2016-11-10T13:56:24-06:00 2015-12-31 383133790 ANDREWS HOOPER PAVLIK PLC 4295 OKEMOS RD STE 200 OKEMOS MI 488646201 990 2015-01-01 382356288 PHYSICIANS HEALTH PLAN PHYS 5173648400 PO BOX 30377 LANSING MI 48909 DENNIS REESE PRESIDENT & CEO 5173648400 2016-11-02 true MARK E HOOPER P00039887 5177060800 2016-11-02 2015 2017-02-10 21:41:12Z DENNIS SWAN 1215 E MICHIGAN AVENUE LANSING MI 48912 169630611 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. 15 11 139 0 0 158456463 165732809 3361517 2360512 0 161817980 168093321 0 141494444 151171648 5456099 6805779 0 0 11309827 10246010 158260370 168223437 3557610 -130116 94236687 87576070 26625539 23140552 67611148 64435518 X PHYSICIANS HEALTH PLAN'S MISSION IS TO IMPROVE THE HEALTH STATUS OF ITS MEMBERS BY FACILITATING QUALITY, COMPASSIONATE, ACCESSIBLE, COST EFFECTIVE HEALTHCARE. false true 162207031 165732809 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. PHPS SERVICE AREA INCLUDES THE MICHIGAN COUNTIES OF INGHAM, EATON, CLINTON, SHIAWASSEE, MONTCALM, GRATIOT, IONIA, AND ISABELLA. PHPIC OFFERS PRODUCTS ACROSS MICHIGAN. THE SPARROW PHP PRODUCT IS AVAILABLE TO MEDICAID ENROLLEES IN EATON, CLINTON, INGHAM, IONIA, MONTCALM, ISABELLA, AND SHIAWASSEE COUNTIES. AS OF DECEMBER 31, 2015, THERE WERE APPROXIMATELY 34,000 ENROLLEES IN PHPS COMMERCIAL HMO, 14,700 IN TPA, 9,000 IN PHPIC, AND 21,600 ENROLLEES IN SPHP. PHP AND SPHP CONTRACT DIRECTLY WITH PHYSICIANS HEALTH NETWORK (PHN), A WHOLLY OWNED SUBSIDIARY OF SPARROW. THE PHP NETWORK IS APPROXIMATELY 1,030 PRIMARY CARE PHYSICIANS, 1,816 SPECIALTY CARE PHYSICIANS, 800 ALLIED HEALTH PROFESSIONALS, AND 1,180 ORGANIZATIONAL PROVIDERS THAT INCLUDE 45 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. 162207031 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 2 0 true 139 true false false false false false false X 15 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 1489796 70224 MARK BRETT DIRECTOR 1.00 40.00 X 0 661520 54424 JAMES BUTLER III BOARD CHAIR 1.00 1.00 X X 0 1350 0 MARYLEE DAVIS PHD CHAIR/DIRECT 2.00 2.00 X X 0 1350 0 DAVID KAUFMAN DO DIRECTOR 1.00 1.00 X 0 1350 0 TIMOTHY HODGE DO DIRECTOR 1.00 1.00 X 0 0 0 DIANA RODRIGUEZ ALGRA BOARD VICE C 1.00 1.00 X X 0 0 0 THOMAS HOFMAN PHD TREASURER OF 1.00 1.00 X 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 KENNETH RUDMAN MD DIRECTOR 1.00 1.00 X X 0 0 0 PATRICK MCPHARLIN DIRECTOR 1.00 1.00 X 0 0 0 DENNIS REESE PRESIDENT & 40.00 5.00 X 0 420841 46788 PETER GRAHAM MD MEDICAL DIRE 40.00 5.00 X 0 371971 42105 GEORGE SCHNEIDER CFO/COO 40.00 5.00 X 0 220226 20399 KEVIN KAPLAN VP SALES 40.00 5.00 X 0 214619 33786 ANN HUNT-FUGATE RPH MGR CLINICAL 40.00 5.00 X 156351 0 25761 LINDA DICKINSON DIR OF MED R 40.00 5.00 X 0 155672 27469 KEVIN ESSENMACHER CONTROLLER 40.00 5.00 X 0 153275 27184 PAULA HOWARD SENIOR SALES 40.00 5.00 X 142681 0 25057 THOMAS OSTRANDER FORMER DIREC 0.00 40.00 X 0 367551 45994 DAWN SPRINGER MD FORMER DIREC 0.00 40.00 X 0 231912 32980 LARRY RAWSTHORNE MD FORMER DIREC 0.00 40.00 X 0 67768 8371 SCOTT WILKERSON FORMER PRES/ 0.00 0.00 X 0 40243 3094 299032 4399444 463636 2 true true false TRIZETTO 1085 MORRIS AVENUE UNION NJ 07083 HEALTHCARE IT 3267910 GLOBALCARE INC 6875 SHILOH RD E ALPHARETTA GA 300058403 HEALTH 961073 MILLIMAN 15800 BLUEMOUND RD SUITE 100 BROOKFIELD WI 53005 CONSULTING 794149 THE ADVISORY BOARD COMPANY 227 WEST MONROE STREET SUITE 5100 CHICAGO IL 60606 CONSULTING 724790 HIGHPOINT SOLUTIONS 301 E GERMANTOWN PIKE EAST NORRITON PA 19401 HEALTH 703157 11 PREPAID HEALTHCARE 165732809 165732809 165732809 2221822 -515855 2737677 1675980 1537290 138690 138690 138690 168093321 165216954 2876367 151171648 151171648 1122330 849604 272726 4320404 3270545 1049859 258988 196054 62934 774991 586668 188323 329066 249103 79963 3136803 3136803 68223 51645 16578 206361 206361 109989 109989 1972913 1972913 317852 240614 77238 402090 304382 97708 579248 438491 140757 99085 99085 59192 59192 994 994 1085684 1085684 51690 51690 BROKER COMMISSONS 1094929 1094929 MISCELLANEOUS 543857 411700 132157 ADMINISTRATIVE EXPENSES 492100 492100 PROVISION FOR BAD DEBTS 25000 25000 168223437 162207031 6016406 0 40868943 30792625 2794193 3701297 808083 981041 29159187 22197201 6525889 6961986 23629017 22833135 17997054 20056199 1613508 2249787 94236687 87576070 23279491 19677550 1421575 1686283 1924473 1776719 26625539 23140552 X 67611148 64435518 67611148 64435518 94236687 87576070 -130116 -3045514 X false true X true false 3411165 361583 -49824 15000 3707924 3184706 200567 40893 15000 3411165 2926676 82387 187643 12000 3184706 2641860 147795 149021 12000 2926676 1779759 796243 97691 30000 1833 2641860 1.00000 false true true 455895 455895 4904316 3302665 1601651 23798976 18894536 4904440 6961986 INVESTMENT IN SPARROW PHP 11062002 C INVESTMENT IN PHP INSURANCE COMPANY 8721506 C INVESTMENT IN PHP SERVICE COMPANY 272691 C 20056199 RELATED PARTY PAYABLE 1776719 1776719 162132253 -3045514 973475 -2072039 164204292 3889029 3889029 168093321 165307883 973475 973475 164334408 3889029 3889029 168223437 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 RECLASS BETWEEN REVENUE & EXPENSE 973,475 SCHEDULE D, PAGE 4, PART XI, LINE 4B ACA TAXES/FEES 1,978,517 REINSURANCE 1,910,512 SCHEDULE D, PAGE 4, PART XII, LINE 2D RECLASS BETWEEN REVENUE & EXPENSE 973,475 SCHEDULE D, PAGE 4, PART XII, LINE 4B ACA TAXES/FEES 1,978,517 REINSURANCE 1,910,512 SCHEDULE D, PAGE 4, PART XIII SEPARATE AUDITED FINANCIAL STATEMENTS WERE PREPARED FOR PHYSICIANS HEALTH PLAN UNDER STATUTORY ACCOUNTING PRINCIPLES AS PERMITTED BY THE MICHIGAN DEPARTMENT OF INSURANCE AND FINANCIAL SERVICES (DIFS). THE DIFS REQUIRES THAT INSURANCE COMPANIES DOMICILED IN THE STATE OF MICHIGAN PREPARE THEIR STATUTORY-BASIS FINANCIAL STATEMENTS IN ACCORDANCE WITH PRACTICES ESTABLISHED BY THE NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS. THESE PRACTICES DIFFER IN SOME RESPECTS FROM U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. PHYSICIANS HEALTH PLAN WAS INCLUDED AS PART OF THE CONSOLIDATED FINANCIAL STATEMENTS OF SPARROW HEALTH SYSTEM. SPARROW HEALTH SYSTEM IS THE SOLE MEMBER OF PHYSICIANS HEALTH PLAN. THE SPARROW HEALTH SYSTEM FINANCIAL STATEMENTS WERE PREPARED USING THE U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. THE FORM 990 FOR PHYSICIANS HEALTH PLAN HAS BEEN PREPARED USING U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. X X X X X X true false false true true true true true false DENNIS SWAN PRES/CEO - SHS 829199 623169 37428 19610 50614 1560020 MARK BRETT DIRECTOR 446334 211487 3699 15750 38674 715944 DENNIS REESE PRESIDENT & CEO 315720 102981 2140 23700 23088 467629 PETER GRAHAM MD MEDICAL DIRECTOR 294993 74641 2337 19610 22495 414076 GEORGE SCHNEIDER CFO/COO 199951 20000 275 5360 15039 240625 KEVIN KAPLAN VP SALES 150013 64484 122 18139 15647 248405 ANN HUNT-FUGATE RPH MGR CLINICAL PHARM 119402 17604 19345 11494 14267 182112 LINDA DICKINSON DIR OF MED RES MGMT 128969 26289 414 13314 14155 183141 KEVIN ESSENMACHER CONTROLLER 127090 26100 85 8689 18495 180459 PAULA HOWARD SENIOR SALES REP 89915 52668 98 12674 12383 167738 THOMAS OSTRANDER FORMER DIRECTOR 292807 53798 20946 23700 22294 413545 DAWN SPRINGER MD FORMER DIRECTOR 177270 50929 3713 16916 16064 264892 LARRY RAWSTHORNE MD FORMER DIRECTOR 62461 5307 8371 76139 SCOTT WILKERSON FORMER PRES/CEO/SEC 40243 3094 43337 SCHEDULE J, PAGE 1, PART I, LINE 4 SCOTT WILKERSON 43,337 0 0 SCHEDULE J, PAGE 1, PART I, LINE 5A THE 2015 INCENTIVE COMPENSATION PLAN PAYMENTS WERE ACCRUED IN 2015 AND WILL BE PAID IN 2016. THE INCENTIVE COMPENSATION PLAN IS BASED, IN PART, ON THE OPERATING MARGIN OF SPARROW HEALTH SYSTEM, WHICH INCLUDES PHP AS WELL AS AFFILIATED COMPANIES. SCHEDULE J, PAGE 1, PART I, LINE 5B THE 2015 INCENTIVE COMPENSATION PLAN PAYMENTS WERE ACCRUED IN 2015 AND WILL BE PAID IN 2016. THE INCENTIVE COMPENSATION PLAN IS BASED, IN PART, ON THE OPERATING MARGIN OF SPARROW HEALTH SYSTEM, WHICH INCLUDES PHP AS WELL AS AFFILIATED COMPANIES. SCHEDULE J, PAGE 1, PART I, LINE 6A THE 2015 INCENTIVE COMPENSATION PLAN PAYMENTS WERE ACCRUED IN 2015 AND WILL BE PAID IN 2016. THE INCENTIVE COMPENSATION PLAN IS BASED, IN PART, ON THE OPERATING MARGIN OF SPARROW HEALTH SYSTEM, WHICH INCLUDES PHP AS WELL AS AFFILIATED COMPANIES. SCHEDULE J, PAGE 1, PART I, LINE 6B THE 2015 INCENTIVE COMPENSATION PLAN PAYMENTS WERE ACCRUED IN 2015 AND WILL BE PAID IN 2016. THE INCENTIVE COMPENSATION PLAN IS BASED, IN PART, ON THE OPERATING MARGIN OF SPARROW HEALTH SYSTEM, WHICH INCLUDES PHP 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 THOMAS OSTRANDER, LARRY RAWSTHORNE, AND DAWN SPRINGER 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 3 PHP NO LONGER ADMINISTERS THE TEMPORARY HIGH RISK INSURANCE POOL PROGRAM THAT PREVIOUSLY PROVIDED HEALTH INSURANCE COVERAGE TO UNINSURED INDIVIDUALS WITH PRE-EXISTING CONDITIONS. THIS PROGRAM WAS A TEMPORARY PROGRAM SET TO TERMINATE AS OF JUNE 30, 2013. AS OF 12/31/14 THERE WERE NO MEMBERS ENROLLED IN THE PROGRAM AND NO EXPENDITURES INCURRED AFTER THIS DATE. FORM 990, PAGE 2, PART III, LINE 4A CLINTON, SHIAWASSEE, MONTCALM, GRATIOT, IONIA, AND ISABELLA. PHPIC OFFERS PRODUCTS ACROSS MICHIGAN. THE SPARROW PHP PRODUCT IS AVAILABLE TO MEDICAID ENROLLEES IN EATON, CLINTON, INGHAM, IONIA, MONTCALM, ISABELLA, AND SHIAWASSEE COUNTIES. AS OF DECEMBER 31, 2015, THERE WERE APPROXIMATELY 34,000 ENROLLEES IN PHPS COMMERCIAL HMO, 14,700 IN TPA, 9,000 IN PHPIC, AND 21,600 ENROLLEES IN SPHP. PHP AND SPHP CONTRACT DIRECTLY WITH PHYSICIANS HEALTH NETWORK (PHN), A WHOLLY OWNED SUBSIDIARY OF SPARROW. THE PHP NETWORK IS APPROXIMATELY 1,030 PRIMARY CARE PHYSICIANS, 1,816 SPECIALTY CARE PHYSICIANS, 800 ALLIED HEALTH PROFESSIONALS, AND 1,180 ORGANIZATIONAL PROVIDERS THAT INCLUDE 45 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. FORM 990, PAGE 6, PART VI, LINE 6 SPARROW HEALTH SYSTEM (SHS) 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 2015 FORM 990 ARE REVIEWED BY MANAGEMENT. ONCE MANAGEMENT COMPLETED ITS REVIEW OF THE FORM 990 COPIES WERE PROVIDED AT THE SEPTEMBER 2016 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 SHS 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 SHS 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 HEALTH SYSTEM BY REQUESTING THE POLICY FROM THE SPARROW COMPLIANCE OFFICER. FORM 990, PART XI, LINE 9 RECLASS BETWEEN REVENUE & EXPENSE 973,475 ACA TAXES/FEES -1,978,517 REINSURANCE -1,910,512 RECLASS BETWEEN REVENUE & EXPENSE -973,475 ACA TAXES/FEES 1,978,517 REINSURANCE 1,910,512 SPARROW HEALTH SYSTEM 1215 E MICHIGAN AVENUE LANSING MI 48912 382542859 PARENT MI 501C3 11A 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 11B SHS true SPARROW COMMUNITY CARE 3315 E MICHIGAN AVENUE STE 4 LANSING MI 48912 382543305 HOME HLTH MI 501C3 9 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 3 3 SHS true CARSON CITY FOUNDATION 406 E ELM STREET PO BOX 879 CARSON CITY MI 48811 460877509 FUNDRAISE MI 3 11A CCH true PHP INSURANCE COMPANY 1400 E MICHIGAN AVENUE LANSING MI 48912 205565219 INSURANCE MI PHP C CORP -2409393 13961841 1.00000 true PHP SERVICE COMPANY 1400 E MICHIGAN AVENUE LANSING MI 48912 383344741 MED SVS MI PHP C CORP -3142 3482065 1.00000 true SPARROW DEVELOPMENT INC 1215 E MICHIGAN AVENUE LANSING MI 48912 382595963 RENTAL PRO 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 MEDICAL CENTER WEST CONDO ASSOC 1322 E MICHIGAN AVENUE LANSING MI 48912 382635630 CONDO ASSO MI N/A true CLINTON SERVICES CORPORATION 805 S OAKLAND ST JOHNS MI 48879 382494110 SERVICES MI N/A true false false false false false false false false false false false true true true true true true true false PHYSICIANS HEALTH NETWORK M 147197286 COST EDWARD W SPARROW HOSPITAL L 2336200 COST EDWARD W SPARROW HOSPITAL Q 1863229 COST SPARROW PHP Q 5812174 COST PHP INSURANCE COMPANY Q 3494617 COST PHP SERVICE CO (TPA) Q 3043245 COST PHP INSURANCE COMPANY R 2575000 COST