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 270093404 MY CHOICE WISCONSIN HEALTH PLAN 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 148850535 0 X WWW.MYCHOICEWI.ORG X 2004 WI PROMOTE THE QUALITY OF LIFE OF OUR COMMUNITIES BY EMPOWERING OTHERS' LONG TERM CARE NEEDS. X 9 9 0 0 0 0 0 0 202747795 136460285 881291 1857089 22209 2073484 203651295 140390858 0 0 167995390 113582892 0 0 0 0 0 31499723 25933468 199495113 139516360 4156182 874498 99487218 59548184 30341398 0 69145820 59548184 X MY CHOICE WISCONSIN HEALTH PLAN, INC. IS A NONPROFIT MANAGED CARE ORGANIZATION THAT MATCHES FRAIL SENIORS AND PEOPLE WITH PHYSICAL AND INTELLECTUAL DISABILITIES TO THE HEALTH CARE AND LONG-TERM SUPPORTS AND SERVICES THEY NEED. WE OFFER GOVERNMENT-FUNDED (MEDICARE AND MEDICAID) PROGRAMS AND PARTNER WITH PROVIDERS TO CREATE STRONG, LOCAL PROVIDER NETWORKS. WE ARE DEDICATED TO OUR MISSIONS AND VALUES TO PROMOTE THE QUALITY OF LIFE OF OUR COMMUNITIES BY EMPOWERING OTHERS AND WORKING TOGETHER TO CREATIVELY SOLVE UNIQUE HEALTH AND LONG-TERM CARE NEEDS. 0 1 73928876 83143037 MY CHOICE WISCONSIN HEALTH PLAN, INC (MCWHP) OFFERS THE PARTNERSHIP PROGRAM, WHICH PROVIDES HEALTH AND LONG-TERM MANAGEMENT AND CARE SERVICES TO THE ELDERLY AND ADULTS WITH DISABILITIES. MCWHP'S PARTNERSHIP PROGRAM HAD APPROXIMATELY 1,400 MEMBERS. 29023531 34106777 MY CHOICE WISCONSIN HEALTH PLAN, INC OFFERS THE MEDICAID BADGERCARE PLUS PROGRAM, A HEALTH INSURANCE PROGRAM FOR PARENTS/CARETAKERS OF DEPENDENT CHILDREN, PREGNANT WOMEN, WISCONSIN CHILDREN, AND CHILDLESS ADULTS THAT MEET CERTAIN INCOME REQUIREMENTS. THE BADGERCARE PLUS PROGRAM HAD APPROXIMATELY 23,000 MEMBERS. 13009705 10498266 MY CHOICE WISCONSIN HEALTH PLAN, INC OFFERS THE MEDICAID SSI PROGRAM, A HEALTH INSURANCE PROGRAM FOR INDIVIDUALS WHO QUALIFY FOR FEDERAL SSI. THE SSI PROGRAM HAD APPROXIMATELY 3,100 MEMBERS. 8769518 10754819 MY CHOICE WISCONSIN HEALTH PLAN, INC BEGAN OFFERING A MEDICARE DUAL ADVANTAGE PROGRAM ON JANUARY 1, 2017, FOR INDIVIDUALS WHO HAVE BOTH MEDICARE AND MEDICAID. THE MEDICARE DUAL ADVANTAGE PROGRAM HAD APPROXIMATELY 800 MEMBERS. 8769518 10754819 124731630 1 0 0 1 0 0 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 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1016 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X MARIA LEDGER 4142877600 PO BOX 131 GREENDALE WI 531290131 THOMAS ORENDORFF DIRECTOR AND CHAIR 1.00 3.00 X X 0 800 0 MICHAEL MAYO SR DIRECTOR AND VICE CHAIR 1.00 2.00 X X 0 800 0 MARIA RODRIGUEZ DIRECTOR AND TREASURER 1.00 1.00 X X 0 600 0 KENNETH BYOM DO DIRECTOR AND SECRETARY 1.00 2.00 X X 0 400 0 LYNDA KRELLWITZ DIRECTOR 1.00 1.00 X 0 400 0 LEE S SEESE DIRECTOR 1.00 2.00 X 0 800 0 THOMAS BERGERUD DIRECTOR 1.00 1.00 X 0 200 0 KATHRYN BRIETZMAN DIRECTOR 1.00 1.00 X 0 600 0 JOHN HINTZE DIRECTOR 1.00 2.00 X 0 800 0 MARIA LEDGER CHIEF EXECUTIVE OFFICER 24.00 26.00 X 0 610937 8495 JAMES HODSON CHIEF FINANCIAL OFFICER 20.00 30.00 X 0 493698 12552 KEVIN COLLINS CHIEF COMPLIANCE OFFICER 23.00 27.00 X 0 360904 18621 BETSY VAN HEESCH CHIEF OPERATIONS OFFICER 20.00 25.00 X 0 276145 27307 BRION BEAUCHENE CHIEF INFORMATION OFFICER 25.00 25.00 X 0 215270 17376 BRIAN HENRIKSEN DIRECTOR ACCOUNTING/FINANCE 17.00 33.00 X 0 144429 22047 NICOLE PAGLIARO DIRECTOR PROVIDER SERVICES 10.00 40.00 X 0 141353 5650 EMILY FAHEY DIRECTOR REGULATORY AFFAIRS 37.00 13.00 X 0 140018 5598 JONATHAN PEKELNICKY DIRECTOR APPLICATION DEVELOPMENT 25.00 25.00 X 0 126817 21327 JEFF WALSH LEAD DEVELOPER ARCHITECT 21.00 21.00 X 0 124910 14767 0 2639881 153740 0 0 1 0 UNIVERITY OF WISCONSIN HOSPITALS & CLINI 600 HIGHLAND AVE MADISON WI 53792 MEDICAL SERVICES 8955324 SSM HEALTH CARE OF WISCONSIN INC 10101 WOODFIELD LN ST LOUIS MO 63132 MEDICAL SERVICES 4451314 FROEDTERT MEMORIAL LUTHERAN HOSPITAL INC 9200 W WISCONSIN AVE MILWAUKEE WI 53226 MEDICAL SERVICES 4311320 MERITER HOSPITAL INC 202 S PARK ST MADISON WI 53715 MEDICAL SERVICES 4152250 AURORA HEALTH CARE METRO INC PO BOX 341880 MILWAUKEE WI 53234 MEDICAL SERVICES 3371945 218 MEDICARE/MEDICAID REVENUE 624100 128239656 128239656 COST SHARE/ROOM & BOARD 624100 5238782 5238782 PREMIUM REVENUE 624100 2981847 2981847 136460285 1933765 1933765 8383001 8459677 -76676 -76676 -76676 GAIN ON SALE OF OPERATIONS 900099 2042614 2042614 ALL OTHER REVENUE 900099 30870 30870 2073484 140390858 138502899 0 1887959 113582892 113582892 91406 91406 3471 3471 34292 34292 5955796 604248 5351548 32523 32523 66686 29564 37122 183577 183577 115496 109579 5917 15871 15317 554 2569441 2569441 ALLOCATED ADMINISTRATIO 13669107 9735053 3934054 INCOME TAXES 2478193 2478193 BAD DEBT EXPENSE 642459 642459 BANK FEES 26354 26354 48796 12518 36278 139516360 124731630 14784730 0 222978 0 63216439 0 10134276 0 206925 0 23137159 59548184 2569441 0 99487218 59548184 30298398 0 43000 0 30341398 0 X 69145820 59548184 69145820 59548184 99487218 59548184 X 874498 431415 -10903549 X X 0 1 X 1 0 X 154656258 211437893 198676131 202747795 136460283 903978360 154656258 211437893 198676131 202747795 136460283 903978360 0 0 0 903978360 1417787 1109523 763852 954952 1933765 6179879 1417787 1109523 763852 954952 1933765 6179879 19656 27617 22209 30870 100352 156074045 212567072 199467600 203724956 138424918 910258591 0.99310 0.99000 0.00680 0.00560 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CLOSE OUT PYMT FROM CLSD PLAN - OTHER NON-OPERATING - 2020 AMOUNT: $ 19,656. 2021 AMOUNT: $ 27,617. 2022 AMOUNT: $ 22,209. 2023 AMOUNT: $ 30,870. 0 0 0 0 0 0 0 0 1 3471 3471 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 ATTRIBUTATBLE TO LOBBYING. X X X 0 0 0 0 0 0 0 0 0 MARIA LEDGER CHIEF EXECUTIVE OFFICER 0 555937 0 55000 0 0 0 8016 0 479 0 619432 0 0 JAMES HODSON CHIEF FINANCIAL OFFICER 0 458698 0 35000 0 0 0 7096 0 5456 0 506250 0 0 KEVIN COLLINS CHIEF COMPLIANCE OFFICER 0 325904 0 35000 0 0 0 13165 0 5456 0 379525 0 0 BETSY VAN HEESCH CHIEF OPERATIONS OFFICER 0 268645 0 7500 0 0 0 11316 0 15991 0 303452 0 0 BRION BEAUCHENE CHIEF INFORMATION OFFICER 0 190270 0 25000 0 0 0 7801 0 9575 0 232646 0 0 BRIAN HENRIKSEN DIRECTOR ACCOUNTING/FINANCE 0 126429 0 18000 0 0 0 6056 0 15991 0 166476 0 0 PART I, LINE 3 THE CEO/EXECUTIVE DIRECTOR IS PAID BY A RELATED ORGANIZATION, MY CHOICE WISCONSIN, INC., WHICH USES THE FOLLOWING METHODS TO DETERMINE COMPENSATION: (1) COMPENSATION COMMITTEE (2) COMPENSATION SURVEY OR STUDY AND (3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE CASH AND INVESTMENT SECURITIES, NET OF INCOME TAX LIABILITIES 2023-09-01 10903549 CASH & 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 2042614 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 HEALTH PLAN, 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 A, LINE 6 MY CHOICE WISCONSIN, INC. A WISCONSIN NONPROFIT 501(C)(3) CORPORATION IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A EACH YEAR AT ITS ANNUAL MEETING, MY CHOICE WISCONSIN, INC., AS THE SOLE MEMBER OF THE ORGANIZATION, SHALL ELECT THE DIRECTORS ACCORDING TO THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS REQUIRE THE PRIOR AUTHORIZATION OR APPROVAL OF MY CHOICE WISCONSIN, INC. AS ITS SOLE MEMBER: A. MERGER, CONVERSION INTO A STOCK OR MUTUAL CORPORATION, OR VOLUNTARY DISSOLUTION OF THE CORPORATION; B. AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OF THE CORPORATION OR OF THE BYLAWS, EXCEPT AS PROVIDED IN ARTICLE XIII; C. A TRANSFER OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE CORPORATION; OR, D. THE ESTABLISHMENT, FORMATION, ACQUISITION, MERGER, CONSOLIDATION OR DISSOLUTION OF ANY SUBSIDIARY CORPORATION OF THE CORPORATION. E. ANY ACTION THAT WOULD AFFECT THE TAX-EXEMPT STATUS OF EITHER THE CORPORATION OR THE VOTING MEMBER. F. ACTION ON ANY MATTER THAT IS DETERMINED TO BE UNDER THE CONTROL OF THE VOTING MEMBER UNDER THE ARTICLES OF INCORPORATION, THE BYLAWS, OR CHAPTER 613 OF THE WISCONSIN STATUTES. 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 ALL WAGES ARE PAID BY MY CHOICE WISCONSIN, INC. WHICH IS THEN REIMBURSED BY MY CHOICE WISCONSIN HEALTH PLAN, INC. THE FOLLOWING DESCRIBES HOW MY CHOICE WISCONSIN, INC. DETERMINES ITS SALARY AND WAGES FOR THE EXECUTIVE TEAM. A CONSULTANT HELPS WITH REVIEWING THE MARKET DATA FROM SIMILAR ORGANIZATION FOR DETERMINING THE APPROPRIATE PAY RANGES AND PAY RATES FOR THE INCUMBENTS. THE CONSULTANT WILL MAKE THE RECOMMENDATION FOR THE COMPENSATION FOR THE CEO, FOR THE EXECUTIVE TEAM MEMBERS, WHO THEN REVIEWS AND APPROVES FOR THE CEO'S COMPENSATION. THE BOARD RECEIVES THE RECOMMENDATION FROM THE CONSULTANT AND WILL REVIEW AND APPROVE. 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 -10,903,549. 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 INC PO BOX 131 GREENDALE WI 531290131 811970070 CARE MGMT WI 501(C)(3) LINE 10 N/A 0 MY CHOICE FOUNDATION HOLDINGS INC PO BOX 131 GREENDALE WI 531290131 871303591 SUPPORTING ORG WI 501(C)(3) LINE 12A, I MY CHOICE WISCONSIN INC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 MY CHOICE WISCONSIN INC P 13669107 COST MY CHOICE WISCONSIN HOLDINGS INC R 10903549 FMV