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ObjectId: 201603199349311750 - Submission: 2016-11-14
TIN: 04-2452600
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Information about Schedule R (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
15
Open to Public Inspection
Name of the organization
HARVARD PILGRIM HEALTH CARE INC
Employer identification number
04-2452600
Part I
Identification of Disregarded Entities
Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) 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
(1)
Harvard Pilgrim Health Care Inst LLC
133 BROOKLINE AVE
BOSTON
,
MA
02215
94-3477531
RESEARCH
MA
5,930,986
28,326,038
HPHC INC
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 entity?
Yes
No
(1)
HPHC FOUNDATION INC
93 WORCESTER STREET
WELLESLEY
,
MA
02481
04-2708004
community svc
MA
501(c)(3)
11a-I
HPHC Inc
Yes
(2)
HPHC of New England Inc
93 WORCESTER STREET
WELLESLEY
,
MA
02481
04-2663394
health insura
MA
501(c)(4)
HPHC Inc
Yes
(3)
HPHC OF CONNECTICUT
185 ASYLUM STREET
HARTFORD
,
CT
06103
46-1681667
HEALTH INSURA
CT
501(C)(4)
HPHC Inc
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2015
Page 2
Schedule R (Form 990) 2015
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
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
HPHC Insurance Company Inc
93 WORCESTER STREET
WELLESLEY
,
MA
024819181
04-3149694
HEALTH INSURANCE
MA
HPHC INC
C CORP
667,987,158
226,348,021
100.000 %
Yes
(2)
HPHC Holding Corporation
93 WORCESTER STREET
WELLESLEY
,
MA
024819181
04-3306439
HOLDING COMPANY
MA
HPHC INC
C CORP
8,361,543
15,429,085
100.000 %
Yes
(3)
Plan Marketing Insurance Agency Inc
1500 W PARK DRIVE STE 330
WESTBOROUGH
,
MA
01581
04-2734281
BROKERAGE
MA
HEALTH PLANS
C CORP
100.000 %
Yes
(4)
HPHC Insurance Agency Inc
93 WORCESTER STREET
WELLESLEY
,
MA
024819181
04-3016201
BROKERAGE
MA
HPHC INC
C CORP
39,939
484,625
100.000 %
Yes
(5)
Health Plans Inc
1500 W PARK DRIVE STE 330
WESTBOROUGH
,
MA
01581
04-2734278
TPA
MA
HPHC INC
C CORP
37,279,452
20,955,481
100.000 %
Yes
(6)
Care Management Services Inc
1500 W PARK DRIVE STE 330
WESTBOROUGH
,
MA
01581
04-3438779
ASO SERVICES
MA
HEALTH PLANS
C CORP
100.000 %
Yes
(7)
HARVARD PILGRIM PHYSICIANS ASSOC INC
93 WORCESTER ST
WELLESLEY
,
MA
024819181
PHYSICIAN ORG
MA
HPHC INC
SEE PART VII
100.000 %
Yes
Schedule R (Form 990) 2015
Page 3
Schedule R (Form 990) 2015
Page
3
Part V
Transactions With Related Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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, or
(iv)
rent from a controlled entity
.....................
1a
Yes
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
Yes
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
Yes
d
Loans or loan guarantees to or for related organization(s)
............................
1d
Yes
e
Loans or loan guarantees by related organization(s)
............................
1e
Yes
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
Yes
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
Yes
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
Yes
o
Sharing of paid employees with related organization(s)
............................
1o
Yes
p
Reimbursement paid to related organization(s) for expenses
............................
1p
No
q
Reimbursement paid by related organization(s) for expenses
............................
1q
Yes
r
Other transfer of cash or property to related organization(s)
............................
1r
No
s
Other transfer of cash or property from related organization(s)
............................
1s
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 related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
HPHC FOUNDATION INC
B
6,220,994
CASH
(2)
HPHC OF NEW ENGLAND INC
L,N,O
41,177,853
ALLOCATION
(3)
HPHC FOUNDATION INC
L,N,O
681,244
ALLOCATION
(4)
HPHC INSURANCE COMPANY INC
L,N,O
92,697,803
ALLOCATION
(5)
HEALTH PLANS INC
L,N,O
4,638,653
ALLOCATION
(6)
HPHC OF CONNECTICUT
L,N,O
1,654,851
ALLOCATION
(7)
HPHC FOUNDATION INC
A (IV
649,592
CONTRACT
(8)
HEALTH PLANS INC
A (IV
293,451
CONTRACT
(9)
HPHC OF CONNECTICUT
B
3,000,000
CASH
(10)
HPHC Holding Corporation
B
1,843,135
CASH
(11)
HPHC INSURANCE COMPANY INC
B
40,000,000
CASH
(12)
HPHC FOUNDATION INC
D
344,259
CONTRACT
(13)
HEALTH PLANS INC
D
756,147
CONTRACT
(14)
HPHC OF NEW ENGLAND INC
E
11,513,605
CONTRACT
(15)
HPHC INSURANCE COMPANY INC
E
18,951,813
CONTRACT
(16)
HPHC INSURANCE AGENCY INC
E
2,941
CONTRACT
(17)
HPHC OF CONNECTICUT
D
215,366
CONTRACT
(18)
HPHC OF NEW ENGLAND INC
C
10,000,000
RET. OF CAPITAL
Schedule R (Form 990) 2015
Page 4
Schedule R (Form 990) 2015
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)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(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
Yes
No
Schedule R (Form 990) 2015
Page 5
Schedule R (Form 990) 2015
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference
Explanation
Schedule R, Part IV
HARVARD PILGRIM PHYSICIANS ASSOCIATION, INC. IS A NONPROFIT ORGANIZED UNDER THE LAWS OF MASSACHUSETTS. THIS IS AN INACTIVE ORGANIZATION WHICH WAS DISSOLVED IN 2015.
Schedule R (Form 990) 2015
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