2021-11-15T13:38:10-06:00 2020-12-31 383133790 ANDREWS HOOPER PAVLIK PLC 4295 OKEMOS RD STE 200 OKEMOS MI 488646201 990 2020-01-01 382356288 PHYSICIANS HEALTH PLAN PHYS 5173648400 PO BOX 30377 LANSING MI 48909 DENNIS REESE PRESIDENT & CEO 5173648400 2021-11-12 true DENNIS REESE 999009999 JULIE M PFEIFLE P00751307 5177060800 2021-11-12 2020 2022-09-23 18:48:47Z JAMES F DOVER 1215 E MICHIGAN AVENUE LANSING MI 48912 190709016 false X WWW.PHPMICHIGAN.COM X 1980 MI PHYSICIANS HEALTH PLAN'S MISSION IS TO IMPROVE THE HEALTH STATUS OF ITS MEMBERS BY FACILITATING QUALITY, COMPASSIONATE, ACCESSIBLE, COST EFFECTIVE HEALTHCARE. 10 4 166 0 0 179219675 169660793 1591760 1843979 107347 15145 180918782 171519917 0 156315486 149468557 8523999 9193561 0 0 17237547 26542852 182077032 185204970 -1158250 -13685053 104484330 97555482 26056366 31281305 78427964 66274177 X PHYSICIANS HEALTH PLAN'S MISSION IS TO IMPROVE THE HEALTH STATUS OF ITS MEMBERS BY FACILITATING QUALITY, COMPASSIONATE, ACCESSIBLE, COST EFFECTIVE HEALTHCARE. false false 177904358 169660793 PHYSICIANS HEALTH PLAN (PHP) IS OWNED BY PHP HOLDINGS, LLC AND HOLDS A CERTIFICATE OF AUTHORITY AS AN HMO IN THE STATE OF MICHIGAN. PHP IS PRIMARILY A COMMERCIAL HMO AND ALSO OPERATES THREE SUBSIDIARIES, PHP INSURANCE COMPANY (PHPIC), A COMMERCIAL INSURANCE COMPANY, PHP MEDICARE (PHPMA), A MICHIGAN MEDICARE PLAN, AND PHP SERVICE COMPANY A THIRD PARTY ADMINISTRATOR. ALL STAFFING FUNCTIONS AND REPORTING ARE ACCOMPLISHED THROUGH THE USE OF THE SAME STAFF AS PHP. UNLESS SPECIFICALLY NOTED, ALL REFERENCES TO PHP APPLY TO PHP, PHPIC, PHPTA AND PHPMA. PHPS SERVICE AREA INCLUDES THE MICHIGAN COUNTIES OF INGHAM, EATON, CLINTON, SHIAWASSEE, MONTCALM, GRATIOT, IONIA, JACKSON, HILLSDALE AND PORTIONS OF ISABELLA, SAGINAW, WASHTENAW, AND LENAWEE. PHP IC OFFERS PRODUCTS ACROSS MICHIGAN. AS OF DECEMBER 31, 2020, THERE WERE APPROXIMATELY 30,500 ENROLLEES IN PHPS COMMERCIAL HMO, 17,200 IN TPA, 3,200 IN PHP-IC, AND 3,600 ENROLLEES IN PHPMA. PHP CONTRACTS DIRECTLY WITH PHYSICIANS HEALTH NETWORK (PHN). THE PHP NETWORK IS APPROXIMATELY 870 PRIMARY CARE PHYSICIANS, 1,366 SPECIALTY CARE PHYSICIANS, 834 ALLIED HEALTH PROFESSIONALS, 1,202 BEHAVIORAL HEALTH PROVIDERS AND 648 ORGANIZATIONAL PROVIDERS THAT INCLUDE 36 HOSPITALS. PHP CONTRACTS WITH VARIOUS HDNS WHO PROVIDE HEALTHCARE SERVICES TO MEMBERS. PHPS COMMITMENT IS TO DEVELOP AND DELIVER QUALITY MANAGED CARE PRODUCTS AT REASONABLE COSTS FOR ITS MEMBERS. PHPS SUCCESS IN MANAGING HEALTH CARE IS DUE IN PART TO THE EXTENSIVE NETWORK OF PARTICIPATING PROVIDERS IN THE HDN NETWORK. THE HMO/HDN CONTRACTUAL ARRANGEMENTS ALLOW PHP TO ARRANGE FOR HEALTHCARE TO PATIENTS COVERED BY THE STATE OF MICHIGANS MEDICAID BENEFIT PLAN. THIS ARRANGEMENT ALLOWS THE MEMBERS TO ACCESS A WIDE VARIETY OF INDEPENDENT PROVIDERS WITHIN EACH HDN INCLUDING PHYSICIANS, HOSPITALS, PHARMACIES, SKILLED NURSING FACILITIES, AND ALLIED HEALTH PROFESSIONALS. PHP MEMBERS MAY ALSO RECEIVE CARE FOR SERVICES FROM A NONPARTICIPATING PROVIDER IF SUCH REFERRAL IS RECOMMENDED BY AN HDN PARTICIPATING PHYSICIAN AND THE SERVICE REQUIRED FOR TREATMENT, AS DETERMINED BY HDN, IS NOT AVAILABLE WITHIN THE HDNS NETWORK. PHP OFFERS A VARIETY OF HEALTHCARE PROGRAMS, OR PRODUCTS TO GROUPS AND INDIVIDUALS. PHP OFFERS CHOICES THAT PROVIDE COVERAGE WITHIN THE NETWORK OF CONTRACTED HDN PROVIDERS, LIMITED COVERAGE OUTSIDE OF THE PHP NETWORK, VARIOUS LEVELS OF DEDUCTIBLES, CO-PAYMENTS, AND COVERAGE LIMITS, ALL OF WHICH ARE DESIGNED TO BE RESPONSIVE TO CUSTOMER NEEDS. PHP MEASURES THE QUALITY OF CARE PROVIDED TO ITS ENROLLEES THROUGH ANNUAL REVIEW OF INDICATORS SUCH AS: DISEASE MANAGEMENT PROGRAM PARTICIPATION AND OUTCOMES. QUALITY OF CARE CONCERNS. HEDIS MEASURES THE HEALTH PLAN EFFECTIVENESS DATA AND INFORMATION SET (HEDIS) IS A GROUP OF NATIONALLY RECOGNIZED MEASURES OF HEALTH PLANS PERFORMANCE IN A VARIETY OF CLINICAL AND NON-CLINICAL AREAS. PHP USES THE EFFECTIVENESS OF CARE MEASURES TO DETERMINE PROGRESS AND IMPROVEMENT IN AREAS SUCH AS: -DIABETES, -ASTHMA, -DEPRESSION AND FOLLOW-UP AFTER MENTAL HEALTH ADMISSIONS, -BREAST AND CERVICAL CANCER SCREENING, -USE OF BETA-BLOCKERS AFTER HEART ATTACKS, -CHILD AND ADOLESCENT IMMUNIZATIONS, -CHOLESTEROL MANAGEMENT, -CONTROLLING HIGH BLOOD PRESSURE, -SMOKING CESSATION, -PRENATAL AND POSTPARTUM CARE, AND -TREATMENT OF CHILDHOOD RESPIRATORY INFECTIONS. PHP MEASURES THE QUALITY OF SERVICE PROVIDED TO ITS ENROLLEES BY THE REVIEW OF PERFORMANCE MEASURES RELATED TO: ACCESS AND AVAILABILITY OF PROVIDERS, ENROLLEE COMPLAINTS AND APPEALS, CUSTOMER SERVICE TELEPHONE ACCESS PERFORMANCE, AND MEMBER ASSESSMENT: THE CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (CAHPS) SURVEY GIVES A GENERAL INDICATION OF HOW WELL THE ORGANIZATION MEETS MEMBERS EXPECTATIONS. THE PHP QI PROGRAM IS ULTIMATELY ACCOUNTABLE TO THE BOARD OF DIRECTORS. IN 2021 PHP RECEIVED FULL ACCREDITATION STATUS FROM URAC FOR BOTH HEALTH PLAN ACCREDITATION AND HEALTH PLAN ACCREDITATION WITH HEALTH INSURANCE MARKETPLACE. URAC ACCREDITATION SIGNIFIES AN ISSUER HAS UNDERGONE AND PASSED A RIGOROUS AND INDEPENDENT REVIEW OF ITS OPERATION, INCLUDING THE QUALITY OF CARE AND LEVEL OF SERVICE PROVIDED TO ENROLLEES. ACCREDITATION HEALTH PLAN STANDARDS INCORPORATE MARKET TRENDS AND ADDRESS MAJOR POLICY ISSUES WHILE ALIGNING WITH CORE REQUIREMENTS FOUND IN THE AFFORDABLE CARE ACT. PHP HAS BEEN ACCREDITED BY URAC UNDER THE HEALTH PLAN STANDARDS SINCE 2012. THE CURRENT ACCREDITATION IS EFFECTIVE THROUGH JULY 1, 2024 AT WHICH TIME REACCREDITATION WILL OCCUR. 177904358 false false false false false false false false true true false true false true false true true false false false false false false false false false false false true false false false false false false false false false false false false false true true true false true 214 0 true 166 true false false false false false false false false X 10 4 false false false false true true true true true false false true true true true true true true true false MI X DENNIS REESE 5173648400 1400 E MICHIGAN AVENUE LANSING MI 48909 JAMES F DOVER PRES/CEO - S 1.00 40.00 X 0 850757 172522 JOSEPH RUTH DIRECTOR 1.00 40.00 X 0 569821 111949 MARK BRETT FORMER DIREC 0.00 0.00 X 0 363011 290522 PAULA REICHLE TREASURER 1.00 40.00 X 0 528386 103935 DOUGLAS EDEMA MD DIRECTOR 1.00 40.00 X 0 481099 48010 DENNIS REESE PRESIDENT & 40.00 5.00 X 404877 0 56375 PETER GRAHAM MD MEDICAL DIRE 40.00 5.00 X 315071 0 58532 GEORGE SCHNEIDER CFO/COO 40.00 5.00 X 331416 0 38704 ANDREA KOSLOSKI DIRECTOR 1.00 40.00 X 0 281247 37668 SCOTT NORMAN VP OF SALES 40.00 5.00 X 262609 0 50738 SUSAN ARMBRUSTER DIRECTOR OF 40.00 5.00 X 217242 0 35465 WALTER BRIGGS DIRECTOR OF 40.00 5.00 X 159968 0 39144 KENNETH WALKER DIR OF NETWO 40.00 5.00 X 147530 0 43076 NICHOLAS D'ISA DIR LEGAL/CO 40.00 5.00 X 146654 0 35564 ANN HUNT-FUGATE RPH MGR CLINICAL 40.00 5.00 X 145586 0 24929 IFTIKER AHMAD MD DIRECTOR 1.00 1.00 X 0 658 0 KEITH DICKEY DIRECTOR 1.00 0.00 X 0 0 0 JOHN AYANIAN MD DIRECTOR 1.00 0.00 X 0 0 0 TIMOTHY PETERSON MD DIRECTOR 1.00 0.00 X 0 0 0 2130953 3074979 1147133 27 true true false TRIZETTO 1085 MORRIS AVENUE UNION NJ 07083 HEALTHCARE IT 4137716 ZELIS HEALTHCARE 6875 SHILOH RD E ALPHARETTA GA 300058403 COST CONT & CIR 961964 CHANGE HEALTHCARE INC 3055 LEBANON PIKE NASHVILLE TN 37214 COST CONT & CIR 713219 MILLIMAN 15800 BLUEMOUND RD SUITE 100 BROOKFIELD WI 53005 MGMT CONSULTING 622924 CHANGE HEALTHCARE 2187 NETWORK PL CHICAGO IL 606731219 COST CON & CIR 318885 20 PREPAID HEALTHCARE 621990 169660793 169660793 169660793 1345647 1345647 19687431 19189099 498332 498332 498332 OTHER REVENUE 900099 15145 15145 15145 171519917 169675938 1843979 149468557 149468557 1518323 1149371 368952 6026573 4562116 1464457 404119 305918 98201 694538 525765 168773 550008 416356 133652 3179778 3179778 440 333 107 111363 111363 70859 70859 2554001 2554001 239876 181586 58290 513242 388524 124718 1073022 812278 260744 176423 176423 26969 26969 1354735 1354735 61235 61235 LOSS - UNCONSOLIDATED SUB 12700216 12700216 BROKER COMMISSIONS 2370336 2370336 MISCELLANEOUS 1243948 941668 302280 ADMINISTRATIVE EXPENSES 866409 866409 185204970 177904358 7300612 0 31715093 34144364 7816089 6322140 1626204 1683969 19842315 14394735 5399683 5447580 30627064 25038995 26141753 22166907 1158444 2751527 104484330 97555482 21906232 23418863 3517104 1738388 633030 6124054 26056366 31281305 X 78427964 66274177 78427964 66274177 104484330 97555482 X -13685053 1405897 125369 X false true X true true true 4912247 237860 456214 5606321 4700296 39943 172008 4912247 3236464 314065 55042 3605571 3070379 114433 51652 3236465 2839263 191313 39803 3070379 1.00000 false true true 455895 455895 6276388 4314932 1961456 13110032 10079803 3030229 5447580 INVESTMENT IN PHP INSURANCE COMPANY 15825893 C INVESTMENT IN PHP MEDICARE 3969476 C INVESTMENT IN PHP SERVICE COMPANY 2371538 C 22166907 RELATED PARTY PAYABLE 6124054 6124054 162463635 12700216 -7211003 5489213 156974422 276821 14268674 14545495 171519917 163392041 -7268368 -7268368 170660409 276821 14267740 14544561 185204970 SCHEDULE D, PAGE 2, PART V, LINE 4 PHP DOES NOT HOLD ENDOWMENTS. THE ENDOWMENTS ARE HELD BY SPARROW FOUNDATION, CARSON FOUNDATION INC, AND SPARROW EATON HOSPITAL. SPARROW HEALTH SYSTEM HAS AN INDIRECT CONTROLLING INTEREST IN PHP AND IS THE SOLE MEMBER OF SPARROW EATON HOSPITAL, CARSON FOUNDATION INC, AND SPARROW FOUNDATION. THE ENDOWMENTS ARE MAINTAINED TO PROVIDE A PERMANENT SOURCE OF INCOME, WITH THE STIPULATION THE PRINCIPAL IS KEPT INTACT IN PERPETUITY AND THE INCOME GENERATED FROM INVESTMENTS OF THE ENDOWMENT FUNDS CAN BE USED FOR THE PURPOSE ESTABLISHED BY THE ENDOWMENT. SCHEDULE D, PAGE 4, PART XI, LINE 2D RISK ADJ INCOME/EXPENSE RECLASS -7,215,861 BAD DEBT 57,364 PENSION -52,506 SCHEDULE D, PAGE 4, PART XI, LINE 4B REINSURANCE 1,568,458 LOSS ON UNCONSOLIDATED SUBSIDIARY 12,700,216 SCHEDULE D, PAGE 4, PART XII, LINE 2D ACA FEES -7,215,861 PENSION NON-OPERATING -52,507 SCHEDULE D, PAGE 4, PART XII, LINE 4B REINSURANCE 1,568,458 MISCELLANEOUS -934 LOSS ON UNCONSOLIDATED SUBSIDIARY 12,700,216 X true true X X X X X X true true false true true true true true false JAMES F DOVER PRES/CEO - SHS 823407 27350 101283 71239 1023279 JOSEPH RUTH DIRECTOR 545744 24077 78163 33786 681770 MARK BRETT FORMER DIRECTOR 363011 273157 17365 653533 PAULA REICHLE TREASURER 500829 27557 54528 49407 632321 DOUGLAS EDEMA MD DIRECTOR 471784 9315 8400 39610 529109 DENNIS REESE PRESIDENT & CEO 355687 42500 6690 16950 39425 461252 PETER GRAHAM MD MEDICAL DIRECTOR 309754 4094 1223 27360 31172 373603 GEORGE SCHNEIDER CFO/COO 299206 30000 2210 16273 22431 370120 ANDREA KOSLOSKI DIRECTOR 279260 1987 15617 22051 318915 SCOTT NORMAN VP OF SALES 262000 609 14040 36698 313347 SUSAN ARMBRUSTER DIRECTOR OF OPER. 196883 20359 11594 23871 252707 WALTER BRIGGS DIRECTOR OF IMP. 159256 712 4704 34440 199112 KENNETH WALKER DIR OF NETWORK SERV. 147249 281 8892 34184 190606 NICHOLAS D'ISA DIR LEGAL/COMPLIANCE 146369 285 8977 26587 182218 ANN HUNT-FUGATE RPH MGR CLINICAL PHARM 122220 23366 24929 170515 SCHEDULE J, PAGE 1, PART I, LINE 1A CERTAIN BOARD MEMBERS- AND EXECUTIVES' MICHIGAN ATHLETIC CLUB DUES ARE PAID BY AN AFFILIATED ENTITY. THESE AMOUNTS ARE CONSIDERED TAXABLE COMPENSATION. SCHEDULE J, PAGE 1, PART I, LINE 3 PHP HOLDINGS IS THE SOLE MEMBER OF PHYSICIANS HEALTH PLAN WITH SPARROW HEALTH SYSTEM OWNING 75% OF PHP HOLDINGS. SPARROW HEALTH SYSTEM IS AN INTEGRATED NON-PROFIT ORGANIZATION THAT INCLUDES A NUMBER OF NON-PROFIT ENTITIES. THE METHODS SELECTED FOR DETERMINING THE COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR ARE METHODS WHICH ARE BEING USED BY ALL SPARROW HEALTH SYSTEM RELATED ENTITIES. SCHEDULE J, PAGE 1, PART I, LINE 4 JAMES F. DOVER 0 101,283 0 JOSEPH RUTH 0 50,803 0 MARK BRETT 363,011 0 0 PAULA REICHLE 0 46,128 0 SCHEDULE J, PAGE 1, PART I, LINE 5A THE 2020 INCENTIVE COMPENSATION PLAN PAYMENTS WERE ACCRUED IN 2020 AND WILL BE PAID IN 2021. THE INCENTIVE COMPENSATION PLAN IS BASED, IN PART, ON THE OPERATING MARGIN OF SPARROW HEALTH SYSTEM AS WELL AS AFFILIATED COMPANIES. SCHEDULE J, PAGE 1, PART I, LINE 5B THE 2020 INCENTIVE COMPENSATION PLAN PAYMENTS WERE ACCRUED IN 2020 AND WILL BE PAID IN 2021. THE INCENTIVE COMPENSATION PLAN IS BASED, IN PART, ON THE OPERATING MARGIN OF SPARROW HEALTH SYSTEM AS WELL AS AFFILIATED COMPANIES. SCHEDULE J, PAGE 1, PART I, LINE 6A THE 2020 INCENTIVE COMPENSATION PLAN PAYMENTS WERE ACCRUED IN 2020 AND WILL BE PAID IN 2021. THE INCENTIVE COMPENSATION PLAN IS BASED, IN PART, ON THE OPERATING MARGIN OF SPARROW HEALTH SYSTEM AS WELL AS AFFILIATED COMPANIES. SCHEDULE J, PAGE 1, PART I, LINE 6B THE 2020 INCENTIVE COMPENSATION PLAN PAYMENTS WERE ACCRUED IN 2020 AND WILL BE PAID IN 2021. THE INCENTIVE COMPENSATION PLAN IS BASED, IN PART, ON THE OPERATING MARGIN OF SPARROW HEALTH SYSTEM AS WELL AS AFFILIATED COMPANIES. SCHEDULE J, PAGE 1, PART I, LINE 7 COMPENSATION INCLUDES BOTH BASE AND VARIABLE COMPENSATION (NON-FIXED PAYMENTS). IN ACCORDANCE WITH ITS POLICIES, ALL ELEMENTS (BASE, VARIABLE, BENEFITS, AND PREREQUISITES) ARE COMPARED TO MARKET. SCHEDULE J, PART III MARK BRETT IS A FORMER BOARD MEMBER OF PHYSICIANS HEALTH PLAN. THE BOARD MEMBER IS BEING COMPENSATED BY SPARROW HEALTH SYSTEM AND AFFILIATES FOR SERVICES PROVIDED TO SPARROW HEALTH SYSTEM AND AFFILIATES IN POSITIONS OTHER THAN AS BOARD MEMBER OF PHYSICIANS HEALTH PLAN. THE BOARD MEMBER IS NOT BEING COMPENSATED FOR ANY PAST SERVICES PROVIDED TO PHYSICIANS HEALTH PLAN. FORM 990 ALL LINES LEFT BLANK ARE NOT APPLICABLE TO THE ORGANIZATION. FORM 990, PAGE 2, PART III, LINE 4A PHYSICIANS HEALTH PLAN (PHP) IS OWNED BY PHP HOLDINGS, LLC AND HOLDS A CERTIFICATE OF AUTHORITY AS AN HMO IN THE STATE OF MICHIGAN. PHP IS PRIMARILY A COMMERCIAL HMO AND ALSO OPERATES THREE SUBSIDIARIES, PHP INSURANCE COMPANY (PHPIC), A COMMERCIAL INSURANCE COMPANY, PHP MEDICARE (PHPMA), A MICHIGAN MEDICARE PLAN, AND PHP SERVICE COMPANY A THIRD PARTY ADMINISTRATOR. ALL STAFFING FUNCTIONS AND REPORTING ARE ACCOMPLISHED THROUGH THE USE OF THE SAME STAFF AS PHP. UNLESS SPECIFICALLY NOTED, ALL REFERENCES TO PHP APPLY TO PHP, PHPIC, PHPTA AND PHPMA. PHPS SERVICE AREA INCLUDES THE MICHIGAN COUNTIES OF INGHAM, EATON, CLINTON, SHIAWASSEE, MONTCALM, GRATIOT, IONIA, JACKSON, HILLSDALE AND PORTIONS OF ISABELLA, SAGINAW, WASHTENAW, AND LENAWEE. PHP IC OFFERS PRODUCTS ACROSS MICHIGAN. AS OF DECEMBER 31, 2020, THERE WERE APPROXIMATELY 30,500 ENROLLEES IN PHPS COMMERCIAL HMO, 17,200 IN TPA, 3,200 IN PHP-IC, AND 3,600 ENROLLEES IN PHPMA. PHP CONTRACTS DIRECTLY WITH PHYSICIANS HEALTH NETWORK (PHN). THE PHP NETWORK IS APPROXIMATELY 870 PRIMARY CARE PHYSICIANS, 1,366 SPECIALTY CARE PHYSICIANS, 834 ALLIED HEALTH PROFESSIONALS, 1,202 BEHAVIORAL HEALTH PROVIDERS AND 648 ORGANIZATIONAL PROVIDERS THAT INCLUDE 36 HOSPITALS. PHP CONTRACTS WITH VARIOUS HDNS WHO PROVIDE HEALTHCARE SERVICES TO MEMBERS. PHPS COMMITMENT IS TO DEVELOP AND DELIVER QUALITY MANAGED CARE PRODUCTS AT REASONABLE COSTS FOR ITS MEMBERS. PHPS SUCCESS IN MANAGING HEALTH CARE IS DUE IN PART TO THE EXTENSIVE NETWORK OF PARTICIPATING PROVIDERS IN THE HDN NETWORK. THE HMO/HDN CONTRACTUAL ARRANGEMENTS ALLOW PHP TO ARRANGE FOR HEALTHCARE TO PATIENTS COVERED BY THE STATE OF MICHIGANS MEDICAID BENEFIT PLAN. THIS ARRANGEMENT ALLOWS THE MEMBERS TO ACCESS A WIDE VARIETY OF INDEPENDENT PROVIDERS WITHIN EACH HDN INCLUDING PHYSICIANS, HOSPITALS, PHARMACIES, SKILLED NURSING FACILITIES, AND ALLIED HEALTH PROFESSIONALS. PHP MEMBERS MAY ALSO RECEIVE CARE FOR SERVICES FROM A NONPARTICIPATING PROVIDER IF SUCH REFERRAL IS RECOMMENDED BY AN HDN PARTICIPATING PHYSICIAN AND THE SERVICE REQUIRED FOR TREATMENT, AS DETERMINED BY HDN, IS NOT AVAILABLE WITHIN THE HDNS NETWORK. PHP OFFERS A VARIETY OF HEALTHCARE PROGRAMS, OR PRODUCTS TO GROUPS AND INDIVIDUALS. PHP OFFERS CHOICES THAT PROVIDE COVERAGE WITHIN THE NETWORK OF CONTRACTED HDN PROVIDERS, LIMITED COVERAGE OUTSIDE OF THE PHP NETWORK, VARIOUS LEVELS OF DEDUCTIBLES, CO-PAYMENTS, AND COVERAGE LIMITS, ALL OF WHICH ARE DESIGNED TO BE RESPONSIVE TO CUSTOMER NEEDS. PHP MEASURES THE QUALITY OF CARE PROVIDED TO ITS ENROLLEES THROUGH ANNUAL REVIEW OF INDICATORS SUCH AS: DISEASE MANAGEMENT PROGRAM PARTICIPATION AND OUTCOMES. QUALITY OF CARE CONCERNS. HEDIS MEASURES THE HEALTH PLAN EFFECTIVENESS DATA AND INFORMATION SET (HEDIS) IS A GROUP OF NATIONALLY RECOGNIZED MEASURES OF HEALTH PLANS PERFORMANCE IN A VARIETY OF CLINICAL AND NON-CLINICAL AREAS. PHP USES THE EFFECTIVENESS OF CARE MEASURES TO DETERMINE PROGRESS AND IMPROVEMENT IN AREAS SUCH AS: -DIABETES, -ASTHMA, -DEPRESSION AND FOLLOW-UP AFTER MENTAL HEALTH ADMISSIONS, -BREAST AND CERVICAL CANCER SCREENING, -USE OF BETA-BLOCKERS AFTER HEART ATTACKS, -CHILD AND ADOLESCENT IMMUNIZATIONS, -CHOLESTEROL MANAGEMENT, -CONTROLLING HIGH BLOOD PRESSURE, -SMOKING CESSATION, -PRENATAL AND POSTPARTUM CARE, AND -TREATMENT OF CHILDHOOD RESPIRATORY INFECTIONS. PHP MEASURES THE QUALITY OF SERVICE PROVIDED TO ITS ENROLLEES BY THE REVIEW OF PERFORMANCE MEASURES RELATED TO: ACCESS AND AVAILABILITY OF PROVIDERS, ENROLLEE COMPLAINTS AND APPEALS, CUSTOMER SERVICE TELEPHONE ACCESS PERFORMANCE, AND MEMBER ASSESSMENT: THE CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (CAHPS) SURVEY GIVES A GENERAL INDICATION OF HOW WELL THE ORGANIZATION MEETS MEMBERS EXPECTATIONS. THE PHP QI PROGRAM IS ULTIMATELY ACCOUNTABLE TO THE BOARD OF DIRECTORS. IN 2021 PHP RECEIVED FULL ACCREDITATION STATUS FROM URAC FOR BOTH HEALTH PLAN ACCREDITATION AND HEALTH PLAN ACCREDITATION WITH HEALTH INSURANCE MARKETPLACE. URAC ACCREDITATION SIGNIFIES AN ISSUER HAS UNDERGONE AND PASSED A RIGOROUS AND INDEPENDENT REVIEW OF ITS OPERATION, INCLUDING THE QUALITY OF CARE AND LEVEL OF SERVICE PROVIDED TO ENROLLEES. ACCREDITATION HEALTH PLAN STANDARDS INCORPORATE MARKET TRENDS AND ADDRESS MAJOR POLICY ISSUES WHILE ALIGNING WITH CORE REQUIREMENTS FOUND IN THE AFFORDABLE CARE ACT. PHP HAS BEEN ACCREDITED BY URAC UNDER THE HEALTH PLAN STANDARDS SINCE 2012. THE CURRENT ACCREDITATION IS EFFECTIVE THROUGH JULY 1, 2024 AT WHICH TIME REACCREDITATION WILL OCCUR. FORM 990, PAGE 6, PART VI, LINE 6 PHP HOLDINGS IS THE PARENT AND SOLE MEMBER OF PHP AND HAS 100% OWNERSHIP. PHP HOLDINGS IS OWNED BY SPARROW HEALTH SYSTEM (SHS) AT 75% AND MICHIGAN MEDICINE AT 25%. FORM 990, PAGE 6, PART VI, LINE 7A THE NON-ENROLLEE MEMBERS OF THE BOARD OF DIRECTORS OF PHYSICIANS HEALTH PLAN ARE RATIFIED BY THE BOARD OF DIRECTORS OF SPARROW HEALTH SYSTEM. FORM 990, PAGE 6, PART VI, LINE 7B THE NON-ENROLLEE MEMBERS OF THE BOARD OF DIRECTORS OF PHYSICIANS HEALTH PLAN ARE RATIFIED BY THE BOARD OF DIRECTORS OF SPARROW HEALTH SYSTEM. THE DECISIONS OF THE PHYSICIANS HEALTH PLAN BOARD OF DIRECTORS MAY BE SUBJECT TO THE APPROVAL OF THE BOARD OF DIRECTORS OF SPARROW HEALTH SYSTEM. FORM 990, PAGE 6, PART VI, LINE 11B COPIES OF THE 2020 FORM 990 ARE REVIEWED BY MANAGEMENT. ONCE MANAGEMENT COMPLETED ITS REVIEW OF THE FORM 990 COPIES WERE PROVIDED AT THE FALL 2021 BOARD MEETING FOR ALL BOARD MEMBERS TO REVIEW AND COMMENT ON. FORM 990, PAGE 6, PART VI, LINE 12C 1) CORPORATE COMPLIANCE SENDS OUT THE CONFLICT OF INTEREST POLICY AND QUESTIONNAIRES TO ALL VOTING BOARD MEMBERS AND THE EXECUTIVE TEAM ANNUALLY. 2) ALL DISCLOSURES ARE RECEIVED AND REVIEWED BY CORPORATE COMPLIANCE. 3) ALL DISCLOSURES ARE GIVEN A RESOLUTION CODE AND PRESENTED TO THE CEO AND GOVERNANCE COMMITTEE OF THE BOARD. 4) ALL BOARD/COMMITTEE LEVEL DISCLOSURES ARE PROVIDED TO THE RESPECTIVE BOARD CHAIR AND EXECUTIVE LIAISON TO ENSURE ISSUES CAN BE ADDRESSED ON A TRANSACTIONAL LEVEL (I.E. IF A VOTE IS REQUIRED ON A TRANSACTION INVOLVING AN INTERESTED PERSON). FORM 990, PAGE 6, PART VI, LINE 15A THE PROCESS FOR DETERMINING COMPENSATION FOR THE CEO INVOLVED THE FOLLOWING: UTILIZING THE COMPENSATION COMMITTEE, USING INDEPENDENT CONSULTANTS, REVIEWING OTHER SIMILAR ORGANIZATIONS' 990S, USING COMPENSATION SURVEYS, AND FINAL APPROVAL BY THE SPARROW BOARD OF DIRECTORS, AS WELL AS FINALIZING THE SALARY PACKAGE WITH A WRITTEN EMPLOYMENT CONTRACT. FORM 990, PAGE 6, PART VI, LINE 15B THE PROCESS FOR DETERMINING COMPENSATION FOR OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION INVOLVED THE FOLLOWING: UTILIZING THE COMPENSATION COMMITTEE, USING INDEPENDENT CONSULTANTS, REVIEWING OTHER SIMILAR ORGANIZATIONS' 990S, USING COMPENSATION SURVEYS, AND FINAL APPROVAL BY THE SPARROW BOARD OF DIRECTORS, AS WELL AS FINALIZING THE SALARY PACKAGE WITH A WRITTEN EMPLOYMENT CONTRACT. FORM 990, PAGE 6, PART VI, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC AS FOLLOWS: THE GOVERNING DOCUMENTS OF PHP ARE SUBMITTED TO THE DEPARTMENT OF INSURANCE AND FINANCIAL SERVICES (DIFS). THOSE ARE PUBLICLY AVAILABLE TO INTERESTED PARTIES. THE CONFLICT OF INTEREST IS AVAILABLE THROUGH SPARROW BY REQUESTING THE POLICY FROM THE SPARROW COMPLIANCE OFFICER. FORM 990, PART XI, LINE 9 EQUITY ADJUSTMENT ON AFFILIATES 125,369 SPARROW HEALTH SYSTEM 1215 E MICHIGAN AVENUE LANSING MI 48912 382542859 PARENT MI 501C3 12A N/A false PHYSICIANS HEALTH NETWORK 1400 E MICHIGAN AVENUE LANSING MI 48912 382594856 HMO MI 501C4 PHP HO true SPARROW FOUNDATION 1215 E MICHIGAN AVENUE LANSING MI 48912 386100687 FUNDRAISE MI 501C3 12B SHS true SPARROW COMMUNITY CARE 3315 E MICHIGAN AVENUE STE 4 LANSING MI 48912 382543305 HOME HLTH MI 501C3 10 SHS true SPARROW CLINTON HOSPITAL 805 S OAKLAND STREET ST JOHNS MI 48879 381358172 HLTH CARE MI 501C3 3 SHS true EDWARD W SPARROW HOSPITAL 1215 E MICHIGAN AVENUE LANSING MI 48912 381360584 HLTH CARE MI 501C3 3 SHS true SPARROW IONIA HOSPITAL 3565 S STATE RD IONIA MI 48846 383218134 HLTH CARE MI 501C3 3 SHS true SPARROW SPECIALTY HOSPITAL 1215 E MICH AVE 8W SPARROW TOWER LANSING MI 48912 141885340 LT ACUTE MI 501C3 3 SHS true SPARROW CLINICAL RESEARCH INSTITUTE 1200 E MICHIGAN AVENUE LANSING MI 48912 383075242 RESEARCH MI 501C3 4 SHS true SPARROW CARSON HOSPITAL 406 E ELM STREET PO BOX 879 CARSON CITY MI 48811 381490180 HLTH CARE MI 501C3 3 SHS true CARSON CITY FOUNDATION 406 E ELM STREET PO BOX 879 CARSON CITY MI 48811 460877509 FUNDRAISE MI 501C3 12A CCH true PHP MEDICARE 1400 E MICHIGAN AVENUE LANSING MI 48912 832766121 HMO MI 501C4 PHP true SPARROW EATON HOSPITAL 321 E HARRIS ST CHARLOTTE MI 48813 382007629 HLTH CARE MI 501C3 3 SHS true SPARROW EATON HOSPITAL AUXILIARY 321 E HARRIS ST CHARLOTTE MI 48813 382377160 FUNDRAISE MI 501C3 3 SHS true PHP HOLDINGS LLC 1400 E MICHIGAN AVENUE LANSING MI 48912 833965697 HOLDING CO MI N/A false false PHP INSURANCE COMPANY 1400 E MICHIGAN AVENUE LANSING MI 48912 205565219 INSURANCE MI N/A true PHP SERVICE COMPANY 1400 E MICHIGAN AVENUE LANSING MI 48912 383344741 MED SVS MI N/A true SPARROW DEVELOPMENT INC 1215 E MICHIGAN AVENUE LANSING MI 48912 382595963 MED SUPPL MI N/A true EAST LANSING ATHLETIC CLUB 2900 HANNAH BLVD EAST LANSING MI 48823 382886420 HLTH CLUB MI N/A true MAC RESTAURANT LLC 2900 HANNAH BLVD EAST LANSING MI 48823 205120690 RESTAURANT MI N/A true CLINTON SERVICES CORPORATION 805 S OAKLAND ST JOHNS MI 48879 382494110 SERVICES MI N/A true EAST LANSING ATHLETIC CLUB & HSP 1200 E MICHIGAN AVENUE STE 600 LANSING MI 48912 813131851 CONDO ASSO MI N/A true false true false false false false false false false false true true true true true true true true false PHYSICIANS HEALTH NETWORK M 133048393 COST EDWARD W SPARROW HOSPITAL Q 10127229 COST PHP INSURANCE COMPANY Q 2350152 COST PHP SERVICE COMPANY Q 4990437 COST PHP MEDICARE Q 769411 COST PHP MEDICARE B 8600000 COST