COREWELL HEALTH: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- COREWELL HEALTH (EIN 31-1069321)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-08
- IRS object ID
- 201103129349300610
- Schema version
- 2010v3.4
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-08T08:23:56-06:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 E Main St Suite 700 | AddressLine1 |
| City | Fort Wayne | City |
| State | IN | State |
| ZIP Code | 46802 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311069321 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PHYSICIANS HEALTH PLAN | BusinessNameLine1 |
| Business Name Line2 | OF NORTHERN INDIANA INC | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PHYS | NameControl |
| Phone | 2604326690 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8101 WEST JEFFERSON BLVD | AddressLine1 |
| City | FORT WAYNE | City |
| State | IN | State |
| ZIP Code | 46804 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES A BRUNNEMER | Name |
| Title | CFO | Title |
| Phone | 2604326690 | Phone |
| Date Signed | 2011-11-07 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Joyce A Dulworth | Name |
| Phone | 2604604000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JAY M GILBERT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8101 WEST JEFFERSON BLVD | AddressLine1 |
| City | FORT WAYNE | City |
| State | IN | State |
| ZIP Code | 46804 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 163172443 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.PHPNI.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1983 | YearFormation |
| State Legal Domicile | IN | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 15 | NbrIndependentVotingMembers |
| Total Nbr Employees | 112 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 385820 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 143717261 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 152389253 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -699408 | InvestmentIncomePriorYear |
| Investment Income Current Year | 3146056 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 423486 | OtherRevenuePriorYear |
| Other Revenue Current Year | 419716 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 143441339 | TotalRevenuePriorYear |
| Total Revenue Current Year | 155955025 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 107825 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 530068 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 131263706 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 133916546 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 8154370 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 8849001 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 11158775 | OtherExpensePriorYear |
| Other Expenses Current Year | 10067675 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 150684676 | TotalExpensesPriorYear |
| Total Expenses Current Year | 153363290 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -7243337 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2591735 | RevenuesLessExpensesCY |
| Total Assets BOY | 61572421 | TotalAssetsBOY |
| Total Assets EOY | 64584421 | TotalAssetsEOY |
| Total Liabilities BOY | 29657636 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 29654365 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 31914785 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 34930056 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 145407591 | Expense |
| Grants | 530068 | Grants |
| Revenue | 152423149 | Revenue |
| Description | THE INCHES AWAY PROGRAM OFFERS REIMBURSEMENT FOR PARTICIPATION IN A PHYSICIAN SUPERVISED WEIGHT LOSS PROGRAM FOR ADULTS AND ADOLESCENTS WITH UP TO $3000/MEMBER/LIFETIME. THE UNDER PRESSURE PROGRAM TARGETS EDUCATIONAL MAILINGS FOR THOSE MEMBERS WITH HIGH BLOOD PRESSURE. NINE MONTHLY MAILINGS PROVIDE MEDICATION, NUTRITION AND EXERCISE INFORMATION TO TEACH MEMBERS HOW TO IMPROVE THEIR BLOOD PRESSURE AND LOWER THEIR RISK FOR OTHER COMPLICATIONS. SWEET PHP REWARDS IS A TELEPHONIC DIABETES DISEASE MANAGEMENT PROGRAM OFFERED TO ALL MEMBERS WITH DIABETES. PARTICIPATION IN THE PROGRAM REQUIRES MEMBERS TO COMPLETE A HEALTH ASSESSMENT, SUBMIT BLOOD GLUCOSE LOGS, AND TEST RESULTS SUCH AS ALC AND CHOLESTEROL. MEMBERS ALSO SPEAK DIRECTLY TO AN RN CARE MANAGER WHO PROVIDES THEM WITH EDUCATIONAL INFORMATION TO ASSIST THEM WITH IMPROVING THEIR LIFESTYLES RELATED TO WEIGHT LOSS, EXERCISE, SMOKING CESSATION ETC. MEMBERS RECEIVE REWARDS SUCH AS WAIVED CO-PAYS OR GIFT CARDS TO HELP OFFSET THE COST OF DIABETIC SUPPLIES, DIABETIC MEDICATIONS, HIGH BLOOD PRESSURE MEDICINE AND CHOLESTEROL LOWERING MEDICATIONS. HEALTHWISE SELF CARE HANDBOOKS (~1,000 DISTRIBUTED TO MEMBERS VIA EMPLOYER GROUPS, AND TO COMMUNITY AGENCIES UPON REQUEST AND APPROVAL. THIS PUBLICATION WAS ALSO PROVIDED IN SPANISH WHEN REQUESTED. HEALTH RELATED BROCHURES DISTRIBUTED TO NUMEROUS EMPLOYER GROUPS, MEMBER HOMES, AND PHYSICIAN OFFICERS. PREVENTIVE HEALTH CARE, SAFETY, AND OTHER HEALTHCARE REMINDERS PROVIDED WEEKLY TO MEMBERS AND PROVIDERS VIA DESIGNATED OUTGOING MAIL (~4,500 PER WEEK). SMOKING CESSATION LITERATURE, RESOURCE LIST, AND CLASS SCHEDULES PROVIDED TO OUR MEMBERS AND PROVIDERS VIA EMPLOYER GROUPS AND TO ALL INTERESTED MEMBERS BY REQUEST. SMOKING REIMBURSEMENT UP TO $300/LIFETIME AVAILABLE, INFORMATION IS AVAILABLE THROUGH CUSTOMER SERVICE. PHP ALSO OFFERS PRESCRIPTION MEDICATION TO ASSIST WITH SMOKING CESSATION. HEALTHNEWS NEWSLETTER PUBLISHED QUARTERLY AND PROVIDED TO MEMBERS AND PROVIDERS. CONTAINS EDUCATIONAL ARTICLES RELATED TO FITNESS, NUTRITION, SAFETY, PREVENTIVE HEALTHCARE SCREENS, AND DISEASE PREVENTION MEASURES. SPECIAL DISCOUNT RATES FOR PHP MEMBERS NEGOTIATED WITH COMMUNITY BUSINESSES FOR HEALTHY LIFESTYLE CLASSES AND CLUBS. MEMBERS NOTIFIED VIA DIRECT MAIL AND WEBSITE. ASSISTED WITH EMPLOYER SPONSORED HEALTH FAIRS, BLOOD SCREENINGS PROVIDING BLOOD PRESSURE SCREENINGS, AND EDUCATIONAL INFORMATION RELATED TO CARDIOVASCULAR DISEASE, DIABETES, CHOLESTEROL, DIET AND NUTRITION. | Description |
| Total Program Service Expense | 145407591 | TotalProgramServiceExpense |
| Described In501 C3 | false | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | true | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | true | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 2115 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 112 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 15 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | true | InvestmentInJointVenture |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | IN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DUSTIN W CRIDER | NamePerson |
| Telephone Number | 2604326690 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8101 WEST JEFFERSON BLVD | AddressLine1 |
| City | FORT WAYNE | City |
| State | IN | State |
| ZIP Code | 46804 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (24 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| DAVID W STEIN MD | |||||||
| CHAIRMAN | 1.0 | X | X | 7500 | 0 | 0 | |
| JAMES C WEHRENBERG MD | |||||||
| VICE CHAIRMAN | 1.0 | X | X | 4750 | 0 | 0 | |
| KARL R LAPAN | |||||||
| SECRETARY | 1.0 | X | X | 6000 | 0 | 0 | |
| MICHAEL R DEWALD CPA | |||||||
| TREASURER | 1.0 | X | X | 6600 | 0 | 0 | |
| PETER P FETTIG | |||||||
| DIRECTOR | 1.0 | X | 5625 | 0 | 0 | ||
| THERESA A GUTIERREZ MD | |||||||
| DIRECTOR | 1.0 | X | 2500 | 0 | 0 | ||
| ANDREANA L HODGINI DO | |||||||
| DIRECTOR | 1.0 | X | 4000 | 0 | 0 | ||
| MICHAEL LARKIN | |||||||
| DIRECTOR | 1.0 | X | 7500 | 0 | 0 | ||
| DAVID E LENTZ DO | |||||||
| DIRECTOR | 1.0 | X | 2500 | 0 | 0 | ||
| ANDREW O'SHAUGHNESSY MD | |||||||
| DIRECTOR | 1.0 | X | 1000 | 0 | 0 | ||
| FRED L RASP MD | |||||||
| DIRECTOR | 1.0 | X | 3000 | 0 | 0 | ||
| DONALD F SCHENKEL | |||||||
| DIRECTOR | 1.0 | X | 3750 | 0 | 0 | ||
| RON L SLOAN MD | |||||||
| DIRECTOR | 1.0 | X | 2500 | 0 | 0 | ||
| JOSEPH P YURKANIN MD | |||||||
| DIRECTOR | 1.0 | X | 2500 | 0 | 0 | ||
| JERRY A DEARTH | |||||||
| DIRECTOR | 1.0 | X | 3000 | 0 | 0 | ||
| JAY M GILBERT | |||||||
| CHIEF EXECUTIVE OFFICER | 49.0 | X | 355873 | 0 | 37038 | ||
| PHILIP C WRIGHT MD | |||||||
| MEDICAL DIRECTOR | 39.0 | X | 296822 | 0 | 31116 | ||
| JAMES A BRUNNEMER | |||||||
| CHIEF FINANCIAL OFFICER | 44.0 | X | 229076 | 0 | 27219 | ||
| GAIL M DORAN | |||||||
| CHIEF OPERATIONS OFFICER | 49.0 | X | 189437 | 0 | 25078 | ||
| DALE BULTEMEIER | |||||||
| ASST VP OF ANCILLARY SERVICES | 42.0 | 132149 | 0 | 21876 | X | ||
| KEVEN LINKER | |||||||
| DIRECTOR OF ACTUARIAL SERVICES | 42.0 | 131144 | 0 | 20731 | X | ||
| BRIAN W STEINER | |||||||
| SENIOR ACCOUNT EXECUTIVE | 40.0 | 194586 | 0 | 23214 | X | ||
| DUSTIN CRIDER CPA | |||||||
| CORPORATE CONTROLLER | 50.0 | 112061 | 0 | 19544 | X | ||
| TERESA BAIR | |||||||
| DIRECTOR OF SALES | 50.0 | 109486 | 0 | 15297 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1813359 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 221113 | TotalOtherCompensation |
| Number Individuals GT100 K | 10 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES LLC | |||||
| PO BOX 885 | FORT WAYNE | IN | 46801 | BROKER | 798067 |
| NHBC | |||||
| 17851 N 85TH STREET STE 105 | SCOTTSDALE | AZ | 85255 | PROVIDER NETWORKS | 563976 |
| THE TRIZETTO GROUP INC | |||||
| DEPT 2140 PO BOX 122140 | DALLAS | TX | 75312 | SOFTWARE VENDOR | 575976 |
| ONEBEACON PROFESSIONAL PARTNERS | |||||
| 30 TOWER LANE | AVON | CT | 06001 | REINSURER | 964370 |
| ONB INSURANCE GROUP | |||||
| PO BOX 80159 | INDIANAPOLIS | IN | 46280 | BROKER | 454847 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 21 | NumberOfContractorsGT100K |
| Total Contributions | 0 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PREMIUM REVENUE | Description |
| Business Code | 524114 | BusinessCode |
| Total Revenue Column | 152389253 | TotalRevenueColumn |
| Related Or Exempt Function Income | 152291490 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 97763 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 152389253 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1608073 | TotalRevenueColumn |
| Exclusion | $1,608,073 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 8755401 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 7217418 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1537983 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1537983 | TotalRevenueColumn |
| Exclusion | $1,537,983 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| ALLOCATED ADMIN | 524298 | 288057 | 288057 | |
| MISCELLANEOUS | 900099 | 131659 | 131659 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 419716 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 155955025 | TotalRevenueColumn |
| Related Or Exempt Function Income | 152423149 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 385820 | UnrelatedBusinessRevenue |
| Exclusion | $3,146,056 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 530068 | Total |
| Program Services | 530068 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 133916546 | Total |
| Program Services | 133916546 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2034472 | Total |
| Program Services | 738717 | ProgramServices |
| Management And General | 1295755 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4984152 | Total |
| Program Services | 2651569 | ProgramServices |
| Management And General | 2332583 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 220641 | Total |
| Program Services | 117381 | ProgramServices |
| Management And General | 103260 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1343472 | Total |
| Program Services | 714727 | ProgramServices |
| Management And General | 628745 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 266264 | Total |
| Program Services | 141652 | ProgramServices |
| Management And General | 124612 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 99567 | Total |
| Management And General | 99567 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 107425 | Total |
| Management And General | 107425 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19981 | Total |
| Management And General | 19981 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Fundraising | 0 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60000 | Total |
| Management And General | 60000 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 95789 | Total |
| Management And General | 95789 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 500258 | Total |
| Management And General | 500258 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 765899 | Total |
| Management And General | 765899 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 222061 | Total |
| Management And General | 222061 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 450276 | Total |
| Management And General | 450276 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 99597 | Total |
| Management And General | 99597 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21 | Total |
| Management And General | 21 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 588828 | Total |
| Management And General | 588828 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 129577 | Total |
| Management And General | 129577 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| COMMISSIONS | 5711179 | 5711179 | |
| PREMIUM TAXES - ICHIA | 627015 | 627015 | |
| HEALTH RELATED ACTIVITY | 196933 | 196933 | |
| MEMBER MATERIALS | 61804 | 61804 | |
| MISCELLANEOUS | 331465 | 331465 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 153363290 | Total |
| Program Services | 145407591 | ProgramServices |
| Management And General | 7955699 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1197871 | BOY |
| EOY | -708303 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9837008 | BOY |
| EOY | 9433279 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2336786 | BOY |
| EOY | 3357256 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 4584961 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 2450636 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2281459 | BOY |
| EOY | 2134325 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43091305 | BOY |
| EOY | 47449590 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2197385 | BOY |
| EOY | 2274974 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 630607 | BOY |
| EOY | 643300 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 61572421 | BOY |
| EOY | 64584421 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2161576 | BOY |
| EOY | 2879532 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4474153 | BOY |
| EOY | 4425510 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23021907 | BOY |
| EOY | 22349323 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29657636 | BOY |
| EOY | 29654365 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2225100 | BOY |
| EOY | 2278600 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29689685 | BOY |
| EOY | 32651456 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31914785 | BOY |
| EOY | 34930056 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 61572421 | BOY |
| EOY | 64584421 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2591735 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 423536 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 400300 | OtherCostOrOtherBasis |
| Book Value | 400300 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 2724373 | OtherCostOrOtherBasis |
| Depreciation | 1242725 | Depreciation |
| Book Value | 1481648 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 1330473 | OtherCostOrOtherBasis |
| Depreciation | 118679 | Depreciation |
| Book Value | 211794 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 129815 | OtherCostOrOtherBasis |
| Depreciation | 89232 | Depreciation |
| Book Value | 40583 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 2134325 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | IBNR CLAIMS AND CLAIMS PAYABLE | Description |
| Amount | $22,349,323 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 22349323 | TotalOfAmounts |
| Total Revenue | 155955025 | TotalRevenue |
| Total Expenses | 153363290 | TotalExpenses |
| Excess Or Deficit For Year | 2591735 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -174210 | NetUnrealizedGLOnInvestments |
| Other | $597,746 | OtherAmount |
| Total Adjustments | 423536 | TotalAdjustments |
| Excess Or Deficit Per FS | 3015271 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 156035518 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -174210 | NetUnrealizedGainsInvestments |
| Other Revenues | 597746 | OtherRevenues |
| Revenue Not Rptd F990 | 423536 | RevenueNotRptdF990 |
| Revenue Subtotal | 155611982 | RevenueSubtotal |
| Other Revenues Not Included | 343043 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 343043 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 155955025 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 153020247 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 153020247 | ExpensesSubtotal |
| Other Expenses Not Included | 343043 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 343043 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 153363290 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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 9 & PART XII, LINE 2D | $544,246 CHANGES IN NONADMITTED ASSETS + $53,500 INCREASE IN CONTRIBUTED CAPITAL = $597,746 PART XII & PART XIII, LINE 4B $283,022 ADMINISTRATIVE FEES + $21 INTEREST EXPENSE + $60,000 INVESTMENT FEES = $343,043 |
Schedule F IRS990ScheduleF
Accts Actvs Out US Table AcctsActvsOutUSTable (4 entries)
| RegionRegion | Number Of OfficesNumberOfOffices | Number Of EmployeesNumberOfEmployees | Type Of Activities ConductedTypeOfActivitiesConducted | Total ExpendituresTotalExpenditures |
|---|---|---|---|---|
| East Asia and the Pacific | 0 | 0 | Investments | 1140782 |
| Europe (Including Iceland and Greenland) | 0 | 0 | Investments | 1109218 |
| South America | 0 | 0 | Investments | 162344 |
| South Asia | 0 | 0 | Investments | 80559 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Number Of Offices | 0 | SubtotalNumberOfOffices |
| Subtotal Number Of Employees | 0 | SubtotalNumberOfEmployees |
| Total Number Of Offices | 0 | TotalNumberOfOffices |
| Total Number Of Employees | 0 | TotalNumberOfEmployees |
| Subtotal Amount Spent | 2492903 | SubtotalAmountSpent |
| Total Amount Spent | 2492903 | TotalAmountSpent |
| Transfer To Foreign Corp | false | TransferToForeignCorp |
| Interest In Foreign Trust | false | InterestInForeignTrust |
| Own Foreign Corp | false | OwnForeignCorp |
| Passive Foreign Invest Co | false | PassiveForeignInvestCo |
| Foreign Partnership | false | ForeignPartnership |
| Boycott Countries | false | BoycottCountries |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| CANCER SERVICES OF NORTHEAST INDIANA | |||||||
| 2925 E STATE BLVD | FORT WAYNE | IN | 46805 | 352089785 | 501(c)3 | 10000 | MEDICAL ASSISTANCE |
| TURNSTONE CENTER FOR THE DISABLED | |||||||
| 3320 NORTH CLINTON ST | FORT WAYNE | IN | 46805 | 350913541 | 501(c)3 | 10000 | MEDICAL ASSISTANCE |
| MIDWEST ALLIANCE FOR HEALTH EDUCATION | |||||||
| 1819 CAREW ST | FORT WAYNE | IN | 46805 | 351637515 | 501(c)3 | 10000 | MEDICAL ASSISTANCE |
| AMERICAN HEART ASSOCIATION | |||||||
| 460 LINDBERGH BLVD | ST LOUIS | MO | 63141 | 135613797 | 501(c)3 | 25000 | MEDICAL ASSISTANCE |
| PHP FOUNDATION | |||||||
| 8101 W JEFFERSON BLVD | FORT WAYNE | IN | 46804 | 204615314 | 501(C)(3) | 400000 | MEDICAL ASSISTANCE |
| UNITED WAY OF ALLEN COUNTY | |||||||
| 334 E BERRY ST | FORT WAYNE | IN | 46802 | 350867932 | 501(C)(3) | 10000 | MEDICAL ASSISTANCE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 6 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | GRANTS AND ALLOCATIONS | Identifier |
| Return Reference | SCHEDULE I | ReturnReference |
| Explanation | 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAY M GILBERT | |||||||||||||
| 321123 | 0 | 25150 | 0 | 9600 | 0 | 12250 | 0 | 24788 | 0 | 392911 | 0 | 0 | 0 |
| PHILIP C WRIGHT MD | |||||||||||||
| 250091 | 0 | 46731 | 0 | 0 | 0 | 12250 | 0 | 18866 | 0 | 327938 | 0 | 0 | 0 |
| JAMES A BRUNNEMER | |||||||||||||
| 202129 | 0 | 26947 | 0 | 0 | 0 | 11399 | 0 | 15820 | 0 | 256295 | 0 | 0 | 0 |
| GAIL M DORAN | |||||||||||||
| 161137 | 0 | 28300 | 0 | 0 | 0 | 9417 | 0 | 15661 | 0 | 214515 | 0 | 0 | 0 |
| DALE BULTEMEIER | |||||||||||||
| 118785 | 0 | 13364 | 0 | 0 | 0 | 6552 | 0 | 15324 | 0 | 154025 | 0 | 0 | 0 |
| KEVEN LINKER | |||||||||||||
| 117704 | 0 | 13440 | 0 | 0 | 0 | 6557 | 0 | 14174 | 0 | 151875 | 0 | 0 | 0 |
| BRIAN W STEINER | |||||||||||||
| 68913 | 0 | 125673 | 0 | 0 | 0 | 9674 | 0 | 13540 | 0 | 217800 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | PHP MANAGEMENT SYSTEMS INC | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | FOR PROFIT SUB-100% OWNED | Relationship |
| Amount Of Transaction | 236635 | AmountOfTransaction |
| Description Of Transaction | PERFORMANCE OF SERVICES | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE L | Identifier |
| Explanation | 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. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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 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 THEN 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 AND CHIEF FINANCIAL OFFICER. 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. 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 | LINE 5 $53,500 INCREASE IN CONTRIBUTED CAPITAL + $(174,210) UNREALIZED GAINS + $544,246 CHANGES IN NONADMITTED ASSETS = $423,536 | PART XI |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:JAY M GILBERT TITLE:CHIEF EXECUTIVE OFFICER HOURS:1 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:PHILIP C WRIGHT MD TITLE:MEDICAL DIRECTOR HOURS:1 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:JAMES A. BRUNNEMER TITLE:CHIEF FINANCIAL OFFICER HOURS:1 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:GAIL M DORAN TITLE:CHIEF OPERATIONS OFFICER HOURS:1 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:DALE BULTEMEIER TITLE:ASST VP OF ANCILLARY SERVICES HOURS:1 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:KEVEN LINKER TITLE:DIRECTOR OF ACTUARIAL SERVICES HOURS:1 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:DUSTIN CRIDER CPA TITLE:CORPORATE CONTROLLER HOURS:5 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:TERESA BAIR TITLE:DIRECTOR OF SALES HOURS:5 | FORM 990 PART VII |
Schedule R IRS990ScheduleR
Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|
| PHP HOLDING COMPANY | |||||||||||
| 8101 WEST JEFFERSON BLVD | FORT WAYNE | IN | 46804 | 208074365 | HOLDING COMPA | IN | NA | C CORPORATION | 30548 | 2305296 | 1.00000 |
| PHP MANAGEMENT SYSTEMS INC | |||||||||||
| 8101 WEST JEFFERSON BLVD | FORT WAYNE | IN | 46804 | 351826719 | LICENSED TPA | IN | PHP HOLDING CO | C CORPORATION | -6156 | 420990 | 1.00000 |
| PHP INSURANCE COMPANY OF INDIANA INC | |||||||||||
| 8101 WEST JEFFERSON BLVD | FORT WAYNE | IN | 46804 | 203064284 | DENTAL INSURA | IN | PHP HOLDING CO | C CORPORATION | 36009 | 2305059 | 1.00000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | true | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| PHP MANAGEMENT SYSTEMS INC | |
| K | 236635 |
| PHP INSURANCE COMPANY OF INDIANA INC | |
| P | 74234 |