2024-10-23T13:52:48-05:00 2023-12-31 420714325 RSM US LLP 4650 EAST 53RD STREET DAVENPORT IA 528073479 990 2023-01-01 391519198 THE MEDICAL ASSOCIATES CLINIC HEALTH PLAN OF WISCONSIN MEDI 5635568070 1605 ASSOCIATES DR 101 DUBUQUE IA 52001 LYNEE ROBSON COO, TREASURER 5635568070 2024-10-21 1 0 JENIFER L CHASE P01306883 5638884000 2024-10-21 2023 2024-10-15 13:58:12Z ZACHARY C KEELING 1605 ASSOCIATES DR 101 DUBUQUE IA 52001 40212668 0 X N/A X 1983 WI THE MEDICAL ASSOCIATES CLINIC HEALTH PLAN OF WISCONSIN IS ORGANIZED AND SHALL BE OPERATED EXCLUSIVELY TO PROMOTE SOCIAL WELFARE BY ESTABLISHING A NONPROFIT PLAN TO OFFER EFFICIENT, QUALITY HEALTH CARE SERVICES TO THE GENERAL PUBLIC. 9 3 0 3 0 0 0 0 38686990 39732887 71684 149331 0 0 38758674 39882218 0 0 0 0 0 1674828 0 0 0 38625813 37609987 38625813 39284815 132861 597403 5665423 7431483 1964747 3053479 3700676 4378004 NONE 0 0 36431326 39732887 THE ORGANIZATION PROVIDES COMPREHENSIVE HEALTH CARE SERVICES ON A PREPAID BASIS 36431326 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 2 0 1 0 0 0 0 0 0 0 0 0 X 9 3 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X ANDREW COGAN CPA 5635568070 1605 ASSOCIATES DR SUITE 101 DUBUQUE IA 52001 X MARK JANES MD VICE CHAIRMAN 1.00 40.00 X X 0 636785 58523 BRAD MCCLIMON MD DIRECTOR 1.00 40.00 X 0 394533 61273 JEFFREY WHITE DIRECTOR 1.00 40.00 X 0 321829 61043 ANDREA RIES MD CHAIRMAN 1.00 40.00 X X 0 365791 61933 SARA LOETSCHER MD DIRECTOR 1.00 40.00 X 0 263473 36557 MICHAEL PEROSKI MD DIRECTOR 1.00 40.00 X 0 852606 64844 LAURIE GARMS MD FORMER DIRECTOR 1.00 40.00 X 0 25804 3577 DUANE CAYLOR DIRECTOR 1.00 X 0 0 0 LAWRENCE KUKLA DIRECTOR 1.00 X 0 0 0 JOHN O'CONNOR DIRECTOR 1.00 X 0 0 0 ZACH KEELING CHIEF EXECUTIVE OFFICER 1.00 X 0 593748 33123 JILL MITCHELL COO, SECRETARY 1.00 X 0 223699 32832 LYNEE ROBSON COO, TREASURER 1.00 X 0 255691 36640 HENDRIK SCHULTZ CHIEF MEDICAL OFFICER 1.00 X 0 421782 34575 0 4355741 484920 0 0 1 0 0 PREMIUM REVENUE 524114 24173441 24173441 MEDICARE COST REIMBURSEMENT 524114 15559446 15559446 39732887 121239 121239 358542 330450 28092 28092 28092 39882218 39732887 0 149331 1674828 1674828 623 623 166282 166282 10155 10155 75342 75342 38824 32809 6015 232008 232008 23910 23910 7383 6816 567 16311 16311 22859 22859 MEDICAL CAPITATION 36238366 36238366 COMMISSION EXPENSE 324994 324994 CORPORATE DUES & SUBSCR 121446 121446 331484 129425 202059 39284815 36431326 2853489 0 1519100 1972335 1573638 2665790 1052 483 2571633 2792875 5665423 7431483 1808142 2856052 156605 197427 1964747 3053479 X 3700676 4378004 3700676 4378004 5665423 7431483 597403 79925 0 X X 0 1 X 1 0 0 X 3584198 79925 79925 3504273 10155 36367790 36377945 39882218 2906870 0 2906870 10155 36367790 36377945 39284815 PART X, LINE 2: THE MEDICAL ASSOCIATES CLINIC HEALTH PLAN OF WISCONSIN (THE HEALTH PLAN) IS EXEMPT FROM PAYING INCOME TAXES ON ALL INCOME OTHER THAN UNRELATED BUSINESS INCOME AND INTEREST UNDER SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE AND A SIMILAR SECTION OF THE STATE CODE AS EVIDENCED BY A LETTER FROM THE DISTRICT DIRECTOR OF INTERNAL REVENUE SERVICE, DATED JULY 10, 1985. MANAGEMENT EVALUATES ITS TAX POSITION ANNUALLY AND CONCLUDED THAT THE PLAN HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS. WITH FEW EXCEPTIONS, THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE OR LOCAL TAX AUTHORITIES FOR YEARS BEFORE 2020. PART XI, LINE 4B - OTHER ADJUSTMENTS: SELF INSURANCE REPORTED AS CONTRA REVENUES 129,424. HEALTH CARE SERVICE COSTS CAPITATION AND REINSURANCE 36,238,366. PART XII, LINE 4B - OTHER ADJUSTMENTS: HEALTH CARE SERVICE COSTS CAPITATION AND REINSURANCE 36,238,366. SELF INSURANCE REPORTED AS CONTRA REVENUES 129,424. 0 0 0 0 0 0 0 0 0 MICHAEL PEROSKI MD DIRECTOR 0 852606 0 0 0 0 0 35051 0 29793 0 917450 0 0 MARK JANES MD VICE CHAIRMAN 0 636785 0 0 0 0 0 36300 0 22223 0 695308 0 0 ZACH KEELING CHIEF EXECUTIVE OFFICER 0 490148 0 103600 0 0 0 9892 0 23231 0 626871 0 0 HENDRIK SCHULTZ CHIEF MEDICAL OFFICER 0 344740 0 77042 0 0 0 10196 0 24379 0 456357 0 0 BRAD MCCLIMON MD DIRECTOR 0 394533 0 0 0 0 0 36000 0 25273 0 455806 0 0 ANDREA RIES MD CHAIRMAN 0 365791 0 0 0 0 0 36300 0 25633 0 427724 0 0 JEFFREY WHITE DIRECTOR 0 321829 0 0 0 0 0 36220 0 24823 0 382872 0 0 SARA LOETSCHER MD DIRECTOR 0 263473 0 0 0 0 0 28677 0 7880 0 300030 0 0 LYNEE ROBSON COO, TREASURER 0 255691 0 0 0 0 0 9012 0 27628 0 292331 0 0 JILL MITCHELL COO, SECRETARY 0 223699 0 0 0 0 0 7345 0 25487 0 256531 0 0 MEDICAL ASSOCIATES CLINIC INC SEE BELOW IN PART V 36238366 THE MEDICAL ASSOCIATES CLINIC HEALTH PLAN OF WISCONSIN (THE HEALTH PLAN) PROCESSES THE BILLINGS AND CLAIMS OF ITS MEMBERS AND ADMINISTERS THE PREMIUM COLLECTION PROCESS. THE HEALTH PLAN RETAINS AN ACTUARIALLY DETERMINED AMOUNT OF THE PREMIUMS BILLED AND PAYS MEDICAL ASSOCIATES CLINIC, INC THE REMAINING PREMIUMS WHICH ITS ACTUARY HAS DETERMINED TO BE CAPITATION. 0 FORM 990, SCHEDULE L, PART IV, COLUMN B: BRAD MCCLIMON, M.D. IS A BOARD MEMBER OF MEDICAL ASSOCIATES CLINIC HEALTH PLAN OF WISCONSIN AND IS REPORTED ON THE FORM 990, PART VII. DURING THE TAX YEAR, BRAD MCCLIMON WAS AN OFFICER OF MEDICAL ASSOCIATES CLINIC, INC. FORM 990, PART VI, SECTION B, LINE 11B THE MEDICAL ASSOCIATES CLINIC HEALTH PLAN OF WISCONSIN'S FORM 990 IS COMPLETED BY AN EXTERNAL ACCOUNTANT WITH INFORMATION PROVIDED BY THE ORGANIZATION. THE CONTROLLER REVIEWS A DRAFT OF THE FORM 990 ONCE COMPLETED. AFTER REVIEW, THE RETURN IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION C, LINE 19 THE MEDICAL ASSOCIATES CLINIC HEALTH PLAN OF WISCONSIN MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT THEIR OFFICE DURING NORMAL BUSINESS HOURS. FORM 990, PART VII, SECTION A: THE FILING ORGANIZATION'S OFFICERS AND DIRECTORS ARE COMPENSATED FOR THEIR SERVICES AS EMPLOYEES OF THE RELATED ORGANIZATION. THEIR TIME SERVED ON THE BOARD IS ON A VOLUNTEER BASIS AND NO COMPENSATION IS RECEIVED FOR THOSE SERVICES. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE ORGANIZATION DID NOT CHANGE THE OVERSIGHT OR THE SELECTION PROCESS FROM THE PRIOR YEAR. MEDICAL ASSOCIATES CLINIC PC 1500 ASSOCIATES DRIVE DUBUQUE IA 52001 421115442 MEDICAL SERVICES IA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0