2023-08-08T15:02:46-05:00 2022-12-31 381357951 PLANTE & MORAN PLLC 3000 TOWN CENTER SUITE 100 SOUTHFIELD MI 48075 990 2022-01-01 272204037 MCLAREN HEALTH PLAN COMMUNITY MCLA 8107339705 G-3245 BEECHER ROAD FLINT MI 48532 RACHEL HAIRSTON ASSISTANT TREASURER 8107339705 2023-08-02 1 RACHEL HAIRSTON 999009999 1 AMY CIMINELLO P00796388 2483522500 2023-08-02 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z NANCY JENKINS G-3245 BEECHER ROAD FLINT MI 48532 95768482 0 X WWW.MCLARENHEALTHPLAN.ORG X 2009 MI ENHANCE OUR MEMBERS' HEALTH STATUS IN THE COMMUNITIES WE SERVE BY PROMOTING: 1. PREVENTIVE CARE AND WELL-BEING 2. ACCESS TO QUALITY HEALTH SERVICES 3. STRONG RELATIONSHIPS WITH OUR MEMBERS, PROVIDERS, AND EMPLOYERS. 6 2 0 0 0 0 0 0 98065522 94997255 196977 723446 0 0 98262499 95720701 0 0 0 0 2217268 1963624 0 0 0 105774359 104962051 107991627 106925675 -9729128 -11204974 49104503 57320079 20564709 18029753 28539794 39290326 ENHANCE OUR MEMBERS' HEALTH STATUS IN THE COMMUNITIES WE SERVE BY PROMOTING: 1. PREVENTIVE CARE AND WELL-BEING 2. ACCESS TO QUALITY HEALTH SERVICES 3. STRONG RELATIONSHIPS WITH OUR MEMBERS, PROVIDERS, AND EMPLOYERS. 0 0 103203911 94410343 TO PROVIDE HEALTH CARE SERVICES TO GROUP EMPLOYERS AND INDIVIDUALS THROUGH CONTRACTS WITH VARIOUS PHYSICIAN GROUPS, HOSPITALS AND OTHER HEALTH CARE PROVIDERS. 653923 586912 TO PROVIDE HEALTH CARE SERVICES TO MEDICARE SUPPLEMENT RECIPIENTS THROUGH CONTRACTS WITH VARIOUS PHYSICIAN GROUPS, HOSPITALS AND OTHER HEALTH CARE PROVIDERS. 103857834 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 2256 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 2 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X RACHEL HAIRSTON 8107339678 G-3245 BEECHER ROAD FLINT MI 48532 KEVIN TOMPKINS CHAIRMAN 1.00 48.30 X X 0 1178342 43741 NANCY JENKINS PRESIDENT & CEO 20.00 20.00 X X 0 624589 123569 DEIDRA WILSON SECRETARY 1.00 40.00 X X 0 348401 46248 DAVID MAZURKIEWICZ TREASURER 1.00 49.00 X X 0 1956528 33460 DENNIS LAFOREST ENROLLEE REPRESENTATIVE 1.00 0.00 X 7000 0 0 PATRICK HAYES BOARD MEMBER 1.00 1.00 X 7000 0 0 KATHLEEN KENDALL VICE PRESIDENT 1.00 49.00 X 0 1564624 44020 CHERYL DIEHL ASSISTANT SECRETARY 20.00 20.00 X 0 322241 43935 RACHEL HAIRSTON ASSISTANT TREASURER 20.00 20.00 X 0 200159 11882 JANE HEILIG ASSISTANT TREASURER 20.00 20.00 X 0 113138 28773 RICK BUXTON ASSISTANT TREASURER 20.00 20.00 X 0 152559 2400 MATTHEW EHRLICH MHP VP, GENERAL COUNSEL 20.00 20.00 X 0 300314 35411 MARYLYNN CLARK MHP VP, HEALTH SERVICES 20.00 20.00 X 0 238809 21976 JEFFREY ROMBACK MHP VP, STRATEGIC INITIATIVES 20.00 20.00 X 0 178333 26152 14000 7178037 461567 0 0 1 0 MEDIMPACT HEALTHCARE SYSTEMS INC 10181 SCRIPPS GATEWAY CT SAN DIEGO CA 92131 PHARMACY BENEFIT MANAGER 27841565 RSC INSURANCE BROKERAGE INC 160 FEDERAL ST FL 4 BOSTON MA 02110 RISK MANAGEMENT CONSULTANT 2128825 WAKELY CONSULTING GROUP LLC 120 N WASHINGTON SQ STE 705 LANSING MI 48933 HEALTHCARE ACTUARIAL CONSULTANT 555513 ALLEGRA MARKETING PRINT MAIL 2863 JOLLY RD OKEMOS MI 48864 MARKETING, MAILING, AND PRINTING PROVIDE 217430 POPHEALTHCARE LLC 113 SEABOARD LANE SUITE 8200 FRANKLIN TN 37067 RISK MANAGEMENT CONSULTANT 171163 6 PREMIUMS 524298 94997255 94997255 94997255 701227 701227 70000 47781 22219 22219 22219 95720701 94997255 0 723446 14000 14000 1517991 859580 658411 62273 57209 5064 260493 221275 39218 108867 84496 24371 117 117 21212 21212 38191 38191 3139011 2985286 153725 199362 199362 243241 179070 64171 425524 425524 27041 27041 5008 4366 642 96 96 10375 9046 1329 44850 44850 32018 32018 HOSPITAL/MED. BENEFITS 47422423 47422423 PHARMACY 27716846 27716846 SPECIALTY CARE POOL 22323333 22323333 HEALTH PLAN ADMINISTRAT 3313403 1325168 1988235 106925675 103857834 3067841 0 46117076 46913488 1892597 3913715 1094830 6492876 49104503 57320079 754209 1143844 1517939 5198617 18292561 11687292 20564709 18029753 X 0 0 40000000 62500000 -11460206 -23209674 28539794 39290326 49104503 57320079 X -11204974 -494038 22449544 X X 0 1 X 1 0 0 RISK ADJUSTMENT PAYABLE 1550857 UNPAID CLAIMS AND RESERVE 8849837 UNPAID CLAIMS ADJUSTMENT EXPENSES 326250 DUE TO AFFILIATES 677454 PROVIDER INCENTIVE PROGRAM PAYABLE 282894 11687292 117638016 -494038 22449544 21955506 95682510 38191 38191 95720701 106887484 0 106887484 38191 38191 106925675 PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN NONADMITTED ASSETS -50,456. CONTRIBUTED SURPLUS FROM PARENT 22,500,000. 0 1 0 0 0 0 0 0 0 DAVID MAZURKIEWICZ TREASURER 0 1025619 0 739629 0 191280 0 0 0 33460 0 1989988 0 0 KATHLEEN KENDALL VICE PRESIDENT 0 800333 0 323944 0 440347 0 0 0 44020 0 1608644 0 0 KEVIN TOMPKINS CHAIRMAN 0 636233 0 386284 0 155825 0 0 0 43741 0 1222083 0 0 NANCY JENKINS PRESIDENT & CEO 0 426606 0 174690 0 23293 0 91605 0 31964 0 748158 0 0 DEIDRA WILSON SECRETARY 0 254613 0 93788 0 0 0 45265 0 983 0 394649 0 0 CHERYL DIEHL ASSISTANT SECRETARY 0 273363 0 48878 0 0 0 0 0 43935 0 366176 0 0 MATTHEW EHRLICH MHP VP, GENERAL COUNSEL 0 257285 0 35215 0 7814 0 0 0 35411 0 335725 0 0 MARYLYNN CLARK MHP VP, HEALTH SERVICES 0 200220 0 37842 0 747 0 0 0 21976 0 260785 0 0 RACHEL HAIRSTON ASSISTANT TREASURER 0 173832 0 26327 0 0 0 0 0 11882 0 212041 0 0 JEFFREY ROMBACK MHP VP, STRATEGIC INITIATIVES 0 162936 0 15397 0 0 0 0 0 26152 0 204485 0 0 RICK BUXTON ASSISTANT TREASURER 0 117888 0 27949 0 6722 0 0 0 2400 0 154959 0 0 PART I, LINE 1A THE CEO/EXECUTIVE DIRECTOR WAS COMPENSATED BY A RELATED ORGANIZATION, AND THEREFORE NONE OF THE LINE 1 BOXES HAVE BEEN CHECKED. THE CORPORATE CEO, SUBSIDIARY CEOS AND CORPORATE EXECUTIVE & SENIOR VICE-PRESIDENTS IN SOME INSTANCES HAVE RECEIVED TAX INDEMNIFICATION FOR THE FOLLOWING BENEFITS: VEHICLE COSTS, GROUP TERM LIFE INSURANCE, SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS, AND HEALTH CLUB OR SOCIAL DUES. THESE BENEFITS HAVE BEEN INCLUDED IN TAXABLE COMPENSATION. PART I, LINE 3 THE CEO/EXECUTIVE DIRECTOR WAS COMPENSATED BY A RELATED ORGANIZATION, AND THEREFORE NONE OF THE LINE 3 BOXES HAVE BEEN CHECKED. THE RELATED ORGANIZATION USED THE FOLLOWING METHODOLOGIES TO ESTABLISH THE COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR OF THE FILING ORGANIZATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B MCLAREN MAINTAINS TWO SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS FOR A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES (THE "SERPS"). THE OLD SERP WAS CLOSED TO NEW PARTICIPANTS ON OCTOBER 1, 2006, AND THE NEW SERP BECAME EFFECTIVE AS OF JANUARY 1, 2007. NO EMPLOYEE MAY PARTICIPATE IN BOTH OF THE SERPS. THE OLD SERP IS STRUCTURED AS A DEFINED BENEFIT PLAN THAT ESSENTIALLY REPLACES THE BENEFITS THE PARTICIPANT IS NOT PERMITTED TO RECEIVE UNDER MCLAREN'S QUALIFIED RETIREMENT PLAN DUE TO IRS LIMITATIONS APPLICABLE TO QUALIFIED PLANS. THE BENEFIT UNDER THE OLD SERP IS PAYABLE IN EITHER THE FORM OF A LUMP SUM DISTRIBUTION OR IN MONTHLY PAYMENTS EQUAL TO THE ACTUARIAL EQUIVALENT OF THE PARTICIPANT'S ACCRUED BENEFIT. THE BENEFIT IS PAID AT AGE 55, AND IF THE PARTICIPANT REMAINS EMPLOYED, THE BENEFIT IS PAID UPON TERMINATION OF EMPLOYMENT, REDUCED TO TAKE INTO ACCOUNT THE BENEFIT PREVIOUSLY PAID. THE NEW SERP IS STRUCTURED AS A DEFINED CONTRIBUTION PLAN, AND MCLAREN CONTRIBUTES 15 PERCENT OF EACH PARTICIPANT'S COMPENSATION TO THE PLAN EACH YEAR FOR ALLOCATION TO THE PARTICIPANT'S ACCOUNT. PARTICIPANTS IN THE NEW SERP BECOME VESTED IN THEIR ACCOUNTS UPON THE EARLIER OF FIVE YEARS OF PARTICIPATION IN THE PLAN OR ATTAINMENT OF AGE 60. PARTICIPANTS IN THE NEW SERP SELF-DIRECT THE INVESTMENT OF THEIR ACCOUNTS AND HAVE THE ACTUAL INVESTMENT RETURN CREDITED THE PARTICIPANT'S ACCOUNT BALANCE, AND THE BENEFIT IS PAID IN A SINGLE SUM SERPS ARE PROVIDED ON A TAX-NEUTRAL BASIS. BOTH SERPS ARE DESIGNED TO OR DEBITED TO THEIR ACCOUNTS. THE BENEFIT UNDER THE NEW SERP IS EQUAL TO WITHIN 60 DAYS OF THE PARTICIPANT'S TERMINATION DATE. BENEFITS UNDER BOTH COMPLY WITH INTERNAL REVENUE CODE SECTIONS 457(F) AND 409A. PART I, LINE 7 MCLAREN HEALTH CARE CORPORATION (MHCC) HAS A LEADERSHIP INCENTIVE PROGRAM FOR LEADERS OF THE CORPORATION, SUBSIDIARY EXECUTIVES AND DIRECTORS, AND MANAGERS. THE PURPOSE OF THE PLAN IS TO ENHANCE THE ORGANIZATION'S ABILITY TO ACHIEVE ITS GOALS BY PROVIDING TOP OFFICIALS AND THE BOARD OF DIRECTORS WITH A TOOL FOR (A) CLEARLY COMMUNICATING PERFORMANCE ON THE PART OF KEY LEADERS, (B) STIMULATING AND REWARDING SUPERIOR LEVELS OF PERFORMANCE ON THE PART OF KEY LEADERS WHICH WILL ULTIMATELY BENEFIT THE COMMUNITIES MHCC SERVES, AND (C) PROTECTING MHCC'S ABILITY TO COMPETE WITH OTHER EMPLOYERS FOR HIGH-TALENT LEADERS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THIS ORGANIZATION IS MCLAREN HEALTH PLAN. FORM 990, PART VI, SECTION A, LINE 7A UNDER MICHIGAN LAW (MCL 500.3511), ONE-THIRD OF THE GOVERNING BODY MUST BE ADULT ENROLLERS OF MCLAREN HEALTH PLAN COMMUNITY, ELECTED BY SUBSCRIBERS/CONTRACT HOLDERS OF MCLAREN HEALTH PLAN COMMUNITY. THE SOLE MEMBER OF MCLAREN HEALTH PLAN COMMUNITY, MCLAREN HEALTH PLAN, INC., MAY APPOINT THE REMAINING TWO-THIRDS OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS BY THE GOVERNING BODY ARE SUBJECT TO THE POWERS OF THE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY MCLAREN HEALTH PLAN COMMUNITY'S PRESIDENT & CEO AND ALSO BY THE CFO PRIOR TO FILING. AS PART OF AN INTEGRATED HEALTH SYSTEM, THE PARENT BOARD ALSO REVIEWS THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C EACH MCLAREN HEALTH PLAN COMMUNITY BOARD MEMBER, OFFICER AND SENIOR MANAGEMENT EXECUTIVE COMPLETES THE MCLAREN HEALTH PLAN COMMUNITY CONFLICT OF INTEREST DISCLOSURE FORM ANNUALLY. THE BOARD CHAIR AND PRESIDENT/CEO REVIEW ALL COMPLETED FORMS TO IDENTIFY ANY POTENTIAL CONFLICTS. ANY IDENTIFIED POTENTIAL CONFLICT IS INVESTIGATED AND RAISED WITH THE INDIVIDUAL, AS APPROPRIATE, TO RESOLVE THE CONFLICT OR DETERMINE IF ANY ACTION IS NEEDED, UP TO AND INCLUDING, POSSIBLE REMOVAL FROM THE BOARD, OR OFFICER/SENIOR MANAGEMENT POSITION. ANY IDENTIFIED CONFLICTS ARE REPORTED TO THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 TO ENSURE A FAIR, COMPETITIVE AND LEGALLY COMPLIANT METHOD OF ADMINISTERING COMPENSATION, MHPC USES INDEPENDENT COMPENSATION STUDIES AND SURVEY DATA TO ESTABLISH THE COMPENSATION STRUCTURE FOR THE MHPC CEO AND OFFICERS. COMPENSATION FOR THE CEO AND OFFICERS ARE REVIEWED ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE PROVIDED UPON REQUEST. THE FINANCIAL STATEMENTS ARE AVAILABLE ON THE MICHIGAN DIFS (FORMERLY OFIR) WEBSITE. FORM 990, PART XI, LINE 9: CHANGE IN NONADMITTED ASSETS -50,456. CONTRIBUTED SURPLUS FROM PARENT 22,500,000. FORM 990, PART XII, LINE 1: THE ORGANIZATION OBTAINED SEPARATE, INDEPENDENT AUDITED FINANCIAL STATEMENT FOR THE TAX YEAR ON A OCBOA STATUTORY ACCOUNTING METHOD. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN THE OVERSIGHT OR SELECTION PROCESS FROM PRIOR YEAR. MCLAREN BAY MEDICAL FOUNDATION 1900 COLUMBUS AVE BAY CITY MI 48708 382156534 FOUNDATION MI 501(C)(3) LINE 12A, I MCLAREN BAY REGION 1 MCLAREN BAY REGION 1900 COLUMBUS AVE BAY CITY MI 48708 381976271 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 BAY REGIONAL MEDICAL CENTER AUXILIARY 1908 COLUMBUS AVENUE BAY CITY MI 48708 386081235 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 12A, I MCLAREN BAY REGION 1 MCLAREN BAY SPECIAL CARE 3250 E MIDLAND ROAD STE 1 BAY CITY MI 48706 383161753 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN BAY REGION 1 MCLAREN CENTRAL MICHIGAN 1221 SOUTH DRIVE MT PLEASANT MI 48858 381420304 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 CHARLEVOIX NURSING HOME CORPORATION DBA BOULDER PARK TERRACE 14676 WEST UPRIGHT CHARLEVOIX MI 49720 383038683 SKILLED NURSING FACILITY MI 501(C)(3) LINE 10 MCLAREN NORTHERN MICHIGAN 1 KARMANOS CANCER FOUNDATION 4100 JOHN R ST DETROIT MI 48201 383584572 FOUNDATION MI 501(C)(3) LINE 7 BARBARA ANN KARMANOS CANCER INSTITUTE 1 MCLAREN GREATER LANSING FOUNDATION 401 W GREENLAWN AVE LANSING MI 48910 382463637 FOUNDATION MI 501(C)(3) LINE 7 MCLAREN GREATER LANSING 1 MCLAREN GREATER LANSING 401 W GREENLAWN AVE LANSING MI 48910 381434090 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 BARBARA ANN KARMANOS CANCER HOSPITAL 4100 JOHN R ST DETROIT MI 48201 201649466 HOSPITAL MI 501(C)(3) LINE 3 BARBARA ANN KARMANOS CANCER INSTITUTE 1 BARBARA ANN KARMANOS CANCER INSTITUTE 4100 JOHN R ST DETROIT MI 48201 381613280 CANCER RESEARCH & CARE CENTER MI 501(C)(3) LINE 7 MCLAREN HEALTH CARE CORPORATION 1 MCLAREN LAPEER REGION 1375 N MAIN ST LAPEER MI 48446 382689033 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 MCLAREN LAPEER REGION FOUNDATION 1375 N MAIN ST LAPEER MI 48446 382689603 FOUNDATION MI 501(C)(3) LINE 12A, I MCLAREN LAPEER REGION 1 MARWOOD MANOR NURSING HOME PO BOX 5011 PORT HURON MI 48060 382683251 NURSING HOME MI 501(C)(3) LINE 10 PORT HURON HOSPITAL 1 MCLAREN HEALTH CARE CORPORATION ONE MCLAREN PARKWAY GRAND BLANC MI 48439 382397643 SUPPORTING ORG MI 501(C)(3) LINE 12A, I N/A 0 MCLAREN HEALTH CARE VILLAGE FOUNDATION 401 S BALLENGER HIGHWAY FLINT MI 48532 262693350 SUPPORTING ORG MI 501(C)(3) LINE 12A, I MCLAREN HEALTH CARE CORPORATION 1 MCLAREN HEALTH PLAN COMMUNITY G-3245 BEECHER ROAD FLINT MI 48532 272204037 INSURANCE MI 501(C)(4) 1 MCLAREN HEALTH PLAN 1 MCLAREN HEALTH PLAN INC G-3245 BEECHER ROAD FLINT MI 48532 383252216 HEALTH CARE SERVICES MI 501(C)(4) MCLAREN INTEGRATED HMO GROUP 1 MCLAREN HOSPICE AND HOME CARE FOUNDATION 1515 CAL DR DAVISON MI 48423 463643089 FOUNDATION MI 501(C)(3) LINE 12A, I MCLAREN HEALTH MANAGEMENT GROUP 1 MCLAREN MEDICAL GROUP 401 S BALLENGER HWY FLINT MI 48532 382988086 MANAGEMENT COMPANY MI 501(C)(3) LINE 12A, I MCLAREN HEALTH CARE CORPORATION 1 MCLAREN NORTHERN MICHIGAN 416 CONNABLE AVENUE PETOSKEY MI 49770 382146751 ACUTE CARE HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 MCLAREN NORTHERN MICHIGAN 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49721 382527255 HOSPICE CARE/HOME HEALTH SERVICES MI 501(C)(3) LINE 10 MCLAREN NORTHERN MICHIGAN 1 MCLAREN FLINT FOUNDATION 401 S BALLENGER HIGHWAY FLINT MI 48532 381358053 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 12A, I MCLAREN FLINT 1 CARO COMMUNITY HOSPITAL 401 N HOOPER ST CARO MI 48723 383426063 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 CARO COMMUNITY HOSPITAL ENDOWMENT FOUNDATION 401 N HOOPER ST CARO MI 48724 382422995 FOUNDATION MI 501(C)(3) LINE 12C, III-FI CARO COMMUNITY HOSPITAL 1 MDWISE INC 2955 N MERIDIAN STREET SUITE 201 INDIANAPOLIS IN 46208 351931354 HEALTH MAINTENANCE ORGANIZATION IN 501(C)(4) MCLAREN INTEGRATED HMO GROUP 1 MDWISE MEDICAID NETWORK INC 2955 N MERIDIAN STREET SUITE 201 INDIANAPOLIS IN 46208 473192307 INSURANCE IN 501(C)(4) MCLAREN INTEGRATED HMO GROUP 1 HURON MEMORIAL HOSPITAL 1100 S VAN DYKE ROAD BAD AXE MI 48413 381474929 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 HURON MEMORIAL FOUNDATION 1100 S VAN DYKE ROAD 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