THE HEALTH PLAN OF WEST VIRGINIA I… - Form 990 Financial Data

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Financial Vulnerability Assessment (Tuckman-Chang)

4 risk indicators measuring financial stability and operational resilience

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Financial Trends

Organization Details

Formation Year

1979

Legal Domicile

Principal Officer

JEFFREY M KNIGHT

Phone

8006246961

Tax Period

2024-01-01 to 2024-12-31

THE HEALTH PLAN OF WEST VIRGINIA INC, founded in 1979, is a major nonprofit that reported $772.7M in total revenue in fiscal year 2024.

Mission

ESTABLISHED AS A COMMUNITY HEALTH ORGANIZATION, THE HEALTH PLAN DELIVERS A CLINICALLY-DRIVEN, TECHNOLOGY-ENHANCED, CUSTOMER-FOCUSED PLATFORM BY DEVELOPING AND IMPLEMENTING PRODUCTS AND SERVICES THAT MANAGE AND IMPROVE THE HEALTH AND WELL-BEING OF OUR MEMBERS. WE ACHIEVE THESE RESULTS THROUGH A TEAM OF HEALTHCARE PROFESSIONALS AND PARTNERS ACROSS OUR COMMUNITY.

Program Service Accomplishments

Program 1

Expenses: $124,279,965 Revenue: $123,811,581

THE PRIMARY EXEMPT PURPOSE OF THE HEALTH PLAN OF WEST VIRGINA, INC. (THE HEALTH PLAN) IS TO OPERATE A STATE CERTIFIED, FEDERALLY QUALIFIED HEALTH MAINTENANCE ORGANIZATION (HMO) WHICH PROVIDES...

THE PRIMARY EXEMPT PURPOSE OF THE HEALTH PLAN OF WEST VIRGINA, INC. (THE HEALTH PLAN) IS TO OPERATE A STATE CERTIFIED, FEDERALLY QUALIFIED HEALTH MAINTENANCE ORGANIZATION (HMO) WHICH PROVIDES COMPREHENSIVE HEALTH CARE SERVICES ON A PREPAID BASIS. THE NUMBER OF COMMERCIAL HMO MEMBERS AT DECEMBER 31, 2024 WAS 18,696.

Program 2

Expenses: $501,019,957 Revenue: $492,163,592

THE HEALTH PLAN OFFERS A MANAGED CARE PROGRAM FOR MOUNTAIN HEALTH TRUST (MHT), WEST VIRGINIA'S MEDICAID PROGRAM. AT DECEMBER 31, 2024, THE HEALTH PLAN'S MHT PLAN SERVICED 100,002 MEMBERS WITH 42,679 MEMBERS ENROLLED FROM THE EXPANSION POPULATION, 41,915 MEMBERS ENROLLED FOR THE TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) POPULATION, 9,911 MEMBERS ENROLLED FROM THE SUPPLEMENTAL SECURITY INCOME (SSI) POPULATION, AND 5,497 MEMBERS ENROLLED FROM THE WV CHILDREN'S HEALTH INSURANCE PROGRAM (WVCHIP).

Program 3

Expenses: $136,047,351 Revenue: $133,642,487

THE HEALTH PLAN OFFERS A MEDICARE ADVANTAGE PROGRAM KNOWN AS SECURE CARE AND A PROGRAM FOR MEMBERS ELIGIBLE FOR BOTH MEDICARE AND MEDICAID KNOWN AS A MEDICARE DUAL SPECIAL NEEDS PLAN (DSNP). SECURE CARE ENABLES THE MEDICARE ELIGIBLE POPULATION TO SELECT MEDICARE COVERAGE AT A MUCH LOWER COST DUE TO THEIR AGREEMENT TO UTILIZE THE HEALTH PLAN NETWORK AND WITH PLAN OPTIONS FOR EXPANDED BENEFITS SUCH AS DENTAL, VISION, HEARING, TELEHEALTH, GYM MEMBERSHIPS, COVERAGE FOR "OVER-THE-COUNTER" ITEMS, IN-HOME MEAL DELIVERY AFTER HOSPITAL STAYS, AND ROUTINE TRANSPORTATION TO HEALTH-RELATED LOCATIONS. ENROLLMENT AT DECEMBER 31, 2024 FOR THESE PROGRAMS INCLUDED 8,218 MEMBERS.

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Trantor Score

Financial Health Score (300–850) · Liquidity · Solvency · Sustainability · Efficiency

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Liquidity (40%) • Solvency (30%) • Sustainability (20%) • Efficiency (10%)

Financial Overview (2024)

Revenue Breakdown

Contributions & Grants $0

Program Service Revenue $747,972,277

Investment Income $22,964,459

Other Revenue $1,739,426

TOTAL REVENUE $772,676,162

Expense Breakdown

Grants Paid $532,522

Salaries & Benefits $41,327,747

Fundraising Expenses $0

Program Expenses $761,347,273

Other Expenses $41,306,768

TOTAL EXPENSES $776,295,208

Year-over-Year Comparison

	2024	2023	Change
Revenue	$772,676,162	$793,217,524	0.0%
Expenses	$776,295,208	$780,774,378	0.0%
Net Income	$-3,619,046	$12,443,146	-1.3%

Key Indicators

✓ Grants to Organizations ✓ Grants to Individuals ✗ Lobbying ✗ Political Activity ✓ Foreign Activities ✗ Donor Advised Fund ✗ Schedule B Required

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Financial Health Indicators

Comprehensive financial analysis: Altman Z-Score, liquidity, solvency, sustainability, efficiency, and growth metrics

Financial Distress Indicator

Liquidity & Cash Position

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Altman Z-Score • Liquidity Ratios • Solvency Analysis • Growth Indicators • Efficiency Metrics

Governance

Voting Members

Independent Members

Employees

623

Volunteers

N/A

Governance Policies

✓ Conflict of Interest Policy

✓ Whistleblower Policy

✓ Document Retention Policy

Special Practices & Reported Activities

✗ Operated a School

✗ Operated a Hospital

✗ Provided First Class Travel

✗ Reported Conflict of Interest

✗ Reported Asset Diversion

✗ Excess Benefit Transaction

✗ Made Political Expenditures

✗ Engaged in Lobbying

✗ Operated Donor Advised Fund

✗ Maintained Art Collections

✗ Filed Form 720

Compensation of Officers, Directors & Key Employees

Total Officers

$1,327,147

Total Directors

$153,500

Key Employees

$2,258,010

Highest Compensated

reported

Name	Title	Hours/Week	Role	Reportable Comp	Other Comp	Total
DENISE D PENTINO	CHAIR OF THE BOARD	1.00	Officer Director	$21,000	$0	$21,000
WESLEY NICKELL	VICE CHAIR OF THE BOARD	1.00	Officer Director	$20,000	$0	$20,000
MARK LANCELLOTTI	MEMBER	1.00	Director	$20,000	$0	$20,000
SUSAN BUCHANAN CPA	SECRETARY	1.00	Officer Director	$17,500	$0	$17,500
LEA RIDENHOUR	MEMBER	1.00	Director	$17,500	$0	$17,500
DAVID COOK	MEMBER	1.00	Director	$17,500	$0	$17,500
JOSEPH G DONZELLA DO	MEMBER	1.00	Director	$17,500	$0	$17,500
WILLIAM D CRONIN	MEMBER	1.00	Director	$17,500	$0	$17,500
MANINDER SINGH BEDI MD	MEMBER (THRU 11/2024)	1.00	Director	$2,500	$0	$2,500
MARK VOELLINGER MD	MEMBER	1.00	Director	$2,500	$0	$2,500
JEFFREY KNIGHT	PRESIDENT & CEO	40.00	Officer	$690,739	$59,639	$750,378
RYAN RALSTON	CHIEF FINANCIAL OFFICER	40.00	Officer	$438,346	$79,923	$518,269
JAMIE LEARY	CHIEF LEGAL COUNSEL	40.00	Key Emp	$339,859	$25,651	$365,510
RYAN JEWELL	SVP SALES & ACCOUNT MGMT	40.00	Key Emp	$291,573	$52,228	$343,801
MUMTAZ IBRAHIM MD	CHIEF MEDICAL OFFICER	40.00	Key Emp	$296,176	$47,117	$343,293
KENNETH BRYAN	CHIEF INFORMATION OFFICER	40.00	Key Emp	$282,353	$58,804	$341,157
E DAVID MATHIEU SVP -	UNDERWRITING & REGULATORY SERVICES	40.00	Key Emp	$255,891	$57,752	$313,643
CHRISTINA DONOHUE	SVP MHT	40.00	Key Emp	$265,513	$39,033	$304,546
ANTOINETTE GEYER SVP PROVIDER	DELIVERY SERVICES (THRU 09/2024)	40.00	Key Emp	$219,362	$26,698	$246,060
EMILY KEANE DIRECTOR	AUDIT & ADVISORY (THRU 04/2024)	40.00	Highest	$224,093	$2,664	$226,757
ROBERT CROSS	MEDICAL DIRECTOR	40.00	Highest	$248,483	$55,348	$303,831
ROBERT J ROSET	SVP - IT OPERATIONS & QUALITY	40.00	Highest	$247,602	$52,212	$299,814
LARRY WELLING	DIRECTOR - IT SOFTWARE	40.00	Highest	$241,296	$49,709	$291,005
CHARLES F LUCAS	VP, IT SOFTWARE DEVELOPMENT	40.00	Highest	$241,888	$17,347	$259,235

Note: Compensation data is self-reported by the organization on their Form 990. "Reportable Comp" includes salary, bonuses, and other reportable compensation from the organization and related organizations. "Other Comp" includes benefits, deferred compensation, and non-taxable benefits.

Historical Data

Year	Revenue	Expenses	Assets	Net Income
2024	$772,676,162	$776,295,208	$461,774,997	$-3,619,046
2023	$793,217,524	$780,774,378	$452,146,751	$12,443,146
2022	$818,781,263	$793,131,867	$409,672,896	$25,649,396
2021	$789,215,656	$722,817,093	$406,104,117	$66,398,563
2020	$703,647,414	$667,694,307	$336,962,051	$35,953,107
2019	$634,436,588	$650,865,803	$259,859,925	$-16,429,215
2018	$582,586,786	$597,021,474	$232,379,264	$-14,434,688

THE HEALTH PLAN OF WEST VIRGINIA INC