2025-11-12T12:01:15-06:00 2024-12-31 390859910 BAKER TILLY ADVISORY GROUP LP 790 N WATER ST SUITE 2000 MILWAUKEE WI 53202 990 2024-01-01 452633920 QUARTZ HEALTH PLAN MN CORPORATION QUAR 6084714771 2650 NOVATION PKWY FITCHBURG WI 53713 JEFFREY A BUTCHER SENIOR VP, CFO AND TREASURER 6084714771 2025-11-12 1 1 SHELBY NETZ P01405265 4147775500 2025-11-12 2024 2025-03-06 01:10:19Z CHRISTINE C SENTY 2650 NOVATION PKWY FITCHBURG WI 53713 51571251 0 X WWW.QUARTZBENEFITS.COM X 2011 MN TO PROMOTE SOCIAL WELFARE BY OPERATION OF A HEALTH MAINTENANCE ORGANIZATION AND OTHER ACTIVITIES INCIDENTAL THERETO. 5 4 0 5 0 0 0 0 43747329 51016060 521167 555191 0 0 44268496 51571251 0 0 0 0 1339577 1527695 0 0 0 42350198 50242978 43689775 51770673 578721 -199422 19664103 21301599 10688717 12525752 8975386 8775847 X 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. 0 0 48491227 51016060 TO PROMOTE SOCIAL WELFARE BY OPERATION OF HEALTH MAINTENANCE ORGANIZATION PROVIDING COMPREHENSIVE HEALTH CARE INSURANCE AND OTHER HEALTH CARE ACTIVITIES FOR 6,156 MINNESOTA MEMBERS UNDER THE MINNESOTA NONPROFIT CORPORATION ACT, SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE AND THE MINNESOTA HEALTH MAINTENANCE ACT. 48491227 0 0 0 0 0 0 0 0 0 0 0 0 1 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 0 0 1 X 254 0 1 0 0 0 0 0 0 0 0 0 X 5 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X JEFFREY A BUTCHER 6084714771 2650 NOVATION PKWY FITCHBURG WI 53713 CHRISTINE C SENTY JD PRESIDENT & CEO 2.00 48.00 X X 0 1071410 59967 CHARLES L JOHNSON BOD - MEMBER 1.00 48.00 X 0 0 0 CHRISTINA BRENNAN OTT BOD - MEMBER 1.00 48.00 X 0 0 0 ROBERTA J HAUGAN BOD - MEMBER 1.00 0.00 X 0 0 0 STACEY L MOUNCE ARNOLD BOD - MEMBER 1.00 0.00 X 0 0 0 JEFFREY A BUTCHER SENIOR VP, TREASURER & CFO 2.00 48.00 X 0 551459 48786 JAMI J BERGER SR VP CHIEF CLINICAL OFFICER 2.00 48.00 X 0 404439 64507 DAVID S HANEKOM MD SENIOR VP & CMO (TERM 03/2024) 2.00 48.00 X 0 384198 17467 KRISTIE S BREUNIG JD GENERAL COUNSEL, VP & SECRETARY 2.00 48.00 X 0 317126 52618 JAMIE A STOCK-RETZLOFF JD DEPUTY GENERAL COUNSEL, SR. DIRECTOR & ASSISTANT S 2.00 48.00 X 0 249141 44950 0 2977773 288295 0 0 1 0 GUNDERSEN LUTHERAN MEDICAL CENTER PO BOX 4444 LA CROSSE WI 54602 MEDICAL SERVICES 26014020 OPTUM RX INC ATTN CORP TX MN00-T390 9900 BREN R MINNETONKA MN 55343 MEDICAL SERVICES 14361106 WINONA HEALTH SERVICES 855 MANKATO AVE WINONA MN 55987 MEDICAL SERVICES 4585662 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1900 SOUTH AVE LA CROSSE WI 54601 MEDICAL SERVICES 3901276 OLMSTED MEDICAL CENTER 210 9TH ST SE ROCHESTER MN 55904 MEDICAL SERVICES 2324034 23 PREMIUM REVENUE 524114 51016060 51016060 51016060 555191 555191 51571251 51016060 0 555191 1189265 393409 795856 55053 19125 35928 199817 1774 198043 83560 30716 52844 3251 3251 23099 23099 36828 36828 23705 23705 151060 10051 141009 137751 7088 130663 435907 190645 245262 42614 42614 11956 2444 9512 5076 591 4485 3004 2937 67 35072 687 34385 24370 24370 MEDICAL EXPENSES 47356540 47356540 OUTSOURCED SERVICES 654339 456922 197417 COMMISSIONS 639999 639999 REGULATORY ACA FEES 424796 424796 233611 18298 215313 51770673 48491227 3279446 0 12965829 15206018 278141 0 4749744 3842166 291406 596573 1378983 1656842 19664103 21301599 5140212 6906141 433821 569971 5114684 5049640 10688717 12525752 X 0 0 7950000 7950000 1025386 825847 8975386 8775847 19664103 21301599 X -199422 734 -851 X X 0 1 X 1 0 0 DUE FROM QUARTZ HEALTH SOLUTIONS, INC. 8776 DUE FROM QUARTZ HEALTH BENEFIT PLANS CORPORATION 24427 REINSURANCE RECEIVABLE 1610554 DUE FROM QUARTZ HEALTH PLAN CORPORATION 4510 INVESTMENT INCOME ACCRUED 5294 STATE INCOME TAX RECEIVABLE 3281 1656842 PPACA PAYABLE 4595937 DUE TO QUARTZ HEALTH SOLUTIONS, INC. 423591 DUE TO QUARTZ HEALTH BENEFIT PLANS CORPORATION 457 ESCHEAT PAYABLE 11793 DUE TO QUARTZ HEALTH PLAN CORPORATION 17862 5049640 X 51571985 734 734 51571251 0 51571251 51771524 851 851 51770673 0 51770673 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, 2024 AND 2023. PART XII, LINE 2D - OTHER ADJUSTMENTS: RX REBATE ADJUSTMENT ADDED FOR STAT 851. 0 1 0 0 0 0 0 0 0 CHRISTINE C SENTY JD PRESIDENT & CEO 0 638044 0 337668 0 95698 0 20267 0 39700 0 1131377 0 61500 JEFFREY A BUTCHER SENIOR VP, TREASURER & CFO 0 437269 0 111510 0 2680 0 20382 0 28404 0 600245 0 0 JAMI J BERGER SR VP CHIEF CLINICAL OFFICER 0 352721 0 14913 0 36805 0 19108 0 45399 0 468946 0 0 DAVID S HANEKOM MD SENIOR VP & CMO (TERM 03/2024) 0 133117 0 250000 0 1081 0 7773 0 9694 0 401665 0 0 KRISTIE S BREUNIG JD GENERAL COUNSEL, VP & SECRETARY 0 313501 0 2000 0 1625 0 18800 0 33818 0 369744 0 0 JAMIE A STOCK-RETZLOFF JD DEPUTY GENERAL COUNSEL, SR. DIRECTOR 0 221136 0 25901 0 2104 0 13344 0 31606 0 294091 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, 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 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 CHRISTINE C. SENTY DURING 2024 WAS $76,875. THERE WERE NO AMOUNTS PAID OUT TO ANY OTHER PARTICIPANTS LISTED ON PART VII/SCHEDULE J. 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 THREE 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 ADVISORY GROUP, LP 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 -851. 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. QUARTZ HEALTH PLAN CORPORATION 2650 NOVATION PKWY FITCHBURG WI 53713 391807071 HEALTH MAINTENANCE ORGANIZATION WI 501(C)(4) 0 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 0 1 1 1 1 0 0 0 QUARTZ HEALTH SOLUTIONS INC P 2770125 COST AND FEES