2025-05-09T08:18:03-05:00 2024-12-31 420714325 RSM US LLP 4650 EAST 53RD STREET DAVENPORT IA 528073479 990 2024-01-01 391519198 THE MEDICAL ASSOCIATES CLINIC HEALTH PLAN OF WISCONSIN MEDI 5635568070 1605 ASSOCIATES DR 101 DUBUQUE IA 52001 LYNEE ROBSON CFO, TREASURER 5635568070 2025-05-07 1 0 JENIFER L CHASE P01306883 5638884000 2025-05-07 2024 2025-03-06 01:10:19Z ZACHARY C KEELING 1605 ASSOCIATES DR 101 DUBUQUE IA 52001 56682700 0 X HTTPS://WWW.MAHEALTHPLANS.COM/HP/ 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 39732887 55810366 149331 211271 0 0 39882218 56021637 0 150000 0 0 1674828 2294492 0 0 0 37609987 53536784 39284815 55981276 597403 40361 7431483 7880115 3053479 3389411 4378004 4490704 TO PROVIDE SUPERIOR HEALTHCARE AND AN EXCELLENT PATIENT EXPERIENCE. 0 0 52208806 150000 55810366 THE MEDICAL ASSOCIATES CLINIC HEALTH PLAN OF WISCONSIN PROVIDES COMPREHENSIVE HEALTHCARE SERVICES ON A PREPAID BASIS 52208806 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 1 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 0 0 0 0 0 0 0 0 0 0 X LYNEE ROBSON CFO 5635568070 1605 ASSOCIATES DR 101 DUBUQUE IA 52001 X MARK JANES MD VICE CHAIRMAN 1.00 40.00 X X 0 581947 69484 BRAD MCCLIMON MD DIRECTOR 1.00 40.00 X 0 447939 71184 ANDREA RIES MD CHAIRMAN 1.00 40.00 X X 0 407061 69896 SARA LOETSCHER MD DIRECTOR 1.00 40.00 X 0 274298 45049 MICHAEL PEROSKI MD DIRECTOR 1.00 40.00 X 0 868877 77170 DUANE CAYLOR DIRECTOR 1.00 0.00 X 0 0 0 LAWRENCE KUKLA DIRECTOR 1.00 0.00 X 0 0 0 JOHN O'CONNOR DIRECTOR 1.00 0.00 X 0 0 0 JEFFREY WHITE DO DIRECTOR 1.00 40.00 X 0 332620 70526 ZACH KEELING CHIEF EXECUTIVE OFFICER 1.00 0.00 X 0 639518 42324 JILL MITCHELL FORMER COO, SECRETARY 1.00 0.00 X 0 128958 10979 LYNEE ROBSON CFO, TREASURER 1.00 0.00 X 0 348695 41450 0 4029913 498062 0 0 1 0 0 PREMIUM REVENUE 524114 35096323 35096323 MEDICARE COST REIMBURSEMENT 524114 20714043 20714043 55810366 181164 181164 691170 661063 30107 30107 30107 56021637 55810366 0 211271 150000 150000 2294492 2294492 159892 159892 8202 8202 119046 119046 53641 47962 5679 309555 309555 44666 44666 12761 12049 712 17565 17565 34577 34577 MEDICAL CAPITATION 51760370 51760370 COMMISSION EXPENSE 424430 424430 CORPORATE DUES & SUBSCR 148747 148747 443332 193759 249573 55981276 52208806 3772470 0 1972335 1537753 2665790 3476796 483 492 2792875 2865074 7431483 7880115 2856052 3142509 197427 246902 3053479 3389411 X 4378004 4490704 4378004 4490704 7431483 7880115 40361 72339 0 X X 0 1 X 1 0 0 X 4131646 72339 72339 4059307 8202 51954128 51962330 56021637 4018946 0 4018946 8202 51954128 51962330 55981276 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 2021. PART XI, LINE 4B - OTHER ADJUSTMENTS: SELF INSURANCE REPORTED AS CONTRA REVENUES 193,759. HEALTH CARE SERVICE COSTS CAPITATION AND REINSURANCE 51,760,369. PART XII, LINE 4B - OTHER ADJUSTMENTS: HEALTH CARE SERVICE COSTS CAPITATION AND REINSURANCE 51,760,369. SELF INSURANCE REPORTED AS CONTRA REVENUES 193,759. 0 MEDICAL ASSOCIATES FOUNDATION OF DUBUQUE 1605 ASSOCIATES DRIVE STE 101 DUBUQUE IA 520222270 421172640 501(C)(3) 150000 0 GENERAL SUPPORT 1 0 PART I, LINE 2: THE MEDICAL ASSOCIATES CLINIC HEALTH PLAN OF WISCONSIN PROVIDES FUNDS TO MEDICAL ASSOCIATES FOUNDATION OF DUBUQUE TO BE USED AT ITS DISCRETION. 0 0 0 0 0 0 0 0 0 MICHAEL PEROSKI MD DIRECTOR 0 868553 0 0 0 324 0 45966 0 31204 0 946047 0 0 ZACH KEELING CHIEF EXECUTIVE OFFICER 0 539561 0 99507 0 450 0 28733 0 13591 0 681842 0 0 MARK JANES MD VICE CHAIRMAN 0 579571 0 0 0 2376 0 46000 0 23484 0 651431 0 0 BRAD MCCLIMON MD DIRECTOR 0 447111 0 0 0 828 0 46000 0 25184 0 519123 0 0 ANDREA RIES MD CHAIRMAN 0 405513 0 0 0 1548 0 46000 0 23896 0 476957 0 0 JEFFREY WHITE DO DIRECTOR 0 331072 0 0 0 1548 0 45742 0 24784 0 403146 0 0 LYNEE ROBSON CFO, TREASURER 0 296084 0 51921 0 690 0 29308 0 12142 0 390145 0 0 SARA LOETSCHER MD DIRECTOR 0 271922 0 0 0 2376 0 36718 0 8331 0 319347 0 0 MEDICAL ASSOCIATES CLINIC INC SEE BELOW IN PART V 51760369 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 A, LINE 8B THE MEDICAL ASSOCIATES CLINIC HEALTH PLAN OF WISCONSIN DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF ITS GOVERNING BODY. 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 AND DIRECTOR OF FINANCE 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 (THE HEALTH PLAN) MAKE ITS GOVERNING DOCUMENTS AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT ITS OFFICE DURING NORMAL BUSINESS HOURS. THE HEALTH PLAN DOES NOT HAVE A FORMAL CONFLICT OF INTEREST POLICY. FORM 990, PART VII, SECTION A: THE MEDICAL ASSOCIATES CLINIC HEALTH PLAN OF WISCONSIN'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 MEDICAL ASSOCIATES CLINIC HEALTH PLAN OF WISCONSIN HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED SINCE THE PRIOR TAX 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