2024-11-13T11:58:31-06:00 2023-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2023-01-01 391572880 SECURITY HEALTH PLAN OF WISCONSIN INC SECU 7152219555 PO BOX 8000 MARSHFIELD WI 544498000 JEANETTE WOJTALEWICZ INTERIM CFO 7152219555 2024-11-11 1 1 DAVID LOWENTHAL P00378651 3122071040 2024-11-11 2023 2024-10-15 13:58:12Z KRISTA HOGLUND SHP CEO PO BOX 8000 MARSHFIELD WI 544498000 1564428089 0 X WWW.SECURITYHEALTH.ORG X 1986 WI SECURITY HEALTH PLAN'S MISSION IS TO ENRICH LIVES TO HELP CONSUMERS AND COMMUNITIES REACH THEIR BEST HEALTH BY ENSURING ACCESS TO AFFORDABLE AND HIGH QUALITY HEALTH INSURANCE. 8 3 0 3 0 0 0 0 1298672749 1418655775 7783386 15507781 3149043 4353048 1309605178 1438516604 244047 45425 0 0 43522208 46553038 0 0 0 1251992721 1380963669 1295758976 1427562132 13846202 10954472 411409960 403621294 253005199 256582598 158404761 147038696 SECURITY HEALTH PLAN'S MISSION IS TO ENRICH LIVES TO HELP CONSUMERS AND COMMUNITIES REACH THEIR BEST HEALTH BY ENSURING ACCESS TO AFFORDABLE AND HIGH QUALITY HEALTH INSURANCE. 0 0 1377722891 45425 1423008823 SECURITY HEALTH PLAN OF WISCONSIN, INC. (SHP) PROVIDES A NETWORK FOR PREPAID HEALTH CARE SERVICES TO APPROXIMATELY 227,000 MEMBERS. IN 2023, 32% OF SHP ENROLLMENT WAS FROM EMPLOYER GROUPS AND DIRECT PAY SUBSCRIBERS WITHIN THE HEALTHCARE, MANUFACTURING, GOVERNMENT, AND DAIRY INDUSTRIES; 35% FROM MEDICAID; 2% FROM MEDICARE SUPPLEMENT; 31% WAS FROM MEDICARE ADVANTAGE. SHP ALSO OFFERS ADMINISTRATIVE SERVICES ONLY CONTRACTS (ASO) TO SELF-INSURED GROUPS. SHP OFFERS COMMUNITY RATING FOR MEDICARE SUPPLEMENT MEMBERS PARTICIPATING IN THE MEDICAID HMO. IN ADDITION, SHP OFFERS COVERAGE TO INDIVIDUALS AND LARGE AND SMALL GROUPS, WITH PORTABILITY UPON LEAVING THE GROUP. SHP PARTICIPATES IN MEDICAL RESEARCH, EDUCATION OF OUR MEMBERS, COMMUNITY EDUCATION, CANCER SCREENING TESTS, AND THE MEDICARE ADVANTAGE PROGRAM. 1377722891 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 X 2790 0 1 0 0 0 0 0 0 0 0 0 X 8 3 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 WI X JANETTE TOWNSEND VP OF FINANCE 7153875511 1000 N OAK AVENUE MARSHFIELD WI 54449 X SUSAN TURNEY MD BOARD MEMBER/MCHS CEO - PART YEAR 1.00 54.00 X 0 3125033 382007 ELVIS PETER MD BOARD MEMBER 1.00 56.00 X 0 855841 46401 BRIAN HOERNEMAN MD BOARD MEMBER/MCHS INTERIM CEO 1.00 54.00 X 0 848741 40127 SAMANTHA KLEBE DO BOARD MEMBER/MCHS CMO 1.00 54.00 X 0 515015 29993 EDWARD FERNANDEZ MD BOARD MEMBER - PART YEAR 1.00 56.00 X 0 536206 43230 ALPA SHAH MD BOARD MEMBER 1.00 42.00 X 0 294888 10485 WILLIAM MELMS MD VICE CHAIR/MCHS CMO - PART YEAR 1.00 54.00 X X 0 1053823 21091 MICHAEL LUEBKE CHAIR 1.00 4.00 X X 0 26500 0 MARK BRADLEY SECRETARY 1.00 5.00 X X 0 13000 0 TERRY FRANKLAND TREASURER 1.00 4.00 X X 0 13000 0 MARY JO JOHNSON BOARD MEMBER 1.00 0.00 X 0 0 0 CATHY BUKOWSKI MCHS CFO - PART YEAR 1.00 54.00 X 0 725840 23393 KRISTA HOGLUND SHP CEO 1.00 54.00 X 0 518946 40520 JEANETTE WOJTALEWICZ INTERIM MCHS CFO 1.00 54.00 X 0 116564 0 CHRIS BUEL SHP VP OF FINANCE/CFO 50.00 0.00 X 314221 0 47105 JENNIFER SHERMO CHIEF GROWTH OFFICER 50.00 0.00 X 250529 0 33880 DAVID NYMAN CHIEF OPERATING OFFICER 50.00 0.00 X 273704 0 36932 LISA BOERO CHIEF LEGAL & COMPLIANCE OFFICER 50.00 0.00 X 299574 0 10965 MICHAEL SAUTEBIN FORMER SHP CHIEF ACTUARY 0.00 50.00 X 0 207780 38223 1138028 8851177 804352 4 1 1 0 EVICORE HEALTHCARE MSI LLC 400 BUCKWALTER PLACE BLVD BLUFFTON SC 29910 MEDICAL & PROFESSIONAL SERVICES 13813587 NAVIHEALTH INC 210 WESTWOOD PLACE SUITE 400 BRENTWOOD TN 37027 MEDICAL SERVICES 5685776 UNITED MEDCO INC 4613 N UNIVERSITY DRIVE 586 CORAL SPRINGS FL 33067 PHARMACY 4456161 INSURANCE CENTER 701 SAND LAKE ROAD ONALASKA WI 54650 SALES AGENCY 3954148 ASPIRUS WAUSAU HOSPITAL INC 2200 WESTWOOD DR WAUSAU WI 54401 MEDICAL CLAIMS 3398284 121 PREPAID HEALTH FEES 524298 1418655775 1418655775 1418655775 15375908 15375908 1371096 1371096 0 124672262 124540389 131873 131873 131873 STOP LOSS REVENUE 561000 2612321 2612321 ASO ADMIN REVENUE 561000 1397666 1397666 ALL OTHER REVENUE 561000 343061 343061 4353048 1438516604 1423008823 0 15507781 45425 45425 1266910 1266910 34536040 34536040 10750088 10750088 276942 276942 380915 380915 80810 80810 639993 639993 9749600 9749600 4341801 4341801 2559904 2559904 9092191 9092191 531608 531608 1567 1567 241868 241868 1179498 1179498 HOSPITAL/MED. BENEFITS 1304046387 1304046387 COMMISSIONS 22817493 22817493 AFFORDABLE CARE ACT FEE 5527458 5527458 19495634 19495634 1427562132 1377722891 49839241 0 85030864 94092565 59062452 66105448 137442 138219 20934663 12792028 9088854 8142635 33420603 6748462 224669745 228393965 411409960 403621294 229378334 229546553 23626865 26203045 0 833000 253005199 256582598 X 0 0 0 0 158404761 147038696 158404761 147038696 411409960 403621294 X 10954472 1597939 -23918476 X 0 1 X 1 0 17963493 9820858 8142635 2971170 2971170 0 8142635 LTD PTNSHP COMM INV 228393965 F 228393965 CONTRACT RESERVES 833000 833000 X 1436725697 1371096 1371096 1435354601 181709 2980294 3162003 1438516604 1425771225 1371096 1371096 1424400129 181709 2980294 3162003 1427562132 PART X, LINE 2: THE ORGANIZATION APPLIES FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES (ASC 740), WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. UNDER ASC 740, TAX POSITIONS WILL BE EVALUATED FOR RECOGNITION, DERECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND WILL PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. THE SYSTEM HAS DETERMINED THAT IT DOESN'T HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2023 OR DECEMBER 31, 2022. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSE 1,371,096. PART XI, LINE 4B - OTHER ADJUSTMENTS: MANAGEMENT FEES 639,993. ASO ADMIN REVENUE 1,394,082. REAL ESTATE DEPRECIATION 946,219. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSE 1,371,096. PART XII, LINE 4B - OTHER ADJUSTMENTS: MANAGEMENT FEES 639,993. ASO ADMIN REVENUE 1,394,082. REAL ESTATE DEPRECIATION 946,219. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS N/A 844864 0 0 0 0 0 0 844864 0 844864 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 SUSAN TURNEY MD BOARD MEMBER/MCHS CEO - PART YEAR 0 1225308 0 450000 0 1449725 0 361730 0 20277 0 3507040 0 264534 WILLIAM MELMS MD VICE CHAIR/MCHS CMO - PART YEAR 0 206266 0 152673 0 694884 0 9900 0 11191 0 1074914 0 0 ELVIS PETER MD BOARD MEMBER 0 820410 0 0 0 35431 0 9900 0 36501 0 902242 0 0 BRIAN HOERNEMAN MD BOARD MEMBER/MCHS INTERIM CEO 0 741668 0 73943 0 33130 0 9900 0 30227 0 888868 0 0 CATHY BUKOWSKI MCHS CFO - PART YEAR 0 571918 0 9200 0 144722 0 9900 0 13493 0 749233 0 0 EDWARD FERNANDEZ MD BOARD MEMBER - PART YEAR 0 349775 0 148993 0 37438 0 9900 0 33330 0 579436 0 0 KRISTA HOGLUND SHP CEO 0 394369 0 82316 0 42261 0 9900 0 30620 0 559466 0 0 SAMANTHA KLEBE DO BOARD MEMBER/MCHS CMO 0 466567 0 21085 0 27363 0 9900 0 20093 0 545008 0 0 CHRIS BUEL SHP VP OF FINANCE/CFO 308163 0 1130 0 4928 0 9741 0 37364 0 361326 0 0 0 DAVID NYMAN CHIEF OPERATING OFFICER 254452 0 7748 0 11504 0 8268 0 28664 0 310636 0 0 0 LISA BOERO CHIEF LEGAL & COMPLIANCE OFFICER 296099 0 0 0 3475 0 8883 0 2082 0 310539 0 0 0 ALPA SHAH MD BOARD MEMBER 0 284161 0 0 0 10727 0 8525 0 1960 0 305373 0 0 JENNIFER SHERMO CHIEF GROWTH OFFICER 230998 0 9000 0 10531 0 7596 0 26284 0 284409 0 0 0 MICHAEL SAUTEBIN FORMER SHP CHIEF ACTUARY 0 207090 0 0 0 690 0 6512 0 31711 0 246003 0 0 PART I, LINE 3 THE MARSHFIELD CLINIC HEALTH SYSTEM'S (MCHS) INDEPENDENT COMPENSATION COMMITTEE (THE COMMITTEE) HAS FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSONS EMPLOYED BY ANY OF THE ORGANIZATIONS IN THE SYSTEM. THE COMMITTEE USES COMBINATIONS OF THE FOLLOWING TO EVALUATE COMPENSATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE, AND WRITTEN EMPLOYMENT CONTRACTS. PART I, LINES 4A-B LINE 4A: IN 2023, SUSAN TURNEY, MD RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $614,466, WILLIAM MELMS, MD RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $610,615, AND CATHY BUKOWSKI RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $82,431. LINE 4B: THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AND RECEIVED A DISTRIBUTION FROM OR HAD AMOUNTS VEST IN THE PLAN: SUSAN TURNEY, MD - $275,424 THE FOLLOWING INDIVIDUALS PARTICATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN BUT DID NOT RECEIVE A DISTRIBUTION OR HAVE AN AMOUNT VEST IN THE PLAN. UNDER THE PLAN, AMOUNTS DO NOT VEST UNTIL TWO YEARS AFTER SEPARATION FROM THE ORGANIZATION: WILLIAM MELMS, MD SAMANTHA KLEBE, DO ALPA SHAH, MD BRIAN HOERNEMAN, MD EDWARD FERNANDEZ, MD ELVIS PETER, MD KRISTA HOGLUND CATHY BUKOWSKI JENNIFER SHERMO DAVID NYMAN LISA BOERO FORM 990, PART IV, LINE 12A: THE AUDITED FINANCIAL STATEMENTS WERE PREPARED USING ACCOUNTING PRACTICES PRESCRIBED OR PERMITTED BY THE STATE OF WISCONSIN OFFICE OF THE COMMISSIONER OF INSURANCE, STATUTORY ACCOUNTING, WHICH DIFFERS FROM U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. FORM 990, PART V, LINE 1C: COMPENSATION REPORTED FOR THE INDEPENDENT CONTRACTORS HAS BEEN PAID BY A RELATED ORGANIZATION AND CENTRAL PURCHASING ORGANIZATION, MARSHFIELD CLINIC HEALTH SYSTEM, EIN 46-1495343. COMPENSATION REPORTED REPRESENTS SERVICES SOLELY PROVIDED TO SECURITY HEALTH PLAN OF WISCONSIN, INC SO IS INCLUDED AS IF PAID BY THE ORGANIZATION. MARSHFIELD CLINIC HEALTH SYSTEM HAS COMPLIED WITH A/P FILING REQUIREMENTS. FORM 990, PART V, LINE 2A: ALL PERSONNEL SERVICES FOR SECURITY HEALTH PLAN OF WISCONSIN, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 6 MARSHFIELD CLINIC HEALTH SYSTEM, INC. (A WISCONSIN NONSTOCK, NONPROFIT ORGANIZATION DESCRIBED IN CODE SECTION 501(C)(3)) IS THE SOLE MEMBER OF SECURITY HEALTH PLAN OF WISCONSIN, INC. FORM 990, PART VI, SECTION A, LINE 7A MARSHFIELD CLINIC HEALTH SYSTEM, INC. (AS THE SOLE MEMBER) HAS THE RESERVE POWER TO APPOINT OR REMOVE MEMBERS OF THE BOARD OF DIRECTORS OF SECURITY HEALTH PLAN OF WISCONSIN, INC. FORM 990, PART VI, SECTION A, LINE 7B MARSHFIELD CLINIC HEALTH SYSTEM, INC. (THE SOLE MEMBER) HAS THE RIGHT TO APPROVE ANY CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS OF SECURITY HEALTH PLAN OF WISCONSIN, INC. MARSHFIELD CLINIC HEALTH SYSTEM, INC. (THE SOLE MEMBER) HAS THE RIGHT TO INITIATE AND APPROVE LONG-TERM BORROWING AND OTHER FORMS OF LONG-TERM INDEBTEDNESS, INITIATE AND APPROVE THE PURCHASE, SALE OR ENCUMBRANCE OF REAL AND PERSONAL PROPERTY AND APPROVE OR DISAPPROVE ANNUAL OPERATING AND CAPITAL BUDGETS. MARSHFIELD CLINIC HEALTH SYSTEM, INC. (THE SOLE MEMBER) ALSO HAS THE RIGHT TO INITIATE AND APPROVE ANY OF THE FOLLOWING ACTIONS: MERGER, CONSOLIDATION, AFFILIATION OR JOINT VENTURE WITH ANY OTHER ENTITY OR ENTITIES; LIQUIDATION, REORGANIZATION OR DISSOLUTION OF THE ORGANIZATION; FILING OF A VOLUNTARY PETITION IN BANKRUPTCY; ANY CHANGE IN CONTROL OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B MARSHFIELD CLINIC HEALTH SYSTEM, INC. ENGAGES A PUBLIC ACCOUNTING FIRM TO PREPARE AND REVIEW THE FORM 990 IN ADDITION TO REVIEW BY THE SYSTEM CFO, VP OF FINANCE AND TAX DEPARTMENT. PRIOR TO FILING THE FORM WITH THE IRS, THE CFO AND HIS/HER DESIGNEE WILL PROVIDE TO EACH MEMBER OF THE SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE (A SUBCOMMITTEE OF THE BOARD OF DIRECTORS) A COPY IN ELECTRONIC OR PAPER FORM OF THE COMPLETED FORM 990 (AND ALL REQUIRED SCHEDULES) FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, BOARD DIRECTORS, AND KEY EMPLOYEES OF EVERY MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) ENTITY, AS WELL AS ANY OTHER PERSON DESIGNATED BY THE AUDIT AND COMPLIANCE COMMITTEE (ACC) TO BE A REQUIRED REPORTER BY VIRTUE OF HIS OR HER POSITION AT A SYSTEM ENTITY, SHALL ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. SUCH FORMS SHALL BE DISTRIBUTED AND RECORDED BY THE SYSTEM'S DESIGNATED COMPLIANCE OFFICER. ALL FINANCIAL INTERESTS DISCLOSED AS PART OF THE ANNUAL DISCLOSURE PROCESS SHALL BE REVIEWED BY THE ACC. THE ACC SHALL INFORM THE BOARD OF DISCLOSED FINANCIAL INTERESTS WHICH MAY BEAR UPON OR RELATE TO A TRANSACTION UPON WHICH THE BOARD OR ANOTHER BOARD, COMMITTEE OR OTHER BODY OF A SYSTEM ENTITY, MAY DELIBERATE OR ACT. IN ADDITION TO THE ANNUAL DISCLOSURES, IF AT ANY TIME BETWEEN ANNUAL DISCLOSURES, A REQUIRED REPORTER BECOMES AWARE THAT THE BOARD, OR A BOARD, COMMITTEE OR OTHER BODY, OR ANY SYSTEM ENTITY MAY DELIBERATE OR ACT UPON ANY TRANSACTION THAT MAY HAVE ANY BEARING OF ANY KIND UPON, OR MAY RELATE IN ANY MANNER TO, AN EXISTING, INTENDED OR EXPECTED FINANCIAL INTEREST OF THE REQUIRED REPORTER, HE OR SHE SHALL DISCLOSE THE FINANCIAL INTEREST TO THE RELEVANT SYSTEM ENTITY BOARD, COMMITTEE OR BODY CHAIR, AS WELL AS TO THE SYSTEM'S COMPLIANCE OFFICER, IN ADVANCE OF ANY DELIBERATIONS OR ACTIONS, WRITTEN DISCLOSURE OF THE EXISTENCE, NATURE AND EXTENT OF HIS ORHER FINANCIAL INTEREST. ALL WRITTEN OR ORAL DISCLOSURES OF FINANCIAL INTERESTS SHALL BE RECORDED IN THE MINUTES OF THE BOARD AND BY THE OFFICE OF THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER SHALL DISCLOSE THE COMPLETED FORMS AS NECESSARY TO THOSE MCHS EMPLOYEES RESPONSIBLE FOR COMPLETION OF THE IRS FORM 990. FORM 990, PART VI, SECTION B, LINE 15 THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE (COMPENSATION COMMITTEE) SHALL HAVE FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSONS (AS THAT TERM IS DEFINED IN 4958 OF THE INTERNAL REVENUE CODE (THE CODE)) EMPLOYED BY THE CORPORATION, INCLUDING BUT NOT LIMITED TO THE CORPORATION'S CEO. THE TERM DISQUALIFIED PERSONS INCLUDES (BUT IS NOT LIMITED TO) ANY PERSON (OR THE PERSON'S FAMILY MEMBER) WHO WAS, AT ANY TIME DURING THE 5-YEAR PERIOD ENDING ON THE DATE OF THE TRANSACTION, IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION. IT SHALL BE THE RESPONSIBILITY OF THE COMPENSATION COMMITTEE TO ENSURE THAT THE SYSTEM DOES NOT PAY AN AMOUNT THAT EXCEEDS REASONABLE COMPENSATION FOR ANY DISQUALIFIED PERSON. THE COMPENSATION COMMITTEE AND ITS OPERATING PROCEDURES SHALL BE DESIGNED TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS OF COMPENSATION OUTLINED IN TREASURY REG. SEC. 53.4958-6 WITH RESPECT TO EACH DISQUALIFIED PERSON. IN DETERMINING REASONABLENESS OF COMPENSATION, THE COMPENSATION COMMITTEE SHALL EVALUATE APPROPRIATE INFORMATION AS TO COMPARABILITY OF COMPENSATION, INCLUDING BUT NOT LIMITED TO: COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE SYSTEM'S GEOGRAPHIC AREA; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; AND ACTUAL WRITTEN JOB OFFERS FROM SIMILAR INSTITUTIONS. THE COMPENSATION COMMITTEE SHALL HAVE INDEPENDENT AUTHORITY TO OBTAIN OUTSIDE EXPERT OPINIONS ON THE REASONABLENESS AND FAIR MARKET VALUE OF COMPENSATION AND GATHER OTHER INFORMATION IT CONSIDERS NECESSARY OR APPROPRIATE TO MAKE ITS DECISIONS ON COMPENSATION. THE COMPENSATION COMMITTEE SHALL TIMELY DOCUMENT ITS DETERMINATION OF REASONABLENESS OF COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE AUDITED FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, AND GOVERNING DOCUMENTS ARE AVAILABLE FOR REVIEW UPON REQUEST. ANNUAL FINANCIAL STATEMENTS ARE ALSO AVAILABLE UPON REQUEST FROM THE WISCONSIN OFFICE OF THE COMMISSIONER OF INSURANCE. FORM 990, PART VII, SECTION A: COMPENSATION REPORTED FOR LISA BOERO, DAVID NYMAN, AND JENNIFER SHERMO HAS BEEN PAID BY A RELATED ORGANIZATION AND COMMON PAYMASTER, MARSHFIELD CLINIC HEALTH SYSTEM, EIN 46-1495343. SINCE ALL SERVICES PERFORMED BY THESE INDIVIDUALS WERE FOR SECURITY HEALTH PLAN OF WISCONSIN, INC, THE COMPENSATION HAS BEEN REPORTED IN COLUMN D AS IF PAID BY THE ORGANIZATION. MARSHFIELD CLINIC HEALTH SYSTEM HAS COMPLIED WITH PAYROLL FILING REQUIREMENTS. FORM 990, PART XI, LINE 9: CHANGE IN NON-ADMITTED ASSETS -23,918,476. SECURITY ADMINISTRATIVE SERVICES LLC 1515 N ST JOSEPH AVE MARSHFIELD WI 54449 474820788 ADMINISTRATOR WI 6147648 2378057 SECURITY HEALTH PLAN OF WISCONSIN INC SECURITY HEALTH PLAN OF MICHIGAN LLC 1721 S STEPHENSON AVE IRON MOUNTAIN MI 49801 921201782 ADMINISTRATOR MI 0 0 SECURITY HEALTH PLAN OF WISCONSIN INC MARSHFIELD CLINIC INC 1000 N OAK AVE MARSHFIELD WI 54449 390452970 MEDICAL SVCS WI 501(C)(3) LINE 3 MCHS 0 LAKEVIEW MEDICAL CENTER INC 1700 W STOUT ST RICE LAKE WI 54868 390837206 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 VOLUNTEER PARTNERS OF LAKEVIEW MEDICAL 1700 W STOUT ST RICE LAKE WI 54868 391329084 SUPPORT ORG WI 501(C)(3) LINE 12D, III-O N/A 0 FLAMBEAU HOSPITAL INC 98 SHERRY AVE PARK FALLS WI 54552 390973724 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 MARSHFIELD CLINIC HEALTH SYSTEM INC 1000 N OAK AVE MARSHFIELD WI 54449 461495343 SUPPORT ORG WI 501(C)(3) LINE 12D, III-O N/A 0 FAMILY HEALTH CENTER OF MARSHFIELD INC 1000 N OAK AVE MARSHFIELD WI 54449 391681547 COM HLTH CTR WI 501(C)(3) LINE 7 N/A 0 MCHS HOSPITALS INC 1000 N OAK AVE MARSHFIELD WI 54449 810977948 HOSPITAL WI 501(C)(3) LINE 3 MCHS 0 MCHS FOUNDATION INC 1000 N OAK AVE MARSHFIELD WI 54449 812822823 PHILANTHROPY WI 501(C)(3) LINE 7 MCHS 0 BEAVER DAM COMMUNITY HOSPITALS INC 707 S UNIVERSITY AVE BEAVER DAM WI 53916 391157876 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 MEMORIAL HOSPITAL INC N3708 RIVER AVE NEILLSVILLE WI 54456 390806828 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 DICKINSON COUNTY HEALTHCARE SYSTEM 1721 S STEPHENSON AVE IRON MOUNTAIN MI 49801 382780429 HOSPITAL MI 501(C)(3) LINE 3 MCHS HOSP 0 THE DIAGNOSTIC & TREATMENT CENTER LLC 3401 CRANBERRY BLVD WESTON WI 54476 200691634 MEDICAL SERVICES WI N/A 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0 SCHEDULE R, PART V, LINE 1: MARSHFIELD CLINIC HEALTH SYSTEM, INC. (A 501(C)(3) ORGANIZATION), IS THE PARENT ORGANIZATION OF SECURITY HEALTH PLAN OF WISCONSIN, INC. THE FOLLOWING COMPANIES ARE RELATED TO SECURITY HEALTH PLAN OF WISCONSIN, INC. THROUGH BROTHER/SISTER RELATIONSHIPS DUE TO A COMMON PARENT ORGANIZATION: MARSHFIELD CLINIC, INC. MCHS HOSPITALS, INC. MARSHFIELD CLINIC HEALTH SYSTEM FOUNDATION, INC. SECURITY ADMINISTRATIVE SERVICES, LLC IS A 100% OWNED SUBSIDIARY OF SECURITY HEALTH PLAN OF WISCONSIN, INC. AND IS TREATED AS A DISREGARDED ENTITY OF SECURITY HEALTH PLAN OF WISCONSIN, INC. FOR TAX PURPOSES. SECURITY HEALTH PLAN OF MICHIGAN, LLC IS A 100% OWNED SUBSIDIARY OF SECURITY HEALTH PLAN OF WISCONSIN, INC. AND IS TREATED AS A DISREGARDED ENTITY OF SECURITY HEALTH PLAN OF WISCONSIN, INC. FOR TAX PURPOSES.