2014-11-14T09:48:28-06:00 2013-12-31 383133790 ANDREWS HOOPER PAVLIK PLC 4295 OKEMOS RD STE 200 OKEMOS MI 488646201 990 2013-01-01 382356288 PHYSICIANS HEALTH PLAN PHYS 5173648400 PO BOX 30377 LANSING MI 48909 DENNIS REESE ACTING CEO 5173648400 2014-11-11 true MARK E HOOPER P00039887 5177060800 2014-11-11 2013 2015-11-30 17:44:51Z DENNIS SWAN 1215 E MICHIGAN AVENUE LANSING MI 48912 197699374 false X WWW.PHPMM.ORG 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 12 107 0 0 215135024 195352910 715086 2346464 25000 0 215875110 197699374 0 199674863 180398538 5995642 5869700 0 0 10370093 8428154 216040598 194696392 -165488 3002982 86786890 89679813 27350374 25054855 59436516 64624958 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 159109927 164571158 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, PHP FAMILYCARE (PHPFC) 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, TPA, AND PHPFC. PHPS SERVICE AREA INCLUDES THE MICHIGAN COUNTIES OF INGHAM, EATON, CLINTON, SHIAWASSEE, MONTCALM, GRATIOT, IONIA, AND ISABELLA. PHPIC OFFERS PRODUCTS ACROSS MICHIGAN. THE FAMILYCARE PRODUCT IS AVAILABLE TO MEDICAID ENROLLEES IN EATON, CLINTON, INGHAM, IONIA, MONTCALM, AND SHIAWASSEE COUNTIES. THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH (MDCH) AND THE DEPARTMENT OF INSURANCE AND FINANCIAL SERVICES (DIFS) APPROVED A SERVICE AREA EXPANSION OF PHPFC INTO ISABELLA COUNTY EFFECTIVE JANUARY 1, 2012. AS OF DECEMBER 31, 2013, THERE WERE APPROXIMATELY 31,900 ENROLLEES IN PHPS COMMERCIAL HMO, 12,600 IN TPA, 10,900 IN PHPIC, AND 17,600 ENROLLEES IN PHP. PHP ALSO OPERATES THE STATE OF MICHIGANS PRE-EXISTING CONDITION INSURANCE PLAN CALLED HIP MICHIGAN. THE HIP PROGRAM WAS TERMINATED EFFECTIVE JUNE 30, 2013. PHP AND PHPFC CONTRACT DIRECTLY WITH PHYSICIANS HEALTH NETWORK (PHN), A WHOLLY OWNED SUBSIDIARY OF SPARROW. THE PHP NETWORK IS APPROXIMATELY 761 PRIMARY CARE PHYSICIANS, 1,021 SPECIALTY CARE PHYSICIANS, 378 ALLIED HEALTH PROFESSIONALS, AND 313 ORGANIZATIONAL PROVIDERS THAT INCLUDE 30 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, AND - 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 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. PHP RECEIVED THE HIGHEST RATING OF EXCELLENT FROM THE UTILIZATION REVIEW ACCREDITATION COMMITTEE (URAC). THIS STATUS IS GRANTED TO HEALTHCARE PLANS THAT HAVE DEMONSTRATED CONTINUOUS QUALITY IMPROVEMENT IN THEIR PROGRAMS WHILE MEETING OR EXCEEDING URAC'S RIGOROUS ACCREDITATION STANDARDS. PHP FAMILYCARE RECEIVED AN "EXCELLENT" RATING. PHP AND PHP FAMILYCARE WERE REVIEWED BY URAC IN 2012. 30781752 30781752 PHYSICIANS HEALTH PLAN ESTABLISHED AND OPERATES A TEMPORARY HIGH RISK HEALTH INSURANCE POOL PROGRAM (PHP-HRPP) IN MICHIGAN TO PROVIDE AFFORDABLE HEALTH INSURANCE COVERAGE TO CURRENTLY UNINSURED INDIVIDUALS WITH PRE- EXISTING CONDITIONS. IT IS PART OF A FEDERAL PROGRAM ESTABLISHED BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) IN RESPONSE TO THE AFFORDABLE CARE ACT. THE PROGRAM PROVIDES COVERAGE FOR ELIGIBLE INDIVIDUALS BEGINNING OCTOBER 1, 2010, THROUGH AND ENDING JUNE 30, 2013. AS OF DECEMBER 31, 2013, THERE WERE NO MEMBERS ENROLLED IN THE PROGRAM. 189891679 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 true true true true false true 125 0 true 107 true false false false false false false X 14 12 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 1394403 33278 SCOTT WILKERSON PRESIDENT/CE 40.00 5.00 X X 0 375173 33828 DENNIS REESE ACTING CEO 40.00 5.00 X X 0 213957 28807 TIMOTHY HODGE DO DIRECTOR 1.00 1.00 X 0 2500 0 DAVID KAUFMAN DO DIRECTOR 1.00 40.00 X 0 1449 0 JAMES BUTLER III DIRECTOR 1.00 1.00 X 0 1394 0 MARYLEE DAVIS PHD CHAIR/DIRECT 2.00 2.00 X X 0 0 0 JUDITH CARDENAS PHD DIRECTOR 1.00 1.00 X 0 0 0 PATRICK GRIBBEN JR TREASURER/DI 1.00 1.00 X X 0 0 0 DIANA RODRIGUEZ ALGRA SECRETARY/DI 1.00 1.00 X X 0 0 0 PATRICK MCPHARLIN DIRECTOR 1.00 1.00 X 0 0 0 BRADLEY HOOPINGARNER MD DIRECTOR 1.00 1.00 X 0 0 0 KENNETH RUDMAN MD DIRECTOR 1.00 1.00 X 0 0 0 KATHLEEN CONKLIN DIRECTOR 1.00 1.00 X 0 0 0 THOMAS HOFMAN PHD DIRECTOR 1.00 1.00 X 0 0 0 DEBORAH MUCHMORE DIRECTOR 1.00 1.00 X 0 0 0 PAULA HOWARD SENIOR SALES 40.00 5.00 X 134057 0 19262 ANN HUNT-FUGATE RPH MGR CLINICAL 40.00 5.00 X 123609 0 26508 ANTHONY ABBATE IT MANAGER 40.00 5.00 X 0 122493 23180 LINDA DICKINSON DIR OF MED R 40.00 5.00 X 0 121960 22591 KEVIN ESSENMACHER CONTROLLER 40.00 5.00 X 0 115279 25993 THOMAS OSTRANDER FORMER DIREC 0.00 40.00 X 0 360008 39220 LARRY RAWSTHORNE MD DIRECTOR 0.00 40.00 X 0 282448 33770 DAWN SPRINGER MD FORMER DIREC 0.00 40.00 X 0 193621 15034 257666 3184685 301471 8 true true false GLOBALCARE INC 6875 SHILOH RD E ALPHARETTA GA 300058403 HEALTH 1493580 HEALTHHELP LLC 654 N SAM HOUSTON PKWY E STE 250 HOUSTON TX 770605913 HEALTH 276988 ERNST & YOUNG LLP PO BOX 96550 CHICAGO IL 60693 AUDITING 237133 HIGHPOINT SOLUTIONS 301 E GERMANTOWN PIKE EAST NORRITON PA 19401 CONSULTING 225943 FOSTER SWIFT COLLINS & SMITH 313 S WASHINGTON SQUARE LANSING MI 48933 LEGAL 148721 6 PREPAID HEALTHCARE 621990 164571158 164571158 HHS HRPP REIMBURSEMENT 621990 30781752 30781752 195352910 725879 -21196 747075 1620585 1620585 1620585 1620585 197699374 195331714 2367660 180398538 180398538 651765 651765 3925935 3465319 460616 271621 205617 66004 734218 555803 178415 286161 216624 69537 2203849 2203849 112670 85291 27379 260963 260963 117455 117455 413608 413608 220199 166691 53508 386014 292213 93801 562499 425812 136687 91967 91967 34771 34771 2162 2162 1895689 1895689 55583 55583 BROKER COMMISSONS 1061500 1061500 MISCELLANEOUS 518399 392428 125971 ADMINISTRATIVE EXPENSES 490826 490826 194696392 189891679 4804713 0 28075228 36960522 15323815 5991862 635168 1482488 24363619 19269814 5711581 5093805 19366195 22003000 16059158 16885749 1615745 1262387 86786890 89679813 26144589 23605184 1016433 410050 189352 1039621 27350374 25054855 X 59436516 64624958 59436516 64624958 86786890 89679813 3002982 2185460 X false true X true 2926676 82387 187643 12000 3184706 2641860 147795 149021 12000 2926676 1779759 796243 97691 30000 1833 2641860 1550687 163793 65279 1779759 1307182 134195 109310 1550687 1.00000 false true true 455895 455895 4369072 3064556 1304516 19538652 16205258 3333394 5093805 INVESTMENT IN PHP INSURANCE COMPANY 8630997 C INVESTMENT IN PHP FAMILYCARE 7903134 C INVESTMENT IN PHP SERVICE COMPANY 351618 C 16885749 RELATED PARTY PAYABLE 1039621 1039621 199884834 2185460 2185460 197699374 197699374 194696392 194696392 194696392 SCHEDULE D, PAGE 2, PART V, LINE 4 PHYSICIANS HEALTH PLAN DOES NOT HOLD ENDOWMENTS. THE ENDOWMENTS ARE HELD BY SPARROW CLINTON HOSPITAL AND SPARROW FOUNDATION. SPARROW HEALTH SYSTEM IS THE SOLE MEMBER OF PHYSICIANS HEALTH PLAN, 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 XIII SCHEDULE D, PART XI 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 PRACTICES. THE FORM 990 FOR PHYSICIANS HEALTH PLAN HAS BEEN PRESENTED USING U.S. GENERALLY ACCEPTED ACCOUNTING PRACTICES. X true true X X X X X X true false false true true true true true false DENNIS SWAN PRES/CEO - SHS 785333 574149 34921 18870 14408 1427681 SCOTT WILKERSON PRESIDENT/CEO/SEC 345529 12166 17478 18870 14958 409001 DENNIS REESE ACTING CEO 200671 11915 1371 13306 15501 242764 PAULA HOWARD SENIOR SALES REP 125437 8539 81 11716 7546 153319 ANN HUNT-FUGATE RPH MGR CLINICAL PHARM 120421 2986 202 9147 17361 150117 THOMAS OSTRANDER FORMER DIRECTOR 283627 56037 20344 22800 16420 399228 LARRY RAWSTHORNE MD DIRECTOR 263850 18598 18870 14900 316218 DAWN SPRINGER MD FORMER DIRECTOR 148179 42328 3114 14328 706 208655 SCHEDULE J, PAGE 1, PART I, LINE 1A PHYSICIANS HEALTH PLAN PAYS SOCIAL DUES ON BEHALF OF SCOTT WILKERSON, CEO. THESE AMOUNTS ARE CONSIDERED TAXABLE COMPENSATION. SCHEDULE J, PAGE 1, PART I, LINE 3 SPARROW HEALTH SYSTEM IS THE SOLE MEMBER OF PHYSICIANS 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 SCOTT WILKERSON 26,962 0 0 SCHEDULE J, PAGE 1, PART I, LINE 5A THE 2013 INCENTIVE COMPENSATION PLAN PAYMENTS WERE ACCRUED IN 2013 AND WILL BE PAID IN 2014. THE INCENTIVE COMPENSATION PLAN IS BASED, IN PART, ON THE OPERATING MARGIN OF SPARROW HEALTH SYSTEM, WHICH INCLUDES PHYSICIANS HEALTH PLAN AS WELL AS AFFILIATED COMPANIES. SCHEDULE J, PAGE 1, PART I, LINE 5B THE 2013 INCENTIVE COMPENSATION PLAN PAYMENTS WERE ACCRUED IN 2013 AND WILL BE PAID IN 2014. THE INCENTIVE COMPENSATION PLAN IS BASED, IN PART, ON THE OPERATING MARGIN OF SPARROW HEALTH SYSTEM, WHICH INCLUDES PHYSICIANS HEALTH PLAN AS WELL AS AFFILIATED COMPANIES. SCHEDULE J, PAGE 1, PART I, LINE 6A THE 2013 INCENTIVE COMPENSATION PLAN PAYMENTS WERE ACCRUED IN 2013 AND WILL BE PAID IN 2014. THE INCENTIVE COMPENSATION PLAN IS BASED, IN PART, ON THE OPERATING MARGIN OF SPARROW HEALTH SYSTEM, WHICH INCLUDES PHYSICIANS HEALTH PLAN AS WELL AS AFFILIATED COMPANIES. SCHEDULE J, PAGE 1, PART I, LINE 6B THE 2013 INCENTIVE COMPENSATION PLAN PAYMENTS WERE ACCRUED IN 2013 AND WILL BE PAID IN 2014. THE INCENTIVE COMPENSATION PLAN IS BASED, IN PART, ON THE OPERATING MARGIN OF SPARROW HEALTH SYSTEM, WHICH INCLUDES PHYSICIANS HEALTH PLAN 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 PERQUISITES) 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 4A CLINTON, SHIAWASSEE, MONTCALM, GRATIOT, IONIA, AND ISABELLA. PHPIC OFFERS PRODUCTS ACROSS MICHIGAN. THE FAMILYCARE PRODUCT IS AVAILABLE TO MEDICAID ENROLLEES IN EATON, CLINTON, INGHAM, IONIA, MONTCALM, AND SHIAWASSEE COUNTIES. THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH (MDCH) AND THE DEPARTMENT OF INSURANCE AND FINANCIAL SERVICES (DIFS) APPROVED A SERVICE AREA EXPANSION OF PHPFC INTO ISABELLA COUNTY EFFECTIVE JANUARY 1, 2012. AS OF DECEMBER 31, 2013, THERE WERE APPROXIMATELY 31,900 ENROLLEES IN PHPS COMMERCIAL HMO, 12,600 IN TPA, 10,900 IN PHPIC, AND 17,600 ENROLLEES IN PHP. PHP ALSO OPERATES THE STATE OF MICHIGANS PRE-EXISTING CONDITION INSURANCE PLAN CALLED HIP MICHIGAN. THE HIP PROGRAM WAS TERMINATED EFFECTIVE JUNE 30, 2013. PHP AND PHPFC CONTRACT DIRECTLY WITH PHYSICIANS HEALTH NETWORK (PHN), A WHOLLY OWNED SUBSIDIARY OF SPARROW. THE PHP NETWORK IS APPROXIMATELY 761 PRIMARY CARE PHYSICIANS, 1,021 SPECIALTY CARE PHYSICIANS, 378 ALLIED HEALTH PROFESSIONALS, AND 313 ORGANIZATIONAL PROVIDERS THAT INCLUDE 30 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, AND - 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 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. PHP RECEIVED THE HIGHEST RATING OF EXCELLENT FROM THE UTILIZATION REVIEW ACCREDITATION COMMITTEE (URAC). THIS STATUS IS GRANTED TO HEALTHCARE PLANS THAT HAVE DEMONSTRATED CONTINUOUS QUALITY IMPROVEMENT IN THEIR PROGRAMS WHILE MEETING OR EXCEEDING URAC'S RIGOROUS ACCREDITATION STANDARDS. PHP FAMILYCARE RECEIVED AN "EXCELLENT" RATING. PHP AND PHP FAMILYCARE WERE REVIEWED BY URAC IN 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 2013 FORM 990 ARE REVIEWED BY MANAGEMENT. ONCE MANAGEMENT COMPLETED ITS REVIEW OF THE FORM 990 COPIES WERE PROVIDED AT THE SEPTEMBER 2014 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 OF THE ORGANIZATION INVOLVED THE FOLLOWING: UTILIZING THE COMPENSATION COMMITTEE, INDEPENDENT CONSULTANTS, REVIEWING OTHER SIMILAR ORGANIZATIONS' 990S, 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, INDEPENDENT CONSULTANTS, REVIEWING OTHER SIMILAR ORGANIZATIONS' 990S, 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. PHP SHARED SERVICES LLP PO BOX 30377 LANSING MI 48909 383361367 CONTRACTS MI PHP SPARROW HEALTH SYSTEM 1215 E MICHIGAN AVENUE LANSING MI 48912 382542859 PARENT MI 501C3 11A N/A false PHP FAMILYCARE 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 1110 E MICHIGAN AVENUE LANSING MI 48912 386100687 FUNDRAISE MI 501C3 11B SHS true SPARROW COMMUNITY CARE 2909 E GRAND RIVER 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 520 E WASHINGTON ST IONIA MI 48846 383218134 HLTH CARE MI 501C3 3 SHS true SPARROW SPECIALTY HOSPITAL 1210 W SAGINAW LANSING MI 48915 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 LANSING MEDICAL DENTAL BUILDING 2909 E GRAND RIVER LANSING MI 48909 382566150 RENTAL PRO MI N/A false false PHP INSURANCE COMPANY 1400 E MICHIGAN AVENUE LANSING MI 48912 205565219 INSURANCE MI PHP C CORP -1024851 14858137 1.00000 true PHP SERVICE COMPANY 1400 E MICHIGAN AVENUE LANSING MI 48912 383344741 MED SVS MI PHP C CORP -210875 2851358 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 1100 W SAGINAW ST LANSING MI 48915 382635630 CONDO ASSO MI N/A true CLINTON SERVICES CORPORATION 805 S OAKLAND ST JOHNS MI 48879 382494110 SERVICES MI N/A true false true false false false false false false false false false false true false true true true false false EDWARD W SPARROW HOSPITAL L 1778488 COST PHYSICIANS HEALTH NETWORK M 153399335 COST EDWARD W SPARROW HOSPITAL Q 1647172 COST PHP FAMILYCARE Q 4224805 COST PHP INSURANCE COMPANY Q 3497196 COST PHP SERVICE CO (TPA) Q 2417319 COST