SECURITY HEALTH PLAN OF WISCONSIN INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- SECURITY HEALTH PLAN OF WISCONSIN INC (EIN 39-1572880)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-10-10
- IRS object ID
- 201242849349300624
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-10-10T10:56:58-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4200 WELLS FARGO CTR 90 S 7TH ST | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391572880 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Security Health Plan of Wisconsin Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % TIM SCHULTZ CFO | InCareOfName |
| Name Control | SECU | NameControl |
| Phone | 7152219500 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 8000 | AddressLine1 |
| City | Marshfield | City |
| State | WI | State |
| ZIP Code | 544498000 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Tim Schultz | Name |
| Title | CFO | Title |
| Date Signed | 2012-09-17 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6123055000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | KARL ULRICH PRESIDENT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 ST JOSEPH AVE | AddressLine1 |
| City | MARSHFIELD | City |
| State | WI | State |
| ZIP Code | 54449 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 1082568229 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.securityhealth.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1986 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | SECURITY HEALTH PLAN WILL OPTIMIZE THE HEALTH OF THE POPULATION IT SERVES BY PROVIDING ACCESS TO HEALTH CARE, SERVING AS AN ADVOCATE FOR CUSTOMERS, AND MANAGING HEALTH RESOURCES TO MAXIMIZE VALUE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 3 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 3 | TotalNbrVolunteers |
| Total Gross UBI | 4384717 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -611084 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 909996315 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 942224093 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 8711440 | InvestmentIncomePriorYear |
| Investment Income Current Year | 12908385 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 2857200 | OtherRevenuePriorYear |
| Other Revenue Current Year | 4384717 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 921564955 | TotalRevenuePriorYear |
| Total Revenue Current Year | 959517195 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 10000998 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 864238185 | OtherExpensePriorYear |
| Other Expenses Current Year | 915168405 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 874239183 | TotalExpensesPriorYear |
| Total Expenses Current Year | 915168405 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 47325772 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 44348790 | RevenuesLessExpensesCY |
| Total Assets BOY | 294708887 | TotalAssetsBOY |
| Total Assets EOY | 326201824 | TotalAssetsEOY |
| Total Liabilities BOY | 135633988 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 133706638 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 159074899 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 192495186 | NetAssetsOrFundBalancesEOY |
| Mission Description | SECURITY HEALTH PLAN WILL OPTIMIZE THE HEALTH OF THE POPULATION IT SERVES BY PROVIDING ACCESS TO HEALTH CARE, SERVING AS AN ADVOCATE FOR CUSTOMERS, AND MANAGING HEALTH RESOURCES TO MAXIMIZE VALUE. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 845077855 | Expense |
| Revenue | 942224093 | Revenue |
| Description | SECURITY HEALTH PLAN OF WISCONSIN, INC.(SHP) PROVIDES A NETWORK FOR PREPAID HEALTH CARE SERVICES TO APPROXIMATELY 176,542 MEMBERS. THE ORGANIZATION OFFERS COMMUNITY RATING FOR MEDICARE SUPPLEMENT MEMBERS PARTICIPATING IN THE WISCONSIN MEDICAID HMO. IN ADDITION, SHP OFFERS COVERAGE OF 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. | Description |
| Total Program Service Expense | 845077855 | TotalProgramServiceExpense |
| Described In501 C3 | false | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Activities Conducted Partnership | true | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 3419 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 3 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | TIM SCHULTZ CFO | NamePerson |
| Telephone Number | 7152219447 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1515 ST JOSEPH AVE | AddressLine1 |
| City | MARSHFIELD | City |
| State | WI | State |
| ZIP Code | 54449 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (37 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| KARL ULRICH MD | |||||||||
| PRESIDENT | 3.0 | X | X | 0 | 673080 | 53013 | |||
| DOUG REDING MD | |||||||||
| VICE PRESIDENT | 3.0 | X | X | 0 | 625803 | 53434 | |||
| BRIAN EWERT MD | |||||||||
| SECRETARY | 2.0 | X | X | 0 | 255716 | 51516 | |||
| DAVID SIMENSTAD MD | |||||||||
| TREASURER | 2.0 | X | X | 0 | 1074143 | 54434 | |||
| STEPHEN L BLONSKY | |||||||||
| DIRECTOR | 1.0 | X | 0 | 309857 | 59343 | ||||
| WALLACE B BRUCKER | |||||||||
| DIRECTOR | 1.0 | X | 0 | 617989 | 56425 | ||||
| DANIEL R ERICKSON MD | |||||||||
| DIRECTOR | 1.0 | X | 0 | 216038 | 53545 | ||||
| HUMAYUN A KHAN MD | |||||||||
| DIRECTOR | 1.0 | X | 0 | 232260 | 49133 | ||||
| SHARLENE P KREITLOW MD | |||||||||
| DIRECTOR | 1.0 | X | 0 | 236242 | 53690 | ||||
| MARK A LEPAGE MD | |||||||||
| DIRECTOR | 1.0 | X | 0 | 454714 | 53213 | ||||
| RONALD F MARTIN MD | |||||||||
| DIRECTOR | 1.0 | X | 0 | 293039 | 39782 | ||||
| QASIM RAZA MD | |||||||||
| DIRECTOR | 1.0 | X | 0 | 280231 | 53697 | ||||
| IVAN SCHALLER MD | |||||||||
| DIRECTOR | 1.0 | X | 0 | 209252 | 51336 | ||||
| C TODD STEWART MD | |||||||||
| DIRECTOR | 1.0 | X | 0 | 422444 | 53013 | ||||
| HUMBERTO VIDAILLET MD | |||||||||
| DIRECTOR | 1.0 | X | 0 | 430830 | 57057 | ||||
| MATTHIAS WEISS MD | |||||||||
| DIRECTOR | 1.0 | X | 0 | 489265 | 58649 | ||||
| MATTHEW THOMAS | |||||||||
| DIRECTOR | 0.5 | X | 0 | 375758 | 47307 | ||||
| MICHAEL J LUEBKE | |||||||||
| DIRECTOR | 0.5 | X | |||||||
| ROBERT A CHRIST | |||||||||
| DIRECTOR | 0.5 | X | |||||||
| TIMOTHY PETERSON | |||||||||
| DIRECTOR | 0.5 | X | |||||||
| JOHN MELSKI MD | |||||||||
| DIRECTOR | 0.5 | X | 382939 | 53321 | |||||
| GARY JANKOWSKI | |||||||||
| SYSTEM CFO | 2.0 | X | 0 | 391319 | 53487 | ||||
| STEVE YOUSO | |||||||||
| CAO | 55.0 | X | 0 | 363247 | 47307 | ||||
| STEVEN E SZEBENYI MD | |||||||||
| CMO | 55.0 | X | 0 | 298793 | 22605 | ||||
| TIMOTHY SCHULTZ | |||||||||
| SHP CFO | 55.0 | X | 0 | 198748 | 25512 | ||||
| CHRIS BRUNI | |||||||||
| DIRECTOR OF SALES | 55.0 | 0 | 194801 | 47168 | X | ||||
| CHARLES PAINE | |||||||||
| DIRECTOR OF MARKETING | 55.0 | 0 | 166634 | 24122 | X | ||||
| JANE WOLF | |||||||||
| DIRECTOR OF HEALTH SERVICES | 55.0 | 0 | 125309 | 35264 | X | ||||
| LISA BOERO | |||||||||
| SHP LEGAL COUNCIL | 55.0 | 147141 | 20662 | X | |||||
| JULIE BRUSSOW | |||||||||
| DIRECTOR OF GOV. PROGRAMS | 55.0 | 106208 | 32331 | X | |||||
| LAWRENCE MCFARLENE MD | |||||||||
| MEDICAL DIRECTOR | 45.0 | 0 | 260583 | 50275 | X | ||||
| ANDREA HILLERUD MD | |||||||||
| MEDICAL DIRECTOR | 25.0 | 211606 | 49193 | X | |||||
| EDWARD KRALL MD | |||||||||
| MEDICAL DIRECTOR | 30.0 | 267532 | 52517 | X | |||||
| GINGER WOLF | |||||||||
| SALES MANAGER | 55.0 | 200449 | 46796 | X | |||||
| JILL BROSTOWITZ | |||||||||
| GOVERNMENT ACTUARIAL MANAGER | 55.0 | 140641 | 36434 | X | |||||
| JAY COLDWELL | |||||||||
| COMMERCIAL ACTUARIAL MANAGER | 55.0 | 139232 | 42812 | X | |||||
| TIMOTHY SWAN MD | |||||||||
| FORMER SECRETARY/MD | 0.0 | 0 | 523515 | 49327 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 11315358 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1587720 | TotalOtherCompensation |
| Number Individuals GT100 K | 33 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MEDASSURANT INC | |||||
| 4321 COLLINGTON RD | BOWIE | MD | 20716 | CONSULTANT | 7692758 |
| PARAGON DEVELOPMENT SYSTEMS | |||||
| 1823 EXECUTIVE DRIVE | OCONOMOWOC | WI | 53066 | IT CONSULTANT | 950149 |
| TRIZETTO GROUP INC | |||||
| 1085 MORRIS AVE | UNION | NJ | 07083 | SOFTWARE CONSULTANT | 2510198 |
| ROBERTS COMMUNICATIONS INC | |||||
| 64 COMMERCIAL STREET | ROCHESTER | NY | 14614 | ADVERTISING | 2496443 |
| MCKESSON HEALTH SOLUTIONS | |||||
| 275 GROVE STREET SUITE 1-110 | NEWTON | MA | 024662273 | SOFTWARE CONSULTANT | 934405 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 53 | NumberOfContractorsGT100K |
| Total Contributions | 0 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | FEES FOR PROV OF PREPAID HEALTH | Description |
| Total Revenue Column | 942224093 | TotalRevenueColumn |
| Related Or Exempt Function Income | 942224093 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 942224093 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6757459 | TotalRevenueColumn |
| Exclusion | $6,757,459 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1402909 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1402909 | Real |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 127785975 | Securities |
| Other | 13076 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 121648125 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 6137850 | Securities |
| Other | 13076 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6150926 | TotalRevenueColumn |
| Exclusion | $6,150,926 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|
| ASO ADMIN FEES | 561000 | 4376903 | 4376903 |
| CREDENTIALING FEES | 561000 | 7814 | 7814 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 4384717 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 959517195 | TotalRevenueColumn |
| Related Or Exempt Function Income | 942224093 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 4384717 | UnrelatedBusinessRevenue |
| Exclusion | $12,908,385 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2556117 | Total |
| Management And General | 2556117 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 276347 | Total |
| Management And General | 276347 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 312477 | Total |
| Management And General | 312477 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5000 | Total |
| Management And General | 5000 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 355915 | Total |
| Management And General | 355915 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9748753 | Total |
| Management And General | 9748753 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3468228 | Total |
| Management And General | 3468228 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2401217 | Total |
| Management And General | 2401217 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3058487 | Total |
| Management And General | 3058487 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 651641 | Total |
| Management And General | 651641 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1292440 | Total |
| Management And General | 1292440 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 177167 | Total |
| Management And General | 177167 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 408630 | Total |
| Management And General | 408630 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1118644 | Total |
| Management And General | 1118644 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 214439 | Total |
| Management And General | 214439 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | FundraisingFundraising | Management And GeneralManagementAndGeneral |
|---|---|---|---|---|
| HOSPITAL/MEDICAL BENEFITS | 773102262 | 773102262 | 0 | |
| PRESCRIPTION DRUGS | 71975593 | 71975593 | ||
| ADMINISTRATIVE CAPITATION | 29153809 | 29153809 | ||
| COMMISSIONS | 8164228 | 8164228 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6727011 | Total |
| Management And General | 6727011 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 915168405 | Total |
| Program Services | 845077855 | ProgramServices |
| Management And General | 70090550 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1350 | BOY |
| EOY | 1350 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 66938637 | BOY |
| EOY | 59252373 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13970768 | BOY |
| EOY | 25840252 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25000000 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18715038 | BOY |
| EOY | 18025131 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 37453873 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 9284167 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14743405 | BOY |
| EOY | 28169706 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 155339689 | BOY |
| EOY | 194913012 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 294708887 | BOY |
| EOY | 326201824 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 72321425 | BOY |
| EOY | 98966874 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53795306 | BOY |
| EOY | 28407317 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5877997 | BOY |
| EOY | 5358237 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3639260 | BOY |
| EOY | 974210 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 135633988 | BOY |
| EOY | 133706638 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 159074899 | BOY |
| EOY | 192495186 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 159074899 | BOY |
| EOY | 192495186 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 294708887 | BOY |
| EOY | 326201824 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 44348790 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -10928503 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Land | Land |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 8423911 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 3026797 | Depreciation |
| Book Value | 5397114 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 560089 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 376875 | Depreciation |
| Book Value | 183214 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 5318882 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 4389206 | Depreciation |
| Book Value | 929676 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 23150993 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 1491291 | Depreciation |
| Book Value | 21659702 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 28169706 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CONTRACT RESERVES | Description |
| Amount | $974,210 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 974210 | TotalOfAmounts |
| Total Revenue | 959517195 | TotalRevenue |
| Total Expenses | 915168405 | TotalExpenses |
| Excess Or Deficit For Year | 44348790 | ExcessOrDeficitForYear |
| Other | -$161,331 | OtherAmount |
| Total Adjustments | -161331 | TotalAdjustments |
| Excess Or Deficit Per FS | 44187459 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 955119402 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 955119402 | RevenueSubtotal |
| Other Revenues Not Included | 4397793 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 4397793 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 959517195 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 920709551 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 9938939 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 9938939 | ExpensesNotRptdF990 |
| Expenses Subtotal | 910770612 | ExpensesSubtotal |
| Other Expenses Not Included | 4397793 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 4397793 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 915168405 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| RECONCILIATION OF CHANGE IN NET ASSETS FROM 990 TO AUDITED FINANCIALS | SCH D, PART XI, LINE 8 | CHANGE IN RESERVES (9,938,939) CHANGE IN NON ADMITTED ASSETS 10,767,174 CONTRIBUTION TO PARENT (797,384) UNREALIZED GAIN/LOSS (192,182) ------------ TOTAL (161,331) |
| RECONCILIATION OF REVENUE PER AUDITED FINANCIALS WITH 990 | SCH D, PART XII, LINE 4B AND PART XIII, LINE 4B | NET GAIN(LOSS) ON THE SALE OF ASSETS 13,076 ASO ADMINISTRATION FEES 4,376,903 CREDENTIALING FEES 6,711 COMMISSION 955 MISC 148 ------------- TOTAL 4,397,793 |
| RECONCILIATION OF EXPENSES PER AUDITED FINANCIALS WITH 990 | SCH D, PART XIII, LINE 2D | CHANGE IN RESERVES 9,938,939 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (33 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KARL ULRICH MD | |||||||||||||
| 0 | 670308 | 0 | 0 | 0 | 2772 | 0 | 30729 | 0 | 22284 | 0 | 726093 | 0 | 0 |
| DOUG REDING MD | |||||||||||||
| 0 | 616247 | 0 | 7750 | 0 | 1806 | 0 | 30729 | 0 | 22705 | 0 | 679237 | 0 | 0 |
| BRIAN EWERT MD | |||||||||||||
| 0 | 254750 | 0 | 0 | 0 | 966 | 0 | 30728 | 0 | 20788 | 0 | 307232 | 0 | 0 |
| DAVID SIMENSTAD MD | |||||||||||||
| 0 | 1073177 | 0 | 0 | 0 | 966 | 0 | 30729 | 0 | 23705 | 0 | 1128577 | 0 | 0 |
| STEPHEN L BLONSKY | |||||||||||||
| 0 | 306051 | 0 | 2000 | 0 | 1806 | 0 | 30728 | 0 | 28615 | 0 | 369200 | 0 | 0 |
| WALLACE B BRUCKER | |||||||||||||
| 0 | 617023 | 0 | 0 | 0 | 966 | 0 | 30728 | 0 | 25697 | 0 | 674414 | 0 | 0 |
| DANIEL R ERICKSON MD | |||||||||||||
| 0 | 214232 | 0 | 0 | 0 | 1806 | 0 | 28648 | 0 | 24897 | 0 | 269583 | 0 | 0 |
| HUMAYUN A KHAN MD | |||||||||||||
| 0 | 228770 | 0 | 2860 | 0 | 630 | 0 | 30728 | 0 | 18405 | 0 | 281393 | 0 | 0 |
| SHARLENE P KREITLOW MD | |||||||||||||
| 0 | 235612 | 0 | 0 | 0 | 630 | 0 | 30728 | 0 | 22962 | 0 | 289932 | 0 | 0 |
| MARK A LEPAGE MD | |||||||||||||
| 0 | 454294 | 0 | 0 | 0 | 420 | 0 | 30729 | 0 | 22484 | 0 | 507927 | 0 | 0 |
| RONALD F MARTIN MD | |||||||||||||
| 0 | 292553 | 0 | 0 | 0 | 486 | 0 | 30728 | 0 | 9054 | 0 | 332821 | 0 | 0 |
| QASIM RAZA MD | |||||||||||||
| 0 | 235322 | 0 | 44279 | 0 | 630 | 0 | 30728 | 0 | 22969 | 0 | 333928 | 0 | 0 |
| IVAN SCHALLER MD | |||||||||||||
| 0 | 207446 | 0 | 0 | 0 | 1806 | 0 | 30728 | 0 | 20608 | 0 | 260588 | 0 | 0 |
| C TODD STEWART MD | |||||||||||||
| 0 | 421814 | 0 | 0 | 0 | 630 | 0 | 30728 | 0 | 22285 | 0 | 475457 | 0 | 0 |
| HUMBERTO VIDAILLET MD | |||||||||||||
| 0 | 429024 | 0 | 0 | 0 | 1806 | 0 | 30728 | 0 | 26329 | 0 | 487887 | 0 | 0 |
| MATTHIAS WEISS MD | |||||||||||||
| 0 | 488299 | 0 | 0 | 0 | 966 | 0 | 30729 | 0 | 27920 | 0 | 547914 | 0 | 0 |
| GARY JANKOWSKI | |||||||||||||
| 0 | 381495 | 0 | 100 | 0 | 9724 | 0 | 30728 | 0 | 22759 | 0 | 444806 | 0 | 0 |
| STEVE YOUSO | |||||||||||||
| 0 | 362181 | 0 | 100 | 0 | 966 | 0 | 30728 | 0 | 16579 | 0 | 410554 | 0 | 0 |
| STEVEN E SZEBENYI MD | |||||||||||||
| 0 | 296887 | 0 | 100 | 0 | 1806 | 0 | 2080 | 0 | 20525 | 0 | 321398 | 0 | 0 |
| TIMOTHY SCHULTZ | |||||||||||||
| 0 | 197958 | 0 | 100 | 0 | 690 | 0 | 2046 | 0 | 23466 | 0 | 224260 | 0 | 0 |
| CHRIS BRUNI | |||||||||||||
| 0 | 154154 | 0 | 40347 | 0 | 300 | 0 | 29592 | 0 | 17576 | 0 | 241969 | 0 | 0 |
| CHARLES PAINE | |||||||||||||
| 0 | 165283 | 0 | 100 | 0 | 1251 | 0 | 23186 | 0 | 936 | 0 | 190756 | 0 | 0 |
| JANE WOLF | |||||||||||||
| 0 | 124293 | 0 | 100 | 0 | 916 | 0 | 16662 | 0 | 18602 | 0 | 160573 | 0 | 0 |
| LAWRENCE MCFARLENE MD | |||||||||||||
| 0 | 257811 | 0 | 0 | 0 | 2772 | 0 | 30728 | 0 | 19547 | 0 | 310858 | 0 | 0 |
| TIMOTHY SWAN MD | |||||||||||||
| 0 | 521709 | 0 | 0 | 0 | 1806 | 0 | 30728 | 0 | 18599 | 0 | 572842 | 0 | 0 |
| MATTHEW THOMAS | |||||||||||||
| 375338 | 0 | 0 | 420 | 0 | 30728 | 0 | 16579 | 0 | 423065 | 0 | 0 | ||
| JOHN MELSKI MD | |||||||||||||
| 377605 | 5334 | 30728 | 22593 | 436260 | |||||||||
| LISA BOERO | |||||||||||||
| 146824 | 100 | 217 | 19918 | 744 | 167803 | ||||||||
| ANDREA HILLERUD MD | |||||||||||||
| 211186 | 420 | 30728 | 18465 | 260799 | |||||||||
| EDWARD KRALL MD | |||||||||||||
| 264760 | 2772 | 30728 | 21789 | 320049 | |||||||||
| GINGER WOLF | |||||||||||||
| 99781 | 100509 | 159 | 29541 | 17255 | 247245 | ||||||||
| JILL BROSTOWITZ | |||||||||||||
| 139347 | 100 | 1194 | 18948 | 17486 | 177075 | ||||||||
| JAY COLDWELL | |||||||||||||
| 138559 | 100 | 573 | 19638 | 23174 | 182044 | ||||||||
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | COMPENSATION | Identifier |
| Return Reference | 990 PART VII, LINE 1 AND SCHEDULES J-1 AND J-2 | ReturnReference |
| Explanation | MARSHFIELD CLINIC (EIN#39-0452970) IS THE PARENT COMPANY FOR SECURITY HEALTH PLAN. ALL SECURITY HEALTH PLAN STAFF ARE EMPLOYEES OF THE MARSHFIELD CLINIC AND ALL PAYROLL AND BENEFITS ARE PAID AND ADMINISTERED BY THE MARSHFIELD CLINIC. SCHEDULE J, PART I LINE 3 SECURITY HEALTH PLAN RELIED ON MARSHFIELD CLINIC TO ESTABLISH THE COMPENSATION OF THE PRESIDENT, KARL ULRICH. MARSHFIELD CLINIC ESTABLISHED THE COMPENSATION WITH THE USE OF A COMPENSATION COMMITTEE, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. TIMOTHY SWAN SCHEDULE J PART II TIMOTHY SWAN WAS NOT AN OFFICER AT ANY TIME DURING 2011, BUT WAS IN THE PAST FIVE YEARS. HIS COMPENSATION DURING 2011 WAS FOR HIS ROLE AS A PAID EMPLOYEE. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (23 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| AUDITED FINANCIAL STATEMENTS | 990 PART IV, LINE 12 | 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 ACCOUTING PRINCIPLES. GOVERNING BODY ELECTION 990 PART VI, LINE 7A MARSHFIELD CLINIC, THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, HAS THE ABILITY TO APPOINT SIX OF THE NINE DIRECTORS. GOVERNANCE DECISIONS 990 PART VI, LINE 8A CERTAIN DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL OF MARSHFIELD CLINIC DUE TO THE ABILITY OF MARSHFIELD CLINIC TO APPOINT A MAJORITY OF THE ORGANIZATION'S BOARD OF DIRECTORS. |
| 990 REVIEW PROCESS | 990 PART VI, LINE 11A | AFTER AN IN-DEPTH REVIEW BY THE CFO AS WELL AS OUTSIDE TAX ADVISOR, KPMG LLP, AND PRIOR TO FILING WITH THE IRS, FORM 990 WILL BE DISTRIBUTED TO EACH MEMBER OF THE BOARD. ANY QUESTIONS THAT ARISE FROM THE BOARD OF DIRECTORS ARE ANSWERED BY THE CFO. |
| CONFLICT OF INTEREST POLICY | 990 PART VI, LINE 12C | SECURITY HEALTH PLAN OFFICERS, BOARD OF DIRECTORS, KEY EMPLOYEES, AND OTHER MANAGEMENT PERSONNEL ALL SIGN A CONFLICT OF INTEREST DISCLOSURE FORM EACH YEAR. |
| DISCLOSURE | 990 PART VI, 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. |
| RECONCILIATION OF CHANGE IN NET ASSETS OR FUND BALANCE - OTHER | 990 PART XI, LINE 5 | CHANGE IN UNREALIZED GAIN(LOSS) ON SALE OF INV (192,182) CHANGE IN RESERVES (9,938,939) CHANGE IN CONTRIBUTION TO PARENT (797,384) (10,928,505) |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:KARL ULRICH, MD TITLE:PRESIDENT HOURS:65 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:DOUG REDING, MD TITLE:VICE PRESIDENT HOURS:56 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:BRIAN EWERT, MD TITLE:SECRETARY HOURS:55 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:DAVID SIMENSTAD, MD TITLE:TREASURER HOURS:60 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:STEPHEN L. BLONSKY TITLE:DIRECTOR HOURS:55 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:WALLACE B. BRUCKER TITLE:DIRECTOR HOURS:55 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:DANIEL R. ERICKSON, MD TITLE:DIRECTOR HOURS:55 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:HUMAYUN A. KHAN, MD TITLE:DIRECTOR HOURS:55 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:SHARLENE P, KREITLOW, MD TITLE:DIRECTOR HOURS:55 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:MARK A. LEPAGE, MD TITLE:DIRECTOR HOURS:55 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:RONALD F. MARTIN, MD TITLE:DIRECTOR HOURS:55 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:QASIM RAZA, MD TITLE:DIRECTOR HOURS:55 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:IVAN SCHALLER, MD TITLE:DIRECTOR HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:C. TODD STEWART, MD TITLE:DIRECTOR HOURS:55 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:HUMBERTO VIDAILLET, MD TITLE:DIRECTOR HOURS:55 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:MATTHIAS WEISS, MD TITLE:DIRECTOR HOURS:55 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:GARY JANKOWSKI TITLE:SYSTEM CFO HOURS:55 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:TIMOTHY SWAN, MD TITLE:FORMER SECRETARY/MD HOURS:60 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MARSHFIELD CLINIC | |||||||||||
| 1000 NORTH OAK AVENUE | MARSHFIELD | WI | 54449 | 390452970 | HEALTHCARE | WI | 501(C)(3) | 3 | NA | false | |
| LAKEVIEW MEDICAL CENTER INC OF RICE LAKE | |||||||||||
| 1100 N MAIN STREET | RICE LAKE | WI | 54868 | 390837206 | HEALTHCARE | WI | 501(C)(3) | 3 | NA | false | |
| THE HERITAGE FOUNDATION | |||||||||||
| 1000 N MAIN STREET | MARSHFIELD | WI | 54449 | 391865942 | HONOR INDIVID | WI | 501(C)(3) | 11 - TYPE 1 | false | N/A | |
| VOLUNTEER PARTNERS OF LAKEVIEW MEDICAL C | |||||||||||
| 1100 N MAIN STREET | RICE LAKE | WI | 54868 | 391329084 | SUPPORT ORG | WI | 501(C)(3) | 11, III-O | false | N/A | |
| FLAMBEAU HOSPITAL INC | |||||||||||
| 98 SHERRY AVE | PARK FALLS | WI | 54552 | 390973724 | HOSPITAL | WI | 501(C)(3) | 3 | false | N/A | |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|
| MARSHFIELD FOOD SAFETY | ||||||||
| FOOD TESTING | WI | MFLD CLINIC | RELATED | 0 | 0 | false | false | 0.00000 |
| DIAGNOSTIC TREATMENT CTR | ||||||||
| MEDICAL SVCS | WI | MFLD CLINIC | RELATED | 0 | 0 | false | false | 0.00000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | true | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | true | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |