2011-11-08T08:23:56-06:00 2010-12-31 BKD LLP 200 E Main St Suite 700 Fort Wayne IN 46802 990 2010-01-01 311069321 PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA INC PHYS 2604326690 8101 WEST JEFFERSON BLVD FORT WAYNE IN 46804 JAMES A BRUNNEMER 2604326690 2011-11-07 true Joyce A Dulworth 2604604000 2010 2016-02-24 21:20:13Z JAY M GILBERT 8101 WEST JEFFERSON BLVD FORT WAYNE IN 46804 163172443 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 15 112 0 385820 0 0 0 143717261 152389253 -699408 3146056 423486 419716 143441339 155955025 107825 530068 131263706 133916546 8154370 8849001 0 0 0 11158775 10067675 150684676 153363290 -7243337 2591735 61572421 64584421 29657636 29654365 31914785 34930056 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 145407591 530068 152423149 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. 145407591 false false false false false false false false false false true false false false true true 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 2115 0 112 true true true false false false false false X 15 15 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 1.0 X X 7500 0 0 JAMES C WEHRENBERG MD 1.0 X X 4750 0 0 KARL R LAPAN 1.0 X X 6000 0 0 MICHAEL R DEWALD CPA 1.0 X X 6600 0 0 PETER P FETTIG 1.0 X 5625 0 0 THERESA A GUTIERREZ MD 1.0 X 2500 0 0 ANDREANA L HODGINI DO 1.0 X 4000 0 0 MICHAEL LARKIN 1.0 X 7500 0 0 DAVID E LENTZ DO 1.0 X 2500 0 0 ANDREW O'SHAUGHNESSY MD 1.0 X 1000 0 0 FRED L RASP MD 1.0 X 3000 0 0 DONALD F SCHENKEL 1.0 X 3750 0 0 RON L SLOAN MD 1.0 X 2500 0 0 JOSEPH P YURKANIN MD 1.0 X 2500 0 0 JERRY A DEARTH 1.0 X 3000 0 0 JAY M GILBERT 49.0 X 355873 0 37038 PHILIP C WRIGHT MD 39.0 X 296822 0 31116 JAMES A BRUNNEMER 44.0 X 229076 0 27219 GAIL M DORAN 49.0 X 189437 0 25078 DALE BULTEMEIER 42.0 X 132149 0 21876 KEVEN LINKER 42.0 X 131144 0 20731 BRIAN W STEINER 40.0 X 194586 0 23214 DUSTIN CRIDER CPA 50.0 X 112061 0 19544 TERESA BAIR 50.0 X 109486 0 15297 1813359 0 221113 10 false true false 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 21 0 PREMIUM REVENUE 524114 152389253 152291490 97763 152389253 1608073 1608073 0 0 8755401 7217418 1537983 1537983 1537983 0 0 0 ALLOCATED ADMIN 524298 288057 288057 MISCELLANEOUS 900099 131659 131659 419716 155955025 152423149 385820 3146056 530068 530068 0 0 133916546 133916546 2034472 738717 1295755 0 4984152 2651569 2332583 220641 117381 103260 1343472 714727 628745 266264 141652 124612 0 99567 99567 107425 107425 19981 19981 0 0 60000 60000 95789 95789 500258 500258 765899 765899 222061 222061 0 450276 450276 99597 99597 0 0 21 21 0 588828 588828 129577 129577 COMMISSIONS 5711179 5711179 PREMIUM TAXES - ICHIA 627015 627015 HEALTH RELATED ACTIVITY 196933 196933 MEMBER MATERIALS 61804 61804 MISCELLANEOUS 331465 331465 153363290 145407591 7955699 0 1197871 -708303 9837008 9433279 2336786 3357256 4584961 2450636 2281459 2134325 43091305 47449590 2197385 2274974 630607 643300 61572421 64584421 2161576 2879532 4474153 4425510 23021907 22349323 29657636 29654365 X 2225100 2278600 29689685 32651456 31914785 34930056 61572421 64584421 X 2591735 423536 X false true true X false 0 400300 400300 0 2724373 1242725 1481648 0 1330473 118679 211794 0 129815 89232 40583 2134325 0 IBNR CLAIMS AND CLAIMS PAYABLE 22349323 22349323 155955025 153363290 2591735 -174210 597746 423536 3015271 156035518 -174210 597746 423536 155611982 343043 343043 155955025 153020247 153020247 343043 343043 153363290 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 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 0 0 0 0 2492903 2492903 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 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 6 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 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 PHP MANAGEMENT SYSTEMS INC FOR PROFIT SUB-100% OWNED 236635 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 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 PART XI LINE 5 $53,500 INCREASE IN CONTRIBUTED CAPITAL + $(174,210) UNREALIZED GAINS + $544,246 CHANGES IN NONADMITTED ASSETS = $423,536 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAY M GILBERT TITLE:CHIEF EXECUTIVE OFFICER HOURS:1 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 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 false true false false false false false false false false true false true true false true false false PHP MANAGEMENT SYSTEMS INC K 236635 PHP INSURANCE COMPANY OF INDIANA INC P 74234