2012-11-13T11:04:31-06:00 2011-12-31 BKD LLP 200 E Main St Suite 700 Fort Wayne IN 46802 990 2011-01-01 311069321 PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA INC % DUSTIN W CRIDER PHYS 2604326690 8101 WEST JEFFERSON BLVD FORT WAYNE IN 46804 JAMES A BRUNNEMER 2012-11-15 true Joyce A Dulworth 2604604000 2011 2016-02-24 21:20:13Z DR DAVID W STEIN 8101 WEST JEFFERSON BLVD FORT WAYNE IN 46804 177618316 false X WWW.PHPNI.COM X 1983 IN THE ORGANIZATION HAS BEEN ABLE TO PROVIDE INSURANCE COVERAGE AND EDUCATIONAL MATERIALS PROMOTING A HEALTHY LIFESTYLE TO THOUSANDS OF INDIVIDUALS AND FAMILIES THROUGHOUT NORTHERN INDIANA. 15 12 110 401400 0 0 152389253 152438753 3146056 2446774 419716 522047 155955025 155407574 530068 1166750 133916546 129481899 8849001 8887084 0 0 0 10067675 10185439 153363290 149721172 2591735 5686402 64584421 64468042 29654365 25728787 34930056 38739255 X PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA, INC. IS SPONSORED BY INDEPENDENT PHYSICIANS AS A NOT-FOR-PROFIT, INDIANA CERTIFIED AND FEDERALLY QUALIFIED HEALTH MAINTENANCE ORGANIZATION. THROUGH OUR PROGRAM SERVICES, WE PROVIDE INSURANCE COVERAGE AND EDUCATIONAL MATERIALS PROMOTING A HEALTHY LIFESTYLE TO THOUSANDS OF INDIVIDUALS AND FAMILIES THROUGHOUT NORTHERN INDIANA. false false 141341133 1166750 152559400 PHP Sweet Rewards is a telephonic diabetes disease management program offered to members with diabetes. Members complete a health risk assessment, and submit glucose logs and test results. Members have access to educational material about diabetes and speak to a nurse regularly to reinforce teaching and answer any questions. This program is designed to assist the member in changing their lifestyle in order to minimize complications and achieve a healthier lifestyle. Members receive rewards such as waived co-pays or gift cards to help offset the cost of diabetic supplies and medications. Inches Away is an incentive program for losing weight. Members can participate in a weight loss program of their choice. Inches Away rewards at least a 10% body weight loss with a financial award, and then when the member has kept the weight off for one year, another financial award is provided. Members qualify if they have a BMI of 27 or greater. Members are weighed at the beginning of the program, when they have achieved the weight loss and then again after a year of keeping the weight off. All weights are documented by the attending physician. Members have the ability to earn up to $1500 with successful completion of all steps of the program. PHP has discounted rates on health related activities including membership to gyms and other community businesses feared toward healthy lifestyles. Members access this information via the web and direct mail. 24/7/365 nurse line available to all members for any questions they may have regarding current or emergent healthcare issues or conditions that they may have questions about. PHP's website is filled with information, resources, and tips for members to use to meet their healthcare needs. This website was recently redesigned to enhance user friendliness and be even more useful to our members. Our health risk assessment is available on the website as are many other forms and information to access resources for the member. PHP provides an RN to assist employer groups with health fairs, screenings, and educational information related to a variety of diagnoses and conditions in order to assist them in managing the health needs of their employees. PHP has a smoking cessation program for members to encourage them to improve their health by stopping smoking. PHP will cover Chantix up to 24 weeks of therapy per attempt with one attempt per year. If a member would like to take advantage of a different program, they can pay for that program up front and PHP will reimburse up to $300/lifetime/member at the successful completion of their first smoke free year. PHP provides several member and employer health education programs including distribution of Self-Care Essentials which is a book that has lots of health and lifestyle tips, management of everyday condition information, and just in time reminders about healthy lifestyle initiatives; PHP Member Handbook which assists members with navigation through information that need to become informed consumers of health care as well as information about insurance, their rights, providers, etc.; Health News, the PHP newsletter that is published quarterly and includes information on healthy lifestyles, information about physicians, navigation through the healthcare system, fitness, nutrition, safety, preventative healthcare screenings, etc.; several brochures on various conditions that can educate consumers of healthcare and help them make choices that would benefit their health. All these materials are provided in English and Spanish. 141341133 false false false false false false false false false false true false false false true false false false false false true false false false false false false true false true false false false false false false false true false false false false false true true true false true 2039 0 true 110 true true true false false false false false X 15 12 false false false false true true true true true false false true true true true true true true false true false IN X DUSTIN W CRIDER 2604326690 8101 WEST JEFFERSON BLVD FORT WAYNE IN 46804 X DAVID W STEIN MD 4.0 X X 66315 0 0 JAMES C WEHRENBERG MD 1.0 X X 7125 0 0 KARL R LAPAN 1.0 X X 7000 0 0 MICHAEL R DEWALD CPA 1.0 X X 10475 0 0 PETER P FETTIG 1.0 X 4250 0 0 THERESA A GUTIERREZ MD 1.0 X 3500 0 0 ANDREANA L HODGINI DO 1.0 X 1875 0 0 MICHAEL LARKIN 1.0 X 7875 0 0 DAVID E LENTZ DO 1.0 X 2000 0 0 ANDREW O'SHAUGHNESSY MD 1.0 X 2500 0 0 FRED L RASP MD 1.0 X 12850 0 0 DONALD F SCHENKEL 1.0 X 6750 0 0 RON L SLOAN MD 1.0 X 1500 0 0 JOSEPH P YURKANIN MD 1.0 X 2000 0 0 JERRY A DEARTH 1.0 X 3000 0 0 RHYS A RUDOLPH 1.0 X 5000 0 0 PHILIP C WRIGHT MD 39.0 X 376808 0 33185 JAMES A BRUNNEMER 44.0 X 305144 0 27292 GAIL M DORAN 49.0 X 267874 0 27046 DALE BULTEMEIER 42.0 X 160608 0 22812 KEVEN LINKER 42.0 X 159943 0 22821 DUSTIN CRIDER CPA 50.0 X 135090 0 21630 TERESA BAIR 50.0 X 131684 0 15885 SUZANNE FISK 49.0 X 139634 0 10125 CARRIE MARION 39.0 X 135623 0 10600 JAY M GILBERT 34.0 X 355297 0 31286 2311720 0 222682 12 true true false WELLS FARGO INSURANCE SERVICES LLC PO BOX 885 FORT WAYNE IN 46801 BROKER 710392 NHBC 17851 N 85TH STREET STE 105 SCOTTSDALE AZ 85255 PROVIDER NETWORKS 605121 THE TRIZETTO GROUP INC DEPT 2140 PO BOX 122140 DALLAS TX 75312 SOFTWARE VENDOR 606940 RBS RE 7301 SW 57TH COURT SUITE 450 SOUTH MIAMI FL 33143 REINSURER 2256921 ONB INSURANCE GROUP PO BOX 80159 INDIANAPOLIS IN 46280 BROKER 407082 24 0 PREMIUM REVENUE 524114 152438753 152363952 74801 152438753 1558581 1558581 0 0 23098935 22210742 888193 888193 888193 0 0 0 ALLOCATED ADMIN 524298 334340 334340 PARTNERSHIP INCOME 524298 -7741 -7741 MISCELLANEOUS 900099 195448 195448 522047 155407574 152559400 401400 2446774 1166750 1166750 0 0 129481899 129481899 1751367 598617 1152750 0 5183089 2524164 2658925 269870 131427 138443 1378752 671452 707300 304006 148051 155955 0 108009 108009 88080 88080 20370 20370 0 64167 64167 100857 100857 0 362362 362362 685443 685443 237421 237421 0 534841 534841 102654 102654 0 0 0 0 347354 347354 129189 129189 COMMISSIONS 5718637 5718637 PREMIUM TAXES - ICHIA 573141 573141 HEALTH RELATED ACTIVITY 185304 185304 MEMBER MATERIALS 77494 77494 850116 64197 785919 149721172 141341133 8380039 0 -708303 -1028665 9433279 8355091 0 0 3357256 1684945 0 0 0 0 0 0 0 0 0 0 4691484 2629765 2134325 2061719 47449590 50689942 2274974 2256080 0 0 0 0 643300 448930 64584421 64468042 2879532 3591400 0 0 4425510 3769538 0 0 0 0 0 0 0 0 0 0 22349323 18367849 29654365 25728787 X 0 0 2278600 2355600 32651456 36383655 34930056 38739255 64584421 64468042 X 5686402 -1877203 X false true true X false 400300 400300 2724373 1317217 1407156 1436996 1216825 220171 129815 95723 34092 2061719 0 IBNR CLAIMS AND CLAIMS PAYABLE 18367849 18367849 155407574 149721172 5686402 -1074610 -802593 -1877203 3809199 153136640 -1074610 -802593 -1877203 155013843 393731 393731 155407574 149327441 149327441 393731 393731 149721172 PART X FIN 48 FOOTNOTE MANAGEMENT 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. SCHEDULE D PART XI, LINE 8 & PART XII, LINE 2D: $(188,858) CHANGES IN NONADMITTED ASSETS + $77,000 INCREASE IN CONTRIBUTED CAPITAL + (690,735) TEMP IMPAIRMENT OF STOCK = $(802,593) PART XII, LINE 4B & PART XIII, LINE 4B: $329,564 ADMINISTRATIVE FEES + $64,167 INVESTMENT FEES = $393,731 East Asia and the Pacific Investments 4512268 Europe (Including Iceland and Greenland) Investments 2228358 North America Investments 1888944 South America Investments 175085 Sub-Saharan Africa Investments 77569 South Asia Investments 72725 Russia and the Newly Independent States Investments 54942 Middle East and North Africa Investments 48336 9058227 9058227 false false false false false false true CANCER SERVICES OF NORTHEAST INDIANA 2925 E STATE BLVD FORT WAYNE IN 46805 352089785 501(C)(3) 10000 MEDICAL ASSISTANCE FRANCINE'S FRIENDS 709 CLAY STREET 300 FORT WAYNE IN 46802 383730516 501(C)(3) 50000 MEDICAL ASSISTANCE AMERICAN HEART ASSOCIATION 460 LINDBERGH BLVD ST LOUIS MO 63141 135613797 501(C)(3) 22598 MEDICAL ASSISTANCE PHP FOUNDATION 8101 W JEFFERSON BLVD FORT WAYNE IN 46804 204615314 501(C)(3) 1004716 MEDICAL ASSISTANCE FORT WAYNE PHILHARMONIC 4901 FULLER DRIVE FORT WAYNE IN 46835 350867932 501(C)(3) 8100 MEDICAL ASSISTANCE 5 GRANTS AND ALLOCATIONS SCHEDULE I CHARITABLE 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. X X X X X X false false false false false false false false false JAY M GILBERT 214980 0 133671 0 6646 0 12250 0 19036 0 386583 0 0 0 PHILIP C WRIGHT MD 254110 0 122698 0 0 0 12250 0 20935 0 409993 0 0 0 JAMES A BRUNNEMER 205850 0 99294 0 0 0 11399 0 15893 0 332436 0 0 0 GAIL M DORAN 188834 0 79040 0 0 0 9417 0 17629 0 294920 0 0 0 DALE BULTEMEIER 120184 0 40424 0 0 0 6552 0 16260 0 183420 0 0 0 KEVEN LINKER 119359 0 40584 0 0 0 6557 0 16264 0 182764 0 0 0 DUSTIN CRIDER CPA 100853 0 34237 0 0 0 5603 0 16027 0 156720 0 0 0 PHP MANAGEMENT SYSTEMS INC FOR PROFIT SUB-100% OWNED 281723 PERFORMANCE OF SERVICES false SCHEDULE L TRANSACTIONS WITH RELATED ORGANIZATIONS ARE DISCLOSED TO BE IN COMPLIANCE WITH IRS PRESCRIBED INSTRUCTIONS. PER THE FORM 990 INSTRUCTIONS, TRANSACTIONS BETWEEN ENTITIES WITH COMMON OFFICERS SHOULD BE DISCLOSED ON SCHEDULE L PART IV. THE TRANSACTION LISTED IN PART IV IS DISCLOSED ONLY DUE TO COMMON OFFICER RELATIONSHIP AND NOT DUE TO OWNERSHIP BY INTERESTED PERSONS. PART IV QUESTION 12 PHYSICIAN 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. PART VI, SECTION A QUESTION 1A DR. DAVID STEIN AGREED TO SERVE AS INTERIM CEO OF PHP AND ITS AFFILIATES DURING THE SEARCH FOR A FULL-TIME CEO. DR. STEIN DEVOTED APPROXIMATELY ONE DAY PER WEEK TO THE CEO POSITION AND WAS COMPENSATED FOR HIS CONSULTING SERVICES IN THIS CAPACITY. QUESTION 6 ONLY 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. QUESTION 7A: MEMBER DOCTORS ELECT 10 MEMBER DOCTORS TO SIT ON THE COMPANY'S GOVERNING BOARD OF DIRECTORS. THE 10 MEMBER DOCTORS WHICH ARE PART OF THE BOARD APPOINT THE 5 CONSUMER MEMBERS OF THE BOARD OF DIRECTORS. ALL 15 MEMBERS OF THE BOARD OF DIRECTORS HAVE THE SAME VOTING RIGHTS. QUESTION 7B MEMBER DOCTORS HAVE THE ABILITY TO ELECT AND REMOVE MEMBERS OF THE GOVERNING BODY. PART VI, SECTION B QUESTION 11B THE 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. QUESTION 12C A 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 TRANSACTIONS. QUESTION 15A THE CEO'S PAY (INCLUDING BASE PAY AND BONUS) ARE 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 THREE OF THE FIVE CONSUMER DIRECTORS. BONUS PAY IS DETERMINED ANNUALLY. BASE PAY IS REVIEWED EVERY THREE YEARS. A REVIEW INVOLVING AN INDEPENDENT THIRD-PARTY CONSULTANT WAS COMPLETED DURING 2010 TO DETERMINE 2011 BASE PAY. THIS REVIEW RESULTED IN NO CHANGE TO 2011 BASE PAY FROM 2010. THESE REVIEWS INCLUDE A REVIEW OF COMPARABILITY DATA FROM SOURCES SUCH AS WARREN SALARY SURVEY. CONTEMPORANEOUS SUBSTANTIATION OF THE RESULTING DECISIONS IS RETAINED. QUESTION 16B THE 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. PART VI, SECTION C QUESTION 19 PHYSICIANS HEALTH PLAN'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE FOR PUBLIC INSPECTION. PHYSICIANS HEALTH PLAN'S FINANCIAL STATEMENTS ARE AVAILABLE THRU THE NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS (NAIC) WEBSITE. NET ASSET RECONCILIATION PART XI LINE 5 $77,000 INCREASE IN CONTRIBUTED CAPITAL + $(1,074,610) UNREALIZED GAINS + $(188,858) CHANGES IN NONADMITTED ASSETS +(690,735) TEMP IMPAIRMENT OF STOCK = $(1,877,203) HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PHILIP C WRIGHT MD TITLE:MEDICAL DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAMES A. BRUNNEMER TITLE:CHIEF FINANCIAL OFFICER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GAIL M DORAN TITLE:CHIEF OPERATIONS OFFICER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DALE BULTEMEIER TITLE:ASST VP OF ANCILLARY SERVICES HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KEVEN LINKER TITLE:DIRECTOR OF ACTUARIAL SERVICES HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DUSTIN CRIDER CPA TITLE:CORPORATE CONTROLLER HOURS:5 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TERESA BAIR TITLE:DIRECTOR OF SALES HOURS:5 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SUZANNE FISK TITLE:EXEC. DIRECTOR OF OPERATIONS HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CARRIE MARION TITLE:EXEC. DIRECTOR OF HEALTH SVCS HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAY M GILBERT TITLE:CHIEF EXECUTIVE OFFICER HOURS:1 PHP FOUNDATION INC 8101 WEST JEFFERSON BLVD FORT WAYNE IN 46804 204615314 PRIVATE FDN IN 501(C)(3) PF NA false PHP HOLDING COMPANY 8101 WEST JEFFERSON BLVD FORT WAYNE IN 46804 208074365 HOLDING CO. IN PHP OF NI C CORPORATION 9286 2319688 1.00000 PHP MANAGEMENT SYSTEMS INC 8101 WEST JEFFERSON BLVD FORT WAYNE IN 46804 351826719 LICENSED TPA IN PHP HOLDING CO C CORPORATION PHP INSURANCE COMPANY OF INDIANA INC 8101 WEST JEFFERSON BLVD FORT WAYNE IN 46804 203064284 DENTAL INS. IN PHP HOLDING CO C CORPORATION false true false false false false false false false false true false true true false true false false