2018-11-14T16:55:11-05:00 2017-12-31 383133790 ANDREWS HOOPER PAVLIK PLC 4295 OKEMOS RD STE 200 OKEMOS MI 488646201 990 2017-01-01 382356288 PHYSICIANS HEALTH PLAN PHYS 5173648400 PO BOX 30377 LANSING MI 48909 DENNIS REESE PRESIDENT & CEO 5173648400 2018-11-06 true MARK E HOOPER P00039887 5177060800 2018-11-06 167.68.16.49 2018-11-14 15:55:11 CS P 80068F944CACDA910C931033D0123EB22FEB5640 F54AA8E5C2852FAB473639AD7A0166FAFED196F4 2017 2019-02-21 02:37:17Z DENNIS SWAN 1215 E MICHIGAN AVENUE LANSING MI 48912 218595574 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. 14 11 115 0 0 181532866 192156736 5395064 7491045 19107 186927930 199666888 0 165855312 170435625 7288308 7182541 0 0 11295202 11459399 184438822 189077565 2489108 10589323 97291075 92056926 29749795 33134026 67541280 58922900 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 182016148 192175843 PHYSICIANS HEALTH PLAN (PHP) IS OWNED BY SPARROW HEALTH SYSTEM (SPARROW) 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, SPARROW PHP (SPHP) A MICHIGAN MEDICAID MANAGED CARE PLAN, AND PHP SERVICE COMPANY (TPA) 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, SPHP, AND TPA. EFFECTIVE APRIL 30, 2017 SPARROW PHP WAS MERGED INTO PHYSICIANS HEALTH PLAN AFTER APPROVAL BY THE BOARD OF DIRECTORS AND THE COMMISSIONER OF THE DEPARTMENT OF INSURANCE AND FINANCIAL SERVICES (DIFS). PHPS SERVICE AREA INCLUDES THE MICHIGAN COUNTIES OF INGHAM, EATON, CLINTON, SHIAWASSEE, MONTCALM, GRATIOT, IONIA, JACKSON, HILLSDALE, PORTIONS OF ISABELLA, SAGINAW, WASHTENAW, AND LENAWEE. PHPIC OFFERS PRODUCTS ACROSS MICHIGAN. THE SPHP PRODUCT WAS AVAILABLE TO MEDICAID ENROLLEES IN EATON, CLINTON, INGHAM, IONIA, MONTCALM, ISABELLA, AND SHIAWASSEE COUNTIES. AS OF DECEMBER 31, 2017, THERE WERE APPROXIMATELY 34,800 ENROLLEES IN PHPS COMMERCIAL HMO, 17,400 IN TPA, 5,500 IN PHPIC, AND 0 ENROLLEES IN SPHP. ONE HUNDRED PERCENT OF SPHP'S MEMBERSHIP WAS SOLD TO AN UNRELATED HEALTH PLAN EFFECTIVE DECEMBER 31, 2015. PHP AND SPHP CONTRACT DIRECTLY WITH PHYSICIANS HEALTH NETWORK (PHN), A WHOLLY OWNED SUBSIDIARY OF SPARROW. THE PHP NETWORK IS APPROXIMATELY 805 PRIMARY CARE PHYSICIANS, 1,291 SPECIALTY CARE PHYSICIANS, 548 ALLIED HEALTH PROFESSIONALS, AND 593 ORGANIZATIONAL PROVIDERS THAT INCLUDE 31 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 A 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, AND - HEDIS MEASURES: THE HEALTH PLAN EFFECTIVENESS DATA AND INFORMATION SET (HEDIS) IS A GROUP OF NATIONALLY RECOGNIZED MEASURES OF HEALTH PLAN 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 SCREENINGS, 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 2015 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 NEXT ACCREDITATION WILL OCCUR FOR THE YEAR ENDED DECEMBER 31, 2018. 182016148 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 1 0 true 115 true false false false false false false X 14 11 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 DENNIS SWAN PRES/CEO - S 1.00 40.00 X 0 1479664 241534 PAULA REICHLE DIRECTOR 1.00 40.00 X 0 693098 113951 DENNIS REESE PRESIDENT & 40.00 5.00 X X 0 381833 50070 DAVID KAUFMAN DO DIRECTOR 1.00 40.00 X 0 1368 0 JAMES BUTLER III BOARD CHAIR 1.00 1.00 X 0 1368 0 TIMOTHY HODGE DO DIRECTOR 1.00 1.00 X 0 0 0 DIANA RODRIGUEZ ALGRA BOARD VICE C 1.00 1.00 X 0 0 0 THOMAS HOFMAN PHD TREASURER/SE 1.00 1.00 X 0 0 0 DEBORAH MUCHMORE DIRECTOR 1.00 1.00 X 0 0 0 MERRITTA PROCTOR DIRECTOR 1.00 1.00 X 0 0 0 SHALIMAR MAYNARD DIRECTOR 1.00 1.00 X 0 0 0 JAMES TISCHLER DIRECTOR 1.00 1.00 X 0 0 0 BRITTANY BOGAN DIRECTOR 1.00 1.00 X 0 0 0 APRIL CLOBES DIRECTOR 1.00 1.00 X 0 0 0 PETER GRAHAM MD MEDICAL DIRE 5.00 40.00 X 0 343544 45501 GEORGE SCHNEIDER CFO/COO 40.00 5.00 X 0 326747 52333 SUSAN ARMBRUSTER DIRECTOR OF 40.00 5.00 X 284270 0 22122 ANN HUNT-FUGATE RPH MGR CLINICAL 40.00 5.00 X 155875 0 38767 LINDA DICKINSON DIR OF MED R 40.00 5.00 X 0 144591 34445 PAULA HOWARD SENIOR SALES 40.00 5.00 X 139508 0 33488 KEVIN KAPLAN FORMER VP SA 40.00 5.00 X 0 128792 28519 MARK BRETT FORMER DIREC 0.00 40.00 X 0 707603 144320 DAWN SPRINGER MD FORMER DIREC 0.00 40.00 X 0 233161 39590 LARRY RAWSTHORNE FORMER DIREC X 0 143663 8860 579653 4585432 853500 12 true true false TRIZETTO 1085 MORRIS AVENUE UNION NJ 07083 HEALTHCARE IT 4293693 ZELIS HEALTHCARE 6875 SHILOH RD E ALPHARETTA GA 300058403 COST CONT & CIR 1020608 MILLIMAN 15800 BLUEMOUND RD SUITE 100 BROOKFIELD WI 53005 CONSULTING 826194 CHANGE HEALTHCARE INC 3055 LEBANON PIKE NASHVILLE TN 37214 COST CONT & CIR 725469 MCG HEALTH LLC 901 FIFTH AVENUE SUITE 200 SEATTLE WA 98164 HEALTHCARE IT 255803 12 PREPAID HEALTHCARE 621990 192156736 192156736 192156736 4090532 4090532 22329199 18924493 4193 3404706 -4193 3400513 3400513 OTHER REVENUE 900099 19107 19107 19107 199666888 192175843 7491045 170435625 170435625 880114 666246 213868 4755921 3600232 1155689 335132 253695 81437 813778 616030 197748 397596 300980 96616 3662220 3662220 196 148 48 204093 204093 142088 142088 839796 839796 229390 173648 55742 471263 356746 114517 560884 424589 136295 156797 156797 120883 120883 2187 2187 1903128 1903128 66579 66579 BROKER COMMISSONS 1783540 1783540 ADMINISTRATIVE EXPENSES 799746 799746 MISCELLANEOUS 516609 391073 125536 189077565 182016148 7061417 0 37087370 46765765 4637672 5177591 1130592 1604841 16989823 10047614 6515900 6942209 23073138 17241788 23762652 14083852 1083751 240880 97291075 92056926 23941913 28827629 2351430 3240998 3456452 1065399 29749795 33134026 X 67541280 58922900 67541280 58922900 97291075 92056926 10589323 75096 -19282799 X false true X true false 3986792 114433 211750 15000 4297975 3707924 191313 102555 15000 3986792 3411165 361583 -49824 15000 3707924 3184706 200566 40893 15000 3411165 2926676 82387 187643 12000 3184706 1.00000 false true true 455895 455895 6259335 3681729 2577606 10274593 6365885 3908708 6942209 INVESTMENT IN PHP INSURANCE COMPANY 13087139 C INVESTMENT IN PHP SERVICE COMPANY 996713 C 14083852 RELATED PARTY PAYABLE 1065399 1065399 189488858 75096 2814150 2889246 186599612 13067276 13067276 199666888 178482658 2097199 2097199 176385459 12692106 12692106 189077565 SCHEDULE D, PAGE 2, PART V, LINE 4 PHP DOES NOT HOLD ENDOWMENTS. THE ENDOWMENTS ARE HELD BY SPARROW CLINTON HOSPITAL AND SPARROW FOUNDATION. SPARROW HEALTH SYSTEM IS THE SOLE MEMBER OF PHP, SPARROW CLINTON HOSPITAL, 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 TRANSITIONAL REINS/EXPENSE RECLASS 1,310,000 HICA INCOME/ EXPENSE RECLASS 1,504,150 SCHEDULE D, PAGE 4, PART XI, LINE 4B INVESTMENT EXPENSES 142,088 REINSURANCE 1,294,624 RISK ADJ INCOME/EXPENSE RECLASS 11,235,815 OTHER CHANGES 15,137 CHANGE IN NON ADMINTTED ASSETS 379,612 SCHEDULE D, PAGE 4, PART XII, LINE 2D HICA INCOME/EXPENSE RECLASS 1,504,150 TRANSITIONAL REINS/EXPENSE RECLASS 593,049 SCHEDULE D, PAGE 4, PART XII, LINE 4B INVESTMENT EXPENSES 142,088 RISK ADJ/EXPENSE RECLASS 11,235,815 MISCELLANEOUS 19,579 REINSURANCE 1,294,624 X X X X X X true true false true true true true true false DENNIS SWAN PRES/CEO - SHS 924728 487986 66950 185394 56140 1721198 PAULA REICHLE DIRECTOR 472500 196328 24270 61779 52172 807049 DENNIS REESE PRESIDENT & CEO 319100 60539 2194 16050 34020 431903 PETER GRAHAM MD MEDICAL DIRECTOR 303961 36664 2919 22410 23091 389045 GEORGE SCHNEIDER CFO/COO 281185 41996 3566 16050 36283 379080 SUSAN ARMBRUSTER DIRECTOR OF OPER. 156776 127494 3635 18487 306392 ANN HUNT-FUGATE RPH MGR CLINICAL PHARM 122838 11655 21382 13052 25715 194642 LINDA DICKINSON DIR OF MED RES MGMT 127853 16294 444 9232 25213 179036 PAULA HOWARD SENIOR SALES REP 84878 54434 196 14781 18707 172996 KEVIN KAPLAN FORMER VP SALES 91936 36799 57 8919 19600 157311 MARK BRETT FORMER DIRECTOR 513921 189701 3981 87714 56606 851923 DAWN SPRINGER MD FORMER DIRECTOR 189252 39989 3920 22410 17180 272751 LARRY RAWSTHORNE FORMER DIRECTOR 95663 48000 1349 7511 152523 SCHEDULE J, PAGE 1, PART I, LINE 3 SPARROW HEALTH SYSTEM IS THE SOLE MEMBER OF PHYSICIAN HEALTH PLAN. 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 PAULA REICHLE 0 53,829 0 KEVIN KAPLAN 43,387 0 0 MARK BRETT 0 57,354 0 LARRY RAWSTHORNE 0 48,000 0 SCHEDULE J, PAGE 1, PART I, LINE 5A THERE WERE NO INCENTIVE COMPENSATION ACCRUALS FOR 2017. THE 2016 INCENTIVE COMPENSATION PLAN PAYMENTS WERE ACCRUED IN 2016 AND WERE PAID IN 2017. 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 THERE WERE NO INCENTIVE COMPENSATION ACCRUALS FOR 2017. THE 2016 INCENTIVE COMPENSATION PLAN PAYMENTS WERE ACCRUED IN 2016 AND WERE PAID IN 2017. 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 THERE WERE NO INCENTIVE COMPENSATION ACCRUALS FOR 2017. THE 2016 INCENTIVE COMPENSATION PLAN PAYMENTS WERE ACCRUED IN 2016 AND WERE PAID IN 2017. 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 THERE WERE NO INCENTIVE COMPENSATION ACCRUALS FOR 2017. THE 2016 INCENTIVE COMPENSATION PLAN PAYMENTS WERE ACCRUED IN 2016 AND WERE PAID IN 2017. 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, DAWN SPRINGER, AND LARRY RAWSTHORNE ARE FORMER BOARD MEMBERS OF PHYSICIANS HEALTH PLAN. THE BOARD MEMBERS ARE BEING COMPENSATED BY SPARROW HEALTH SYSTEM AND AFFILIATES FOR SERVICES PROVIDED TO SPARROW HEALTH SYSTEM AND AFFILIATES IN POSITIONS OTHER THAN AS BOARD MEMBERS OF PHYSICIANS HEALTH PLAN. THE BOARD MEMBERS ARE 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 PHPS SERVICE AREA INCLUDES THE MICHIGAN COUNTIES OF INGHAM, EATON, CLINTON, SHIAWASSEE, MONTCALM, GRATIOT, IONIA, JACKSON, HILLSDALE, PORTIONS OF ISABELLA, SAGINAW, WASHTENAW, AND LENAWEE. PHPIC OFFERS PRODUCTS ACROSS MICHIGAN. THE SPHP PRODUCT WAS AVAILABLE TO MEDICAID ENROLLEES IN EATON, CLINTON, INGHAM, IONIA, MONTCALM, ISABELLA, AND SHIAWASSEE COUNTIES. AS OF DECEMBER 31, 2017, THERE WERE APPROXIMATELY 34,800 ENROLLEES IN PHPS COMMERCIAL HMO, 17,400 IN TPA, 5,500 IN PHPIC, AND 0 ENROLLEES IN SPHP. ONE HUNDRED PERCENT OF SPHP'S MEMBERSHIP WAS SOLD TO AN UNRELATED HEALTH PLAN EFFECTIVE DECEMBER 31, 2015. PHP AND SPHP CONTRACT DIRECTLY WITH PHYSICIANS HEALTH NETWORK (PHN), A WHOLLY OWNED SUBSIDIARY OF SPARROW. THE PHP NETWORK IS APPROXIMATELY 805 PRIMARY CARE PHYSICIANS, 1,291 SPECIALTY CARE PHYSICIANS, 548 ALLIED HEALTH PROFESSIONALS, AND 593 ORGANIZATIONAL PROVIDERS THAT INCLUDE 31 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 A 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, AND - HEDIS MEASURES: THE HEALTH PLAN EFFECTIVENESS DATA AND INFORMATION SET (HEDIS) IS A GROUP OF NATIONALLY RECOGNIZED MEASURES OF HEALTH PLAN 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 SCREENINGS, 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 2015 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 NEXT ACCREDITATION WILL OCCUR FOR THE YEAR ENDED DECEMBER 31, 2018. FORM 990, PAGE 6, PART VI, LINE 6 SPARROW HEALTH SYSTEM IS THE PARENT AND SOLE MEMBER OF PHYSICIANS HEALTH PLAN AND HAS 100% OWNERSHIP. 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 2017 FORM 990 ARE REVIEWED BY MANAGEMENT. ONCE MANAGEMENT COMPLETED ITS REVIEW OF THE FORM 990 COPIES WERE PROVIDED AT THE OCTOBER 2018 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 DIVIDEND TO PARENT -20,000,000 TRANSFER FROM SUBSIDIARY 1,058,981 STATUTORY/GAAP DIFFERENCES -341,780 TOTAL -19,282,799 SPARROW HEALTH SYSTEM 1215 E MICHIGAN AVENUE LANSING MI 48912 382542859 PARENT MI 501C3 12A N/A false SPARROW PHP 1400 E MICHIGAN AVENUE LANSING MI 48912 364497604 HMO MI 501C4 PHP true PHYSICIANS HEALTH NETWORK 1400 E MICHIGAN AVENUE LANSING MI 48912 382594856 HMO MI 501C4 SHS 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 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 false false false false false false false false false false true true true true true true true false EDWARD W SPARROW HOSPITAL L 1103057 COST PHYSICIANS HEALTH NETWORK M 157489577 COST PHP INSURANCE COMPANY Q 2878777 COST PHP SERVICE COMPANY Q 947469 COST