2020-11-13T11:03:20-06:00 2019-12-31 383133790 ANDREWS HOOPER PAVLIK PLC 4295 OKEMOS RD STE 200 OKEMOS MI 488646201 990 2019-01-01 382356288 PHYSICIANS HEALTH PLAN PHYS 5173648400 PO BOX 30377 LANSING MI 48909 DENNIS REESE PRESIDENT & CEO 5173648400 2020-11-11 true JULIE M PFEIFLE P00751307 5177060800 2020-11-11 52.37.240.203 2020-11-13 11:03:20 CS P 7EAAAA8737DE4B218ECA784B8663C2F42330AC2A B61FCFACF4DC7316CEEE1EFA998B902DB577BE66 2019 2021-04-22 16:20:28Z JAMES F DOVER 1215 E MICHIGAN AVENUE LANSING MI 48912 189559145 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. 8 0 144 0 0 201613791 179219675 4385644 1591760 58701 107347 206058136 180918782 0 177567791 156315486 8790113 8523999 0 0 13076720 17237547 199434624 182077032 6623512 -1158250 95848627 104484330 34784726 26056366 61063901 78427964 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 175018565 179327022 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 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, PHPTPA, 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. PHPIC OFFERS PRODUCTS ACROSS MICHIGAN. AS OF DECEMBER 31, 2019, THERE WERE APPROXIMATELY 33,000 ENROLLEES IN PHPS COMMERCIAL HMO, 15,700 IN TPA, 3,600 IN PHPIC, AND 0 ENROLLEES IN PHPMA. PHP CONTRACTS DIRECTLY WITH PHYSICIANS HEALTH NETWORK (PHN), A WHOLLY-OWNED SUBSIDIARY OF SHS. THE PHP NETWORK IS APPROXIMATELY 848 PRIMARY CARE PHYSICIANS, 1,368 SPECIALTY CARE PHYSICIANS, 697 ALLIED HEALTH PROFESSIONALS, 1,092 BEHAVIORAL HEALTH PROVIDERS AND 509 ORGANIZATIONAL PROVIDERS THAT INCLUDE 34 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 2018 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, 2021 AT WHICH TIME REACCREDITATION WILL OCCUR. 175018565 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 224 0 true 144 true false false false false false false false false X 8 0 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 JOSEPH RUTH DIRECTOR 1.00 40.00 X 0 635973 120976 PAULA REICHLE TREASURER 1.00 40.00 X 0 535378 103598 MARK BRETT FORMER DIREC 0.00 40.00 X 0 547175 55281 DOUGLAS EDEMA MD DIRECTOR 1.00 40.00 X 0 466814 45477 JAMES F DOVER PRES/CEO - S 1.00 40.00 X 0 446164 41808 DENNIS REESE PRESIDENT & 40.00 5.00 X X 393000 0 49611 PETER GRAHAM MD MEDICAL DIRE 5.00 40.00 X 317707 0 60787 GEORGE SCHNEIDER CFO/COO 40.00 5.00 X 332378 0 37894 SCOTT NORMAN VP OF SALES 40.00 5.00 X 254720 0 48044 ANDREA KOSLOSKI DIRECTOR 1.00 40.00 X 0 261227 35807 E W TIBBS BOARD MEM-PA 0.00 0.00 X 0 254612 25758 SUSAN ARMBRUSTER DIRECTOR OF 40.00 5.00 X 220916 0 35541 KENNETH WALKER DIR OF NETWO 40.00 5.00 X 149288 0 40806 NICHOLAS D'ISA DIR LEGAL/CO 40.00 5.00 X 150647 0 23869 ANN HUNT-FUGATE RPH MGR CLINICAL 40.00 5.00 X 148978 0 23998 JOY WAHAWISAN CLINICAL ANA 40.00 5.00 X 138089 0 30851 BRITTANY BOGAN DIRECTOR 1.00 3.00 X 0 1416 0 DAVID KAUFMAN DO DIRECTOR 1.00 1.00 X 0 1416 0 JAMES BUTLER III BOARD CHAIR 1.00 1.00 X X 0 1416 0 DIANA RODRIGUEZ ALGRA BOARD VICE C 1.00 1.00 X 0 0 0 IFTIKER AHMAD MD DIRECTOR 1.00 3.00 X 0 0 0 SHALIMAR MAYNARD DIRECTOR 1.00 1.00 X 0 0 0 DEBORAH MUCHMORE DIRECTOR 1.00 1.00 X 0 0 0 THOMAS HOFMAN PHD TREASURER/SE 1.00 1.00 X 0 0 0 MERRITTA PROCTOR DIRECTOR 1.00 1.00 X 0 0 0 2105723 3151591 780106 19 true true false TRIZETTO 1085 MORRIS AVENUE UNION NJ 07083 HEALTHCARE IT 3045087 MILLIMAN 15800 BLUEMOUND RD SUITE 100 BROOKFIELD WI 53005 MGMT CONSULTING 1057288 CHANGE HEALTHCARE INC 3055 LEBANON PIKE NASHVILLE TN 37214 COST CONT & CIR 787830 ZELIS HEALTHCARE 6875 SHILOH RD E ALPHARETTA GA 300058403 COST CONT & CIR 746175 CHANGE HEALTHCARE 2187 NETWORK PL CHICAGO IL 606731219 COST CON & CIR 280899 17 PREPAID HEALTHCARE 621990 179219675 179219675 179219675 2491094 2491094 7741029 8640363 -899334 -899334 -899334 OTHER REVENUE 900099 107347 107347 107347 180918782 179327022 1591760 156315486 156315486 1191376 901872 289504 5718502 4328906 1389596 402936 305023 97913 685330 518795 166535 525855 398072 127783 3106790 3106790 47166 47166 104394 104394 3238621 3238621 273143 206769 66374 550083 416413 133670 945151 715479 229672 146162 146162 89444 89444 1709 1709 1164520 1164520 73013 73013 LOSS - UNCONSOLIDATED SUB 3213968 3213968 BROKER COMMISSONS 2284852 2284852 MISCELLANEOUS 1175178 889610 285568 ADMINISTRATIVE EXPENSES 823353 823353 182077032 175018565 7058467 0 49545947 31715093 8671065 7816089 1760497 1626204 18407461 13007778 6061182 5399683 13920530 30627064 14743721 26141753 1145685 1158444 95848627 104484330 30319683 21906232 1707393 3517104 2757650 633030 34784726 26056366 X 61063901 78427964 61063901 78427964 95848627 104484330 X -1158250 3910313 14612000 X false true X true true true 4700296 39943 232639 4972878 3236464 314065 55042 3605571 3070379 114433 51652 3236465 2839263 191313 39803 3070379 2481728 361583 -4048 2839263 1.00000 false true true 455895 455895 6276388 4108541 2167847 11675178 8899237 2775941 5399683 INVESTMENT IN PHP INSURANCE COMPANY 14633277 C INVESTMENT IN PHP MEDICARE 9354491 C INVESTMENT IN PHP SERVICE COMPANY 2153985 C 26141753 RELATED PARTY PAYABLE 633030 633030 180016778 3213968 291817 3505785 176510993 315082 4092707 4407789 180918782 177961502 291817 291817 177669685 315082 4092265 4407347 182077032 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 IS THE SOLE MEMBER OF PHP, 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 ACA FEES 240,041 OTHER 51,776 SCHEDULE D, PAGE 4, PART XI, LINE 4B INCOME FROM CONSOLIDATED SUBSIDIARIES 107,347 REINSURANCE 1,245,937 RISK ADJ INCOME/EXPENSE RECLASS -474,545 LOSS ON UNCONSOLIDATED SUBSIDIARY 3,213,968 SCHEDULE D, PAGE 4, PART XII, LINE 2D ACA FEES 240,041 PENSION NON-OPERATING 51,776 SCHEDULE D, PAGE 4, PART XII, LINE 4B RISK ADJ/EXPENSE RECLASS -474,545 MISCELLANEOUS 106,905 REINSURANCE 1,245,937 LOSS ON UNCONSOLIDATED SUBSIDIARY 3,213,968 SCHEDULE D, PAGE 4, PART XIII DURING THE PREPARATION OF THE 2019 FORM 990, IT WAS DETERMINED THAT AMOUNTS WERE BEING REPORTED ON PART V ENDOWMENT FUNDS FROM AN AFFILIATED HOSPITAL THAT DID NOT MEET THE DEFINITION OF AN ENDOWMENT FUND. THESE AMOUNTS HAVE BEEN REMOVED FROM THE CURRENT SCHEDULE, INCLUDING PREVIOUS YEARS' REPORTING. X true true X X X X X X true true false false false false false true false JOSEPH RUTH DIRECTOR 611013 24960 85259 35717 756949 PAULA REICHLE TREASURER 507438 27940 55319 48279 638976 MARK BRETT FORMER DIRECTOR 546252 923 34570 20711 602456 DOUGLAS EDEMA MD DIRECTOR 457169 9645 8250 37227 512291 JAMES F DOVER PRES/CEO - SHS 445338 826 41808 487972 DENNIS REESE PRESIDENT & CEO 342832 42600 7568 16650 32961 442611 PETER GRAHAM MD MEDICAL DIRECTOR 314368 1351 1988 26320 34467 378494 GEORGE SCHNEIDER CFO/COO 300184 30000 2194 15788 22106 370272 SCOTT NORMAN VP OF SALES 254343 377 16026 32018 302764 ANDREA KOSLOSKI DIRECTOR 258533 2694 14973 20834 297034 E W TIBBS BOARD MEM-PART YEAR 224367 25000 5245 25758 280370 SUSAN ARMBRUSTER DIRECTOR OF OPER. 202043 18873 6923 28618 256457 KENNETH WALKER DIR OF NETWORK SERV. 149156 132 4475 36331 190094 NICHOLAS D'ISA DIR LEGAL/COMPLIANCE 150369 278 8844 15025 174516 ANN HUNT-FUGATE RPH MGR CLINICAL PHARM 125340 23638 23998 172976 JOY WAHAWISAN CLINICAL ANALYTICS 137799 200 90 3988 26863 168940 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 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 JOSEPH RUTH 0 58,939 0 PAULA REICHLE 0 47,069 0 E. W. TIBBS 25,000 0 0 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 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 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 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, PHPTPA, 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. PHPIC OFFERS PRODUCTS ACROSS MICHIGAN. AS OF DECEMBER 31, 2019, THERE WERE APPROXIMATELY 33,000 ENROLLEES IN PHPS COMMERCIAL HMO, 15,700 IN TPA, 3,600 IN PHPIC, AND 0 ENROLLEES IN PHPMA. PHP CONTRACTS DIRECTLY WITH PHYSICIANS HEALTH NETWORK (PHN), A WHOLLY-OWNED SUBSIDIARY OF SHS. THE PHP NETWORK IS APPROXIMATELY 848 PRIMARY CARE PHYSICIANS, 1,368 SPECIALTY CARE PHYSICIANS, 697 ALLIED HEALTH PROFESSIONALS, 1,092 BEHAVIORAL HEALTH PROVIDERS AND 509 ORGANIZATIONAL PROVIDERS THAT INCLUDE 34 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 2018 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, 2021 AT WHICH TIME REACCREDITATION WILL OCCUR. 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 2019 FORM 990 ARE REVIEWED BY MANAGEMENT. ONCE MANAGEMENT COMPLETED ITS REVIEW OF THE FORM 990 COPIES WERE PROVIDED AT THE FALL 2020 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 CAPITAL CONTRIBUTIONS 14,612,000 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 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 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 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 148827179 COST EDWARD W SPARROW HOSPITAL Q 13821219 COST PHP INSURANCE COMPANY Q 2353724 COST PHP SERVICE COMPANY Q 4230916 COST PHP MEDICARE Q 923884 COST PHP MEDICARE B 14612000 COST