QUARTZ HEALTH PLAN MN CORPORATION: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- QUARTZ HEALTH PLAN MN CORPORATION (EIN 45-2633920)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-10
- IRS object ID
- 202223149349302647
- Schema version
- 2021v4.2
- 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) |
|---|---|---|
| Return | 2022-11-10T10:08:34-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 E WISCONSIN AVENUE 32ND FLOOR | AddressLine1Txt |
| City | MILWAUKEE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 452633920 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | QUARTZ HEALTH PLAN MN CORPORATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | QUAR | BusinessNameControlTxt |
| Phone | 6084714806 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2650 NOVATION PKWY | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53713 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JIM HIVELEY | PersonNm |
| Person Title | VP, TREASURER & CFO | PersonTitleTxt |
| Phone | 6084714806 | PhoneNum |
| Signature | 2022-11-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JIM | PersonFirstNm |
| Person Last | HIVELEY | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LAWRENCE H MOHR CPA | PreparerPersonNm |
| PTIN | P00447603 | PTIN |
| Phone | 4147775500 | PhoneNum |
| Preparation | 2022-11-02 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | MARK SELNA MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2650 NOVATION PKWY | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53713 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $31,014,352 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c | Yes (X) | Organization501cInd |
| Website Address | WWW.QUARTZBENEFITS.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2011 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | TO PROMOTE SOCIAL WELFARE BY OPERATION OF A HEALTH MAINTENANCE ORGANIZATION AND OTHER ACTIVITIES INCIDENTAL THERETO. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 2 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $21,587,638 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $30,999,097 | CYProgramServiceRevenueAmt |
| PY Investment Income | $17,462 | PYInvestmentIncomeAmt |
| CY Investment Income | $15,255 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$652 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $21,604,448 | PYTotalRevenueAmt |
| CY Total Revenue | $31,014,352 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $604,790 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,078,527 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $20,453,331 | PYOtherExpensesAmt |
| CY Other Expenses | $29,236,449 | CYOtherExpensesAmt |
| PY Total Expenses | $21,058,121 | PYTotalExpensesAmt |
| CY Total Expenses | $30,314,976 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $546,327 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $699,376 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,565,078 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,772,052 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,095,046 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,595,547 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,470,032 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,176,505 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROMOTE SOCIAL WELFARE BY OPERATION OF A HEALTH MAINTENANCE ORGANIZATION AND OTHER ACTIVITIES INCIDENTAL THERETO, AND ANY OTHER LAWFUL ACTIVITY WITHIN THE PURPOSE FOR WHICH A CORPORATION MAY BE ORGANIZED UNDER THE MINNESOTA NONPROFIT CORPORATION ACT, SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE AND THE MINNESOTA HEALTH MAINTENANCE ACT. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $28,358,986 | ExpenseAmt |
| Revenue | $30,999,097 | RevenueAmt |
| Desc | TO PROMOTE SOCIAL WELFARE BY OPERATION OF HEALTH MAINTENANCE ORGANIZATION PROVIDING COMPREHENSIVE HEALTH CARE INSURANCE AND OTHER HEALTH CARE ACTIVITIES FOR OUR MINNESOTA MEMBERS UNDER THE MINNESOTA NONPROFIT CORPORATION ACT, SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE AND THE MINNESOTA HEALTH MAINTENANCE ACT. | Desc |
| Total Program Service Expenses | $28,358,986 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | 0 | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 213 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 2 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JIM HIVELEY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6084714806 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2650 NOVATION PKWY | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53713 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| KYLE P BRUA | |||||||
| CHIEF ACTUARY (TERM 05/2021) | 2.00 | 48.00 | Yes (X) | $0 | $839,843 | $32,264 | |
| MARK J SELNA MD | |||||||
| PRESIDENT & CEO | 2.00 | 48.00 | Yes (X) | $0 | $809,620 | $51,914 | Yes (X) |
| GARY J LENTH MD | |||||||
| EVP & CMO (TERM 03/2021) | 1.00 | 48.00 | Yes (X) | $0 | $752,878 | $16,372 | Yes (X) |
| CHRISTINE C SENTY | |||||||
| GENERAL COUNSEL, VP & SECRETARY | 2.00 | 48.00 | Yes (X) | $0 | $455,000 | $49,536 | |
| JAMES L HIVELEY | |||||||
| VP, TREASURER & CFO | 2.00 | 48.00 | Yes (X) | $0 | $437,142 | $46,269 | |
| KIMILA A DANIELS | |||||||
| BOD - MEMBER | 1.00 | 48.00 | $0 | $448,972 | $30,732 | Yes (X) | |
| KRISTIE S MEIER | |||||||
| ASSISTANT SECRETARY | 2.00 | 48.00 | Yes (X) | $0 | $178,620 | $23,049 | |
| DAVID S HANEKOM MD | |||||||
| SENIOR VP & CHIEF MEDICAL OFFICER | 2.00 | 48.00 | Yes (X) | $0 | $152,960 | $6,388 | |
| CHARLES L JOHNSON | |||||||
| BOD - MEMBER | 1.00 | 48.00 | $0 | $124,418 | $24,172 | Yes (X) | |
| ROBERTA J HAUGAN | |||||||
| BOD - MEMBER | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| STACEY L MOUNCE ARNOLD | |||||||
| BOD - MEMBER | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,199,453 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $280,696 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| GUNDERSEN LUTHERAN MEDICAL CENTER | |||||
| PO BOX 4444 | LA CROSSE | WI | 54602 | MEDICAL SERVICES | $15,453,355 |
| MEDIMPACT HEALTHCARE SYSTEMS | |||||
| 10181 SCRIPPS GATEWAY COURT | SAN DIEGO | CA | 92131 | MEDICAL SERVICES | $6,225,955 |
| GUNDERSEN HEALTH SYSTEM | |||||
| 855 MANKATO AVE | WINONA | MN | 55987 | MEDICAL SERVICES | $3,243,840 |
| WINONA HEALTH SERVICES | |||||
| PO BOX 5600 | WINONA | MN | 55987 | MEDICAL SERVICES | $3,212,184 |
| OLMSTED MEDICAL CENTER | |||||
| 210 9TH ST SE | ROCHESTER | MN | 55904 | MEDICAL SERVICES | $2,375,126 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 16 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PREMIUM REVENUE | Desc |
| Business | 524114 | BusinessCd |
| Total Revenue Column | $30,999,097 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $30,999,097 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $30,999,097 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,255 | TotalRevenueColumnAmt |
| Exclusion | $15,255 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $31,014,352 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $30,999,097 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $15,255 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $818,023 | TotalAmt |
| Program Services | $300,417 | ProgramServicesAmt |
| Management And General | $517,606 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,532 | TotalAmt |
| Program Services | $15,665 | ProgramServicesAmt |
| Management And General | $21,867 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $168,452 | TotalAmt |
| Program Services | $12,916 | ProgramServicesAmt |
| Management And General | $155,536 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,520 | TotalAmt |
| Program Services | $22,124 | ProgramServicesAmt |
| Management And General | $32,396 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,496 | TotalAmt |
| Program Services | $3,496 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,132 | TotalAmt |
| Management And General | $13,132 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,905 | TotalAmt |
| Program Services | $1,013 | ProgramServicesAmt |
| Management And General | $13,892 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $987 | TotalAmt |
| Management And General | $987 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,273 | TotalAmt |
| Management And General | $56,273 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,600 | TotalAmt |
| Program Services | $572 | ProgramServicesAmt |
| Management And General | $40,028 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,437 | TotalAmt |
| Program Services | $1,248 | ProgramServicesAmt |
| Management And General | $42,189 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,365 | TotalAmt |
| Program Services | $6,380 | ProgramServicesAmt |
| Management And General | $15,985 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $675,764 | TotalAmt |
| Program Services | $366,446 | ProgramServicesAmt |
| Management And General | $309,318 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,070 | TotalAmt |
| Management And General | $39,070 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,036 | TotalAmt |
| Program Services | $577 | ProgramServicesAmt |
| Management And General | $3,459 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,686 | TotalAmt |
| Management And General | $1,686 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,213 | TotalAmt |
| Management And General | $15,213 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL EXPENSES | $27,614,641 | $27,614,641 | |
| COMMISSIONS | $347,831 | $347,831 | |
| ASSESSMENT/FEES | $327,628 | $5 | $327,623 |
| LOSS ADJUSTMENT EXPENSE | $13,486 | $13,486 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,899 | TotalAmt |
| Management And General | $1,899 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,314,976 | TotalAmt |
| Program Services | $28,358,986 | ProgramServicesAmt |
| Management And General | $1,955,990 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,543,287 | BOYAmt |
| EOY | $5,666,934 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $148,825 | BOYAmt |
| EOY | $10,905 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $451,574 | BOYAmt |
| EOY | $5,551,595 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $421,392 | BOYAmt |
| EOY | $558,263 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $984,355 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,565,078 | BOYAmt |
| EOY | $12,772,052 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,193,185 | BOYAmt |
| EOY | $3,437,533 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $374,933 | BOYAmt |
| EOY | $480,300 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,526,928 | BOYAmt |
| EOY | $3,677,714 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,095,046 | BOYAmt |
| EOY | $7,595,547 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,750,000 | BOYAmt |
| EOY | $4,750,000 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$279,968 | BOYAmt |
| EOY | $426,505 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,470,032 | BOYAmt |
| EOY | $5,176,505 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,565,078 | BOYAmt |
| EOY | $12,772,052 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $699,376 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$1,698 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $8,795 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| STATE INCOME TAX REC | $4,856 |
| OTHER | $1,338 |
| INTERCOMPANY RECEIVABLE | $16,888 |
| REINSURANCE RECEIVABLE | $961,273 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $984,355 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| PPACA PAYABLE | $3,326,051 |
| DUE TO QHPC | $213,308 |
| DUE TO QHS | $137,535 |
| DUE TO QHBPC | $820 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,677,714 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $31,012,654 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$1,698 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$1,698 | RevenueNotReportedAmt |
| Revenue Subtotal | $31,014,352 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $31,014,352 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $30,306,181 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$8,795 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$8,795 | ExpensesNotReportedAmt |
| Expenses Subtotal | $30,314,976 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $30,314,976 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 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, 2021 AND 2020. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RX REBATE ADJUSTMENT ADDED FOR STAT -8,795. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KYLE P BRUA | ||||||||||||||
| CHIEF ACTUARY (TERM 05/2021) | $0 | $173,759 | $0 | $144,149 | $0 | $521,935 | $0 | $16,126 | $0 | $16,138 | $0 | $872,107 | $0 | $228,375 |
| MARK J SELNA MD | ||||||||||||||
| PRESIDENT & CEO | $0 | $725,000 | $0 | $84,583 | $0 | $37 | $0 | $17,400 | $0 | $34,514 | $0 | $861,534 | $0 | $0 |
| GARY J LENTH MD | ||||||||||||||
| EVP & CMO (TERM 03/2021) | $0 | $95,154 | $0 | $149,653 | $0 | $508,071 | $0 | $11,409 | $0 | $4,963 | $0 | $769,250 | $0 | $118,125 |
| CHRISTINE C SENTY | ||||||||||||||
| GENERAL COUNSEL, VP & SECRETARY | $0 | $336,799 | $0 | $86,388 | $0 | $31,813 | $0 | $23,100 | $0 | $26,436 | $0 | $504,536 | $0 | $0 |
| JAMES L HIVELEY | ||||||||||||||
| VP, TREASURER & CFO | $0 | $324,600 | $0 | $82,118 | $0 | $30,424 | $0 | $23,100 | $0 | $23,169 | $0 | $483,411 | $0 | $0 |
| KIMILA A DANIELS | ||||||||||||||
| BOD - MEMBER | $0 | $332,440 | $0 | $85,077 | $0 | $31,455 | $0 | $23,100 | $0 | $7,632 | $0 | $479,704 | $0 | $0 |
| KRISTIE S MEIER | ||||||||||||||
| ASSISTANT SECRETARY | $0 | $160,793 | $0 | $17,749 | $0 | $78 | $0 | $13,024 | $0 | $10,025 | $0 | $201,669 | $0 | $0 |
| DAVID S HANEKOM MD | ||||||||||||||
| SENIOR VP & CHIEF MEDICAL OFFICER | $0 | $95,077 | $0 | $57,883 | $0 | $0 | $0 | $1,902 | $0 | $4,486 | $0 | $159,348 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | QUARTZ HEALTH PLAN MN CORPORATION RELIED ON A RELATED ORGANIZATION, QUARTZ HEALTH SOLUTIONS, INC., THAT USED METHODS DESCRIBED BELOW TO ESTABLISH THE TOP MANAGEMENT OFFICIALS' COMPENSATION. - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| PART I, LINES 4A-B | PART I, LINE 4A: KYLE P. BRUA RECEIVED A $293,485 SERVERANCE PAYMENT IN YEAR 2021. GARY J. LENTH RECEIVED A $389,946 SEVERANCE PAYMENT IN YEAR 2021. 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. IN 2021, $228,375 PAID TO KYLE P. BRUA AND $118,125 PAID TO GARY J. LENTH HAD BEEN REPORTED IN 2020 W2 AND FORM 990. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 6 | QUARTZ HEALTH PLAN CORPORATION IS THE SOLE CORPORATE MEMBER OF THIS ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE CORPORATE MEMBER, QUARTZ HEALTH PLAN CORPORATION, ELECTS THREE MEMBERS OF THE BOARD OF DIRECTORS. THE REMAINING TWO MEMBERS OF THE BOARD ARE NOMINATED AND ELECTED BY THE ENROLLEES OF THE PLAN. |
| FORM 990, PART VI, SECTION A, LINE 7B | GOVERNANCE DECISIONS ARE RESERVED TO THE SOLE CORPORATE MEMBER, QUARTZ HEALTH PLAN CORPORATION. |
| 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 BOARD MEMBERS AND OFFICERS MUST REVIEW, COMPLETE, AND SIGN A CONFLICT OF INTEREST DISCLOSURE FORM ON AN ANNUAL BASIS. 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 8,795. |
| FORM 990, PART XII, LINE 2C: | AS OF MAY 2016, THE FILING ORGANIZATION UTILIZES QUARTZ HEALTH PLAN CORPORATION'S AUDIT COMMITTEE. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (16 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| UNIVERSITY HEALTH CARE INC | |||||||||||
| 301 SOUTH WESTFIELD ROAD SUITE 350 | MADISON | WI | 53717 | 472553196 | SUPPORTING ORGANIZATION | WI | 501(C)(3) | LINE 12A, I | UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY | 0 | |
| QUARTZ HEALTH PLAN CORPORATION | |||||||||||
| 840 CAROLINA STREET | SAUK CITY | WI | 53583 | 391807071 | HEALTH MAINTENANCE ORGANIZATION | WI | 501(C)(4) | LINE 4 | UNIVERSITY HEALTH CARE INC | 0 | |
| REGIONAL DIVISION INC | |||||||||||
| 301 SOUTH WESTFIELD ROAD SUITE 320 | MADISON | WI | 53717 | 391446049 | REGIONAL PARENT CORP. TO MANAGE AND DIRECT ACTIVITIES OF ENTITIES | WI | 501(C)(3) | LINE 12A, I | UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY | 0 | |
| SWEDISHAMERICAN HEALTH SYSTEM CORPORATION | |||||||||||
| 1401 EAST STATE STREET | ROCKFORD | IL | 61104 | 363241458 | PARENT CORPORATION TO MANAGE AND DIRECT ACTIVITIES OF ENTITIES | IL | 501(C)(3) | LINE 12A, I | REGIONAL DIVISION INC | 0 | |
| SWEDISHAMERICAN FOUNDATION | |||||||||||
| 1415 EAST STATE STREET | ROCKFORD | IL | 61104 | 363097493 | SUPPORTS FUNDRAISING FOR SWEDISHAMERICAN HOSPITAL | IL | 501(C)(3) | LINE 7 | SWEDISHAMERICAN HOSPITAL | 0 | |
| SWEDISHAMERICAN REALTY CORPORATION | |||||||||||
| 1313 EAST STATE STREET | ROCKFORD | IL | 61104 | 363248013 | TITLE HOLDING COMPANY | IL | 501(C)(2) | LINE 2 | SWEDISHAMERICAN HEALTH SYSTEM CORPORATION | 0 | |
| SWEDISHAMERICAN HOSPITAL SELF INSURANCE TRUST | |||||||||||
| 1401 EAST STATE STREET | ROCKFORD | IL | 61104 | 366652702 | HOSPITAL MALPRACTICE TRUST | VT | 501(C)(3) | LINE 12A, I | SWEDISHAMERICAN HOSPITAL | 0 | |
| WISCONSIN THERAPIES INC | |||||||||||
| 600 HIGHLAND AVENUE | MADISON | WI | 53792 | 391807425 | INFUSION THERAPY | WI | 501(C)(3) | LINE 12D, III-O | UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY | 0 | |
| GENERATIONS FERTILITY CARE | |||||||||||
| 2365 DEMING WAY | MIDDLETON | WI | 53562 | 273496527 | REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY SERVICES | WI | 501(C)(3) | LINE 10 | 0 | N/A | |
| WISCONSIN DIALYSIS | |||||||||||
| 3034 FISH HATCHERY ROAD | FITCHBURG | WI | 53713 | 300072647 | DIALYSIS SERVICES | WI | 501(C)(3) | LINE 12C, III-FI | 0 | N/A | |
| MADISON SURGERY CENTER | |||||||||||
| 7974 UW HEALTH COURT | MIDDLETON | WI | 53562 | 391940656 | HEALTH CARE SERVICES AND TRAINING | WI | 501(C)(3) | LINE 10 | 0 | N/A | |
| UW HEALTH ACO INC | |||||||||||
| 7974 UW HEALTH COURT | MIDDLETON | WI | 53562 | 455490584 | ACCOUNTABLE CARE ORGANIZATION | WI | 501(C)(3) | LINE 10 | UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY | 0 | |
| SWEDISHAMERICAN HOSPITAL | |||||||||||
| 1401 EAST STATE STREET | ROCKFORD | IL | 61104 | 362222696 | HOSPITAL | IL | 501(C)(3) | LINE 3 | SWEDISHAMERICAN HEALTH SYSTEM CORPORATION | 0 | |
| UNIVERSITY OF WISCONSIN HOSPITALS & CLINICS AUTHORITY | |||||||||||
| 7974 UW HEALTH COURT | MIDDLETON | WI | 53562 | 391835630 | HOSPITAL AND CLINICS | WI | 501(C)(3) | LINE 3 | 0 | N/A | |
| ISTHMUS PROJECT INC | |||||||||||
| 600 HIGHLAND AVENUE | MADISON | WI | 53792 | 832278676 | RESEARCH & INNOVATION | WI | 501(C)(3) | LINE 12A, I | UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY | 0 | |
| UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION | |||||||||||
| 9794 UW HEALTH COURT | MIDDLETON | WI | 53562 | 391824445 | PHYSICIAN SERVICES | WI | 501(C)(3) | LINE 10 | UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| CHARTWELL WISCONSIN ENTERPRISES LLC | |||||||||
| 2241 PINEHURST DRIVE | MIDDLETON | WI | 53562 | 391796267 | PARENT ENTITY OF CMW AND CMW-HR | WI | N/A | 0 | 0 |
| SIXTH STREET MEDICAL LLC | |||||||||
| 7974 UW HEALTH COURT | MIDDLETON | WI | 53562 | 472705724 | REAL ESTATE | WI | N/A | 0 | 0 |
| MADISON MEDICAL CENTER LLP | |||||||||
| 7974 UW HEALTH COURT | MIDDLETON | WI | 53562 | 391329429 | REAL ESTATE | WI | N/A | 0 | 0 |
| THREE RIVERS PARTNERS LLC | |||||||||
| 1313 E STATE STREET | ROCKFORD | IL | 61104 | 262231757 | INFORMATION TECHNOLOGY SERVICES | IL | N/A | 0 | 0 |
| NORTHERN ILLINOIS VEIN CLINIC | |||||||||
| 2550 CHARLES STREET | ROCKFORD | IL | 61108 | 201642329 | OUTPATIENT HEALTH SERVICES | IL | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| HEALTH PROFESSIONALS OF WISCONSIN | |||||||||
| 301 SOUTH WESTFIELD ROAD | MADISON | WI | 53717 | 391806711 | REAL ESTATE | WI | N/A | C | 0 |
| QUARTZ HOLDING COMPANY | |||||||||
| 840 CAROLINA STREET | SAUK CITY | WI | 53583 | 821728929 | HOLDING COMPANY | WI | N/A | C | 0 |
| QUARTZ HEALTH INSURANCE CORPORATION | |||||||||
| 840 CAROLINA STREET | SAUK CITY | WI | 53583 | 391565691 | INDEMNITY CORPORATION | WI | N/A | C | 0 |
| QUARTZ HEALTH SOLUTIONS INC | |||||||||
| 840 CAROLINA STREET | SAUK CITY | WI | 53583 | 465710709 | TPA | WI | N/A | C | 0 |
| QUARTZ HEALTH BENEFIT PLANS CORPORATION | |||||||||
| 840 CAROLINA STREET | SAUK CITY | WI | 53583 | 391450766 | HEALTH MAINTENANCE ORGANIZATION | WI | N/A | C | 0 |
| SARI INSURANCE COMPANY | |||||||||
| 76 ST PAUL STREET SUITE 500 | BURLINGTON | VT | 054014477 | 030308753 | CAPTIVE INSURANCE COMPANY | VT | N/A | C | 0 |
| STATE & CHARLES INC | |||||||||
| 1313 EAST STATE STREET | ROCKFORD | IL | 61104 | 363321193 | HOLDING COMPANY | IL | N/A | C | 0 |
| PHYSICIAN'S CARE NETWORK | |||||||||
| 1313 EAST STATE STREET | ROCKFORD | IL | 61104 | 363455791 | HEALTH SERVICES | IL | N/A | C | 0 |
| SWEDISHAMERICAN HEALTH MANAGEMENT CORP | |||||||||
| 1401 E STATE STREET | ROCKFORD | IL | 61104 | 363246511 | MANAGEMENT SERVICES | IL | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| QUARTZ HEALTH PLAN CORPORATION | ||
| P | $1,560,762 | COST |
| QUARTZ HEALTH BENEFIT PLANS CORPORATION | ||
| K | $10,364 | COST |
| QUARTZ HEALTH SOLUTIONS INC | ||
| P | $12,661 | COST |
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