QUARTZ HEALTH PLAN CORPORATION: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- QUARTZ HEALTH PLAN CORPORATION (EIN 39-1807071)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-12
- IRS object ID
- 202103169349303030
- Schema version
- 2020v4.1
- 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 | 2021-11-12T11:53:30-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | 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 | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391807071 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | QUARTZ HEALTH PLAN 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 | 840 CAROLINA STREET | AddressLine1Txt |
| City | SAUK CITY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 535831374 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JIM HIVELEY | PersonNm |
| Person Title | VP, TREASURER & CFO | PersonTitleTxt |
| Phone | 6084714806 | PhoneNum |
| Signature | 2021-11-11 | 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 | 2021-11-09 | PreparationDt |
| Self Employed | Yes (X) | SelfEmployedInd |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MARK SELNA MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 840 CAROLINA STREET | AddressLine1Txt |
| City | SAUK CITY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 535831374 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $280,837,276 | 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 | 1995 | FormationYr |
| Legal Domicile State | WI | 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 | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 1 | 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 | $251,784,977 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $280,569,952 | CYProgramServiceRevenueAmt |
| PY Investment Income | $788,890 | PYInvestmentIncomeAmt |
| CY Investment Income | $267,324 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $252,573,867 | PYTotalRevenueAmt |
| CY Total Revenue | $280,837,276 | 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 | $10,037,509 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,814,652 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $242,345,123 | PYOtherExpensesAmt |
| CY Other Expenses | $262,169,148 | CYOtherExpensesAmt |
| PY Total Expenses | $252,382,632 | PYTotalExpensesAmt |
| CY Total Expenses | $271,983,800 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $191,235 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $8,853,476 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $55,635,092 | TotalAssetsBOYAmt |
| Total Assets EOY | $75,250,286 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $34,638,187 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $48,576,811 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $20,996,905 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $26,673,475 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROMOTE SOCIAL WELFARE BY OPERATION OF A HEALTH MAINTENANCE ORGANIZATION AND OTHER ACTIVITIES INCIDENTAL THERETO. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $255,047,050 | ExpenseAmt |
| Revenue | $280,569,952 | RevenueAmt |
| Desc | PROVISION OF HEALTH CARE SERVICES PROVIDED FOR 66,816 MEMBERS. | Desc |
| Total Program Service Expenses | $255,047,050 | 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 | Yes (1) | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 1084 | 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | 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 | 840 CAROLINA STREET | AddressLine1Txt |
| City | SAUK CITY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 535831374 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| ALAN S KAPLAN MD | |||||||
| BOD - MEMBER | 2.00 | 48.00 | Yes (X) | $0 | $2,722,677 | $99,030 | |
| TERRY R BOLZ | |||||||
| PRESIDENT/CEO (THROUGH 07/2020) | 2.00 | 48.00 | $0 | $1,119,329 | $58,301 | Yes (X) | |
| ROBERT W FLANNERY | |||||||
| BOD - CHAIRMAN | 2.00 | 48.00 | Yes (X) | $0 | $947,493 | $64,848 | |
| MICHAEL E DALLMAN | |||||||
| BOD - MEMBER | 2.00 | 48.00 | Yes (X) | $0 | $859,598 | $93,792 | |
| KYLE P BRUA | |||||||
| CHIEF ACTUARY | 2.00 | 48.00 | $0 | $625,743 | $175,872 | Yes (X) | |
| GARY J LENTH MD | |||||||
| EVP & CMO | 2.00 | 48.00 | $0 | $641,941 | $157,600 | Yes (X) | |
| MICHAEL J DOLAN MD | |||||||
| BOD - MEMBER | 2.00 | 48.00 | Yes (X) | $0 | $621,044 | $31,938 | |
| CHRISTINE C SENTY | |||||||
| GENERAL COUNSEL, VP & SECRETARY | 2.00 | 48.00 | $0 | $480,479 | $137,393 | Yes (X) | |
| JAMES L HIVELEY | |||||||
| VP, TREASURER & CFO | 2.00 | 48.00 | $0 | $430,430 | $125,706 | Yes (X) | |
| WILLIAM J FARRELL | |||||||
| BOD - MEMBER | 2.00 | 48.00 | Yes (X) | $0 | $397,105 | $54 | |
| MARK J SELNA MD | |||||||
| PRESIDENT & CEO (EFF. 08/2020) | 2.00 | 48.00 | $0 | $331,513 | $13,995 | Yes (X) | |
| KRISTIE S MEIER | |||||||
| ASSISTANT SECRETARY | 2.00 | 48.00 | $0 | $184,597 | $23,705 | Yes (X) | |
| GERALD E ARNDT | |||||||
| BOD - MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $26,203 | $0 | |
| GERALD R KEMBER | |||||||
| BOD - MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $18,930 | $0 | |
| VIRGINIA L GRAVES | |||||||
| BOD - MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $13,769 | $0 | |
| HEIDI M EGLASH | |||||||
| BOD - MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $10,809 | $0 | |
| KEVIN R HAUSER | |||||||
| BOD - MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $10,146 | $0 | |
| JAMES A FALCK | |||||||
| BOD - MEMBER (TERM. 2020) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $9,441,806 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $982,234 | 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 | |||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | MEDICAL SERVICES | $105,821,719 |
| UW HOSPITALS & CLINICS AUTHORITY | |||||
| 7974 UW HEALTH COURT | MIDDLETON | WI | 53562 | MEDICAL SERVICES | $37,787,182 |
| MEDIMPACT HEALTHCARE SYSTEMS | |||||
| 10181 SCRIPPS GATEWAY COURT | SAN DIEGO | CA | 92131 | MEDICAL SERVICES | $30,180,839 |
| VERNON MEMORIAL HEALTHCARE | |||||
| 507 S MAIN STREET | VIROQUA | WI | 54665 | MEDICAL SERVICES | $13,711,292 |
| MERITER HOSPITAL INC | |||||
| 202 S PARK ST | MADISON | WI | 53715 | MEDICAL SERVICES | $11,092,012 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 114 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PREMIUM REVENUE | Desc |
| Business | 524114 | BusinessCd |
| Total Revenue Column | $280,569,952 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $280,569,952 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $280,569,952 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $267,324 | TotalRevenueColumnAmt |
| Exclusion | $267,324 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $280,837,276 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $280,569,952 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $267,324 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,865,140 | TotalAmt |
| Program Services | $2,583,382 | ProgramServicesAmt |
| Management And General | $4,281,758 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $451,723 | TotalAmt |
| Program Services | $127,523 | ProgramServicesAmt |
| Management And General | $324,200 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,021,965 | TotalAmt |
| Program Services | $33,315 | ProgramServicesAmt |
| Management And General | $1,988,650 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $475,824 | TotalAmt |
| Program Services | $196,628 | ProgramServicesAmt |
| Management And General | $279,196 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,625 | TotalAmt |
| Program Services | $12,665 | ProgramServicesAmt |
| Management And General | $40,960 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,065 | TotalAmt |
| Management And General | $73,065 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $384,750 | TotalAmt |
| Program Services | $22,317 | ProgramServicesAmt |
| Management And General | $362,433 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,787 | TotalAmt |
| Management And General | $8,787 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $279,228 | TotalAmt |
| Management And General | $279,228 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,780,171 | TotalAmt |
| Program Services | $14,389 | ProgramServicesAmt |
| Management And General | $2,765,782 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $987,380 | TotalAmt |
| Program Services | $93,021 | ProgramServicesAmt |
| Management And General | $894,359 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $500,047 | TotalAmt |
| Program Services | $74,579 | ProgramServicesAmt |
| Management And General | $425,468 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $353,897 | TotalAmt |
| Management And General | $353,897 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,369 | TotalAmt |
| Program Services | $5,836 | ProgramServicesAmt |
| Management And General | $52,533 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,992 | TotalAmt |
| Management And General | $14,992 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,122 | TotalAmt |
| Program Services | $65 | ProgramServicesAmt |
| Management And General | $120,057 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL EXPENSES | $249,215,852 | $249,215,852 | |
| OUTSOURCED SERVICES | $6,505,243 | $2,422,473 | $4,082,770 |
| COMMISSIONS | $661,022 | $661,022 | |
| NON-INCOME STATE TAX BE | -$143,778 | -$143,778 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $316,376 | TotalAmt |
| Program Services | $245,005 | ProgramServicesAmt |
| Management And General | $71,371 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $271,983,800 | TotalAmt |
| Program Services | $255,047,050 | ProgramServicesAmt |
| Management And General | $16,936,750 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,359,355 | BOYAmt |
| EOY | $55,147,535 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,878,863 | BOYAmt |
| EOY | $730,800 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,850,464 | BOYAmt |
| EOY | $6,580,932 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,477,668 | BOYAmt |
| EOY | $7,568,399 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,830,107 | BOYAmt |
| EOY | $4,469,668 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $238,635 | BOYAmt |
| EOY | $752,952 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,635,092 | BOYAmt |
| EOY | $75,250,286 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,464,828 | BOYAmt |
| EOY | $20,453,993 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $640,467 | BOYAmt |
| EOY | $613,018 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,532,892 | BOYAmt |
| EOY | $27,509,800 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,638,187 | BOYAmt |
| EOY | $48,576,811 | 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 | $14,409,750 | BOYAmt |
| EOY | $19,409,750 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,587,155 | BOYAmt |
| EOY | $7,263,725 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,996,905 | BOYAmt |
| EOY | $26,673,475 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,635,092 | BOYAmt |
| EOY | $75,250,286 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $8,853,476 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $173,027 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$3,349,933 | OtherChangesInNetAssetsAmt |
| 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 |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INVESTMENT IN SUBSIDIARY | Desc |
| Book Value | $4,469,668 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $4,469,668 | TotalBookValueProgramRltdAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)
| DescDesc | AmtAmt |
|---|---|
| CLAIMS PAYABLE | $26,649,573 |
| DEFERRED TAX LIABILITY | $14,176 |
| DUE TO QHPMC | $11,064 |
| DUE TO QHIC | $680 |
| DUE TO QHS | $833,916 |
| DUE TO QHBPC | $391 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $27,509,800 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $281,541,740 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $173,027 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $546,327 | OtherRevenueAmt |
| Revenue Not Reported | $719,354 | RevenueNotReportedAmt |
| Revenue Subtotal | $280,822,386 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $14,890 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $14,890 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $280,837,276 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $271,968,910 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $271,968,910 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $14,890 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $14,890 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $271,983,800 | 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, 2020 AND 2019. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | GAIN IN SUBSIDIARY EQUITY 546,327. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | 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 (12 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ALAN S KAPLAN MD | ||||||||||||||
| BOD - MEMBER | $0 | $1,641,092 | $0 | $1,075,540 | $0 | $6,045 | $0 | $51,962 | $0 | $47,068 | $0 | $2,821,707 | $0 | $0 |
| TERRY R BOLZ | ||||||||||||||
| PRESIDENT/CEO (THROUGH 07/2020) | $0 | $676,662 | $0 | $434,277 | $0 | $8,390 | $0 | $0 | $0 | $58,301 | $0 | $1,177,630 | $0 | $0 |
| ROBERT W FLANNERY | ||||||||||||||
| BOD - CHAIRMAN | $0 | $737,908 | $0 | $207,014 | $0 | $2,571 | $0 | $0 | $0 | $64,848 | $0 | $1,012,341 | $0 | $0 |
| MICHAEL E DALLMAN | ||||||||||||||
| BOD - MEMBER | $0 | $541,308 | $0 | $320,954 | $0 | -$2,664 | $0 | $50,921 | $0 | $42,871 | $0 | $953,390 | $0 | $0 |
| KYLE P BRUA | ||||||||||||||
| CHIEF ACTUARY | $0 | $410,881 | $0 | $130,162 | $0 | $84,700 | $0 | $146,853 | $0 | $29,019 | $0 | $801,615 | $0 | $0 |
| GARY J LENTH MD | ||||||||||||||
| EVP & CMO | $0 | $471,894 | $0 | $123,585 | $0 | $46,462 | $0 | $137,625 | $0 | $19,975 | $0 | $799,541 | $0 | $0 |
| MICHAEL J DOLAN MD | ||||||||||||||
| BOD - MEMBER | $0 | $486,291 | $0 | $522 | $0 | $134,231 | $0 | $11,400 | $0 | $20,538 | $0 | $652,982 | $0 | $0 |
| CHRISTINE C SENTY | ||||||||||||||
| GENERAL COUNSEL, VP & SECRETARY | $0 | $292,255 | $0 | $82,058 | $0 | $106,166 | $0 | $109,511 | $0 | $27,882 | $0 | $617,872 | $0 | $0 |
| JAMES L HIVELEY | ||||||||||||||
| VP, TREASURER & CFO | $0 | $270,221 | $0 | $74,781 | $0 | $85,428 | $0 | $104,795 | $0 | $20,911 | $0 | $556,136 | $0 | $0 |
| WILLIAM J FARRELL | ||||||||||||||
| BOD - MEMBER | $0 | $324,728 | $0 | $22 | $0 | $72,355 | $0 | $0 | $0 | $54 | $0 | $397,159 | $0 | $0 |
| MARK J SELNA MD | ||||||||||||||
| PRESIDENT & CEO (EFF. 08/2020) | $0 | $214,977 | $0 | $0 | $0 | $116,536 | $0 | $6,692 | $0 | $7,303 | $0 | $345,508 | $0 | $0 |
| KRISTIE S MEIER | ||||||||||||||
| ASSISTANT SECRETARY | $0 | $143,073 | $0 | $16,559 | $0 | $24,965 | $0 | $14,193 | $0 | $9,512 | $0 | $208,302 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| 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. |
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 2 | MICHAEL DALLMAN, MICHAEL J. DOLAN, ROBERT W. FLANNERY, WILLIAM J. FARRELL AND ALAN S. KAPLAN 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. AND GUNDERSEN HEALTH SYSTEM, INC. SHALL EACH APPOINT THREE MEMBERS OF THE BOARD OF DIRECTORS. UNITYPOINT HEALTH (IOWA HEALTH SYSTEM) WILL APPOINT TWO MEMBERS 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: | GAIN IN SUBSIDIARY EQUITY 546,327. CAPITAL CONTRIBUTION-AURORA HEALTH CARE 5,000,000. DIVIDEND DISTRIBUTION TO GUNDERSEN HEALTH SYSTEM -8,896,260. |
| 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 (17 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 MN CORPORATION | |||||||||||
| 840 CAROLINA STREET | SAUK CITY | WI | 53583 | 452633920 | HEALTH INSURANCE | MN | 501(C)(4) | QUARTZ HEALTH PLAN CORPORATION | Yes (1) | ||
| 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) | 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 | |
| FRIENDS OF UNIVERSITY OF WISCONSIN HOSPITAL | |||||||||||
| 301 SOUTH WESTFIELD ROAD SUITE 250 | MADISON | WI | 53717 | 510137187 | FUND PROGRAMS TO SUPPORT HEALTH RELATED NEEDS OF PATIENTS | WI | 501(C)(3) | LINE 7 | UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY | 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 | Yes (1) | |
| UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION | |||||||||||
| 7974 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 |
| MEDICAL 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 | Yes (1) | 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 | Yes (1) | 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 MN CORPORATION | ||
| Q | $1,136,196 | COST |
| QUARTZ HEALTH SOLUTIONS | ||
| O | $19,773,407 | COST |
| QUARTZ HEALTH BENEFIT PLANS CORPORATION | ||
| K | $353,897 | COST |
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