MY CHOICE WISCONSIN HEALTH PLAN INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- MY CHOICE WISCONSIN HEALTH PLAN INC (EIN 27-0093404)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-15
- IRS object ID
- 202233199349317033
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-15T14:02:49-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 S RIVERSIDE PLAZA 9TH FLOOR | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60606 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 270093404 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MY CHOICE WISCONSIN HEALTH PLAN INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MYCH | BusinessNameControlTxt |
| Phone | 4142877600 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10201 WEST INNOVATION DRIVE 100 | AddressLine1Txt |
| City | WAUWATOSA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53226 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES HODSON | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 4142877600 | PhoneNum |
| Signature | 2022-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JAMES | PersonFirstNm |
| Person Last | HODSON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DAVID LOWENTHAL | PreparerPersonNm |
| PTIN | P00378651 | PTIN |
| Phone | 3122071040 | PhoneNum |
| Preparation | 2022-11-14 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Change | Yes (X) | NameChangeInd |
| Principal Officer | JAMES HODSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10201 WEST INNOVATION DRIVE 100 | AddressLine1Txt |
| City | WAUWATOSA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53226 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $206,107,786 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MYCHOICEWI.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2004 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | PROMOTE THE QUALITY OF LIFE OF OUR COMMUNITIES BY EMPOWERING OTHERS' LONG TERM CARE NEEDS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $211,437,893 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $198,676,131 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,145,207 | PYInvestmentIncomeAmt |
| CY Investment Income | $549,832 | CYInvestmentIncomeAmt |
| PY Other Revenue | $19,656 | PYOtherRevenueAmt |
| CY Other Revenue | $27,617 | CYOtherRevenueAmt |
| PY Total Revenue | $212,602,756 | PYTotalRevenueAmt |
| CY Total Revenue | $199,253,580 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $145,307,395 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $164,985,347 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $50,924,377 | PYOtherExpensesAmt |
| CY Other Expenses | $29,252,859 | CYOtherExpensesAmt |
| PY Total Expenses | $196,231,772 | PYTotalExpensesAmt |
| CY Total Expenses | $194,238,206 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $16,370,984 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,015,374 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $92,657,703 | TotalAssetsBOYAmt |
| Total Assets EOY | $94,864,690 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $28,885,709 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $26,734,830 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $63,771,994 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $68,129,860 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $110,520,643 | ExpenseAmt |
| Revenue | $121,118,640 | RevenueAmt |
| Desc | 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 1,654 MEMBERS AT THE END OF 2021. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $40,469,696 | ExpenseAmt |
| Revenue | $50,211,254 | RevenueAmt |
| Desc | 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 22,993 MEMBERS AT THE END OF 2021. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $18,110,864 | ExpenseAmt |
| Revenue | $17,491,512 | RevenueAmt |
| Desc | 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 3,499 MEMBERS AT THE END OF 2021. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $9,715,116 | ExpenseAmt |
| Revenue | $9,854,725 | RevenueAmt |
| Desc | 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 610 MEMBERS AT THE END OF 2021. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $9,715,116 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $9,854,725 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $178,816,319 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 1337 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMES HODSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4142877600 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10201 WEST INNOVATION DRIVE STE 100 | AddressLine1Txt |
| City | WAUWATOSA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 532664822 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| MARIA LEDGER | ||||||||
| CHIEF EXECUTIVE OFFICER | 19.00 | 31.00 | Yes (X) | $0 | $614,018 | $12,558 | ||
| JAMES HODSON | ||||||||
| CHIEF FINANCIAL OFFICER | 20.00 | 30.00 | Yes (X) | $0 | $508,245 | $19,911 | ||
| BETSY VAN HEESCH | ||||||||
| CHIEF OPERATIONS OFFICER | 20.00 | 25.00 | Yes (X) | $0 | $447,176 | $29,485 | ||
| KEVIN COLLINS | ||||||||
| CHIEF COMPLIANCE OFFICER | 20.00 | 30.00 | Yes (X) | $0 | $392,057 | $17,863 | ||
| DR ERIC QUIVERS | ||||||||
| CHIEF MEDICAL OFFICER | 45.00 | 0.00 | Yes (X) | $0 | $314,487 | $22,225 | ||
| BRION BEAUCHENE | ||||||||
| CHIEF INFORMATION OFFICER | 30.00 | 20.00 | Yes (X) | $0 | $217,817 | $22,151 | ||
| DAVID POELLMANN | ||||||||
| DIRECTOR ACCOUNTING/FINANCE | 10.00 | 40.00 | $0 | $193,880 | $30,709 | Yes (X) | ||
| NICOLE PAGLIARO | ||||||||
| DIRECTOR PROVIDER SERVICES | 20.00 | 25.00 | $0 | $204,989 | $8,195 | Yes (X) | ||
| SARAH WAY-MESSER | ||||||||
| DIRECTOR QUALITY | 39.00 | 6.00 | $0 | $192,167 | $6,959 | Yes (X) | ||
| ANGELA SEIDL | ||||||||
| VP QUALITY & REGULATORY/COMPLIANCE OFFICER | 39.00 | 6.00 | Yes (X) | $0 | $184,209 | $7,386 | ||
| MELISSA EILBES | ||||||||
| DIRECTOR NURSING | 15.00 | 30.00 | $0 | $183,475 | $5,946 | Yes (X) | ||
| JEFF WOBIG | ||||||||
| DIRECTOR CLINICAL & OPS RESOURCES | 41.00 | 4.00 | $0 | $153,051 | $13,818 | Yes (X) | ||
| THOMAS ORENDORFF | ||||||||
| DIRECTOR AND CHAIR | 1.00 | 3.00 | Yes (X) | $0 | $2,200 | $0 | Yes (X) | |
| MICHAEL MAYO SR | ||||||||
| DIRECTOR AND VICE CHAIR | 1.00 | 2.00 | Yes (X) | $0 | $2,000 | $0 | Yes (X) | |
| JOHN HINTZE | ||||||||
| DIRECTOR | 1.00 | 2.00 | $0 | $2,000 | $0 | Yes (X) | ||
| LEE S SEESE | ||||||||
| DIRECTOR | 1.00 | 2.00 | $0 | $1,600 | $0 | Yes (X) | ||
| MARIA RODRIGUEZ | ||||||||
| DIRECTOR AND TREASURER | 1.00 | 1.00 | Yes (X) | $0 | $1,200 | $0 | Yes (X) | |
| THOMAS BERGERUD | ||||||||
| DIRECTOR | 1.00 | 1.00 | $0 | $1,200 | $0 | Yes (X) | ||
| KATHRYN BRIETZMAN | ||||||||
| DIRECTOR | 1.00 | 1.00 | $0 | $1,000 | $0 | Yes (X) | ||
| KENNETH BYOM DO | ||||||||
| DIRECTOR AND SECRETARY | 1.00 | 2.00 | Yes (X) | $0 | $800 | $0 | Yes (X) | |
| LYNDA KRELLWITZ | ||||||||
| DIRECTOR | 1.00 | 1.00 | $0 | $800 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,618,371 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $197,206 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| UNIVERSITY OF WISCONSIN HOSPITALS AND CL | |||||
| 600 HIGHLAND AVE | MADISON | WI | 53792 | MEDICAL SERVICES | $13,902,765 |
| MERITER HOSPITAL INC | |||||
| 202 S PARK ST | MADISON | WI | 53715 | MEDICAL SERVICES | $7,354,435 |
| SSM HEALTH CARE OF WISCONSIN INC | |||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | MEDICAL SERVICES | $6,644,814 |
| FROEDTERT MEMORIAL LUTHERAN HOSPITAL | |||||
| 9200 W WISCONSIN AVE | MILWAUKEE | WI | 53226 | MEDICAL SERVICES | $4,803,521 |
| CHILDRENS HOSPITAL OF WISCONSIN | |||||
| 8915 W CONNELL CT | MILWAUKEE | WI | 53226 | MEDICAL SERVICES | $4,540,993 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 268 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICARE/MEDICAID REVENUE | 624100 | $183,100,868 | $183,100,868 |
| MEMBER REVENUE | 624100 | $8,955,238 | $8,955,238 |
| PREMIUM REVENUE | 624100 | $3,354,136 | $3,354,136 |
| MEDICARE/MEDICAID ADJUSTMENTS | 624100 | $3,265,889 | $3,265,889 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $198,676,131 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $763,852 | TotalRevenueColumnAmt |
| Exclusion | $763,852 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $6,640,186 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $6,854,206 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$214,020 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$214,020 | TotalRevenueColumnAmt |
| Exclusion | -$214,020 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | TAX REFUND | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $27,617 | TotalRevenueColumnAmt |
| Exclusion | $27,617 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $27,617 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $199,253,580 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $198,676,131 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $577,449 | ExclusionAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $164,985,347 | TotalAmt |
| Program Services | $164,985,347 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $146,005 | TotalAmt |
| Management And General | $146,005 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,952 | TotalAmt |
| Management And General | $38,952 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,429 | TotalAmt |
| Management And General | $66,429 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,139,000 | TotalAmt |
| Program Services | $310,545 | ProgramServicesAmt |
| Management And General | $7,828,455 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,986 | TotalAmt |
| Program Services | $15,076 | ProgramServicesAmt |
| Management And General | $78,910 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $296,550 | TotalAmt |
| Management And General | $296,550 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $189,355 | TotalAmt |
| Program Services | $189,355 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,342 | TotalAmt |
| Program Services | $80,651 | ProgramServicesAmt |
| Management And General | $1,691 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,875 | TotalAmt |
| Program Services | $11,642 | ProgramServicesAmt |
| Management And General | $1,233 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $332,112 | TotalAmt |
| Management And General | $332,112 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,435 | TotalAmt |
| Management And General | $8,435 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| ALLOCATED ADMINISTRATIO | $18,502,131 | $12,703,853 | $5,798,278 |
| INCOME TAXES | $617,937 | $617,937 | |
| BAD DEBT EXPENSE | $498,101 | $498,101 | |
| LICENSE & REGISTRATION | $163,271 | $21,749 | $141,522 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,378 | TotalAmt |
| Management And General | $65,378 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $194,238,206 | TotalAmt |
| Program Services | $178,816,319 | ProgramServicesAmt |
| Management And General | $15,421,887 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $168,959 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,346,806 | BOYAmt |
| EOY | $51,887,164 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,790,921 | BOYAmt |
| EOY | $9,021,405 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $867,661 | BOYAmt |
| EOY | $962,361 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,418,650 | BOYAmt |
| EOY | $29,923,248 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,233,665 | BOYAmt |
| EOY | $2,901,553 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,657,703 | BOYAmt |
| EOY | $94,864,690 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,779,083 | BOYAmt |
| EOY | $26,691,830 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,626 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,000 | BOYAmt |
| EOY | $43,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,885,709 | BOYAmt |
| EOY | $26,734,830 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,771,994 | BOYAmt |
| EOY | $68,129,860 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,771,994 | BOYAmt |
| EOY | $68,129,860 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,657,703 | BOYAmt |
| EOY | $94,864,690 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $5,015,374 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$657,508 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $132,638,298 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $154,735,248 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $154,656,258 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $211,437,893 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $198,676,131 | CurrentTaxYearAmt |
| Total | $852,143,828 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $132,638,298 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $154,735,248 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $154,656,258 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $211,437,893 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $198,676,131 | CurrentTaxYearAmt |
| Total | $852,143,828 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $852,143,828 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $688,880 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $929,297 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,417,787 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,109,523 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $763,852 | CurrentTaxYearAmt |
| Total | $4,909,339 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $688,880 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $929,297 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,417,787 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,109,523 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $763,852 | CurrentTaxYearAmt |
| Total | $4,909,339 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $4,073,130 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus1 Year | $19,656 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $27,617 | CurrentTaxYearAmt |
| Total | $4,120,403 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $133,327,178 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $159,737,675 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $156,074,045 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $212,567,072 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $199,467,600 | CurrentTaxYearAmt |
| Total | $861,173,570 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.98950 | PublicSupportCY509Pct |
| Public Support PY509 | 0.98890 | PublicSupportPY509Pct |
| Investment Income CY | 0.00570 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00590 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | CLOSE OUT PYMT FROM CLSD PLAN - 2018 AMOUNT: $ 4,073,130. TAX REFUND - 2020 AMOUNT: $ 19,656. 2021 AMOUNT: $ 27,617. | ExplanationTxt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $38,952 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $38,952 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | LOBBYING ACTIVITIES B (SCHEDULE C, PART II-B | FormAndLineReferenceDesc |
| Explanation | SNP ALLIANCE ($24,432) REPRESENTS SNP MEMBERS AND THE UNIQUE NEEDS OF SNP MEMBERS; AND THE WISCONSIN ASSOCIATION OF HEALTH PLANS ($14,520) REPRESENTS COMMUNITY HEALTH PLANS IN WISCONSIN; THESE AMOUNTS INCLUDE THE LOBBY PORTION OF DUES TO SNP ALLIANCE AND THE WISCONSIN ASSOCIATION OF HEALTH PLANS. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET DEFERRED TAX LIABILITY | Desc |
| Amt | $43,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $43,000 | TotalLiabilityAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARIA LEDGER | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $0 | $614,018 | $0 | $0 | $0 | $0 | $0 | $11,980 | $0 | $578 | $0 | $626,576 | $0 | $0 |
| JAMES HODSON | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $0 | $508,245 | $0 | $0 | $0 | $0 | $0 | $11,888 | $0 | $8,023 | $0 | $528,156 | $0 | $0 |
| BETSY VAN HEESCH | ||||||||||||||
| CHIEF OPERATIONS OFFICER | $0 | $447,176 | $0 | $0 | $0 | $0 | $0 | $5,628 | $0 | $23,857 | $0 | $476,661 | $0 | $0 |
| KEVIN COLLINS | ||||||||||||||
| CHIEF COMPLIANCE OFFICER | $0 | $392,057 | $0 | $0 | $0 | $0 | $0 | $9,840 | $0 | $8,023 | $0 | $409,920 | $0 | $0 |
| DR ERIC QUIVERS | ||||||||||||||
| CHIEF MEDICAL OFFICER | $0 | $314,487 | $0 | $0 | $0 | $0 | $0 | $11,600 | $0 | $10,625 | $0 | $336,712 | $0 | $0 |
| BRION BEAUCHENE | ||||||||||||||
| CHIEF INFORMATION OFFICER | $0 | $217,817 | $0 | $0 | $0 | $0 | $0 | $7,028 | $0 | $15,123 | $0 | $239,968 | $0 | $0 |
| DAVID POELLMANN | ||||||||||||||
| DIRECTOR ACCOUNTING/FINANCE | $0 | $193,880 | $0 | $0 | $0 | $0 | $0 | $6,852 | $0 | $23,857 | $0 | $224,589 | $0 | $0 |
| NICOLE PAGLIARO | ||||||||||||||
| DIRECTOR PROVIDER SERVICES | $0 | $204,989 | $0 | $0 | $0 | $0 | $0 | $8,195 | $0 | $0 | $0 | $213,184 | $0 | $0 |
| SARAH WAY-MESSER | ||||||||||||||
| DIRECTOR QUALITY | $0 | $192,167 | $0 | $0 | $0 | $0 | $0 | $6,959 | $0 | $0 | $0 | $199,126 | $0 | $0 |
| ANGELA SEIDL | ||||||||||||||
| VP QUALITY & REGULATORY/COMPLIANCE O | $0 | $184,209 | $0 | $0 | $0 | $0 | $0 | $7,002 | $0 | $384 | $0 | $191,595 | $0 | $0 |
| MELISSA EILBES | ||||||||||||||
| DIRECTOR NURSING | $0 | $183,475 | $0 | $0 | $0 | $0 | $0 | $5,946 | $0 | $0 | $0 | $189,421 | $0 | $0 |
| JEFF WOBIG | ||||||||||||||
| DIRECTOR CLINICAL & OPS RESOURCES | $0 | $153,051 | $0 | $0 | $0 | $0 | $0 | $5,770 | $0 | $8,048 | $0 | $166,869 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | 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 | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 | N/A | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MY CHOICE WISCONSIN INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | P | TransactionTypeTxt |
| Involved | $18,502,131 | InvolvedAmt |
| Method Of Amount Determination | COST | MethodOfAmountDeterminationTxt |
Comments