2024-11-14T13:37:35+00:00 2023-12-31 440160260 Forvis Mazars LLP 111 E Wayne Street Suite 600 Fort Wayne IN 46802 990 2023-01-01 311069321 PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA INC PHYS 2604326690 1700 MAGNAVOX WAY 201 FORT WAYNE IN 46804 TYLER S SIPE CFO 2604326690 2024-11-14 true Anne White P01708202 2604604000 2024-11-14 2023 2024-10-15 13:58:12Z TYLER S SIPE 1700 MAGNAVOX WAY 201 FORT WAYNE IN 46804 194089027 false X WWW.PHPNI.COM X 1983 IN PHPNI IS A PROVIDER OF EMPLOYEE BENEFIT SERVICES AND SOLUTIONS. WE PROVIDE INSURANCE COVERAGE AND EDUCATIONAL MATERIALS PROMOTING A HEALTHY LIFESTYLE TO OUR MEMBERS. 14 11 215 0 2787651 44779 0 0 166255040 165964228 3724859 3367954 2234636 2849201 172214535 172181383 500000 74209 149472687 149753516 12130308 11848812 0 0 0 9849460 11369520 171952455 173046057 262080 -864674 89283875 87690862 33847312 31454542 55436563 56236320 OUR MISSION IS TO CREATE INNOVATIVE SOLUTIONS THAT CONTRIBUTE TO HEALTHIER COMMUNITIES THROUGH CARING AND COLLABORATION. false false 160909250 74209 166025778 PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA, INC. (PHP) IS SPONSORED BY INDEPENDENT PHYSICIANS AS A NOT-FOR-PROFIT, INDIANA CERTIFIED AND FEDERALLY QUALIFIED HEALTH MAINTENANCE ORGANIZATION. PHP OFFERS FULLY-INSURED HEALTH PRODUCTS TO GROUP SPONSORS THROUGHOUT THE 46 COUNTIES IN NORTHERN INDIANA AND 6 COUNTIES IN NORTHWEST OHIO. PHP'S PROGRAM SERVICE PLACES FOCUS ON MANAGING HEALTHCARE COSTS AND INVESTING IN ACTIVITIES TO IMPROVE THE HEALTHCARE QUALITY OF OUR MEMBER POPULATION. PHP HAS DEVELOPED THE GET PHP FIT PROGRAM WHICH PHP UTILIZES TO PROMOTE WELLNESS AND A HEALTHY LIFESTYLE FOR OUR MEMBERS. PHP PARTNERS WITH A NUMBER OF HEALTH CLUBS TO OFFER DISCOUNTED RATES TO OUR MEMBERS. OUR WEBSITE OFFERS EXTENSIVE INFORMATION ON COMMUNITY HEALTH CLASSES AND OTHER ACTIVITIES WHICH ENCOURAGE A HEALTHY LIFESTYLE. WE PUBLISH A MONTHLY NEWSLETTER WHICH PROVIDES A NUMBER OF TIPS FOR IMPROVING OVERALL HEALTH SUCH AS RECIPES, ACTIVITIES TO ENGAGE IN TO REDUCE STRESS AND IMPROVE MENTAL HEALTH, ETC. OUR WELLNESS PROGRAM COORDINATOR, WHO IS A CERTIFIED WELLNESS AND HEALTH COACH, OFFERS A VARIETY OF OPPORTUNITIES TO HELP IMPROVE EMPLOYEE WELL-BEING IN A FUN AND ENGAGING WAY. HER GROUP WELLNESS PRESENTATIONS CAN CONSIST OF A QUICK 15-MINUTE DISCUSSION, OR A MORE IN-DEPTH 60-MINUTE PRESENTATION, DEPENDING ON THE NEEDS OF THE GROUP. SOME OF THE DISCUSSION TOPICS AVAILABLE INCLUDE NUTRITION, EXERCISE, STRESS MANAGEMENT, SLEEP, AND MUCH MORE. ADDITIONAL WELLNESS OPPORTUNITIES INCLUDE ONE-ON-ONE WELLNESS COACHING, COMPANY CHALLENGES, EXERCISE CLASSES, AND STRESS MANAGEMENT ACTIVITIES. PHP GROUPS ALSO HAVE THE OPPORTUNITY TO SCHEDULE A HEALTH SCREENING FOR THEIR EMPLOYEES EACH YEAR. THE HEALTH SCREENINGS INCLUDE LAB DRAWS AND BIOMETRIC MEASUREMENTS THAT CAN HELP EMPLOYEES TO GET A GOOD PICTURE OF THEIR OVERALL HEALTH. OUR WELLNESS PROGRAM COORDINATOR CAN THEN DISCUSS HEALTH SCREENING RESULTS WITH EMPLOYEES IF DESIRED SO THAT THEY HAVE A BETTER UNDERSTANDING OF WHAT THE RESULTS MEAN FOR THEIR HEALTH STATUS. OUR MEMBERS CAN CALL AND SPEAK TO A NURSE ANY TIME, ANY DAY, ABOUT PERSONAL HEALTH CONCERNS. THE MEMBER WILL BE GIVEN A RECOMMENDATION BY THE NURSE DEPENDING ON THE SITUATION PRESENTED WHICH MIGHT INCLUDE SEEING THEIR FAMILY DOCTOR THE NEXT BUSINESS DAY OR PARTICIPATING IN SOME SELF-CARE INTERVENTIONS WHICH WOULD SOLVE THE PROBLEM. 160909250 false false false false false false false false false true true false false true false true false false false true false false false false false false true false true false false false false false false false false false false false false false true true true false true 2831 0 215 true true true false false false false false false false X 14 11 false false false false true true true true true false false true true true true true true true false true false IN X TYLER SIPE 2604214450 1700 MAGNAVOX WAY SUITE 201 Fort Wayne IN 46804 DR JAMES C STEVENS VICE CHAIR 1.0 0.0 X X 6400 0 0 DR JUDITH L KENNEDY CHAIR 1.0 0.0 X X 11100 0 0 MICHAEL R DEWALD TREASURER 1.0 0.0 X X 13600 0 0 TIMOTHY R DIRIG SECRETARY 1.0 0.0 X X 12125 0 0 DAVID E LENTZ DIRECTOR 1.0 0.0 X 1500 0 0 DAVID W STEIN DIRECTOR 1.0 0.0 X 500 0 0 DONALD F SCHENKEL DIRECTOR 1.0 0.0 X 6750 0 0 DOUGLAS S BEEBE DIRECTOR 1.0 0.0 X 2125 0 0 JERALD L COOPER DIRECTOR 1.0 0.0 X 2000 0 0 JOEL VALCARCEL DIRECTOR 1.0 0.0 X 1000 0 0 JOHN R SAMPSON DIRECTOR 1.0 0.0 X 2750 0 0 MARK C RANCK DIRECTOR 1.0 0.0 X 1500 0 0 SHERY ROUSSARIE DIRECTOR 1.0 0.0 X 4827 0 0 THOMAS W HERENDEEN DIRECTOR 1.0 0.0 X 1500 0 0 GAIL M DORAN CHIEF OPERATING OFFICER 38.0 17.0 X 294444 0 40656 GARY D SHEARER PRESIDENT & CEO 35.0 20.0 X 344431 0 40060 JAMES R FORD CHIEF INFORMATION OFFICER 40.0 3.0 X 212752 0 40722 MARK A King MEDICAL DIRECTOR 15.0 5.0 X 144019 0 20994 ROSS E HENSLEY CHIEF SALES OFFICER 35.0 15.0 X 175131 0 37797 TYLER S SIPE CHIEF FINANCIAL OFFICER 30.0 20.0 X 209265 0 31021 NICHOLAS P SLOFFER DIRECTOR OF PHARMACY 30.0 10.0 X 171724 0 38319 RENEE A GERBER AVP PROVIDER CONTRACTING & NETWORK DEVELOPMENT 38.0 7.0 X 163724 0 19246 CARRIE R LUKINS MANAGER OF UTILIZATION & CASE MANAGEMENT 30.0 10.0 X 123629 0 16321 JANICE L RICHEY SENIOR UNDERWRITER 30.0 10.0 X 132724 0 17428 JUSTIN A STUCKEY DIRECTOR OF ACTUARIAL SERVICES 30.0 10.0 X 125368 0 16836 RICHARD K SPICE LEAD INTEGRATION ARCHITECT 30.0 10.0 X 120045 0 26804 RICHARD R MCENTEE DIRECTOR OF IT, SOFTWARE & DATA 40.0 5.0 X 143254 0 33670 2428187 0 379874 34 false true false SUMMIT REINSURANCE SERVICES 6920 POINTE INVERNESS WAY STE 140 FORT WAYNE IN 46804 REINSURANCE 2117695 OPTUMHEALTH CARE SOLUTIONS 11000 OPTUM CIR EDEN PRAIRIE MN 55344 TRANSPLANT COVERAGE 1980067 INETICO LLC DBA VALENZ CARE DEPT 389 PO BOX 1000 MEMPHIS TN 38148 MEDICAL MANAGEMENT 1728302 COGNIZANT TRIZETTO SOFTWARE GROUP DEPT 2140 PO BOX 122140 DALLAS TX 75312 SOFTWARE VENDOR 1050526 MAGNAWAY LLC 7108 COVINGTON RD FORT WAYNE IN 46804 PROPERTY MANAGEMENT 931987 46 0 PREMIUM REVENUE 524114 165964228 165964228 0 0 0 0 165964228 2236189 2236189 0 0 23039409 21907644 1131765 0 1131765 1131765 ALLOCATED ADMIN 524298 2736816 2736816 MISCELLANEOUS 524298 61550 61550 COMMISSION REVENUE 524298 50835 50835 0 0 0 0 2849201 172181383 166025778 2787651 3367954 74209 74209 0 0 0 0 149753516 149753516 2051982 696648 1355334 0 0 0 0 0 6835155 3313496 3521659 0 467344 226556 240788 0 2053493 995477 1058016 440838 159216 281622 88202 88202 227261 227261 11107 11107 156696 156696 104173 0 104173 0 400674 400674 404258 404258 801017 801017 754643 754643 76043 76043 9364 9364 16298 16298 281611 281611 190233 190233 Broker Commissions 3505926 3505926 Actuarial and Other Consulting Services 2184206 2184206 OTHER 2157808 2157808 0 0 0 0 173046057 160909250 12136807 0 1241337 3134591 1486341 1365673 7362374 8242702 0 0 0 3177657 2828416 58606 349241 72870534 68224382 4569605 5051205 0 1695078 1323068 89283875 87690862 6439444 4885158 4711683 4186899 0 22696185 22382485 33847312 31454542 4007100 4162600 51429463 52073720 55436563 56236320 89283875 87690862 X -864674 1511762 152669 X false true X true false 3177657 2828416 349241 349241 INVESTMENT IN AFFILIATES 5051205 C 5051205 IBNR CLAIMS AND CLAIMS PAYABLE 22382485 22382485 170941523 1511762 155500 1667262 169274261 156696 2750426 2907122 172181383 170141766 0 0 170141766 156696 2747595 2904291 173046057 ASC 740 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 2(d) Other revenues in audited financial statements not in form 990 INCREASE IN CONTRIBUTED CAPITAL - 155500 Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements INTEREST EXPENSE - 16298 ADMINISTRATIVE FEES - 2731297 CHANGE IN NONADMITTED ASSETS - 2831 Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements ADMINISTRATIVE FEES - 2731297 INTEREST EXPENSE - 16298 North America (Canada & Mexico only) Passive Investments 1442172 Europe (Including Iceland and Greenland) Passive Investments 3972310 Middle East and North Africa Passive Investments 135000 Sub-Saharan Africa Passive Investments 45659 East Asia and the Pacific Passive Investments 2837175 South Asia Passive Investments 281532 South America Passive Investments 94677 0 0 0 0 0 0 8808525 0 8808525 false false false false false false Schedule F, Part I, Line 3 Method used to account for expenditures on org's financial statements EAST ASIA AND THE PACIFIC-Accrual; EUROPE (INCLUDING ICELAND AND GREENLAND)-Accrual; MIDDLE EAST AND NORTH AFRICA-Accrual; NORTH AMERICA (CANADA & MEXICO ONLY)-Accrual; SOUTH AMERICA-Accrual; SOUTH ASIA-Accrual; SUB-SAHARAN AFRICA-Accrual true THE ALLIANCE 200 E MAIN ST STE 800 FORT WAYNE IN 46802 351787258 501 (C)(3) 10750 ECONOMIC DEVELOPMENT 1 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. 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 true true X X X X X X false false false false false false false false false GAIL M DORAN CHIEF OPERATING OFFICER 268844 0 25600 0 0 0 15868 0 24788 0 335100 0 0 0 GARY D SHEARER PRESIDENT & CEO 311653 0 26778 0 6000 0 18150 0 21910 0 384491 0 0 0 JAMES R FORD CHIEF INFORMATION OFFICER 196545 0 16207 0 0 0 11532 0 29190 0 253474 0 0 0 TYLER S SIPE CHIEF FINANCIAL OFFICER 194580 0 14685 0 0 0 9893 0 21128 0 240286 0 0 0 ROSS E HENSLEY CHIEF SALES OFFICER 147821 0 27310 0 0 0 8880 0 28917 0 212928 0 0 0 MARK A King MEDICAL DIRECTOR 137460 0 6559 0 0 0 7873 0 13121 0 165013 0 0 0 NICHOLAS P SLOFFER DIRECTOR OF PHARMACY 164018 0 7706 0 0 0 9379 0 28940 0 210043 0 0 0 RENEE A GERBER AVP PROVIDER CONTRACTING & NETWORK DEVELOPMENT 154939 0 8785 0 0 0 8850 0 10396 0 182970 0 0 0 RICHARD R MCENTEE DIRECTOR OF IT, SOFTWARE & DATA 140251 0 3003 0 0 0 4983 0 28687 0 176924 0 0 0 JANICE L RICHEY SENIOR UNDERWRITER 126635 0 6089 0 0 0 7276 0 10152 0 150152 0 0 0 Schedule J, Part I, Line 1a Health or social club dues or initiation fees GARY SHEARER WAS PROVIDED SOCIAL CLUB DUES TO PROVIDE A VENUE FOR CONDUCTING COMPANY BUSINESS. SOCIAL CLUB EXPENSES FOR PERSONAL USE WERE REIMBURSED TO PHP. CAPITAL DUES WERE PRORATED AND THE PORTION OF THE PERSONAL USE WAS INCLUDED IN TAXABLE INCOME. Form 990, Part VI, Line 1b MICHAEL DEWALD, TIMOTHY DIRIG, AND JUDITH KENNEDY ARE NON-INDEPENDENT VOTING MEMBERS OF THE BOARD BECAUSE THEY ARE COMPENSATED GREATER THAN $10,000 BY THE FILING ORGANIZATION Form 990, Part VI, Line 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. Form 990, Part VI, Line 6 Classes of members or stockholders ONLY ONE MEMBER CLASS EXISTS. MEMBERS WITHIN ALLEN COUNTY, INDIANA PAY A $2,000 MEMBERSHIP FEE. MEMBERS IN THE INDIANA COUNTIES SURROUNDING ALLEN COUNTY PAY A $500 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 46 COUNTY SERVICE AREA. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE BOARD OF DIRECTORS CONSISTS OF NO LESS THAN THIRTEEN TO NO MORE THAN SEVENTEEN MEMBERS. THE DIRECTORS MUST BE CLASSIFIED AS PHYSICIAN DIRECTORS OR CONSUMER DIRECTORS. PHYSICIAN DIRECTORS MUST REPRESENT AT LEAST ONE-HALF BUT NO MORE THAN TWO-THIRDS OF THE TOTAL DIRECTORS OF THE BOARD AND CONSUMER DIRECTORS MUST CONSIST OF AT LEAST ONE THIRD OF THE TOTAL DIRECTORS OF THE BOARD. THE PHYSICIAN DIRECTORS ARE ELECTED BY THE MEMBER DOCTORS AND THEN THE ELECTED PHYSICIAN DIRECTORS APPOINT THE CONSUMER DIRECTORS. ALL DIRECTORS, PHYSICIAN OR CONSUMER, HAVE THE SAME VOTING RIGHTS. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders MEMBER DOCTORS HAVE THE ABILITY TO ELECT AND REMOVE MEMBERS OF THE GOVERNING BODY. Form 990, Part VI, Line 11b Review of form 990 by governing body 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. Form 990, Part VI, Line 12c Conflict of interest policy 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. Form 990, Part VI, Line 15a Process to establish compensation of top management official THE CEO'S PAY (INCLUDING BASE PAY AND BONUS) IS REVIEWED AND DETERMINED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE IS MADE UP OF THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. BONUS PAY IS DETERMINED ANNUALLY. BASE PAY IS REVIEWED PERIODICALLY BASED ON THE PROVISIONS SET FORTH IN THE CEO'S EMPLOYMENT AGREEMENT. PERIODICALLY, A REVIEW PERFORMED BY AN INDEPENDENT THIRD-PARTY CONSULTANT IS USED, ALONG WITH OTHER DATA INPUTS, TO SUPPORT THE COMPENSATION COMMITTEE'S DERMINATION OF THE BASE PAY. THESE REVIEWS INCLUDE A REVIEW OF COMPARABILITY DATA FROM SOURCES SUCH AS WARREN SALARY SURVEY. CONTEMPORANEOUS SUBSTANTIATION OF THE RESULTING DECISIONS IS RETAINED. Form 990, Part VI, Line 19 Required documents available to the public 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 THROUGH THE NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS (NAIC) WEBSITE. Form 990, Part XI, Line 9 Other changes in net assets or fund balances INCREASE IN CONTRIBUTED CAPITAL - 155500; CHANGE IN NONADMITTED ASSETS - -2831; PHP FOUNDATION INC 1700 MAGNAVOX WAY SUITE 201 FORT WAYNE IN 46804 204615314 PRIVATE FDN IN 501(c)(3) PF PHPNI false PHP HOLDING CO 1700 MAGNAVOX WAY SUITE 201 FORT WAYNE IN 46804 208074365 HOLDING CO IN PHPNI C Corporation 19367256 16691900 1.00 true PHP MANAGEMENT SYSTEMS INC 1700 MAGNAVOX WAY SUITE 201 FORT WAYNE IN 46804 351826719 LICENSED TPA IN PHP HOLDING CO C Corporation true PHP INSURANCE COMPANY OF INDIANA INC 1700 MAGNAVOX WAY SUITE 201 FORT WAYNE IN 46804 203064284 STOP LOSS REI IN PHP HOLDING CO C Corporation true PRO-CLAIM PLUS INC 1700 MAGNAVOX WAY SUITE 202 FORT WAYNE IN 46804 351938551 LICENSED TPA IN PHPMSI C Corporation true LION TECH INC 1700 MAGNAVOX WAY SUITE 202 FORT WAYNE IN 46804 300319874 CLAIMS SOFTWA IN PHPMSI C Corporation true INNOVATIVE HEALTHCARE STRATEGIES INC 1700 MAGNAVOX WAY SUITE 202 FORT WAYNE IN 46804 474139320 NETWORK NEGOT IN PHPMSI C Corporation true false true false false false false true false false true false true false true true false true false false PRO-CLAIM PLUS INC Q 5862734 COST PHP MANAGEMENT SYSTEMS INC Q 3492437 COST PHP MANAGEMENT SYSTEMS INC L 1789020 COST PHP INSURANCE COMPANY Q 1087077 COST PHP INSURANCE COMPANY L 590418 COST PRO-CLAIM PLUS INC J 377286 FMV PHP HOLDING COMPANY B 350000 CAPITAL