2024-11-12T12:31:10-06:00 2023-12-31 390859910 BAKER TILLY ADVISORY GROUP LP 790 N WATER ST SUITE 2000 MILWAUKEE WI 53202 990 2023-01-01 391807071 QUARTZ HEALTH PLAN CORPORATION QUAR 6084714771 2650 NOVATION PKWY FITCHBURG WI 53713 JEFF A BUTCHER SENIOR VP, CFO AND TREASURER 6084714771 2024-11-12 1 1 TROY MARINE CPA P00187863 4147775500 2024-11-06 2023 2024-10-15 13:58:12Z CHRISTINE C SENTY 2650 NOVATION PKWY FITCHBURG WI 53713 431530483 0 X WWW.QUARTZBENEFITS.COM X 1995 WI TO PROMOTE SOCIAL WELFARE BY OPERATION OF A HEALTH MAINTENANCE ORGANIZATION AND OTHER ACTIVITIES INCIDENTAL THERETO. 11 11 0 14 0 0 0 0 390577636 428752288 543456 2778195 0 0 391121092 431530483 0 0 0 0 14169238 18318756 0 0 0 383120021 420261022 397289259 438579778 -6168167 -7049295 91900389 113470719 52653193 66108118 39247196 47362601 TO PROMOTE SOCIAL WELFARE BY OPERATION OF A HEALTH MAINTENANCE ORGANIZATION AND OTHER ACTIVITIES INCIDENTAL THERETO. 0 0 413383037 428752288 PROVISION OF HEALTH CARE SERVICES PROVIDED FOR 80,793 MEMBERS. 413383037 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 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 1 0 1 X 1777 0 1 0 0 0 0 0 0 0 0 0 X 11 11 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X JEFF A BUTCHER 6084714771 2650 NOVATION PKWY FITCHBURG WI 53713 GERALD E ARNDT BOD - MEMBER 2.00 0.00 X 0 18473 0 GERALD R KEMBER BOD - MEMBER 2.00 0.00 X 0 15092 0 GEORGE H TERVALON III BOD - MEMBER 2.00 0.00 X 0 12175 0 RANDY R BRUEGMAN BOD - MEMBER 2.00 0.00 X 0 10302 0 WILLIAM J FARRELL BOD - CHAIRMAN 2.00 48.00 X 0 0 0 ALAN S KAPLAN MD BOD - MEMBER 2.00 48.00 X 0 0 0 CAREY M GEHL BOD - MEMBER 2.00 0.00 X 0 0 0 GERALD P OETZEL BOD - MEMBER (TERM 08/2023) 2.00 48.00 X 0 0 0 JENNIFER B ATKINS BOD - MEMBER (TERM DURING 2023) 2.00 0.00 X 0 0 0 MICHAEL J DOLAN MD BOD - MEMBER (START 12/2023) 2.00 48.00 X 0 0 0 REBEKAH J GALES SWAIN BOD - MEMBER (START 12/2023) 2.00 48.00 X 0 0 0 ROBERT W FLANNERY BOD - MEMBER 2.00 48.00 X 0 0 0 SUSAN I ERICKSON BOD - MEMBER 2.00 0.00 X 0 0 0 SUSAN R JOHANSEN GREEN BOD - MEMBER (TERM 08/2023) 2.00 0.00 X 0 0 0 MARK J SELNA MD PRESIDENT & CEO (TERM 05/2023) 2.00 48.00 X 0 810251 37104 JEFFREY A BUTCHER SENIOR VP, TREASURER & CFO 2.00 48.00 X 0 650584 35818 CHRISTINE C SENTY JD PRESIDENT & CEO 2.00 48.00 X 0 571762 46696 DAVID S HANEKOM MD SENIOR VP & CHIEF MEDICAL OFFICER 2.00 48.00 X 0 540460 48240 JAMES L HIVELEY VP, TREASURER & CFO (TERM 04/2023) 2.00 48.00 X 0 517354 23113 KRISTIE S BREUNIG JD GENERAL COUNSEL, VP & SECRETARY 2.00 48.00 X 0 272239 38955 JAMI J BERGER SENIOR VP CHIEF CLINICAL OFFICER (AS OF 11/2023) 2.00 48.00 X 0 78958 0 0 3497650 229926 0 0 1 0 GUNDERSEN LUTHERAN MEDICAL CENTER 1910 SOUTH AVE LA CROSSE WI 54601 MEDICAL SERVICES 130628739 MEDIMPACT HEALTHCARE SYSTEMS 10181 SCRIPPS GATEWAY COURT SAN DIEGO CA 92131 MEDICAL SERVICES 73942284 UW HOSPITALS & CLINICS AUTHORITY 7974 UW HEALTH COURT MIDDLETON WI 53562 MEDICAL SERVICES 61829719 MERITER HOSPITAL INC 202 S PARK ST MADISON WI 53715 MEDICAL SERVICES 22662493 UNIVERSITY OF WISCONSIN MEDICAL FOUNDATI PO BOX 620993 MIDDLETON WI 53562 MEDICAL SERVICES 19544187 189 PREMIUM REVENUE 524114 428752288 428752288 428752288 2777760 2777760 435 0 435 435 435 431530483 428752288 0 2778195 14235952 5381751 8854201 442295 172782 269513 2649822 65405 2584417 990687 412758 577929 187270 187270 375759 375759 439957 439957 1148856 44368 1104488 799386 90989 708397 4887786 2225250 2662536 511666 511666 112441 23405 89036 55999 8780 47219 8429 8429 540696 9196 531500 356613 356613 MEDICAL EXPENSES 400572353 400572353 OUTSOURCED SERVICES 6226270 4109016 2117254 COMMISSIONS 3315378 3315378 CORPORATE DUES, LICENSE 192321 973 191348 529842 257582 272260 438579778 413383037 25196741 0 55574858 59630163 144932 151327 20521204 34547214 13300 0 6370906 8479986 8378743 8975385 896446 1686644 91900389 113470719 47566847 53984704 4123487 7376003 962859 4747411 52653193 66108118 X 0 0 32850999 47005731 6396197 356870 39247196 47362601 91900389 113470719 X -7049295 107187 15057513 X 0 1 X 1 0 0 INVESTMENT IN SUBSIDIARY 8975385 C 8975385 DUE TO QUARTZ HEALTH PLAN MN CORPORATION 1553 DUE TO QUARTZ HEALTH SOLUTIONS, INC. 4718981 DUE TO QUARTZ HEALTH BENEFIT PLANS CORPORATION 26877 4747411 X 432234312 107187 596642 703829 431530483 0 431530483 438273639 0 438273639 306139 306139 438579778 PART X, LINE 2: QUARTZ HEALTH PLAN CORPORATION (QHPC) AND QUARTZ HEALTH PLAN MN CORPORATION (QHPMC) ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501( C )(4) OF THE INTERNAL REVENUE CODE. QHPC IS SUBJECT TO WISCONSIN STATE FRANCHISE TAX, ILLINOIS INCOME TAX, ILLINOIS RETALIATORY TAX, AND IOWA PREMIUM TAX. QHPMC IS SUBJECT TO MINNESOTA PREMIUM TAX. QUARTZ RECOGNIZES THE FINANCIAL STATEMENT BENEFIT OF A TAX POSITION ONLY AFTER DETERMINING THAT THE RELEVANT TAX AUTHORITY WOULD MORE LIKELY THAN NOT SUSTAIN THE POSITION FOLLOWING AN AUDIT. FOR TAX POSITIONS MEETING THE MORE-LIKELY-THAN-NOT THRESHOLD, THE AMOUNT RECOGNIZED IN THE FINANCIAL STATEMENTS IS THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT WITH THE RELEVANT TAX AUTHORITY. QUARTZ HAS APPLIED THE UNCERTAIN TAX POSITION GUIDANCE TO ALL TAX POSITIONS FOR WHICH STATUTE OF LIMITATIONS REMAIN OPEN. QUARTZ RECOGNIZES, IF NECESSARY, INTEREST AND PENALTIES RELATED TO INCOME TAXES THAT HAVE BEEN ACCRUED OR RECOGNIZED AS OF AND FOR THE YEARS ENDED DECEMBER 31, 2023 AND 2022. PART XI, LINE 2D - OTHER ADJUSTMENTS: GAIN IN SUBSIDIARY EQUITY 596,642. PART XII, LINE 4B - OTHER ADJUSTMENTS: RX REBATE ADJUSTMENT ADDED FOR STAT 306,139. 1 1 0 0 0 0 0 0 0 MARK J SELNA MD PRESIDENT & CEO (TERM 05/2023) 0 275095 0 179925 0 355231 0 11154 0 25950 0 847355 0 0 JEFFREY A BUTCHER SENIOR VP, TREASURER & CFO 0 379608 0 176057 0 94919 0 12072 0 23746 0 686402 0 0 CHRISTINE C SENTY JD PRESIDENT & CEO 0 485829 0 52629 0 33304 0 13200 0 33496 0 618458 0 0 DAVID S HANEKOM MD SENIOR VP & CHIEF MEDICAL OFFICER 0 460111 0 76685 0 3664 0 13200 0 35040 0 588700 0 0 JAMES L HIVELEY VP, TREASURER & CFO (TERM 04/2023) 0 189501 0 50989 0 276864 0 4688 0 18425 0 540467 0 74823 KRISTIE S BREUNIG JD GENERAL COUNSEL, VP & SECRETARY 0 204156 0 67387 0 696 0 8273 0 30682 0 311194 0 0 PART I, LINE 3 QUARTZ HEALTH PLAN CORPORATION RELIED ON A RELATED ORGANIZATION, QUARTZ HEALTH SOLUTIONS, INC., THAT USED METHODS DESCRIBED BELOW TO ESTABLISH THE TOP MANAGEMENT OFFICIALS' COMPENSATION. - COMPENSATION SURVEY OR STUDY - INDEPENDENT COMPENSATION CONSULTANT - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINES 4A-B PART I, LINE 4A: SOME EMPLOYEES RECEIVED A SEVERANCE PAYMENT DURING THE CALENDER YEAR. THE TERMS AND CONDITIONS OF THE CONFIDENTIAL SEVERANCE AGREEMENT ARE AVAILABLE TO THE INTERNAL REVENUE SERVICE UPON REQUEST. PART I, LINE 4B: QUARTZ HEALTH SOLUTIONS, INC. INITIATED A NONQUALIFIED DEFERRED RETIREMENT PLAN IN 2019 AND STARTED FUNDING IN 2020. A NUMBER OF EMPLOYEES PARTICIPATED IN THE PLAN DURING THE YEAR. THE DEFERRED AMOUNT IS INCLUDED IN PART VII, COLUMN F AND SCHEDULE J, PART II, COLUMN C AND THE VESTED AMOUNT IS INCLUDED IN PART VII, COLUMN D AND SCHEDULE J, PART II, COLUMN B(III). THE TERMS AND CONDITIONS OF THE CONFIDENTIAL AGREEMENTS ARE AVAILABLE TO THE INTERNAL REVENUE SERVICE UPON REQUEST. THE AMOUNT PAID TO JAMES L. HIVELEY DURING 2023 WAS $150,308. THERE WERE NO AMOUNTS PAID OUT TO ANY OTHER PARTICIPANTS. FORM 990, PART V, LINE 2B: ALL EMPLOYEES ARE LEGAL EMPLOYEES OF QUARTZ HEALTH SOLUTIONS (FEIN: 46-5710709), WHICH FILES ALL REQUIRED FEDERAL EMPLOYMENT FORMS EACH YEAR. FORM 990, PART VI, SECTION A, LINE 2 MICHAEL J. DOLAN, ROBERT W. FLANNERY, WILLIAM J. FARRELL, ALAN S. KAPLAN, SUSAN I. ERICKSON, CAREY M. GEHL, AND REBEKAH SWAIN HAVE A BUSINESS RELATIONSHIP OUTSIDE OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 GUNDERSEN HEALTH SYSTEM, INC., UNITYPOINT HEALTH (IOWA HEALTH SYSTEM), UNIVERSITY HEALTH CARE, INC., AND AURORA HEALTH CARE ARE THE CORPORATE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A UNIVERSITY HEALTH CARE, INC. SHALL APPOINT 4 MEMBERS OF THE BOARD OF DIRECTORS, GUNDERSEN HEALTH SYSTEM, INC. SHALL APPOINT 3 MEMBERS OF THE BOARD OF DIRECTORS, AND AURORA HEALTH CARE, SHALL APPOINT 1 MEMBER OF THE BOARD OF DIRECTORS. THE REMAINING THREE INDEPENDENT INDIVIDUAL MEMBERS OF THE BOARD ARE ELECTED BY THE BOARD BY A SUPERMAJORITY. FORM 990, PART VI, SECTION A, LINE 7B SOME GOVERNANCE DECISIONS ARE RESERVED TO THE CORPORATE MEMBERS AND NOT THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY BAKER TILLY US, LLP AND IS REVIEWED FOR COMPLETENESS AND ACCURACY BY MANAGEMENT. FOR THIS PURPOSE, MANAGEMENT INCLUDES THE CFO FOR QUARTZ HEALTH SOLUTIONS, INC. THE ORGANIZATION INFORMS THE MEMBERS OF THE BOARD FINANCE COMMITTEE THAT A COPY OF FORM 990 IS AVAILABLE FOR REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL HEALTH PLAN EMPLOYEES AND COMMITTEE MEMBERS MUST REVIEW, COMPLETE, AND SIGN A CONFLICT OF INTEREST DISCLOSURE FORM ON AN ANNUAL BASIS AS PART OF THE MANDATORY EDUCATION PROCESS. BOARD MEMBERS ARE ALSO SENT A DISCLOSURE FORM TO COMPLETE ON AN ANNUAL BASIS ALONG WITH THE EMPLOYEES AND COMMITTEE MEMBERS. ALL DISCLOSURES ARE TRACKED AND HOUSED IN THE COMPLIANCE DEPARTMENT. FURTHER, IF AT ANY TIME AN INDIVIDUAL BECOMES AWARE OF AN ACTUAL, POTENTIAL, OR PERCEIVED CONFLICT OF INTEREST, THE POLICY INDICATES THAT THE INDIVIDUAL SHALL IMMEDIATELY NOTIFY THE COMPLIANCE OFFICER, WHO THEN REVIEWS ANY DISCLOSED CONFLICTS TO ASSESS ANY RISK AND/OR NEGATIVE INFLUENCE ON THE HEALTH PLAN AND DRAFTS PROPOSED RECOMMENDATIONS TO ANY DISCLOSED CONFLICTS OF INTEREST. THE COMPLIANCE OFFICER THEN PROVIDES THE DISCLOSED CONFLICTS OF INTEREST(S) AND PROPOSED RECOMMENDATION(S) TO A CONFLICT OF INTEREST REVIEW GROUP FOR FINAL REVIEW AND DETERMINATION REGARDING THE RECOMMENDATION. ONCE THE CONFLICT OF INTEREST REVIEW GROUP MAKES ITS FINAL DETERMINATION WITH RESPECT TO THE RECOMMENDATION THE COMPLIANCE OFFICER SHALL COMMUNICATE THE RECOMMENDATION TO THE EMPLOYEE AND, WHEN APPLICABLE, TO THE CHAIRPERSON OF ANY COMMITTEE WHICH MAY BE REFERENCED IN THE RECOMMENDATION. FORM 990, PART VI, SECTION C, LINE 19 REQUESTS FOR THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE THROUGH THE LEGAL DEPARTMENT WHO THEN REVIEWS THE REQUESTS AND MAKES THE APPROPRIATE DOCUMENTS AVAILABLE FOR INSPECTION IN THE LEGAL DEPARTMENT ITSELF FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN IRC SECTION 6104(D). FORM 990, PART XI, LINE 9: RX REBATE ADJUSTMENT ADDED FOR STAT 306,139. GAIN IN SUBSIDIARY INCOME 596,642. ADDITIONAL PAID IN CAPITAL - UNIVERSITY HEALTH CARE, INC. 5,280,000. ADDITIONAL PAID IN CAPITAL - UNITY POINT HEALTH, INC. 1,320,000. ADDITIONAL PAID IN CAPITAL - AURORA HEALTH CARE, INC. 2,154,732. ADDITIONAL PAID IN CAPITAL - GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. 5,400,000. FORM 990, PART X, LINE 33: THE ORGANIZATION HAS PREPARED THE FORM 990 IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP), BUT DOES NOT FOLLOW SFAS 117 (ASC 958). THE IRS DOES NOT REQUIRE REPORTING ACCORDING TO ASC 958. QUARTZ HEALTH PLAN MN CORPORATION 2650 NOVATION PKWY FITCHBURG WI 53713 452633920 HEALTH INSURANCE MN 501(C)(4) QUARTZ HEALTH PLAN CORPORATION 1 QUARTZ HEALTH BENEFIT PLANS CORPORATION 2650 NOVATION PKWY FITCHBURG WI 53713 391450766 HEALTH MAINTENANCE ORGANIZATION WI N/A C 0 QUARTZ HOLDING COMPANY 2650 NOVATION PKWY FITCHBURG WI 53713 821728929 HOLDING COMPANY WI N/A C 0 QUARTZ HEALTH SOLUTIONS INC 2650 NOVATION PKWY FITCHBURG WI 53713 465710709 TPA WI N/A C 0 QUARTZ HEALTH INSURANCE CORPORATION 2650 NOVATION PKWY FITCHBURG WI 53713 391565691 INDEMNITY CORPORATION WI N/A C 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 QUARTZ HEALTH SOLUTIONS P 31671139 COST AND FEES