COREWELL HEALTH: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
COREWELL HEALTH (EIN 31-1069321)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-06
IRS object ID
201743109349301209
Schema version
2016v3.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2017-11-06T10:00:19-06:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1200 E Main St Suite 700AddressLine1Txt
CityFort WayneCityNm
State AbbreviationINStateAbbreviationCd
ZIP46802ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN311069321EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PHYSICIANS HEALTH PLAN OF NORTHERN INDIANABusinessNameLine1Txt
Business Name Line2INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
In Care Of% STACEY OTTENWELLERInCareOfNm
Business Name ControlPHYSBusinessNameControlTxt
Phone2604326690PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line18101 WEST JEFFERSON BLVDAddressLine1Txt
CityFORT WAYNECityNm
State AbbreviationINStateAbbreviationCd
ZIP46804ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDUSTIN W CRIDERPersonNm
Person TitleCFOPersonTitleTxt
Phone2604326690PhoneNum
Signature2017-11-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJoyce A DulworthPreparerPersonNm
PTINP00151125PTIN
Phone2604604000PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address167.68.126.162IPv4AddressTxt
FieldValueIRS element (for citing)
Federal Original Submission Id35027420173105000002FederalOriginalSubmissionId
Federal Original Submission Id2017-11-06FederalOriginalSubmissionIdDt
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id6D61E2A24AA052E41AF4DA6A29299CDAFD2BBB3CAtSubmissionCreationDeviceId
At Submission Filing Device Id1466242D98572CF50F8DAFF8C03C944EFBA58CF0AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerMICHAEL D CAHILLPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line18101 W JEFFERSON BLVDAddressLine1Txt
CityFORT WAYNECityNm
State AbbreviationINStateAbbreviationCd
ZIP46804ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$191,419,237GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressWWW.PHPNI.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1983FormationYr
Legal Domicile StateINLegalDomicileStateCd
Activity Or MissionTHE ORGANIZATION PROVIDES INSURANCE COVERAGE AND EDUCATIONAL MATERIALS PROMOTING A HEALTHY LIFESTYLE TO THOUSANDS OF INDIVIDUALS THROUGHOUT NORTHERN INDIANA.ActivityOrMissionDesc
Voting Members Governing Body16VotingMembersGoverningBodyCnt
Voting Members Independent14VotingMembersIndependentCnt
Total Employee142TotalEmployeeCnt
Total Gross UBI$788,290TotalGrossUBIAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$192,390,280PYProgramServiceRevenueAmt
CY Program Service Revenue$179,922,300CYProgramServiceRevenueAmt
PY Investment Income$1,417,282PYInvestmentIncomeAmt
CY Investment Income$1,477,501CYInvestmentIncomeAmt
PY Other Revenue$690,917PYOtherRevenueAmt
CY Other Revenue$668,011CYOtherRevenueAmt
PY Total Revenue$194,498,479PYTotalRevenueAmt
CY Total Revenue$182,067,812CYTotalRevenueAmt
PY Grants And Similar Paid$817,904PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$91,791CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$164,706,379PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$157,303,654CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$9,806,780PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$10,189,712CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$16,460,103PYOtherExpensesAmt
CY Other Expenses$14,714,639CYOtherExpensesAmt
PY Total Expenses$191,791,166PYTotalExpensesAmt
CY Total Expenses$182,299,796CYTotalExpensesAmt
PY Revenues Less Expenses$2,707,313PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$231,984CYRevenuesLessExpensesAmt
Total Assets BOY$84,627,937TotalAssetsBOYAmt
Total Assets EOY$82,349,132TotalAssetsEOYAmt
Total Liabilities BOY$40,738,485TotalLiabilitiesBOYAmt
Total Liabilities EOY$33,256,011TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$43,889,452NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$49,093,121NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionPHYSICIANS HEALTH PLAN OF NORTHERN INDIANA, INC. IS SPONSORED BY INDEPENDENT PHYSICIANS AS A NOT-FOR-PROFIT, INDIANA CERTIFIED AND FEDERALLY QUALIFIED HEALTH MAINTENANCE ORGANIZATION. PHYSICIANS HEALTH PLAN WILL EXCEED OUR CUSTOMERS' HEALTHCARE EXPERIENCE EXPECTATIONS BY DELIVERING OUR SERVICES WITH A PERSONAL TOUCH, DEVELOPING LONG-TERM RELATIONSHIPS, AND PROVIDING RESOURCES TO IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITIES.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$170,393,056ExpenseAmt
Grant$91,791GrantAmt
Revenue$179,802,021RevenueAmt
DescPHP HAS DEVELOPED A VOLUNTARY DIABETES MANAGEMENT INCENTIVE PROGRAM DESIGNED TO PROVIDE ENCOURAGEMENT FOR COMPLYING WITH TREATMENT GUIDELINES FOR THE MANAGEMENT OF DIABETES AS WELL AS TO OFFER DIABETIC EDUCATION. MEMBERS CAN JOIN THE PROGRAM BY CALLING PHP AND REQUESTING ENROLLMENT, HAVING THEIR PHYSICIAN CALL AND REQUEST ENROLLMENT, A REFERRAL FROM A HOSPITAL CASE MANAGER DURING AN INPATIENT STAY, A REFERRAL AS A RESULT OF A CUSTOMER SERVICE CALL, A REFERRAL AS A RESULT OF A PHARMACY CALL OR BY INVITATION FROM PHP FOLLOWING THE RECEIPT OF A MEDICAL CLAIM WHERE A DIABETIC DIAGNOSIS, DIABETIC SUPPLY, OR DIABETIC MEDICATION IS IDENTIFIED. THE MEMBER MUST FIRST COMPLETE A HEALTH RISK ASSESSMENT AND DIABETES PROGRAM ENROLLMENT FORM WHICH BOTH CAN BE FOUND ON OUR WEBSITE. ONCE A CLAIM OR CLAIMS HAVE BEEN RECEIVED FOR THE HBA1C TEST AND/OR A DIABETIC EYE EXAM HAS BEEN PROCESSED/PAID, THE MEMBER RECEIVES A $50 VISA GIFT CARD FOR A SINGLE TEST/EXAM FOR A TOTAL REWARD OF $100 PER CALENDAR YEAR. OUR HEALTH RISK ASSESSMENT IS INTENDED TO INCREASE MEMBER AWARENESS OF HEALTH BEHAVIORS, ENCOURAGE SCREENING OF TESTS FOR EARLY IDENTIFICATION OF ISSUES, AND SUPPORT MEMBERS IN ADOPTING A HEALTHIER LIFESTYLE. IN ADDITION, THE INFORMATION GATHERED BY PHP, ENABLES A BETTER UNDERSTANDING OF THE HEALTH AND HABITS OF OUR MEMBER POPULATION. THIS IN TURN ALLOWS PHP TO DEVELOP PROGRAMS AND OUTREACH TO ADDRESS AREAS OF CONCERN. MEMBER EDUCATION AND ENCOURAGING SELF-ADVOCACY ARE THE PRIMARY GOALS OF THE HRA. IN COLLABORATION WITH AGING AND IN-HOME SERVICES, PHP HAS CREATED THE CARE TRANSITIONS PROGRAM BECAUSE AT THE TIME OF DISCHARGE, IT IS EASY FOR A MEMBER TO BECOME OVERWHELMED WITH POTENTIAL CHANGES IN MEDICATION, FOLLOW-UP APPOINTMENTS, AND GENERAL CARE NEEDS. THE TEAM AT CARE TRANSITIONS IS AVAILABLE TO ASSIST THE MEMBER WITH ANY ISSUES THEY MAY EXPERIENCE IN TRANSITION FROM A FACILITY SETTING TO HOME FOCUSING ON EDUCATIONAL NEEDS, TREATMENT PLAN COMPLIANCE, AND REMOVAL OF BARRIERS TO CARE. PENDING VERIFICATION OF ELIGIBILITY/NECESSITY, MEMBERS JOIN THE CARE TRANSITIONS PROGRAM THROUGH A REFERRAL FROM A PHP CASE MANAGER, PHYSICIANS RECOMMENDATION, OR A REFERRAL FROM A HOSPITAL CASE MANAGER. THIS IS PROVIDED AT NO COST TO THE MEMBER.Desc
Total Program Service Expenses$170,393,056TotalProgramServiceExpensesAmt
Described In Section501c3falseDescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesYes (true)ForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (true)BusinessRlnWithFamMemInd
Business Rln With Officer EntYes (true)BusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document1848IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee142EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members16GoverningBodyVotingMembersCnt
Independent Voting Member14IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VentureYes (true)InvestmentInJointVentureInd
Written Policy Or ProcedurefalseWrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldINStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonSTACEY OTTENWELLERPersonNm
Phone2604326690PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line18101 W JEFFERSON BLVDAddressLine1Txt
CityFORT WAYNECityNm
State AbbreviationINStateAbbreviationCd
ZIP46804ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
JAMES C WEHRENBERG
CHAIRMAN THRU 6/16, EX-OFFICIO1.01.0Yes (X)Yes (X)$10,250$0$0
JAMES C STEVENS
VICE-CHAIR THRU 6/16, CHAIRMAN1.01.0Yes (X)Yes (X)$8,500$0$0
THERESA A GUTIERREZ
VICE CHAIR STARTING 6/161.01.0Yes (X)Yes (X)$3,900$0$0
MICHAEL R DEWALD
TREASURER1.01.0Yes (X)Yes (X)$10,100$0$0
KARL R LAPAN
SECRETARY1.01.0Yes (X)Yes (X)$9,750$0$0
TIMOTHY R DIRIG
DIRECTOR1.01.0Yes (X)$5,125$0$0
PETER P FETTIG
DIRECTOR1.01.0Yes (X)$4,750$0$0
JUDITH KENNEDY
DIRECTOR1.01.0Yes (X)$3,625$0$0
MICHAEL LARKIN
DIRECTOR1.01.0Yes (X)$4,125$0$0
DAVID E LENTZ
DIRECTOR1.01.0Yes (X)$2,000$0$0
ANDREW O'SHAUGHNESSY
DIRECTOR1.01.0Yes (X)$2,000$0$0
RHYS RUDOLPH
DIRECTOR1.01.0Yes (X)$1,250$0$0
JOHN SAMPSON
DIRECTOR1.01.0Yes (X)$2,750$0$0
DON SCHENKEL
DIRECTOR1.01.0Yes (X)$9,525$0$0
JOEL VALCARCEL
DIRECTOR1.01.0Yes (X)$2,000$0$0
JOSEPH P YURKANIN
DIRECTOR1.01.0Yes (X)$2,000$0$0
MICHAEL D CAHILL
PRESIDENT & CEO40.010.0Yes (X)$331,619$0$38,698
JAMES A BRUNNEMER
CHIEF FINANCIAL OFFICER44.85.2Yes (X)$270,160$0$30,482
GAIL M DORAN
CHIEF OPERATING OFFICER40.03.0Yes (X)$261,997$0$36,477
FRED L RASP
LEAD MEDICAL ADVISOR12.08.0Yes (X)$161,338$0$0
SUZANNE S FISK
AVP OF IT & BUSINESS SERVICES48.02.0$152,807$0$20,461Yes (X)
DALE A BULTEMEIER
AVP OF ANCILLARY SERVICES42.03.0$147,032$0$23,215Yes (X)
KEVEN LINKER
CHIEF ACTUARY/DIR. OF ANALYT.48.04.0$152,329$0$29,803Yes (X)
DUSTIN CRIDER
CORPORATE CONTROLLER50.05.0$129,545$0$28,488Yes (X)
JON ALBRIGHT
GEN. COUNSEL/DIR. OF EMP. REL.47.51.0$117,390$0$27,206Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,805,867TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$234,830TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K11IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
OPTUM
11000 OPTUM CIRCLEEDEN PRAIRIEMN55344TRANSPLANT COVERAGE$1,525,991
MUNICH REINSURANCE
10900 WAYZATA BLVDMINNETONKAMN55305REINSURANCE SOLUTION$1,152,933
THE TRIZETTO GROUP
DEPT 2140 PO BOX 122140DALLASTX75312SOFTWARE VENDOR$833,141
KEYSTONE INSURANCE
1995 POINT TOWNSHIP DRNORTHUMBERLANDPA17857BROKER$587,258
MULTIPLAN INC
PO BOX 29380NEW YORKNY10087NETWORK DISCOUNT$545,895
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K31CntrctRcvdGreaterThan100KCnt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPREMIUM REVENUEDesc
Business524114BusinessCd
Total Revenue Column$179,922,300TotalRevenueColumnAmt
Related Or Exempt Func Income$179,783,425RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$138,875UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$179,922,300TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,397,533TotalRevenueColumnAmt
Exclusion$1,397,533ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$9,431,393SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$9,351,425SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$79,968SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$79,968TotalRevenueColumnAmt
Exclusion$79,968ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
ALLOCATED ADMIN524298$649,415$649,415
MISCELLANEOUS524298$18,596$18,596
FieldValueIRS element (for citing)
Other Revenue Total$668,011OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$182,067,812TotalRevenueColumnAmt
Related Or Exempt Func Income$179,802,021RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$788,290UnrelatedBusinessRevenueAmt
Exclusion$1,477,501ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$91,791TotalAmt
Program Services$91,791ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$157,303,654TotalAmt
Program Services$157,303,654ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,212,421TotalAmt
Program Services$430,773ProgramServicesAmt
Management And General$781,648ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$81,441TotalAmt
Program Services$37,875ProgramServicesAmt
Management And General$43,566ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$6,248,436TotalAmt
Program Services$2,905,914ProgramServicesAmt
Management And General$3,342,522ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$323,838TotalAmt
Program Services$150,605ProgramServicesAmt
Management And General$173,233ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,970,164TotalAmt
Program Services$916,250ProgramServicesAmt
Management And General$1,053,914ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$353,412TotalAmt
Program Services$164,359ProgramServicesAmt
Management And General$189,053ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$207,939TotalAmt
Management And General$207,939ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$212,107TotalAmt
Management And General$212,107ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$18,725TotalAmt
Management And General$18,725ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$92,732TotalAmt
Management And General$92,732ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$159,822TotalAmt
Management And General$159,822ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$618,111TotalAmt
Management And General$618,111ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$806,307TotalAmt
Management And General$806,307ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$542,556TotalAmt
Management And General$542,556ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$431,955TotalAmt
Management And General$431,955ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$114,974TotalAmt
Management And General$114,974ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$15,827TotalAmt
Management And General$15,827ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$975,780TotalAmt
Management And General$975,780ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$181,469TotalAmt
Management And General$181,469ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
COMMISSIONS$5,356,805$5,356,805
ACA ASSESSMENTS$2,903,570$2,903,570
HEALTH RELATED ACTIVITY$66,102$66,102
ACCREDITATION FEES$58,504$58,504

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,951,354TotalAmt
Program Services$6,854ProgramServicesAmt
Management And General$1,944,500ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$182,299,796TotalAmt
Program Services$170,393,056ProgramServicesAmt
Management And General$11,906,740ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$5,293,085BOYAmt
EOY$4,849,101EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$12,422,094BOYAmt
EOY$10,798,481EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$9,957,785BOYAmt
EOY$4,499,584EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$6,211,771LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$3,417,689LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$2,854,128BOYAmt
EOY$2,794,082EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$50,900,204BOYAmt
EOY$56,215,051EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$2,393,934BOYAmt
EOY$2,560,936EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$806,707BOYAmt
EOY$631,897EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$84,627,937BOYAmt
EOY$82,349,132EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$11,224,792BOYAmt
EOY$6,844,074EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$5,172,049BOYAmt
EOY$3,609,852EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$24,341,644BOYAmt
EOY$22,802,085EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$40,738,485BOYAmt
EOY$33,256,011EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$2,759,600BOYAmt
EOY$2,890,600EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$41,129,852BOYAmt
EOY$46,202,521EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$43,889,452BOYAmt
EOY$49,093,121EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$84,627,937BOYAmt
EOY$82,349,132EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$231,984ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$1,766,935NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$3,668,718OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$661,698InvestmentCostOrOtherBasisAmt
Book Value$661,698BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$3,035,177InvestmentCostOrOtherBasisAmt
Depreciation$1,731,170DepreciationAmt
Book Value$1,304,007BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$2,300,823InvestmentCostOrOtherBasisAmt
Depreciation$1,566,346DepreciationAmt
Book Value$734,477BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$214,073InvestmentCostOrOtherBasisAmt
Depreciation$120,173DepreciationAmt
Book Value$93,900BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$2,794,082TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescIBNR CLAIMS AND CLAIMS PAYABLEDesc
Amt$22,802,085Amt
FieldValueIRS element (for citing)
Total Liability$22,802,085TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$186,748,905TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$1,766,935NetUnrealizedGainsInvstAmt
Other Revenue$3,668,718OtherRevenueAmt
Revenue Not Reported$5,435,653RevenueNotReportedAmt
Revenue Subtotal$181,313,252RevenueSubtotalAmt
Investment Expenses Not Incld$92,732InvestmentExpensesNotIncldAmt
Other Revenues Not Included$661,828OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$754,560RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$182,067,812TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$181,545,236TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$181,545,236ExpensesSubtotalAmt
Investment Expenses Not Incld2$92,732InvestmentExpensesNotIncld2Amt
Other Expenses Not Included$661,828OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$754,560ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$182,299,796TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
ASC 740 FOOTNOTEMANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
PART XI, LINE 2DCHANGE IN NONADMITTED ASSETS 3,537,718 INCREASE IN CONTRIBUTED CAPITAL 131,000 TOTAL 3,668,718 PART XI, LINE 4B ADMINISTRATIVE FEES 646,001 INTEREST EXPENSE 15,827 TOTAL 661,828 PART XII, LINE 4B ADMINISTRATIVE FEES 646,001 INTEREST EXPENSE 15,827 OTHER 661,828

Schedule F IRS990ScheduleF

Account Activities Outside US AccountActivitiesOutsideUSGrp (8 entries)

RegionRegionTxtType Of Activities ConductedTypeOfActivitiesConductedTxtRegion Total ExpendituresRegionTotalExpendituresAmt
North AmericaPASSIVE INVESTMENTS$682,091
EuropePASSIVE INVESTMENTS$2,696,358
Middle East and North AfricaPASSIVE INVESTMENTS$45,485
RussiaPASSIVE INVESTMENTS$18,839
SUB-SAHARAN AFRICAPASSIVE INVESTMENTS$36,228
East Asia and the PacificPASSIVE INVESTMENTS$1,180,461
South AsiaPASSIVE INVESTMENTS$56,130
South AmericaPASSIVE INVESTMENTS$225,917
FieldValueIRS element (for citing)
Subtotal Spent$4,941,509SubtotalSpentAmt
Total Spent$4,941,509TotalSpentAmt
Transfer To Foreign CorpfalseTransferToForeignCorpInd
Interest In Foreign TrustfalseInterestInForeignTrustInd
Foreign Corp OwnershipfalseForeignCorpOwnershipInd
Passive Foreign Investmest CofalsePassiveForeignInvestmestCoInd
Foreign PartnershipfalseForeignPartnershipInd
Boycott CountriesfalseBoycottCountriesInd

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
COMMUNITY TRANS NETWORK
5601 INDUSTRIAL RDFORT WAYNEIN46825352109955501(C) 3$5,800MEDICAL ASSISTANCE
THE ALLIANCE
200 E MAIN ST STE 800FORT WAYNEIN46802351787258501(C) 3$10,750ECONOMIC DEVELOPMENT
UNITED WAY OF ALLEN COUNTY
334 E BERRY STFORT WAYNEIN46802350867932501(C) 3$6,200MEDICAL ASSISTANCE
FieldValueIRS element (for citing)
Total501c3 Org3Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PART I, LINE 2FormAndLineReferenceDesc
ExplanationCHARITABLE CONTRIBUTION EXPENDITURES ARE SUBJECT TO THE ORGANIZATION'S CONTRIBUTION POLICY WHICH CALLS FOR THE FIRST $500,000 OF NET INCOME AND 15% OF OPERATING INCOME TO BE ALLOCATED TO CHARITABLE CONTRIBUTIONS. INDIVIDUAL CHARITABLE CONTRIBUTION EXPENDITURES ARE APPROVED BY SENIOR MANAGEMENT AND REVIEWED TO ENSURE THE GRANTEE'S ELIGIBILITY AND ABILITY TO PROVIDE AN APPROPRIATE LEVEL OF MEDICAL ASSISTANCE TO THE UNDERSERVED BASED ON THE AMOUNT OF THE GRANT.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmt
MICHAEL D CAHILL
PRESIDENT & CEO$289,643$0$37,019$0$4,957$0$13,250$0$25,448$0$370,317$0
JAMES A BRUNNEMER
CHIEF FINANCIAL OFFICER$231,145$0$39,015$0$0$0$13,250$0$17,232$0$300,642$0
GAIL M DORAN
CHIEF OPERATING OFFICER$207,583$0$54,414$0$0$0$13,045$0$23,432$0$298,474$0
FRED L RASP
LEAD MEDICAL ADVISOR$161,338$0$0$0$0$0$0$0$0$0$161,338$0
SUZANNE S FISK
AVP OF IT & BUSINESS SERVICES$137,424$0$15,383$0$0$0$4,551$0$15,910$0$173,268$0
DALE A BULTEMEIER
AVP OF ANCILLARY SERVICES$131,205$0$15,827$0$0$0$7,296$0$15,919$0$170,247$0
KEVEN LINKER
CHIEF ACTUARY/DIR. OF ANALYT.$136,363$0$15,966$0$0$0$7,561$0$22,242$0$182,132$0
DUSTIN CRIDER
CORPORATE CONTROLLER$115,958$0$13,587$0$0$0$6,422$0$22,066$0$158,033$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE J, PART I, LINE 1BFormAndLineReferenceDesc
ExplanationMICHAEL CAHILL WAS PROVIDED SOCIAL CLUB DUES TO PROVIDE A VENUE FOR CONDUCTING COMPANY BUSINESS. ALL TIME ACCESSING THE BENEFIT WAS RELATED TO COMPANY BUSINESS. AS A RESULT, IT WAS NOT TREATED AS TAXABLE INCOME TO THE INDIVIDUAL.ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

FieldValueIRS element (for citing)
PersonSEAN CAHILLPersonNm
FieldValueIRS element (for citing)
Relationship DescriptionSON OF CEO/PRESIDENTRelationshipDescriptionTxt
Transaction$81,441TransactionAmt
TransactionEMPLOYEE OF PHPTransactionDesc
Sharing Of RevenuesfalseSharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART IV, LINE 12PHYSICIAN HEALTH PLAN'S AUDITED FINANCIAL STATEMENTS ARE PREPARED USING ACCOUNTING PRACTICES PRESCRIBED OR PERMITTED BY THE INDIANA DEPARTMENT OF INSURANCE, WHICH PRACTICES DIFFER FROM ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA.
FORM 990, PART VI, SECTION A, LINE 1BJAMES WEHRENBERG and MICHAEL DEWALD ARE NON-INDEPENDENT VOTING MEMBERS OF THE BOARD BECAUSE THEY ARE COMPENSATED GREATER THAN $10,000 BY THE FILING ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 6ONLY ONE MEMBER CLASS EXISTS. MEMBERS WITHIN ALLEN COUNTY, INDIANA PAY A $2,000 MEMBERSHIP FEE. MEMBERS IN THE INDIANA COUNTIES SURROUNDING ALLEN (DEKALB, NOBLE, WHITLEY, HUNTINGTON, WELLS, AND ADAMS) PAY A $500 MEMBERSHIP FEE. MEMBERS, NO MATTER THEIR LOCATION, HAVE THE SAME VOTING RIGHTS AND ARE ASSOCIATED WITH THE SAME FEE TABLE. THERE ARE NO MEMBERS OUTSIDE OF THE COUNTIES LISTED ABOVE IN PHP'S 40 COUNTY SERVICE AREA.
FORM 990, PART VI, SECTION A, LINE 7ATHE BOARD OF DIRECTORS CONSISTS OF NO LESS THAN THIRTEEN TO NO MORE THAN SEVENTEEN MEMBERS. THE DIRECTORS MUST BE CLASSIFIED AS PHYSICIAN DIRECTORS OR CONSUMER DIRECTORS. PHYSICIAN DIRECTORS MUST REPRESENT AT LEAST ONE-HALF BUT NO MORE THAN TWO-THIRDS OF THE TOTAL DIRECTORS OF THE BOARD AND CONSUMER DIRECTORS MUST CONSIST OF AT LEAST ONE THIRD OF THE TOTAL DIRECTORS OF THE BOARD. THE PHYSICIAN DIRECTORS ARE ELECTED BY THE MEMBER DOCTORS AND THEN THE ELECTED PHYSICIAN DIRECTORS APPOINT THE CONSUMER DIRECTORS. ALL DIRECTORS, PHYSICIAN OR CONSUMER, HAVE THE SAME VOTING RIGHTS.
FORM 990,PART VI, SECTION A, LINE 7BMEMBER DOCTORS HAVE THE ABILITY TO ELECT AND REMOVE MEMBERS OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 AND RELATED SCHEDULES UNDERGO A THOROUGH REVIEW BY THE CONTROLLER, CHIEF FINANCIAL OFFICER, AND AN INDEPENDENT CPA FIRM. IN ADDITION, A COPY OF THE 990 IS EMAILED TO THE GOVERNING BODY. THE GOVERNING BODY REVIEWS THE 990 AND SUBMITS ANY QUESTIONS, COMMENTS, OR CORRECTIONS PRIOR TO SUBMISSION TO THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CA QUESTIONNAIRE IS SENT OUT ANNUALLY TO ALL OFFICERS, DIRECTORS OR TRUSTEES, AND KEY EMPLOYEES TO DISCLOSE PERSONAL AND BUSINESS RELATIONSHIPS. THE QUESTIONNAIRES ARE REVIEWED ANNUALLY. IF A CONFLICT EXISTS, RESTRICTIONS WILL BE IMPOSED ON PERSONS WITH A CONFLICT SUCH AS PROHIBITING THEM FROM PARTICIPATING IN THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS IN THE TRANSCATIONS.
FORM 990, PART VI, SECTION B, LINE 15ATHE CEO'S PAY (INCLUDING BASE PAY AND BONUS) IS REVIEWED AND DETERMINED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE INCLUDES THE BOARD CHAIR AND VICE-CHAIR (BOTH OF WHICH ARE MEMBER DOCTORS) AND FOUR OF THE CONSUMER DIRECTORS. BONUS PAY IS DETERMINED ANNUALLY. BASE PAY IS REVIEWED PERIODICALLY BASED ON THE PROVISIONS SET FORTH IN THE CEO'S EMPLOYMENT AGREEMENT. A REVIEW INVOLVING AN INDEPENDENT THIRD-PARTY CONSULTANT WAS CONDUCTED DURING 2016 TO DETERMINE 2016 BASE PAY. THESE REVIEWS INCLUDE A REVIEW OF COMPARABILITY DATA FROM SOURCES SUCH AS WARREN SALARY SURVEY. CONTEMPORANEOUS SUBSTANTIATION OF THE RESULTING DECISIONS IS RETAINED.
FORM 990, PART VI, SECTION B, LINE 16BTHE ORGANIZATION HAS AN INFORMAL NON-WRITTEN POLICY REQUIRING THE ORGANIZATION TO EVALUATE ITS PARTICIPATION IN JOINT VENTURE AGREEMENTS UNDER APPLICABLE FEDERAL TAX LAW, AND TAKES STEPS TO SAFEGUARD THE ORGANIZATION'S EXEMPT STATUS WITH RESPECT TO SUCH ARRANGEMENTS.
FORM 990, PART VI, SECTION C, LINE 19PHYSICIANS HEALTH PLAN'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE FOR PUBLIC INSPECTION. PHYSICIANS HEALTH PLAN'S FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS (NAIC) WEBSITE.
FORM 990, PART XI, LINE 9INCREASES IN CONTRIBUTED CAPITAL $131,000 CHANGES IN NONADMITTED ASSETS $3,537,718 TOTAL $3,668,718

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1PHP FOUNDATION INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line18101 W JEFFERSON BLVDAddressLine1Txt
CityFORT WAYNECityNm
State AbbreviationINStateAbbreviationCd
ZIP46804ZIPCd
FieldValueIRS element (for citing)
EIN204615314EIN
Primary ActivitiesPRIVATE FDNPrimaryActivitiesTxt
Legal Domicile StateINLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusPFPublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1PHPNIBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationfalseControlledOrganizationInd

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationInd
PHP HOLDING CO
8101 W JEFFERSON BLVDFORT WAYNEIN46804208074365HOLDING COINPHPNIC CORP$628,405$2,948,6431.00000Yes (true)
PHP MANAGEMENT SYSTEMS
8101 W JEFFERSON BLVDFORT WAYNEIN46804351826719LICENSED TPAINPHP HOLDING COC CORPYes (true)
PHP INSURANCE COMPANY OF INDIANA INC
8101 W JEFFERSON BLVDFORT WAYNEIN46804203064284STOP-LOSS REINSURINPHP HOLDING COC CORPYes (true)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
PHP HOLDING COMPANY
B$300,000CASH PAYMENT
PHP MANAGEMENT SYSTEMS
L$609,597COST

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.