2012-10-10T10:56:58-05:00 2011-12-31 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH ST MINNEAPOLIS MN 55402 990 2011-01-01 391572880 Security Health Plan of Wisconsin Inc % TIM SCHULTZ CFO SECU 7152219500 PO Box 8000 Marshfield WI 544498000 Tim Schultz 2012-09-17 true 6123055000 2011 2016-02-24 21:20:13Z KARL ULRICH PRESIDENT 1000 ST JOSEPH AVE MARSHFIELD WI 54449 1082568229 false X www.securityhealth.org X 1986 WI 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. 9 3 0 3 4384717 -611084 0 0 909996315 942224093 8711440 12908385 2857200 4384717 921564955 959517195 10000998 0 0 0 0 0 0 0 0 864238185 915168405 874239183 915168405 47325772 44348790 294708887 326201824 135633988 133706638 159074899 192495186 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. false false 845077855 942224093 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. 845077855 false false false false false false false false false true false false false true false true true false false false false false false false false false false false true false false false false false false false false false false false false false true false false true true 3419 0 true 0 true true false false false false false X 9 3 false false false false false true true true true false false true true true true true true true false false WI X TIM SCHULTZ CFO 7152219447 1515 ST JOSEPH AVE MARSHFIELD WI 54449 X KARL ULRICH MD 3.0 X X 0 673080 53013 DOUG REDING MD 3.0 X X 0 625803 53434 BRIAN EWERT MD 2.0 X X 0 255716 51516 DAVID SIMENSTAD MD 2.0 X X 0 1074143 54434 STEPHEN L BLONSKY 1.0 X 0 309857 59343 WALLACE B BRUCKER 1.0 X 0 617989 56425 DANIEL R ERICKSON MD 1.0 X 0 216038 53545 HUMAYUN A KHAN MD 1.0 X 0 232260 49133 SHARLENE P KREITLOW MD 1.0 X 0 236242 53690 MARK A LEPAGE MD 1.0 X 0 454714 53213 RONALD F MARTIN MD 1.0 X 0 293039 39782 QASIM RAZA MD 1.0 X 0 280231 53697 IVAN SCHALLER MD 1.0 X 0 209252 51336 C TODD STEWART MD 1.0 X 0 422444 53013 HUMBERTO VIDAILLET MD 1.0 X 0 430830 57057 MATTHIAS WEISS MD 1.0 X 0 489265 58649 MATTHEW THOMAS 0.5 X 0 375758 47307 MICHAEL J LUEBKE 0.5 X ROBERT A CHRIST 0.5 X TIMOTHY PETERSON 0.5 X JOHN MELSKI MD 0.5 X 382939 53321 GARY JANKOWSKI 2.0 X 0 391319 53487 STEVE YOUSO 55.0 X 0 363247 47307 STEVEN E SZEBENYI MD 55.0 X 0 298793 22605 TIMOTHY SCHULTZ 55.0 X 0 198748 25512 CHRIS BRUNI 55.0 X 0 194801 47168 CHARLES PAINE 55.0 X 0 166634 24122 JANE WOLF 55.0 X 0 125309 35264 LISA BOERO 55.0 X 147141 20662 JULIE BRUSSOW 55.0 X 106208 32331 LAWRENCE MCFARLENE MD 45.0 X 0 260583 50275 ANDREA HILLERUD MD 25.0 X 211606 49193 EDWARD KRALL MD 30.0 X 267532 52517 GINGER WOLF 55.0 X 200449 46796 JILL BROSTOWITZ 55.0 X 140641 36434 JAY COLDWELL 55.0 X 139232 42812 TIMOTHY SWAN MD 0.0 X 0 523515 49327 0 11315358 1587720 33 true true false 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 53 0 FEES FOR PROV OF PREPAID HEALTH 942224093 942224093 942224093 6757459 6757459 0 0 1402909 1402909 127785975 13076 121648125 6137850 13076 6150926 6150926 0 0 0 ASO ADMIN FEES 561000 4376903 4376903 CREDENTIALING FEES 561000 7814 7814 4384717 959517195 942224093 4384717 12908385 0 0 0 0 0 0 0 0 0 0 2556117 2556117 276347 276347 312477 312477 5000 5000 0 355915 355915 9748753 9748753 3468228 3468228 2401217 2401217 3058487 3058487 0 651641 651641 1292440 1292440 0 177167 177167 408630 408630 0 1118644 1118644 214439 214439 HOSPITAL/MEDICAL BENEFITS 773102262 773102262 0 PRESCRIPTION DRUGS 71975593 71975593 ADMINISTRATIVE CAPITATION 29153809 29153809 COMMISSIONS 8164228 8164228 6727011 6727011 915168405 845077855 70090550 0 1350 1350 66938637 59252373 0 0 13970768 25840252 0 0 0 0 25000000 0 0 0 18715038 18025131 37453873 9284167 14743405 28169706 155339689 194913012 0 0 0 0 0 0 0 0 294708887 326201824 72321425 98966874 0 0 53795306 28407317 0 0 0 0 0 0 5877997 5358237 0 0 3639260 974210 135633988 133706638 X 0 0 0 0 159074899 192495186 159074899 192495186 294708887 326201824 X 44348790 -10928503 X false true true X false 8423911 0 3026797 5397114 560089 0 376875 183214 5318882 0 4389206 929676 23150993 0 1491291 21659702 28169706 0 CONTRACT RESERVES 974210 974210 959517195 915168405 44348790 -161331 -161331 44187459 955119402 955119402 4397793 4397793 959517195 920709551 9938939 9938939 910770612 4397793 4397793 915168405 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 X X X X false false false false false false false false false 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 COMPENSATION 990 PART VII, LINE 1 AND SCHEDULES J-1 AND J-2 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. 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 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 N/A false VOLUNTEER PARTNERS OF LAKEVIEW MEDICAL C 1100 N MAIN STREET RICE LAKE WI 54868 391329084 SUPPORT ORG WI 501(C)(3) 11, III-O N/A false FLAMBEAU HOSPITAL INC 98 SHERRY AVE PARK FALLS WI 54552 390973724 HOSPITAL WI 501(C)(3) 3 N/A false 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 false true false true false false false false true true false false false false true true true false