2025-11-12T12:00:22-06:00 2024-12-31 390859910 BAKER TILLY ADVISORY GROUP LP 790 N WATER ST SUITE 2000 MILWAUKEE WI 53202 990 2024-01-01 391807071 QUARTZ HEALTH PLAN 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 492331752 0 X WWW.QUARTZBENEFITS.COM X 1995 WI TO PROMOTE SOCIAL WELFARE BY OPERATION OF A HEALTH MAINTENANCE ORGANIZATION AND OTHER ACTIVITIES INCIDENTAL THERETO. 12 12 0 13 0 0 0 0 428752288 473999723 2778195 3344816 0 0 431530483 477344539 0 0 0 0 18318756 17683820 0 0 0 420261022 460194658 438579778 477878478 -7049295 -533939 113470719 129054071 66108118 72676514 47362601 56377557 TO PROMOTE SOCIAL WELFARE BY OPERATION OF A HEALTH MAINTENANCE ORGANIZATION AND OTHER ACTIVITIES INCIDENTAL THERETO. 0 0 451059890 473999723 PROVISION OF HEALTH CARE SERVICES PROVIDED FOR 75,979 MEMBERS. 451059890 0 0 0 0 0 0 0 0 0 0 0 1 0 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 1 1 0 1 X 1876 0 1 0 0 0 0 0 0 0 0 0 X 12 12 1 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 GERALD E ARNDT BOD - MEMBER 2.00 0.00 X 0 14054 0 GERALD R KEMBER BOD - MEMBER 2.00 0.00 X 0 11747 0 GEORGE H TERVALON III BOD - MEMBER 2.00 0.00 X 0 10925 0 CAREY M GEHL BOD - CHAIR 2.00 0.00 X X 0 0 0 ALAN S KAPLAN MD BOD - MEMBER 2.00 0.00 X 0 0 0 DAVID J GRANDIN BOD - MEMBER (START 5/2024) 2.00 0.00 X 0 0 0 HEATHER L SCHIMMERS BOD - MEMBER (START 5/2024) 2.00 0.00 X 0 0 0 MICHAEL J DOLAN MD BOD - MEMBER (TERM 05/2024) 2.00 0.00 X 0 0 0 RANDY R BRUEGMAN BOD - MEMBER 2.00 0.00 X 0 0 0 REBEKAH J GALES SWAIN BOD - MEMBER 2.00 0.00 X 0 0 0 ROBERT W FLANNERY BOD - MEMBER 2.00 0.00 X 0 0 0 SUSAN I ERICKSON BOD - MEMBER 2.00 0.00 X 0 0 0 WILLIAM J FARRELL BOD - MEMBER 2.00 0.00 X 0 0 0 CHRISTINE C SENTY JD PRESIDENT & CEO 2.00 48.00 X 0 1071410 59967 JEFFREY A BUTCHER SENIOR VP, TREASURER & CFO 2.00 48.00 X 0 551459 48786 JAMI J BERGER SENIOR 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 3014499 288295 0 0 1 0 GUNDERSEN LUTHERAN MEDICAL CENTER PO BOX 4444 LA CROSSE WI 54602 MEDICAL SERVICES 142551293 OPTUM RX INC ATTN CORP TX MN00-T390 9900 BREN R MINNETONKA MN 55343 MEDICAL SERVICES 90775571 UNIVERSITY OF WISCONSIN HOSPITAL AND CLI DRAWER 853 MILWAUKEE WI 53278 MEDICAL SERVICES 61559312 MERITER HOSPITAL INC PO BOX 843151 KANAS CITY MT 64184 MEDICAL SERVICES 23600694 UNIVERSITY OF WISCONSIN MEDICAL FOUNDATI DRAWER 78864 MILWAUKEE WI 53278 MEDICAL SERVICES 21476498 208 PREMIUM REVENUE 524114 473999723 473999723 473999723 3281435 3281435 15050594 14987213 63381 63381 63381 477344539 473999723 0 3344816 13766338 4553905 9212433 637257 221377 415880 2312984 20539 2292445 967241 355547 611694 37632 37632 199562 199562 360967 360967 252048 252048 1423969 91411 1332558 1398012 122244 1275768 4694565 1982738 2711827 493277 493277 138347 28203 110144 57862 6837 51025 4098 3322 776 411908 7953 403955 282093 282093 MEDICAL EXPENSES 439019134 439019134 OUTSOURCED SERVICES 6769156 4544415 2224741 COMMISSIONS 3929844 3929844 OTHER EXPENSES 721989 102265 619724 195 195 477878478 451059890 26818588 0 59630163 48282180 151327 0 34547214 41709305 8479986 24416534 8975385 8775847 1686644 5870205 113470719 129054071 53984704 59427539 7376003 8904522 4747411 4344453 66108118 72676514 X 0 0 47005731 57005731 356870 -628174 47362601 56377557 113470719 129054071 X -533939 206533 9342362 X 0 1 X 1 0 0 INVESTMENT IN SUBSIDIARY 8775847 C 8775847 DUE TO QUARTZ HEALTH PLAN MN CORPORATION 4508 DUE TO QUARTZ HEALTH SOLUTIONS, INC. 3832180 DUE TO QUARTZ HEALTH BENEFIT PLANS CORPORATION 47375 STATE INCOME TAX PAYABLE 194944 UNINSURED PLANS PAYABLE 265446 4344453 X 477351534 206533 -199538 6995 477344539 0 477344539 478336578 0 478336578 -458100 -458100 477878478 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 XI, LINE 2D - OTHER ADJUSTMENTS: LOSS IN SUBSIDIARY EQUITY -199,538. PART XII, LINE 4B - OTHER ADJUSTMENTS: RX REBATE ADJUSTMENT ADDED FOR STAT -458,100. 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 SENIOR 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 2 MICHAEL J. DOLAN, ROBERT W. FLANNERY, WILLIAM J. FARRELL, ALAN S. KAPLAN, SUSAN I. ERICKSON, CAREY M. GEHL, REBEKAH SWAIN, AND HEATHER SCHIMMERS HAVE A BUSINESS RELATIONSHIP OUTSIDE OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 GUNDERSEN HEALTH SYSTEM, INC., UNITYPOINT HEALTH (IOWA HEALTH SYSTEM), UNIVERSITY HEALTH CARE, INC., AND AURORA HEALTH CARE ARE THE CORPORATE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A UNIVERSITY HEALTH CARE, INC. SHALL APPOINT 4 MEMBERS OF THE BOARD OF DIRECTORS, GUNDERSEN HEALTH SYSTEM, INC. SHALL APPOINT 3 MEMBERS OF THE BOARD OF DIRECTORS, AND AURORA HEALTH CARE, SHALL APPOINT 1 MEMBER OF THE BOARD OF DIRECTORS. THE REMAINING THREE INDEPENDENT INDIVIDUAL MEMBERS OF THE BOARD ARE ELECTED BY THE BOARD BY A SUPERMAJORITY. FORM 990, PART VI, SECTION A, LINE 7B SOME GOVERNANCE DECISIONS ARE RESERVED TO THE CORPORATE MEMBERS AND NOT THE BOARD. 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 HEALTH PLAN EMPLOYEES AND COMMITTEE MEMBERS MUST REVIEW, COMPLETE, AND SIGN A CONFLICT OF INTEREST DISCLOSURE FORM ON AN ANNUAL BASIS AS PART OF THE MANDATORY EDUCATION PROCESS. BOARD MEMBERS ARE ALSO SENT A DISCLOSURE FORM TO COMPLETE ON AN ANNUAL BASIS ALONG WITH THE EMPLOYEES AND COMMITTEE MEMBERS. 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 -458,100. LOSS IN SUBSIDIARY INCOME -199,538. ADDITIONAL PAID IN CAPITAL - UNIVERSITY HEALTH CARE, INC. 4,400,000. ADDITIONAL PAID IN CAPITAL - IOWA HEALTH SYSTEM,INC 1,100,000. ADDITIONAL PAID IN CAPITAL - GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. 4,500,000. 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 MN CORPORATION 2650 NOVATION PKWY FITCHBURG WI 53713 452633920 HEALTH INSURANCE MN 501(C)(4) QUARTZ HEALTH PLAN CORPORATION 1 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 1 0 1 1 1 0 0 0 QUARTZ HEALTH SOLUTIONS P 30998258 COST AND FEES