2023-11-07T11:59:50-06:00 2022-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2022-01-01 270093404 MY CHOICE WISCONSIN HEALTH PLAN INC MYCH 4142877600 10201 WEST INNOVATION DRIVE 100 WAUWATOSA WI 53226 JAMES HODSON CHIEF FINANCIAL OFFICER 4142877600 2023-11-06 1 JAMES HODSON 999009999 1 DAVID LOWENTHAL P00378651 3122071040 2023-11-06 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JAMES HODSON 10201 WEST INNOVATION DRIVE 100 WAUWATOSA WI 53226 206585857 0 X WWW.MYCHOICEWI.ORG X 2004 WI PROMOTE THE QUALITY OF LIFE OF OUR COMMUNITIES BY EMPOWERING OTHERS' LONG TERM CARE NEEDS. 9 9 0 9 0 0 0 0 198676131 202747795 549832 881291 27617 22209 199253580 203651295 0 0 164985347 167995390 0 0 0 0 0 29252859 31499723 194238206 199495113 5015374 4156182 94864690 99487218 26734830 30341398 68129860 69145820 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 0 113875951 119257336 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 1,469 MEMBERS AT THE END OF 2022. 40776620 54050299 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 24,345 MEMBERS AT THE END OF 2022. 17818295 17126881 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 3,320 MEMBERS AT THE END OF 2022. 12401694 12313279 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 768 MEMBERS AT THE END OF 2022. 12401694 12313279 184872560 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 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 0 0 1 0 0 0 1 1368 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 JAMES HODSON 4142877600 10201 WEST INNOVATION DRIVE STE 100 WAUWATOSA WI 532664822 THOMAS ORENDORFF DIRECTOR AND CHAIR 1.00 3.00 X X 0 1800 0 MICHAEL MAYO SR DIRECTOR AND VICE CHAIR 1.00 2.00 X X 0 1800 0 MARIA RODRIGUEZ DIRECTOR AND TREASURER 1.00 1.00 X X 0 400 0 KENNETH BYOM DO DIRECTOR AND SECRETARY 1.00 2.00 X X 0 400 0 LYNDA KRELLWITZ DIRECTOR 1.00 1.00 X 0 800 0 LEE S SEESE DIRECTOR 1.00 2.00 X 0 1400 0 THOMAS BERGERUD DIRECTOR 1.00 1.00 X 0 600 0 KATHRYN BRIETZMAN DIRECTOR 1.00 1.00 X 0 800 0 JOHN HINTZE DIRECTOR 1.00 2.00 X 0 1600 0 MARIA LEDGER CHIEF EXECUTIVE OFFICER 25.00 25.00 X 0 555972 13265 JAMES HODSON CHIEF FINANCIAL OFFICER 20.00 30.00 X 0 491545 21010 KEVIN COLLINS CHIEF COMPLIANCE OFFICER 23.00 27.00 X 0 416367 20735 BETSY VAN HEESCH CHIEF OPERATIONS OFFICER 20.00 25.00 X 0 364987 35598 DR ERIC QUIVERS CHIEF MEDICAL OFFICER 45.00 0.00 X 0 304115 20608 BRION BEAUCHENE CHIEF INFORMATION OFFICER 25.00 25.00 X 0 237956 21552 DAVID POELLEMANN DIRECTOR ACCOUNTING/FINANCE 10.00 40.00 X 0 170894 29891 NICOLE PAGLIARO DIRECTOR PROVIDER SERVICES 25.00 25.00 X 0 158226 6324 EILEEN MURPHY DIRECTOR PHARMACY SERVICES 45.00 0.00 X 0 152439 19510 JEFF WALSH LEAD DEVELOPER ARCHITECT 35.00 10.00 X 0 147582 20166 SARAH WAY-MESSER DIRECTOR QUALITY 39.00 6.00 X 0 145836 5852 0 3155519 214511 0 0 1 0 UNIVERSITY OF WISCONSIN HOSPITALS & CLIN 600 HIGHLAND AVE MADISON WI 53792 MEDICAL SERVICES 14182156 FROEDTERT MEMORIAL LUTHERAN HOSPITAL INC 9200 W WISCONSIN AVE MILWAUKEE WI 53226 MEDICAL SERVICES 7151891 SSM HEALTH CARE OF WISCONSIN INC 10101 WOODFIELD LN ST LOUIS MO 63132 MEDICAL SERVICES 6902258 MERITER HOSPITAL INC 202 S PARK ST MADISON WI 53715 MEDICAL SERVICES 6420172 CHILDRENS HOSPITAL OF WISCONSIN INC 8915 W CONNELL CT MILWAUKEE WI 53226 MEDICAL SERVICES 6139716 265 MEDICARE/MEDICAID REVENUE 624100 189543401 189543401 COST SHARE/ROOM & BOARD 624100 8164331 8164331 PREMIUM REVENUE 624100 3512474 3512474 MEDICARE/MEDICAID ADJUSTMENTS 624100 1527589 1527589 202747795 954952 954952 2860901 2934562 -73661 -73661 -73661 ALL OTHER REVENUE 900099 22209 22209 22209 203651295 202747795 0 903500 167995390 167995390 147475 147475 14198 14198 53785 53785 8315787 477763 7838024 844 844 52201 29052 23149 295069 295069 137583 131694 5889 9568 9568 332112 332112 274 274 ALLOCATED ADMINISTRATIO 20438699 14959175 5479524 BAD DEBT EXPENSE 1264627 1264627 INCOME TAXES 300807 300807 BANK FEES 62440 62440 74254 5291 68963 199495113 184872560 14622553 0 168959 222978 51887164 63216439 9021405 10134276 962361 206925 29923248 23137159 2901553 2569441 94864690 99487218 26691830 30298398 43000 43000 26734830 30341398 X 68129860 69145820 68129860 69145820 94864690 99487218 4156182 -3140222 0 X 0 1 X 1 0 X 154735248 154656258 211437893 198676131 202747795 922253325 154735248 154656258 211437893 198676131 202747795 922253325 0 0 0 922253325 929297 1417787 1109523 763852 954952 5175411 929297 1417787 1109523 763852 954952 5175411 4073130 19656 27617 22209 4142612 159737675 156074045 212567072 199467600 203724956 931571348 0.99000 0.98950 0.00560 0.00570 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CLOSE OUT PYMT FROM CLSD PLAN - 2018 AMOUNT: $ 4,073,130. OTHER NON-OPERATING - 2020 AMOUNT: $ 19,656. 2021 AMOUNT: $ 27,617. 2022 AMOUNT: $ 22,209. 0 0 0 0 0 0 0 0 1 14198 14198 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. 0 NET DEFERRED TAX LIABILITY 43000 43000 0 0 0 0 0 0 0 0 0 MARIA LEDGER CHIEF EXECUTIVE OFFICER 0 555972 0 0 0 0 0 12627 0 638 0 569237 0 0 JAMES HODSON CHIEF FINANCIAL OFFICER 0 491545 0 0 0 0 0 13001 0 8009 0 512555 0 0 KEVIN COLLINS CHIEF COMPLIANCE OFFICER 0 416367 0 0 0 0 0 12726 0 8009 0 437102 0 0 BETSY VAN HEESCH CHIEF OPERATIONS OFFICER 0 364987 0 0 0 0 0 12200 0 23398 0 400585 0 0 DR ERIC QUIVERS CHIEF MEDICAL OFFICER 0 304115 0 0 0 0 0 12200 0 8408 0 324723 0 0 BRION BEAUCHENE CHIEF INFORMATION OFFICER 0 237956 0 0 0 0 0 7531 0 14021 0 259508 0 0 DAVID POELLEMANN DIRECTOR ACCOUNTING/FINANCE 0 170894 0 0 0 0 0 7213 0 22678 0 200785 0 0 EILEEN MURPHY DIRECTOR PHARMACY SERVICES 0 152439 0 0 0 0 0 5348 0 14162 0 171949 0 0 JEFF WALSH LEAD DEVELOPER ARCHITECT 0 147582 0 0 0 0 0 6181 0 13985 0 167748 0 0 NICOLE PAGLIARO DIRECTOR PROVIDER SERVICES 0 158226 0 0 0 0 0 6324 0 0 0 164550 0 0 SARAH WAY-MESSER DIRECTOR QUALITY 0 145836 0 0 0 0 0 5852 0 0 0 151688 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 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 AN EXTENSIVE 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. MY CHOICE WISCONSIN INC 10201 WEST INNOVATION DR STE 100 WAUWATOSA WI 532264822 811970070 CARE MGMT WI 501(C)(3) LINE 10 N/A 0 MY CHOICE FOUNDATION HOLDINGS INC 10201 WEST INNOVATION DR STE 100 WAUWATOSA WI 532264822 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 0 0 MY CHOICE WISCONSIN INC P 20438699 COST