2024-11-15T13:51:02-06:00 2023-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2023-01-01 811970070 MY CHOICE WISCONSIN INC MYCH 4142877600 PO BOX 131 GREENDALE WI 531290131 MARIA LEDGER CHIEF EXECUTIVE OFFICER 4142877600 2024-11-15 1 1 DAVID LOWENTHAL P00378651 3122071040 2024-11-14 2023 2024-10-15 13:58:12Z X MARIA LEDGER PO BOX 131 GREENDALE WI 531290131 774877490 0 X WWW.MYCHOICEWI.ORG X 2016 WI WISCONSIN BASED MANAGED CARE ORGANIZATION. X 9 9 1247 0 0 0 32386 10361 798043063 533257357 2579412 6233166 46485 146797523 800701346 686298407 0 0 671740571 456229681 66846954 51801148 0 0 0 24173653 16949022 762761178 524979851 37940168 161318556 263499865 266601317 98984930 0 164514935 266601317 X WE INSPIRE PEOPLE TO EXPERIENCE LIFE AT ITS FULLEST BY ENCOURAGING OWNERSHIP OF HEALTH, FOSTERING INDEPENDENCE, AND SERVING THE WHOLE PERSON; AND DO SO WITH AN UNWAVERING COMMITMENT AS STEWARDS OF MEDICAID FUNDING. 0 1 501834210 680022444 MY CHOICE WISCONSIN, INC. (THE "COMPANY OR "MCW") IS A MANAGED CARE ORGANIZATION (MCO) THAT OPERATES THE STATE OF WISCONSIN FAMILY CARE PROGRAM. FAMILY CARE IS A MEDICAID LONG-TERM CARE PROGRAM WHICH HELPS FRAIL ELDERS AND ADULTS WITH DISABILITIES GET THE SERVICES THEY NEED TO REMAIN IN THEIR HOMES. MCW RECEIVES A PER PERSON PER MONTH PAYMENT (CAPITATION RATE) TO MANAGE CARE FOR THE MEMBERS, WHO MAY BE LIVING IN THEIR OWN HOMES, GROUP HOME LIVING SITUATIONS, OR NURSING FACILITIES. MEMBERS RECEIVING THE FAMILY CARE BENEFIT MAY BE REQUIRED TO PAY A COST SHARE AND/OR A ROOM & BOARD FEE TO MCW. MCW SERVES OVER 15,000 MEMBERS IN THIRTY-NINE WISCONSIN COUNTIES. 501834210 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 1 822 0 1 1247 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MARIA LEDGER CEO 4142877600 PO BOX 131 GREENDALE WI 53129 THOMAS ORENDORFF DIRECTOR AND CHAIR 2.00 2.00 X X 800 0 0 MICHAEL MAYO SR DIRECTOR AND VICE CHAIR 1.00 2.00 X X 800 0 0 MARIA RODRIGUEZ DIRECTOR AND TREASURER 1.00 1.00 X X 600 0 0 KENNETH BYOM DO DIRECTOR AND SECRETARY 1.00 2.00 X X 400 0 0 LYNDA KRELLWITZ DIRECTOR 1.00 1.00 X 400 0 0 LEE S SEESE DIRECTOR 1.00 2.00 X 800 0 0 THOMAS BERGERUD DIRECTOR 1.00 1.00 X 200 0 0 KATHRYN BRIETZMAN DIRECTOR 1.00 1.00 X 600 0 0 JOHN HINTZE DIRECTOR 2.00 1.00 X 800 0 0 MARIA LEDGER CHIEF EXECUTIVE OFFICER 25.00 25.00 X 610937 0 8495 JAMES HODSON CHIEF FINANCIAL OFFICER 30.00 20.00 X 493698 0 12552 KEVIN COLLINS CHIEF COMPLIANCE OFFICER 25.00 25.00 X 360904 0 18621 BETSY VAN HEESCH CHIEF OPERATIONS OFFICER 25.00 20.00 X 276145 0 27307 BRION BEAUCHENE CHIEF INFORMATION OFFICER 25.00 25.00 X 215270 0 17376 BRIAN HENRIKSEN DIRECTOR ACCOUNTING/FINANCE 33.00 17.00 X 144429 0 22047 NICOLE PAGLIARO DIRECTOR PROVIDER SERVICES 40.00 10.00 X 141353 0 5650 EMILY FAHEY DIRECTOR REGULATORY AFFAIRS 13.00 37.00 X 140018 0 5598 JONATHAN PEKELNICKY DIRECTOR APPLICATION DEVELOPMENT 25.00 25.00 X 126817 0 21327 JEFF WALSH LEAD DEVELOPER ARCHITECT 21.00 21.00 X 124910 0 14767 2639881 0 153740 22 0 1 0 HOMES FOR INDEPENDENT LIVING OF WI LLC PO BOX 278 DOUSMAN WI 53188 MEMBER SERVICES 5030011 ST COLETTA OF WISCONSIN INC N4637 CO RD Y JEFFERSON WI 535499720 MEMBER SERVICES 4473761 KPI INC (DBA KATHI PAPA INC) 139 E WISCONSIN AVE OCONOMOWOC WI 53066 MEMBER SERVICES 3081144 LORI KNAPP RICHLAND INC 106 S BEAUMONT RD PRAIRIE DU CHIEN WI 53821 MEMBER SERVICES 2876176 CREATIVE COMMUNITY LIVING SERVICES INC 500 E MAIN ST WATERTOWN WI 53094 MEMBER SERVICES 2250076 343 10361 10361 MEDICAID REVENUE 624120 471290678 471290678 COST SHARE/ROOM & BOARD 624120 56141893 56141893 INTERCOMPANY REVENUE 561499 3934054 3934054 MEDICAID ADJUSTMENTS 624120 1824065 1824065 HOSTING REVENUE 624120 66667 66667 533257357 6407598 6407598 88396051 8600 88579083 0 -183032 8600 -174432 8600 -183032 GAIN ON SALE OF OPERATIONS 900099 146678030 146678030 EMPLOYEE BENEFIT REFUNDS/DIVIDEND 900099 78337 78337 ALL OTHER REVENUE 900099 41036 41036 120 120 146797523 686298407 680022444 0 6265602 456229681 456229681 2065031 2065031 38074302 29194153 8880149 1663219 1323571 339648 6439375 5260633 1178742 3559221 2792037 767184 202005 202005 369341 369341 13402 13402 104254 104254 2828362 21552 2806810 532222 532222 1025051 441793 583258 1597724 1597724 1330022 658756 671266 857414 807245 50169 15356 6911 8445 1892495 517307 1375188 1272530 1272530 BAD DEBT EXPENSE 4580145 4580145 LICENSE & REGISTRATION 146382 234 146148 BANK FEES 112497 112497 DUES & SUBSCRIPTIONS 69820 192 69628 524979851 501834210 23145641 0 579293 0 158817918 0 4842987 0 785903 0 0 0 3233905 0 77444835 187973221 9526701 0 2331299 0 5937024 78628096 263499865 266601317 10330438 0 88654492 0 98984930 0 X 164514935 266601317 164514935 266601317 263499865 266601317 X 161318556 1018769 -60250943 X X 0 1 X 1 0 X 15289 31983 274482 32386 10361 364501 353918086 718046189 710270357 798043063 533344414 3113622109 353933375 718078172 710544839 798075449 533354775 3113986610 0 0 0 3113986610 1623940 1135990 2905210 2495173 6407598 14567911 1623940 1135990 2905210 2495173 6407598 14567911 13835 25969 560149 46485 41036 687474 355571150 719240131 714010198 800617107 539803409 3129241995 0.99510 0.99660 0.00470 0.00320 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER - 2019 AMOUNT: $ 13,835. 2020 AMOUNT: $ 25,969. 2021 AMOUNT: $ 560,149. 2022 AMOUNT: $ 46,485. 2023 AMOUNT: $ 41,036. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 1 13402 13402 0 PART II-B, LINE 1: THE WISCONSIN ASSOCIATION OF HEALTH PLANS REPRESENTS COMMUNITY HEALTH PLANS IN WISCONSIN. THE REPORTED AMOUNT IS THE PORTION OF DUES PAID TO THE WISCONSIN ASSOCIATION OF HEALTH PLANS THAT IS ATTRIBUTABLE TO LOBBYING. 0 FUNDS HELD IN ESCROW 30008960 RECEIVABLE FROM SALE 48619136 78628096 X X X 0 0 0 0 0 0 0 1 0 MARIA LEDGER CHIEF EXECUTIVE OFFICER 555937 0 55000 0 0 0 8016 0 479 0 619432 0 0 0 JAMES HODSON CHIEF FINANCIAL OFFICER 458698 0 35000 0 0 0 7096 0 5456 0 506250 0 0 0 KEVIN COLLINS CHIEF COMPLIANCE OFFICER 325904 0 35000 0 0 0 13165 0 5456 0 379525 0 0 0 BETSY VAN HEESCH CHIEF OPERATIONS OFFICER 268645 0 7500 0 0 0 11316 0 15991 0 303452 0 0 0 BRION BEAUCHENE CHIEF INFORMATION OFFICER 190270 0 25000 0 0 0 7801 0 9575 0 232646 0 0 0 BRIAN HENRIKSEN DIRECTOR ACCOUNTING/FINANCE 126429 0 18000 0 0 0 6056 0 15991 0 166476 0 0 0 PART I, LINE 7 AS INDICATED IN SCHEDULE J, PART II, SEVERAL OFFICERS OF THE ORGANIZATION RECEIVED A BONUS BASED ON PERFORMANCE AND OVERALL FINANCIAL RESULTS OF THE ORGANIZATION. THESE BONUSES WERE APPROVED BY THE FINANCE COMMITTEE OF THE BOARD. CASH AND INVESTMENT SECURITIES 2023-09-01 60250943 INVEST FMV ON DATE OF TRANSFER 871303591 MY CHOICE FOUNDATION HOLDINGS INC PO BOX 131 GREENDALE WI 53129 501(C)(3) OPERATING ASSETS AND LIABILITIES 2023-09-01 146678030 NET GAIN ON SALE 134204626 MOLINA HEALTHCARE INC 200 OCEANGATE STE 100 LONG BEACH CA 90802 CORPORATION 1 1 0 0 PART II, LINE 2E: EXPLANATION OF INVOLVEMENT: CERTAIN DIRECTORS OF MY CHOICE WISCONSIN, INC. WERE ALSO DIRECTORS OF MY CHOICE FOUNDATION HOLDINGS BEFORE AND AFTER THE TRANSFER OF ASSETS TO MY CHOICE FOUNDATION. CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, AND CHIEF OPERATING OFFICER OF MY CHOICE WISCONSIN INC BECAME OFFICERS OF MOLINA HEALTHCARE WISCONSIN INC. FORM 990, PART III, LINE 3 EFFECTIVE AUGUST 31, 2023, THE ORGANIZATION COMPLETED THE SALE OF SUBSTANTIALLY ALL OF ITS OPERATING ASSETS AND LIABILITIES TO MOLINA HEALTHCARE, INC. FORM 990, PART VI, SECTION B, LINE 11B THE CHIEF FINANCIAL OFFICER PERFORMS A REVIEW PRIOR TO FILING THE FORM 990 WITH THE INTERNAL REVENUE SERVICE. THE FORM IS MADE AVAILABLE TO THE MEMBERS OF THE BOARD AFTER FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY FOR INTERESTED PERSONS THAT ADDRESSES TRANSACTIONS BETWEEN THE ORGANIZATION AND ANY CURRENT OR FORMER OFFICERS, DIRECTORS, COMMITTEE MEMBERS, KEY EMPLOYEE, STAFF MEMBERS, ANY PERSON IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION, FAMILY MEMBERS, AND OTHER RELATED ENTITIES. CONFLICTS DISCLOSED ARE ADDRESSED IN ACCORDANCE WITH POLICY SUMMARIZED BELOW. IF AN INTERESTED PERSON HAS ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST, THAT INTERESTED PERSON SHALL NOTIFY THE BOARD CHAIR OF SUCH CONFLICT IN WRITING, OR IN THE CASE OF A COMMITTEE MEMBER, THE COMMITTEE CHAIR. THE INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF HIS OR HER FINANCIAL INTEREST AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS OR MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS, WHO ARE CONSIDERING THE PROPOSED MATTER THAT PRESENTS THE POTENTIAL CONFLICT. IF ANY STAFF MEMBER HAS ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, HE/SHE SHALL NOTIFY THE CHIEF EXECUTIVE OFFICER OF SUCH CONFLICT IN THE CONTEXT OF HER/HIS SUPERVISORY ROLE OR SHALL HAVE THE DISCRETION TO REFER THE MATTER TO THE BOARD. IF THE BOARD OR COMMITTEE DECIDES A CONFLICT OF INTEREST EXISTS, THE FOLLOWING PROCEDURES SHALL APPLY: 1. AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. 2. IF THE CONFLICT IS NOT RESOLVED BY RECUSAL OF THE INTERESTED PERSON, THE CHAIRPERSON OF THE BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, IF APPLICABLE. AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. 3. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OF COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. ALL CONFLICT OF INTEREST DETERMINATIONS WILL BE REFLECTED IN THE MINUTES OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE FINANCE COMMITTEE (THE COMMITTEE) OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE ANNUAL REVIEW OF THE COMPENSATION OF THE PRESIDENT/CEO OF THE ORGANIZATION. ALL MEMBERS OF THE COMMITTEE ARE INDEPENDENT IN DETERMINING THE COMPENSATION OF THE PRESIDENT/CEO. THE COMMITTEE EVALUATES THE CEO'S PERFORMANCE AGAINST PREVIOUSLY AGREED UPON CRITERIA, CONSIDERS COMPARABLE MARKET DATA, THEN DEBATES AND DOCUMENTS ITS RECOMMENDATION OF REASONABLE COMPENSATION. THE PROCESS FOR DETERMINING COMPENSATION OF OFFICERS INCLUDES A MARKET ANALYSIS OF COMPARABLE POSITIONS FROM SIMILAR ORGANIZATIONS FOR BENCHMARKING PURPOSES. THIS INFORMATION IS REVIEWED BY INTERNAL HUMAN RESOURCES PROFESSIONALS AND THE CEO. THE CEO EVALUATES THE OFFICERS PERFORMANCE AGAINST PREVIOUSLY AGREED UPON CRITERIA AND A DECISION IS MADE ON THE OFFICERS' SALARY. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. SUMMARY FINANCIAL INFORMATION IS AVAILABLE ON THE STATE OF WISCONSIN DEPARTMENT OF HEALTH SERVICES WEBSITE. FORM 990, PART XI, LINE 9: TRANSFERS OF CASH AND INVESTMENTS TO MY CHOICE FOUNDATION HOLDINGS INC -60,250,943. FORM 990, PART XII, LINE 2: THE FILING ORGANIZATION WAS INCLUDED IN CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR THE PERIOD 1/1/2023 TO 9/1/2023. ACTIVITY THAT OCCURRED AFTER 9/1/2023 WAS NOT INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS HOWEVER THIS FORM 990 INCLUDES ACTIVITY FOR A FULL CALENDAR YEAR 2023. MY CHOICE WISCONSIN HEALTH PLAN INC PO BOX 131 GREENDALE WI 53129 270093404 HEALTH CARE WI 501(C)(3) LINE 10 MY CHOICE WISCONSIN INC 1 MY CHOICE FOUNDATION HOLDINGS INC PO BOX 131 GREENDALE WI 53129 871303591 SUPPORTING ORGANIZATION WI 501(C)(3) LINE 12A, I MY CHOICE WISCONSIN INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 MY CHOICE WISCONSIN HEALTH PLAN INC Q 13669107 COST MY CHOICE FOUNDATION HOLDINGS INC R 60250943 COST