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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
2014
Open to Public
Inspection
Inspection
Name of the organization
SECURITY HEALTH PLAN OF WISCONSIN INC
Employer identification number
39-1572880
39-1572880
| Return Reference | Explanation |
|---|---|
| Form 990, Part III - Program Service, Line 4A | SECURITY HEALTH PLAN OF WISCONSIN, INC. (SHP) PROVIDES A NETWORK FOR PREPAID HEALTH CARE SERVICES TO APPROXIMATELY 225,000 MEMBERS. IN 2014, 52% OF SHP ENROLLMENT WAS FROM EMPLOYER GROUPS AND DIRECT PAY SUBSCRIBERS WITHIN THE HEALTHCARE, MANUFACTURING, GOVERNMENT, AND DAIRY INDUSTRIES; 25% FROM MEDICAID; 1% FROM MEDICARE SUPPLEMENT; 22% WAS FROM MEDICARE ADVANTAGE. SHP ALSO OFFERS ADMINISTRATIVE SERVICES ONLY CONTRACTS (ASO)TO SELF INSURED GROUPS. SHP OFFERS COMMUNITY RATING FOR MEDICARE SUPPLEMENT MEMBERS PARTICIPATING IN THE MEDICAID HMO. IN ADDITION, SHP OFFERS COVERAGE TO 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. |
| Form 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 ACCOUNTING PRINCIPLES. |
| Governing Body Election | Form 990 Part VI, Line 4 MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. THE GOVERNING BODY INCLUDES A TOTAL OF NINE MEMBERS, THREE AT LARGE INDEPENDENT MEMBERS, TWO AT LARGE INDEPENDENT DIRECTORS OF THE MCHS , ONE MARSHFIELD CLINIC (MC) DIRECTOR, MC EXECUTIVE DIRECTOR, CHAIR AND VICE CHAIR OF THE MC BOARD OF DIRECTORS. |
| FORM 990, PART VI, LINE 7A AND 7B | MARSHFIELD CLINIC HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF SECURITY HEALTH PLAN.THERE ARE NINE MEMBERS ON THE SHP BOARD; ONE MEMBER IS AN INDIVIDUAL THEN SERVING ON THE MARSHFIELD CLINIC, INC. BOARD OF DIRECTORS; ONE MEMBER IS THE VICE CHAIR OF MARSHFIELD CLINIC, INC. BOARD OF DIRECTORS, ONE MEMBER IS EXECUTIVE DIRECTOR OF THE MARSHFIELD CLINIC, INC. BOARD OF DIRECTORS AND ONE MEMBER IS THE CHAIR OF MARSHFIELD CLINIC, INC. BOARD OF DIRECTORS: TWO MEMBERS ARE "INDEPENDENT MEMBERS" OF THE SOLE CORPORATE MEMBER'S BOARD OF DIRECTORS AND THREE MEMBERS ARE "INDEPENDENT" MEMBERS WITHIN THE MEANING OF WIS. ADMIN. CODE INS 50.15(4). |
| FORM 990, PART VI, LINE 11A | AFTER AN IN-DEPTH REVIEW BY THE CONTROLLER AS WELL AS OUTSIDE TAX ADVISOR, KPMG, LLP, AND PRIOR TO FILING WITH THE IRS, FORM 990 WILL BE DISTRIBUTED TO EACH BOARD MEMBER. ANY QUESTIONS THAT ARISE FROM THE BOARD OF DIRECTORS ARE ANSWERED BY THE CONTROLLER. |
| FORM 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. |
| FORM 990, PART VI, LINE 15A | SECURITY HEALTH PLAN RELIED ON MARSHFIELD CLINIC TO ESTABLISH THE COMPENSATION OF THE CEO, JULIE BRUSSOW, AND OTHER TOP MANAGEMENT OFFICIALS. 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. |
| FORM 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. |
| FORM 990, PART XI, LINE 9 | CHANGE IN RESERVES 688,773 Form 990, Amended Return Security Health Plan of Wisconsin, Inc. is filing an amended Federal Form 990 in order to attach Schedule F and disclose additional information that was not avaialable at the time in which the original Federal Form 990 was filed. |
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2014
Additional Data
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