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TIN:
SCHEDULE O
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is atwww.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Inspection
Name of the organization
UCare Health Inc
Employer identification number
20-8295948
20-8295948
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, line 3 | In 2015, management reviewed its long-term options in consideration with the 2016 Medicare bid and concluded due to significant losses and ongoing CMS payment pressures due to the ACA, the long term financial viability of continuing to offer Medicare Advantage products in 2016 was not feasible. As a result, the remaining Medicare Advantage product offerings will be closed effective January 1, 2016. The only remaining activity expected in UCare for 2016 and 2017 will be to cover the out of area coverage for UCare Minnesota's individual commercial exchange offerings. |
| Form 990, Part VI, Section A, line 3 | UCare Health, Inc. has an administrative service agreement with UCare Minnesota to provide overall management and administration of UCare Health, Inc.'s business. UCare Health, Inc.'s business, includes but is not limited to, administrative management, financial management, provider contracting services, marketing services and public affairs services, and other tasks as may be necessary to carry out any policies related to UCare Health, Inc.'s business. UCare Health, Inc. reimburses UCare Minnesota for all costs and expenses directly and indirectly incurred and associated with the business and operation of UCare Health, Inc. |
| Form 990, Part VI, Section A, line 6 | The corporation's sole member is UCare Minnesota, a Minnesota non-profit corporation organized to operate as a health maintenance organization under Minnesota Statutes, Chapter 62D and exempt from taxation under section 501(c)(3) of the Internal Revenue Service Code. UCare Minnesota as the corporate member, has all powers and voting rights afforded by law to voting members of services insurance corporations under Wisconsin Statutes, Chapter 613 and applicable sections of Wisconsin Statutes. |
| Form 990, Part VI, Section A, line 7a | The Board of Directors consists of 15 Directors, although one position was vacant at the end of the year. The Directors are elected automatically by virtue of their election to the UCare Minnesota Board of Directors, unless a different Director is elected by UCare Minnesota as corporate member acting through its Board of Directors. Such different Directors need not be resident of Wisconsin, and may or may not be enrollees receiving coverage or services from the Corporation although at least 40% of the Directors shall be enrollees of the Corporation or UCare Minnesota. |
| Form 990, Part VI, Section A, line 7b | In addition to the powers set forth in Wisconsin law for members, UCare Minnesota has reserved to itself the following powers concerning the governance of the Corporation, which shall be expressed through the UCare Minnesota Board of Directors: (a) The approval of any plans of merger or consolidation by the Corporation with any foreign or domestic Corporation, voluntary dissolution of the Corporation, or any sales, lease, or transfer of all or substantially all of the Corporation's assets; (b) the approval of the grant of a security interest in all or substantially all of the Corporation's assets or the guarantee of any indebtedness before such security interest or guarantee becomes legally binding, and (c) the amendment of the articles of incorporation or bylaws. |
| Form 990, Part VI, Section B, line 11 | The 990 Form is prepared by the controller and reviewed by an independent accounting firm. UCare provides a copy and reviews the details of the completed 990 Form with the Board's Finance and Audit Committee. UCare also provides a copy of the completed 990 Form to all members of the Board of Directors via email, and the Board's on-line portal prior to the Finance and Audit Committee's report to the Board. Upon approval by the Board of Directors, the 990 Form is filed with the Internal Revenue Service. |
| Form 990, Part VI, Section B, line 12c | UCare requires completion of an annual questionnaire by its Board members, Officers, and Senior Executives, which is designed to identify potential conflicts of interest. In addition, UCare's policy requires disclosure to the Board Chair and/or CEO of a potential conflict involving a Director, Officer, or Management staff when a particular transaction arises. If the Board or designated Board Committee determines that a potential conflict exists related to a transaction requiring action by the Board, the policy calls for the Board Member with the potential conflict to abstain from voting and for a majority of the disinterested Directors to find that the transaction is fair and reasonable to the operation, and that the organization could not reasonably find a more advantageous transaction from another entity without a potential conflict. In practice, UCare seeks to manage certain business matters so that they are not subject to action by the Board or Senior Executives where a potential conflict exists. For example, the Board includes members who are enrolled in UCare's health plans, and the benefit designs and premium amounts of such plans are not brought before the Board for action. The policy also requires disclosure of potential conflicts to the Board to the designated committee even for transactions not requiring Board action. |
| Form 990, Part VI, Section C, line 18 | UCare Health, Inc.'s Form 990 is available upon request. |
| Form 990, Part VI, Section C, line 19 | UCare will provide governing documents,Conflict of Interest Policy and/or Financial Statements upon request. |
| Form 990, Part IX, line 11g | Medical Costs: Program service expenses 60,585,193. Management and general expenses 0. Fundraising expenses 0. Total expenses 60,585,193. Purchased Services: Program service expenses 594,996. Management and general expenses 153,400. Fundraising expenses 0. Total expenses 748,396. Broker Commissions: Program service expenses 693,984. Management and general expenses 0. Fundraising expenses 0. Total expenses 693,984. Disease Management: Program service expenses 12,266. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,266. Outsourced Services: Program service expenses 385,856. Management and general expenses 58,479. Fundraising expenses 0. Total expenses 444,335. Mayo Service Fees: Program service expenses 67,080. Management and general expenses 36,613. Fundraising expenses 0. Total expenses 103,693. |
| Form 990, Part XI, line 9: | Contributed Capital from UCare Minnesota-bring UCare Health into Compliance 7,000,000. |
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2015
Additional Data
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