total $100,669 · management and general $100,669

  • 11g · Fees: other

    total $211,127 · management and general $211,127

  • 12 · Advertising and promotion

    total $490 · management and general $490

  • 13 · Office expenses

    total $4,719 · management and general $4,719

  • 14 · Information technology

    total $69,104 · management and general $69,104

  • 16 · Occupancy

    total $858 · management and general $858

  • 17 · Travel

    total $55 · management and general $55

  • 23 · Insurance

    total $349,055 · management and general $349,055

  • 24a · Other expenses: BANK CHARGES/FILLING FE

    total $379 · management and general $379

  • 24e · All other expenses

    total -$13,625 · management and general -$13,625

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $14,680,357 · end of year $18,341,212

  • 2 · Savings and temporary cash investments

    beginning of year $8,677,052 · end of year $15,010,783

  • 9 · Prepaid expenses and deferred charges

    beginning of year $2,089,930 · end of year $1,723,631

  • 11 · Investments: publicly traded securities

    beginning of year $29,481,213 · end of year $23,402,569

  • 15 · Other assets

    beginning of year $48,452,356 · end of year $45,766,385

  • 17 · Accounts payable and accrued expenses

    beginning of year $1,377,925 · end of year $437,739

  • 27 · Net assets without donor restrictions

    beginning of year $102,002,983 · end of year $103,806,841

Mission and programs · 2022

Mission

THE MISSION OF AFFINITY LEGACY, INC., F/K/A AFFINITY HEALTH PLAN (AFFINITY), IS TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE.

Activities or mission (Part I)

IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE.

  • COMMUNITY GRANT PROGRAM : DURING 2022, AFFINITY ESTABLISHED A COMMUNITY GRANT PROGRAM (THE PROGRAM) FUNDED BY A PORTION OF THE PROCEEDS FROM THE SALE TO MOLINA HEALTHCARE. UNDER THE PROGRAM, GRANTS ARE DISTRIBUTED TO ELIGIBLE COMMUNITY-BASED ORGANIZATIONS THROUGH AN APPLICATION PROCESS. GRANT FUNDING IS MADE AVAILABLE FOR PROJECTS THAT ARE PROVIDED FOR THE BENEFIT OF RESIDENTS WITHIN THE 10-COUNTY SERVICE AREA PREVIOUSLY SERVED BY AFFINITY HEALTH PLAN AND THAT ARE FOCUSED ON ONE OF FOUR FUNDING PRIORITIES: 1) MENTAL HEALTH; 2) FOOD INSECURITY; 3) FORMERLY INCARCERATED INDIVIDUALS; AND 4) WORKFORCE ADVANCEMENT AND CONSUMER EDUCATION.

    Expenses $5,000,000 · Grants $5,000,000

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Amy Knapp

    TRUSTEE

    Total calculated
    $11,000
    From this org
    $11,000
    From related orgs
    $0
    Other
    $0
    Hours/week
    1 + 2 related

  • John Sardelis

    TRUSTEE

    Total calculated
    $25,000
    From this org
    $25,000
    From related orgs
    $0
    Other
    $0
    Hours/week
    1 + 2 related

  • Yvette Walker MD

    TRUSTEE

    Total calculated
    $25,000
    From this org
    $25,000
    From related orgs
    $0
    Other
    $0
    Hours/week
    1 + 2 related

  • Nanette Falkenberg

    TRUSTEE

    Total calculated
    $24,000
    From this org
    $24,000
    From related orgs
    $0
    Other
    $0
    Hours/week
    1 + 2 related

  • Verona Greenland

    TRUSTEE

    Total calculated
    $17,000
    From this org
    $17,000
    From related orgs
    $0
    Other
    $0
    Hours/week
    1 + 2 related

  • Paloma Izquierdo-Hernandez

    TRUSTEE & CHAIR

    Total calculated
    $25,000
    From this org
    $25,000
    From related orgs
    $0
    Other
    $0
    Hours/week
    1 + 2 related

  • Lynn Sherman

    TRUSTEE & TREASURER

    Total calculated
    $18,000
    From this org
    $18,000
    From related orgs
    $0
    Other
    $0
    Hours/week
    1 + 2 related

  • Brian McIndoe

    TRUSTEE

    Total calculated
    $15,000
    From this org
    $15,000
    From related orgs
    $0
    Other
    $0
    Hours/week
    1 + 2 related

  • Linda Muller

    TRUSTEE & SECRETARY

    Total calculated
    $13,000
    From this org
    $13,000
    From related orgs
    $0
    Other
    $0
    Hours/week
    1 + 2 related

  • Judith Fairweather

    TRUSTEE

    Total calculated
    $18,000
    From this org
    $18,000
    From related orgs
    $0
    Other
    $0
    Hours/week
    1 + 2 related

  • Clara Mercedes Hansen

    EXECUTIVE DIRECTOR

    Total calculated
    $361,764
    From this org
    $333,340
    From related orgs
    $0
    Other
    $28,424
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $273,750
    Bonus
    $59,590
    Other
    $0
    Deferred
    $6,250
    Nontaxable benefits
    $22,174
    Filer's total
    $361,764

  • Rachel Amalfitano

    CONSULTANT/CFO

    Total calculated
    $244,650
    From this org
    $244,650
    From related orgs
    $0
    Other
    $0
    Hours/week
    14

    Schedule J breakdown matched by us

    Base
    $244,650
    Bonus
    $0
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $244,650

  • Scott Breidbart

    FORMER CHIEF MEDICAL OFFICER

    Total calculated
    $143,182
    From this org
    $143,182
    From related orgs
    $0
    Other
    $0
    Hours/week
    35

    Schedule J breakdown matched by us

    Base
    $143,182
    Bonus
    $0
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $143,182

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 3 · Compensation committee
  • 3 · Approval by the board or compensation committee
  • 7 · Other non-fixed payments

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 7
NON-FIXED PAYMENTS FORM 990, SCHEDULE J, PART I, LINE 7 INDIVIDUALS LISTED ON SCHEDULE J, PART II RECEIVED DISCRETIONARY BONUS COMPENSATION, INCLUDING ANNUAL BONUSES IN CALENDAR YEAR 2022.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • AHP ENTERPRISES INC

    C · MGMT SVCS · DE

    Directly controlled by AHSH

  • AFFINITY HEALTH SERVICES HOLDINGS INC

    C · HOLDING CO · DE

Provenance

Return type
form_990
Tax year
2022
Filed
13 November 2023
IRS schema version
2022v5.0
Source object
202303189349300620

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