2023-11-09T15:51:36-06:00 2022-12-31 366055558 GRANT THORNTON LLP 757 THIRD AVENUE 3RD FLOOR NEW YORK NY 100172013 990 2022-01-01 133941542 EMBLEMHEALTH INC EMBL 6464475000 55 WATER STREET TAX DEPT 9TH FL NEW YORK NY 10041 HEATHER TAMBORINO CFO 6464475000 2023-11-09 1 HEATHER TAMBORINO XXX-XX-XXXX 0 SCOTT THOMPSETT P00741490 2125990100 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z KAREN IGNAGNI 55 WATER STREET NEW YORK NY 10041 4648814 0 X EMBLEMHEALTH.COM X 1995 NY EMBLEMHEALTH INC. SUPPORTS THE TAX-EXEMPT MISSION OF HIPNY (SEE SCHEDULE O).EMBLEMHEALTH INC. OPERATES AS A HOLDING COMPANY THAT SUPPORTS THE TAX-EXEMPT HEALTHCARE MISSION OF ITS SUPPORTED ORGANIZATION, HEALTH INSURANCE PLAN OF GREATER NEW YORK.FORM 990, PART V, LINE 1A:IN A CHANGE FROM THE PRIOR YEAR, EMBLEMHEALTH, INC. NO LONGER ISSUES ANY FORM 1099S. THE INDIVIDUALS LISTED IN THE FORM 990 PART VII WERE PAID BY RELATED ORGANIZATION, HEALTH INSURANCE PLAN OF GREATER NEW YORK, THROUGH ITS DISREGARDED ENTITY, EMBLEMHEALTH SERVICES COMPANY, LLC. EMBLEMHEALTH SERVICES COMPANY, LLC ISSUED THE FORM 1099S TO THE INDIVIDUALS BEING LISTED IN FORM 990 PART VII. 14 12 0 0 -2700 0 0 2983 1782555 1647481 -2412601 2998350 0 0 -630046 4648814 102124 99795 0 0 1670429 1536782 0 0 0 10002 11402 1782555 1647979 -2412601 3000835 1528819 590236 3939418 0 -2410599 590236 EMBLEMHEALTH, INC. IS A NOT-FOR-PROFIT CORPORATION INCORPORATED IN NEW YORK STATE THAT, TOGETHER WITH ITS SUBSIDIARIES, PROVIDES MANAGED HEALTH CARE SERVICES TO ITS MEMBERS. 0 0 1647979 99795 1647481 EMBLEMHEALTH'S TAX-EXEMPT MISSION IS TO SUPPORT THE HEALTHCARE ACTIVITIES OF ITS SUPPORTED ORGANIZATION, HEALTH INSURANCE PLAN OF GREATER NEW YORK. ALL EXPENSES INCURRED BY EMBLEMHEALTH, INC. ARE PROGRAM SERVICE EXPENDITURES FOR PURPOSES OF PART IX OF THE FORM 990. 1647979 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 1 X 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 1 1 NY X HEATHER TAMBORINO 6464475000 55 WATER STREET NEW YORK NY 10041 X KAREN IGNAGNI CHIEF EXECUTIVE OFFICER 2.00 35.00 X X 0 5045764 68492 JOHN FEERICK CHAIRMAN 1.00 2.00 X X 0 161125 0 PAUL E GIBSON VICE CHAIRPERSON OF THE BOARD 1.00 2.00 X X 0 149625 0 BERNARD SCHAYES MD DIRECTOR 1.00 2.00 X 0 142391 18989 RICHARD BERMAN DIRECTOR 1.00 2.00 X 0 128000 4877 BARBARA S KOHN DIRECTOR 1.00 0.00 X 0 129500 0 KARIN D MAYHEW DIRECTOR 1.00 0.00 X 0 131500 0 SAM HAVENS DIRECTOR 1.00 0.00 X 0 146994 0 ROSA M GIL DSW DIRECTOR 1.00 0.00 X 0 126795 0 JO IVEY BOUFFORD DIRECTOR 1.00 0.00 X 0 101375 0 JOHN H BANKS III DIRECTOR 1.00 2.00 X 0 118375 178 GREGORY FLOYD DIRECTOR 1.00 2.00 X 0 0 0 WAYNE CAFRAN DIRECTOR 1.00 2.00 X 0 131500 0 KATHY HIRATA CHIN DIRECTOR 1.00 0.00 X 0 109250 0 MICHAEL PALMATEER PRESIDENT 1.00 35.00 X 0 2875045 458092 HEATHER TAMBORINO CHIEF FINANCIAL OFFICER 1.00 35.00 X 0 2046857 57902 DR STUART ALTMAN FORMER DIRECTOR 1.00 2.00 X 0 120000 0 CHARLES P WANG FORMER DIRECTOR 1.00 2.00 X 0 60000 5447 0 11724096 613977 0 1 1 0 0 2983 2983 ADMINISTRATIVE SERVICES 900099 1647481 1647481 1647481 2998350 -2700 3001050 4648814 1647481 -2700 3001050 X 99795 99795 1536782 1536782 902 902 MISCELLANEOUS EXPENSE 10000 10000 STATE AND LOCAL TAXES 500 500 1647979 1647979 0 0 221853 224540 1306966 0 0 365696 1528819 590236 1145430 0 2793988 0 3939418 0 X -2410599 590236 -2410599 590236 1528819 590236 3000835 0 X 0 1 X 1 0 X X 1 HEALTH INSURANCE PLAN OF GREATER NY 131828429 10 1 0 1647979 1 0 1647979 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 SCHEDULE A NARRATIVE: EMBLEMHEALTH'S PRIMARY EXEMPT PURPOSE IS TO SUPPORT THE HEALTHCARE MISSION OF ITS SUPPORTED ORGANIZATION, HEALTH INSURANCE PLAN OF GREATER NEW YORK (HIPGNY). ALL OF THE EXPENDITURES REPORTED ON PART IX OF EMBLEMHEALTH'S FORM 990 ARE INCURRED TO ENABLE HIPGNY TO CARRY-ON ITS TAX-EXEMPT MISSION. IN 2022, TOTAL SUPPORT PROVIDED TO HIPGNY TOTALED $1,647,979. FORM 990, SCHEDULE A, PART IV, LINE 2: EMBLEMHEALTH, INC. SUPPORTS THE TAX-EXEMPT MISSION OF A SECTION 501(C)(4) TAX-EXEMPT ORGANIZATION, HEALTH INSURANCE PLAN OF GREATER NEW YORK, INC. (HIPGNY). HIPGNY FORMERLY QUALIFIED AS A PUBLICLY SUPPORTED ORGANIZATION UNDER SECTION 509(A)(2) (AND AS A SECTION 501(C)(3) PUBLIC CHARITY), BUT IT CONVERTED TO A SECTION 501(C)(4) OVER A DECADE AGO. HIPGNY IS A HEALTH MAINTENANCE ORGANIZATION THAT PROVIDES ACCESS TO HEALTHCARE; ITS PRIMARY SOURCE OF REVENUE IS PREMIUMS (I.E. PROGRAMMATIC REVENUE) THAT WOULD CONSTITUTE PUBLIC SUPPORT UNDER SECTION 509(A)(2). EMBLEMHEALTH, INC.'S BYLAWS (ARTICLE 4) STATE THAT: "IF HIPGNY NO LONGER QUALIFIES AS AN ORGANIZATION DEEMED TO BE DESCRIBED IN SECTION 509(A)(2) OF THE CODE FOR PURPOSES OF SECTION 509(A)(3) OF THE CODE OR IS NO LONGER IN EXISTENCE, THEN EMBLEMHEALTH, INC. SHALL OPERATE IN FURTHERANCE OF THE EDUCATIONAL, SCIENTIFIC, AND CHARITABLE PURPOSES OF ONE OR MORE OTHER ORGANIZATIONS IN THE HEALTHCARE INDUSTRY THAT ARE DESCRIBED IN EITHER SECTION 509(A)(1) OR SECTION 509(A)(2) OF THE CODE." FORM 990, SCHEDULE A, PART IV, LINE 3(B): HIPGNY RECEIVES 99% OF ITS REVENUE FROM MEMBER PREMIUMS; ACCORDINGLY, THERE IS NO QUESTION THAT IT WOULD QUALIFY FOR SECTION 509(A)(2) STATUS (WERE IT EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE) AND NO FURTHER MONITORING IS REQUIRED. FORM 990, SCHEDULE A, PART IV, LINE 3(C): EMBLEMHEALTH, INC'S PRIMARY EXEMPT PURPOSE IS TO SUPPORT THE HEALTHCARE MISSION OF HIPGNY IN WHATEVER CAPACITY IS REQUIRED. EXPENSES INCURRED BY EMBLEMHEALTH, INC. TO SUPPORT HIPGNY'S ACTIVITIES ARE REIMBURSED AT COST. NO FINANCIAL SUPPORT IS REMITTED BACK TO HIPGNY; EMBLEMHEALTH, INC. SOLELY PROVIDES PROGRAMMATIC SUPPORT. FORM 990, SCHEDULE A, PART IV, SCHEDULE D, LINE 3: HIPGNY, THE SUPPORTED ORGANIZATION, OVERSEES ALL OF THE PROGRAMMATIC ACTIVITIES OF EMBLEMHEALTH, INC. HISTORICALLY, EMBLEMHEALTH, INC. HAS NOT HELD ANY INVESTMENTS; THIS CHANGED IN 2019 WHEN EMBLEMHEALTH, INC. INVESTED IN A HEALTHCARE ENTITY CALLED EMBLEMHEALTH CITYBLOCK LLC. THE GOAL OF THIS HEALTHCARE VENTURE IS TO ENABLE HIPGNY TO CREATE HEALTHIER FUTURES FOR ITS CUSTOMERS AND COMMUNITIES BY OFFERING ACCESS TO HIGH-QUALITY, AFFORDABLE HEALTH CARE. FORM 990, SCHEDULE A, PART IV, SCHEDULE E, LINE 3(A) AND 3(B): BOTH EMBLEMHEALTH, INC. AND HEALTH INSURANCE PLAN OF GREATER NEW YORK SHARE COMMON MANAGEMENT EVEN THOUGH THEY DO NOT SHARE A COMMON BOARD OF DIRECTORS. HIPGNY IS NOT RESERVED THE RIGHT IN EMBLEMHEALTH'S BYLAWS TO APPOINT THE BOARD OF DIRECTORS. NEVERTHELESS, HIPGNY GOVERNS AND OVERSEES ALL OF EMBLEMHEALTH'S LIMITED ACTIVITIES (BY NECESSITY). 0 INTERCOMPANY RECEIVABLE 365696 365696 X PART X, LINE 2: FIN 48 DISCLOSURE THE COMPANY HAS NOT TAKEN ANY UNSUBSTANTIATED TAX POSITIONS THAT WOULD REQUIRE PROVISIONS OF A LIABILITY UNDER ASC 740, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE COMPANY DOES NOT BELIEVE THERE ARE ANY MATERIAL UNCERTAIN TAX POSITIONS AND, ACCORDINGLY, DID NOT RECOGNIZE ANY LIABILITY FOR UNRECOGNIZED TAX POSITIONS. FOR THE YEAR ENDED DECEMBER 31, 2022, THERE WERE NO INTEREST OR PENALTIES RECORDED OR INCLUDED IN THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS. 1 EAGLE CLUB 2402 GREEN GINGER CIR ACCOKEEK MD 20607 852898582 501(C)(3) 21670 0 GENERAL SUPPORT GRACE LUTHERAN CHURCH OF MALVERNE NY 400 HEMPSTEAD AVE MALVERNE NY 11565 111981548 501(C)(3) 25000 0 GENERAL SUPPORT GREEN HORNETS OF VALLEY STREAM 183 E MELROSE ST VALLEY STREAM NY 11580 112901121 501(C)(3) 10000 0 GENERAL SUPPORT JAZZ HOUSE KIDS INC 347 BLOOMFIELD AVE LOWER LEVEL MONTCLAIR NJ 07042 562303577 501(C)(3) 10000 0 GENERAL SUPPORT NASSAU COMETS INC 18 PLYMOUTH ROAD EAST ROCKAWAY NY 11518 113525920 501(C)(3) 23125 0 GENERAL SUPPORT 5 0 PART I, LINE 2: IN LIEU OF MAKING CERTAIN DIRECTORS' FEE PAYMENTS TO BOARD MEMBERS WHO RENOUNCED PAYMENT FOR THEIR BOARD SERVICE, EMBLEMHEALTH, INC. MADE VARIOUS CHARITABLE DONATIONS TO LOCAL COMMUNITY CHARITIES TO SUPPORT YOUTH ATHLETICS AND OTHER WORTHWHILE CULTURAL ENDEAVORS. SINCE THE AMOUNTS WERE SO SMALL, EMBLEMHEALTH, INC. DID NOT REQUIRE THE GRANTEES TO PROVIDE REPORTS AS TO HOW THE FUNDS WERE EXPENDED. GRANT APPLICATIONS ARE PRIMARILY ACCEPTED FROM 501(C)(3) TAX-EXEMPT ORGANIZATIONS. TO THE EXTENT ANY OF THE GRANTEES ARE NON 501(C)(3) ORGANIZATIONS, THOSE GRANTEES ARE ORGANIZATIONS WHICH SUPPORT CHARITABLE ENDEAVORS. 0 1 0 0 0 0 0 0 0 KAREN IGNAGNI CHIEF EXECUTIVE OFFICER 0 1205764 0 3840000 0 0 0 45300 0 23192 0 5114256 0 0 MICHAEL PALMATEER PRESIDENT 0 912919 0 1962126 0 0 0 440750 0 17342 0 3333137 0 0 HEATHER TAMBORINO CHIEF FINANCIAL OFFICER 0 795636 0 1251221 0 0 0 45300 0 12602 0 2104759 0 0 BERNARD SCHAYES MD DIRECTOR 0 142391 0 0 0 0 0 0 0 18989 0 161380 0 0 JOHN FEERICK CHAIRMAN 0 161125 0 0 0 0 0 0 0 0 0 161125 0 0 DR STUART ALTMAN FORMER DIRECTOR 0 120000 0 0 0 0 0 0 0 0 0 120000 0 0 CHARLES P WANG FORMER DIRECTOR 0 60000 0 0 0 0 0 0 0 5447 0 65447 0 0 PART I, LINE 4B SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN II COMPENSATION EMBLEMHEALTH, INC. DOES NOT SPONSOR ANY UNQUALIFIED RETIREMENT PLANS, HOWEVER, EMBLEMHEALTH SERVICES COMPANY LLC SPONSORS NONQUALIFIED RETIREMENT PLANS, BUT NO EQUITY BASED COMPENSATION PLANS. OFFICERS WITH THE TITLES OF SENIOR VICE PRESIDENT AND ABOVE HIRED PRIOR TO JUNE 1, 2009, PARTICIPATE IN THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN II FOR EMBLEMHEALTH SERVICES COMPANY, LLC ("SERP II"). THE SERP II PROVIDES A RETIREMENT BENEFIT CALCULATED ON THE BASIS OF 50% OF FINAL AVERAGE PAY, OFFSET BY BENEFITS UNDER ANY QUALIFIED BENEFIT PLAN, SUCH AS THE EMBLEMHEALTH SERVICES COMPANY, LLC EMPLOYEES' RETIREMENT PLAN. PARTICIPANTS REQUIRE THE APPROVAL OF THE BOARD OF DIRECTORS TO RETIRE UNDER THE SERP II BETWEEN THE AGES OF 55 AND 60. PARTICIPANTS WHO RETIRE PRIOR TO AGE 65 HAVE THEIR SERP II BENEFITS REDUCED BY EARLY RETIREMENT FACTORS. DR LESTER LEBLANC SON-IN-LAW OF DIR. 96380 DENT. WAGES 0 FORM 990, SCHEDULE L, PART IV: THE ORGANIZATION TAKES ITS RESPONSIBILITIES OF MONITORING POTENTIAL CONFLICTS OF INTEREST VERY SERIOUSLY (PLEASE SEE DISCLOSURE ON PART VI, LINE 12).EMBLEMHEALTH AND HIPGNY COMPILE A LENGTHY SUMMARY REPORT OF ALL POTENTIAL BUSINESS TRANSACTIONS BETWEEN THE INDIVIDUALS REPORTED ON PART VII OF THE FORM 990 AND HIPGNY OR ONE OF ITS AFFILIATED ORGANIZATIONS. THIS REPORT DISCLOSES ALL POTENTIAL BUSINESS TRANSACTIONS REGARDLESS OF MONETARY VALUE. AMOUNTS REPORTED ON SCHEDULE L REPRESENT THE W-2, BOX 5 WAGES PAID TO EACH OF THESE INDIVIDUALS. ADDITIONAL TAXABLE AND NON-TAXABLE FRINGE BENEFITS MAY HAVE BEEN PROVIDED (BUT ARE NOT INCLUDED ABOVE). ADDITIONAL INFORMATION IS AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION A, LINE 1A OF THE 14 VOTING BOARD MEMBERS, TWO DIRECTORS ARE DEEMED TO BE NON-INDEPENDENT UNDER THE GUIDANCE SET FORTH BY THE INTERNAL REVENUE SERVICE. TRUSTEE COMPENSATION AMOUNTS REPORTED ON PART VII OF THE FORM 990 REPRESENT REASONABLE COMPENSATION PAID FOR SERVICES RENDERED AS A TRUSTEE/DIRECTOR OF THE ORGANIZATION AND SUCH PAYMENTS DO NOT IMPAIR THE INDIVIDUALS' INDEPENDENCE. FORM 990, PART VI, SECTION A, LINE 1B: THE NON-INDEPENDENT INDIVIDUALS ARE KAREN IGNAGNI AND JOHN FEERICK. MS. IGNAGNI IS A COMPENSATED EMPLOYEE OF A RELATED ORGANIZATION, HEALTH INSURANCE PLAN OF GREATER NEW YORK. MR. FEERICK HAS BUSINESS TRANSACTIONS THAT HAVE BEEN DISCLOSED ON SCHEDULE L TO THE 990 (THAT THEREBY IMPAIR HIS INDEPENDENCE). DR. BERNARD SCHAYES RECEIVED PAYMENT FOR SERVICES RENDERED TO THE ORGANIZATION IN THE AMOUNT OF $27,416. THESE FEES ARE REPORTED IN PART ON FORM 990, PART VII AS WAGES, BUT ARE DISTINCT FROM THE BOARD TRUSTEE FEES DR. SCHAYES RECEIVES FOR SERVING AS AN ACTIVE PARTICIPANT OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 2: IN THE INTERESTS OF FULL DISCLOSURE, THE ORGANIZATION NOTES THAT VARIOUS OFFICERS AND/OR DIRECTORS, MAY SERVE ON THE BOARD OF DIRECTORS OF FOR-PROFIT ORGANIZATIONS THAT ARE SUBSIDIARIES OF HIPGNY (E.G. - THOSE DISCLOSED IN SCHEDULE R OF THAT ORGANIZATION'S FORM 990). NO INDIVIDUAL IS COMPENSATED FOR BOARD SERVICE TO THE RELATED FOR-PROFIT ORGANIZATIONS. FORM 990, PART VI, SECTION B, LINE 11B 990 REVIEW PROCESS THE ORGANIZATION'S FORM 990 FOR THE YEAR ENDING DECEMBER 31, 2022 WAS PROVIDED TO EACH MEMBER OF THE ORGANIZATION'S GOVERNING BODY BEFORE IT WAS FILED. A DETAILED REVIEW OF THE FORM 990 WAS UNDERTAKEN BY THE ORGANIZATION'S TAX DIRECTOR, CHIEF ADMINISTRATIVE OFFICER, CHIEF FINANCIAL OFFICER, AND VP, DEPUTY COUNSEL. UPON COMPLETION OF THE REVIEW PROCESS, THE FORM 990 IS THEN ELECTRONICALLY FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C INDEPENDENCE TO DETERMINE IF AN EMPLOYEE'S PERSONAL INTERESTS, ACTIVITIES OR RELATIONSHIPS CONSTITUTE A CONFLICT OF INTEREST OR THE APPEARANCE OF A CONFLICT OF INTEREST, CERTAIN EMPLOYEES, BASED ON FUNCTIONALITY, AS DETERMINED BY THE CHIEF COMPLIANCE OFFICER, AND BY THE VP, DEPUTY COUNSEL, ARE REQUIRED TO FULLY DISCLOSE, ON AN ANNUAL BASIS, ANY REPORTABLE SITUATIONS ON THE COMPANY'S CONFLICT OF INTEREST DISCLOSURE FORM. ALL EMPLOYEES, AT THE TIME OF EMPLOYMENT, ARE REQUIRED TO FULLY DISCLOSE ANY PERSONAL INTERESTS, ACTIVITIES OR RELATIONSHIPS THAT CONSTITUTE A CONFLICT OF INTEREST OR THE APPEARANCE OF A CONFLICT OF INTEREST. DISCLOSURES ARE REVIEWED BY THE CHIEF COMPLIANCE OFFICER, AND BY VP, DEPUTY GENERAL COUNSEL. ANY EMPLOYEE, WHO VIOLATES THE CONFLICT OF INTEREST POLICY, FAILS TO MAKE A REQUIRED REPORT OR FAILS TO COMPLY WITH ANY REMEDIAL ACTION REQUIRED BY THE COMPANY MAY BE SUBJECT TO DISCIPLINARY ACTION, UP TO AND INCLUDING TERMINATION OF EMPLOYMENT. AT YEAR END, THE ORGANIZATION PREPARES A COMPREHENSIVE CONFLICTS OF INTEREST SUMMARY REPORT THAT DISCLOSES ALL KNOWN REPORTED CONFLICTS. THE SUMMARY INCLUDES ALL BOARD MEMBERS, OFFICERS, KEY EMPLOYEES AND EMPLOYEES OF EMBLEMHEALTH, INC., HEALTH INSURANCE PLAN OF GREATER NEW YORK AND ALL RELATED AFFILIATED ENTITIES. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION REVIEW PROCESS THE COMPENSATION PROVIDED TO EMBLEMHEALTH, INC'S TOP MANAGEMENT OFFICIAL, KAREN IGNAGNI, IS PAID OUT BY A RELATED ORGANIZATION, EMBLEMHEALTH SERVICES COMPANY, LLC (A 100% OWNED SUBSIDIARY OF HEALTH INSURANCE PLAN OF GREATER NEW YORK, INC.). THE DIRECTORS LISTED IN PART VII OF THE FORM 990 ARE PROVIDED WITH A STIPEND FOR THEIR BOARD SERVICE. THIS AMOUNT IS REMITTED VIA A FORM 1099 AS THESE INDIVIDUALS ARE NOT EMPLOYEES OF EITHER EMBLEMHEALTH, INC., OR EMBLEMHEALTH SERVICES COMPANY, LLC. EMBLEMHEALTH SERVICES COMPANY, LLC PAYS THE BOARD FEES AND ISSUES THE CORRESPONDING FORM 1099S. THE PROCESS USED TO DETERMINE THE COMPENSATION OF THE OFFICERS LISTED ON PART VII HAS BEEN DISCLOSED ON THE FORM 990 OF HEALTH INSURANCE PLAN OF GREATER NEW YORK, A RELATED ORGANIZATION. EMBLEMHEALTH, INC. DOES NOTE THAT THE PROCESS FOR DETERMINING COMPENSATION OF THESE INDIVIDUALS INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, THE USE OF COMPARABILITY DATA, AND SUBSTANTIATION OF THE DECISION-MAKING PROCESS. FORM 990, PART VI, SECTION C, LINE 19 PUBLIC DOCUMENTS THE ORGANIZATION MAKES ITS FORM 990 AND FORM 1023 AVAILABLE TO THE PUBLIC BY RETAINING A COPY OF EACH AT ITS HEAD OFFICES AT 55 WATER STREET, NEW YORK, NEW YORK. ANY INDIVIDUAL REQUESTING A COPY OF THESE DOCUMENTS IS PROVIDED THAT COPY ON THE SAME BUSINESS DAY. THE ORGANIZATION'S FORM 990 IS ALSO AVAILABLE FOR PUBLIC INSPECTION ON WWW.GUIDESTAR.COM. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION B: FOR THE YEAR ENDING DECEMBER 31, 2022, EMBLEMHEALTH, INC. DID NOT PAY ANY PROFESSIONAL SERVICE PROVIDERS IN EXCESS OF $100,000; HOWEVER, IN THE INTERESTS OF FULL DISCLOSURE, THE ORGANIZATION IS NOTING THAT SEVERAL MEMBERS OF THE BOARD OF DIRECTORS RECEIVED 1099 COMPENSATION FOR THEIR RESPECTIVE BOARD SERVICE THAT MAY HAVE EXCEEDED $100,000. SINCE THESE INDIVIDUALS ARE REPORTED IN PART VII OF THE FORM 990, THE ORGANIZATION DID NOT DUPLICATE THE INFORMATION IN THE INDEPENDENT CONTRACTOR SECTION OF THE FORM 990. FORM 990, PART IX, LINE 5: THE BOARD FEES DISCLOSED IN PART VII OF THE FORM 990 AND PART IX LINE 5 ARE PAID BY RELATED ORGANIZATION, HEALTH INSURANCE PLAN OF GREATER NEW YORK, THROUGH ITS DISREGARDED ENTITY, EMBLEMHEALTH SERVICES COMPANY, LLC. THE COMPENSATION EXPENSE IS REALLOCATED BACK TO EMBLEMHEALTH, INC. HEALTH INSURANCE PLAN OF GREATER NEW YORK 55 WATER STREET NEW YORK NY 10041 131828429 INSURANCE NY 501(C)(4) N/A N/A 0 EMBLEMHEALTH FOUNDATION INC 55 WATER STREET TAX DEPT 9TH FL NEW YORK NY 10041 854100976 FUNDRAISING NY 501(C)(3) LINE 7 N/A 0 EMBLEMHEALTH CITYBLOCK LLC C/O EMBLEMHEALTH 55 WATER STREET NEW YORK NY 10041 831246245 HEALTHCARE NY EMBLEMHEALTH UNRELATED -2700 0 -2700 1 BRONXDOCS MANAGEMENT COMPANY LLC 55 WATER STREET TAX DEPT 9TH FL NEW YORK NY 10041 844004402 HEALTHCARE NY HIPGNY UNRELATED 0 1 0.51000 EMBLEMHEALTH PLAN INC 55 WATER STREET NEW YORK NY 10041 135511997 INSURANCE NY HIPGNY C 551323595 693379804 1.00000 1 HIP HOLDINGS INC & SUBSIDIARIES 55 WATER STREET NEW YORK NY 10041 133819759 INSURANCE NY HIPGNY C 1955522100 943870136 1.00000 1 ADVANTAGECARE PHYSICIANS PC 55 WATER STREET NEW YORK NY 10041 460970995 HEALTHCARE NY HIPGNY C 428884400 154771372 1.00000 1 SIUC MEDICAL PC 55 WATER STREET NEW YORK NY 10041 810689784 HEALTHCARE NY HIPGNY C 9232574 3233456 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 0 0 HEALTH INSURANCE PLAN OF GREATER NEW YORK L 1647979 COST HEALTH INSURANCE PLAN OF GREATER NEW YORK Q 1647979 COST FORM 990, SCHEDULE R, PART V: EMBLEMHEALTH, INC. IS THE PARENT ORGANIZATION OF HEALTH INSURANCE PLAN OF GREATER NEW YORK (HIPGNY), A 501(C)(4) TAX-EXEMPT ORGANIZATION WHOSE MISSION IS TO CREATE HEALTHIER FUTURES FOR ITS CUSTOMERS AND COMMUNITIES. HIPGNY WORKS ALONGSIDE ITS CUSTOMERS TO OFFER ACCESS TO HIGH-QUALITY, AFFORDABLE CARE, HELP NAVIGATE THE HEALTH CARE EXPERIENCE, AND MAKE GOOD HEALTH ACHIEVABLE. EMBLEMHEALTH, INC., THROUGH ITS SUBSIDIARIES HELPS FACILITATE HIPGNY'S COMMUNITY PROGRAMS. COSTS ASSOCIATED WITH RUNNING EMBLEMHEALTH INC. ARE REIMBURSED BY HIPGNY AND ARE MEMORIALIZED WITH TRANSACTION CODE L & Q. EMBLEMHEALTH CITYBLOCK LLC WAS DISSOLVED AS OF JANUARY 2022.