2023-05-15T08:57:05-05:00 2022-12-31 420714325 RSM US LLP 700 LOCUST ST SUITE 205 DUBUQUE IA 520016838 990 2022-01-01 391519198 THE MEDICAL ASSOCIATES CLINIC HEALTH PLAN OF WISCONSIN MEDI 5635568070 1605 ASSOCIATES DR 101 DUBUQUE IA 52001 ZACHARY C KEELING CEO 5635568070 2023-05-10 1 ZACHARY KEELING 999009999 0 JACKIE CARL P00851002 5635884691 2023-05-10 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ZACHARY C KEELING 1605 ASSOCIATES DR 101 DUBUQUE IA 52001 39327603 0 X N/A X 1983 WI THE ORGANIZATION PROVIDES COMPREHENSIVE HEALTH CARE SERVICES ON A PREPAID BASIS. 9 9 0 0 0 0 0 0 43397079 38686990 82709 71684 0 0 43479788 38758674 0 0 0 0 0 0 0 0 0 43283716 38625813 43283716 38625813 196072 132861 5101906 5665423 1241556 1964747 3860350 3700676 THE ORGANIZATION PROVIDES COMPREHENSIVE HEALTH CARE SERVICES TO SUBSCRIBERS ON A PREPAID BASIS 0 0 35792015 38686990 THE ORGANIZATION PROVIDES COMPREHENSIVE HEALTH CARE SERVICES ON A PREPAID BASIS 35792015 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 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X JILL MITCHELL CPA 5635568070 1605 ASSOCIATES DR SUITE 101 DUBUQUE IA 52001 MARK JANES MD VICE CHAIR 1.00 40.00 X X 0 739056 46671 BRAD MCCLIMON MD DIRECTOR 1.00 40.00 X 0 386166 48778 JEFFREY WHITE DIRECTOR 1.00 40.00 X 0 373891 49421 ANDREA RIES MD CHAIRMAN 1.00 40.00 X X 0 370189 48782 SARA LOETSCHER MD DIRECTOR 1.00 40.00 X 0 286676 40205 LAURIE GARMS MD DIRECTOR 1.00 40.00 X 0 200888 24987 JOHN O'CONNOR DIRECTOR 1.00 X 0 3500 0 LAWRENCE KUKLA DIRECTOR 1.00 X 0 3500 0 DUANE CAYLOR DIRECTOR 1.00 X 0 2250 0 ZACH KEELING CHIEF EXECUTIVE OFFICER 1.00 X X 0 0 0 HENDRIK SCHULTZ CHIEF MEDICAL OFFICER 1.00 X X 0 0 0 LYNEE ROBSON COO, TREASURER 1.00 X X 0 0 0 JILL MITCHELL COO, SECRETARY 1.00 X X 0 0 0 0 2366116 258844 0 0 1 0 MEDICAL ASSOCIATES CLINIC INC 1500 ASSOCIATES DRIVE DUBUQUE IA 52001 PAYMENT FOR MEDICAL CARE EXPENSES 35602243 1 PREMIUM REVENUE 524114 22366978 22366978 MEDICARE COST REIMBURSEMENT 524114 16320012 16320012 38686990 76442 76442 564171 568929 -4758 -4758 -4758 38758674 38686990 0 71684 3911 3911 155505 155505 8863 8863 8122 8122 21910 21910 6099 6099 19014 19014 MEDICAL CAPITATION 35602243 35602243 MANAGEMENT SERVICES 1641514 1641514 COMMISSION EXPENSE 337772 337772 REPAIRS & MAINTENANCE 245095 245095 575765 161763 414002 38625813 35792015 2833798 0 1129600 1519100 1182687 1573638 1051 1052 2788568 2571633 5101906 5665423 1031517 1808142 210039 156605 1241556 1964747 X 3860350 3700676 3860350 3700676 5101906 5665423 132861 -292535 0 X X 0 1 X 1 0 0 X 2729078 -292535 -292535 3021613 8863 35728198 35737061 38758674 2888752 0 2888752 8863 35728198 35737061 38625813 PART X, LINE 2: 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 2019. PART XI, LINE 4B - OTHER ADJUSTMENTS: SELF INSURANCE REPORTED AS CONTRA REVENUES (125,955) HEALTH CARE SERVICE COSTS CAPITATION AND REINSURANCE (35,602,243) PART XII, LINE 4B - OTHER ADJUSTMENTS: HEALTH CARE SERVICE COSTS CAPITATION AND REINSURANCE (35,602,243) SELF INSURANCE REPORTED AS CONTRA REVENUES (125,955) 0 0 0 0 0 0 0 0 0 MARK JANES MD VICE CHAIR 0 739056 0 0 0 0 0 40500 0 6171 0 785727 0 0 BRAD MCCLIMON MD DIRECTOR 0 386166 0 0 0 0 0 40500 0 8278 0 434944 0 0 JEFFREY WHITE DIRECTOR 0 373891 0 0 0 0 0 40500 0 8921 0 423312 0 0 ANDREA RIES MD CHAIRMAN 0 370189 0 0 0 0 0 40500 0 8282 0 418971 0 0 SARA LOETSCHER MD DIRECTOR 0 286676 0 0 0 0 0 38095 0 2110 0 326881 0 0 LAURIE GARMS MD DIRECTOR 0 200888 0 0 0 0 0 17384 0 7603 0 225875 0 0 MEDICAL ASSOCIATES CLINIC INC BOARD OF DIRECTORS ARE PHYSICIANS EMPLOYED BY MEDICAL ASSOCIATES CLINIC 35602243 THE ORGANIZATION PROCESSES THE BILLINGS AND CLAIMS OF ITS MEMBERS AND ADMINISTERS THE PREMIUM COLLECTION PROCESS. THE ORGANIZATION 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, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 WAS PROVIDED TO THE ORGANIZATION'S BOARD OF DIRECTORS PRIOR TO FILING FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION SENDS OUT TO ITS BOARD MEMBERS ANNUALLY A DISCLOSURE STATEMENT THAT THE BOARD MEMBERS ARE REQUIRED TO REVIEW AND SIGN THAT DISCLOSE ANY CONFLICTS OF INTEREST. THE DISCLOSURE STATEMENTS ARE THEN REVIEWED BY THE ORGANIZATION AND FOLLOWED UP ON FOR ANY CONFLICTS THAT EXIST. THE DISCLOSURE STATEMENTS ARE THEN MAINTAINED IN THE ORGANIZATION'S FILES FOR RECORD KEEPING PURPOSES. FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PART VI, SECTION B, LINE 15: THIS ORGANIZATION HAS CONTRACTED EMPLOYEES THROUGH MEDICAL ASSOCIATES CLINIC, INC. IT HAS NO EMPLOYEES OF ITS OWN. MEDICAL ASSOCIATES CLINIC, INC. HAS POLICIES IN PLACE TO REVIEW COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST AT THEIR OFFICE DURING NORMAL BUSINESS HOURS. 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 AND THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR FILING OF FORM 990. FORM 990, PART VI, SECTION B, QUESTION 13 ALL EMPLOYEES ARE CONTRACTED THROUGH MEDICAL ASSOCIATES CLINIC, INC. MEDICAL ASSOCIATES CLINIC, INC. HAS A WRITTEN WHISTLEBLOWER POLICY IN PLACE. 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 0 0 0 0 0