2021-11-15T12:09:03-06:00 2020-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2020-01-01 270093404 MY CHOICE WISCONSIN HEALTH PLAN INC MYCH 4142877600 10201 INNOVATION DR SUITE 100 WAUWATOSA WI 53226 JAMES HODSON CHIEF FINANCIAL OFFICER 4142877600 2021-11-15 1 JAMES HODSON 999009999 DAVID LOWENTHAL P00378651 3122071040 2021-11-15 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z X X JAMES HODSON 10201 INNOVATION DR SUITE 100 WAUWATOSA WI 53226 219676771 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 11 0 0 0 0 154656250 211437893 1497811 1145207 0 19656 156154061 212602756 0 0 111165461 145307395 0 0 0 0 0 45727804 50924377 156893265 196231772 -739204 16370984 55339233 92657703 18028250 28885709 37310983 63771994 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. 1 0 118471489 141960868 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 ENROLLMENT AT THE END OF 2020 WAS 1,780 MEMBERS. 34380586 41895159 MY CHOICE WISCONSIN HEALTH PLAN, INC OFFERS THE MEDICAID BADGERCARE PLUS PROGRAM, A HEALTH INSURANCE PROGRAM FOR PARENTS/CARETAKERS OF DEPENDENT CHILDREN, PREGNANT WOMEN, WISCONISN CHILDREN, AND CHILDLESS ADULTS THAT MEET CERTAIN INCOME REQUIREMENTS. THE BADGERCARE PLUS PROGRAM HAD 19,788 MEMBERS AT THE END OF 2020. 18078870 16488118 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 3,232 MEMBERS AT THE END OF 2020. 8866902 11093748 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 569 MEMBERS AT THE END OF 2020. 8866902 11093748 179797847 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 1292 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 1 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 NO 100 WAUWATOSA WI 532664822 THOMAS ORENDORFF DIRECTOR AND CHAIR 1.00 2.00 X X 0 1800 0 MICHAEL MAYO SR DIRECTOR AND VICE CHAIR 1.00 1.00 X X 0 1800 0 JOHN HINTZE DIRECTOR 1.00 2.00 X 0 1600 0 LEE S SEESE DIRECTOR 1.00 1.00 X 0 1400 0 TOM BERGERUD DIRECTOR 1.00 1.00 X 0 800 0 KATHRYN BRIETZMAN DIRECTOR 1.00 1.00 X 0 800 0 KENNETH BYOM DO DIRECTOR AND SECRETARY 1.00 1.00 X X 0 800 0 LYNDA KRELLWITZ DIRECTOR 1.00 1.00 X 0 800 0 MARIA RODRIGUEZ DIRECTOR AND TREASURER 1.00 1.00 X X 0 600 0 ARLYN DOEHLER DIRECTOR 1.00 1.00 X 0 200 0 GLENN JOHNSTON DIRECTOR 1.00 0.00 X 0 0 0 MARIA LEDGER CHIEF EXECUTIVE OFFICER 17.00 33.00 X 0 588379 12622 KEVIN COLLINS CHIEF COMPLIANCE OFFICER 15.00 30.00 X 0 424567 16994 DR ERIC QUIVERS CHIEF MEDICAL OFFICER 45.00 0.00 X 0 340527 22892 JAMES HODSON CHIEF FINANCIAL OFFICER 17.00 33.00 X 0 325252 18849 BETSY VAN HEESCH CHIEF OPERATIONS OFFICER 15.00 30.00 X 0 302875 31716 BRION BEAUCHENE CHIEF INFORMATION OFFICER 30.00 20.00 X 0 283115 22996 ANGELA SEIDL VP QUALITY & REGULATORY/COMPLIANCE 39.00 6.00 X 0 276012 11554 ENZO CIARLETTA SENIOR DIRECTOR, TECHNOLOGY SOLUTIONS 32.00 13.00 X 0 239748 5480 JEFF WOBIG SENIOR DIRECTOR, PROGRAM OPERATIONS 41.00 4.00 X 0 212031 15323 BREANNE TIRADO DIRECTOR OF CLINICAL SERVICES 45.00 0.00 X 0 163683 26799 STACY HACH DIRECTOR OF BUSINESS ANALYTICS 2.00 43.00 X 0 182607 7475 KIMBERLY KUNZ REGIONAL DIRECTOR 45.00 0.00 X 0 176386 7063 DR KEVIN PARK FORMER OFFICER 0.00 0.00 X 0 125537 6234 0 3651319 205997 0 1 1 0 UNIVERSITY OF WISCONSIN HOSPITALS AND CL 600 HIGHLAND AVE MADISON WI 53792 MEDICAL SERVICES 13411017 SSM HEALTH CARE OF WISCONSIN INC 10101 WOODFIELD LANE ST LOUIS MO 63132 MEDICAL SERVICES 7539167 MERITER HOSPITAL INC 202 S PARK ST MADISON WI 53715 MEDICAL SERVICES 7096532 CHILDRENS HOSPITAL OF WISCONSIN DRAWER 531 MILWAUKEE WI 53278 MEDICAL SERVICES 4581972 FROEDTERT MEMORIAL LUTHERAN HOSPITAL 9200 W WISCONSIN AVE MILWAUKEE WI 53226 MEDICAL SERVICES 4569015 253 MEDICARE/MEDICAID REVENUE 624100 201179152 201179152 FAMILY CARE REVENUE 624100 9582283 9582283 INSURANCE RECOVERIES 624100 676458 676458 211437893 1109523 1109523 7109699 7074015 35684 35684 35684 TAX REFUND 900099 19656 19656 19656 212602756 211437893 0 1164863 145307395 145307395 8241 8241 45374 45374 67755 67755 6526029 6526029 37735 37735 16020 16020 490 490 332112 332112 629218 629218 MEDICAID EQUIP/SUPPLIES 21238359 21238359 ALLOCATED ADMIN 18862836 13252093 5610743 STATE INCOME TAX 2429025 2429025 BAD DEBT EXPENSE 731183 731183 196231772 179797847 16433925 0 24347070 37346806 1209087 7790921 1240392 867661 28542684 43418650 3233665 55339233 92657703 17959024 28779083 26226 63626 43000 43000 18028250 28885709 X 37310983 63771994 37310983 63771994 55339233 92657703 X 16370984 563326 9526701 X 0 1 X 1 0 X 125440558 132638298 154735248 154656258 211437893 778908255 125440558 132638298 154735248 154656258 211437893 778908255 0 0 0 778908255 485740 688880 929297 1417787 1109523 4631227 485740 688880 929297 1417787 1109523 4631227 4073130 19656 4092786 125926298 133327178 159737675 156074045 212567072 787632268 0.98890 0.98840 0.00590 0.00580 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CLOSE OUT PYMT FROM CLSD PLAN - 2018 AMOUNT: $ 4,073,130. TAX REFUND - 2020 AMOUNT: $ 19,656. 0 0 0 0 0 0 0 0 1 45374 45374 0 LOBBYING ACTIVITIES B (SCHEDULE C, PART II-B SNP ALLIANCE ($31,406) REPRESENTS SNP MEMBERS AND THE UNIQUE NEEDS OF SNP MEMBERS; AND THE WISCONSIN ASSOCIATION OF HEALTH PLANS ($13,968) REPRESENTS COMMUNITY HEALTH PLANS IN WISCONSIN; THESE AMOUNTS INCLUDE THE LOBBY PORTION OF DUES TO SNP ALLIANCE AND THE WISCONSIN ASSOCIATION OF HEALTH PLANS. 0 NET DEFERRED TAX LIABILITY 43000 43000 1 0 0 0 0 0 0 0 0 MARIA LEDGER CHIEF EXECUTIVE OFFICER 0 416379 0 172000 0 0 0 12062 0 560 0 601001 0 0 KEVIN COLLINS CHIEF COMPLIANCE OFFICER 0 291817 0 132750 0 0 0 9920 0 7074 0 441561 0 0 DR ERIC QUIVERS CHIEF MEDICAL OFFICER 0 300377 0 40150 0 0 0 11522 0 11370 0 363419 0 0 JAMES HODSON CHIEF FINANCIAL OFFICER 0 309002 0 16250 0 0 0 11775 0 7074 0 344101 0 0 BETSY VAN HEESCH CHIEF OPERATIONS OFFICER 0 288125 0 14750 0 0 0 11400 0 20316 0 334591 0 0 BRION BEAUCHENE CHIEF INFORMATION OFFICER 0 190190 0 92925 0 0 0 7466 0 15530 0 306111 0 0 ANGELA SEIDL VP QUALITY & REGULATORY/COMPLIANCE 0 188262 0 87750 0 0 0 11109 0 445 0 287566 0 0 ENZO CIARLETTA SENIOR DIRECTOR, TECHNOLOGY SOLUTION 0 138426 0 0 0 101322 0 5480 0 0 0 245228 0 0 JEFF WOBIG SENIOR DIRECTOR, PROGRAM OPERATIONS 0 145611 0 66420 0 0 0 8521 0 6802 0 227354 0 0 BREANNE TIRADO DIRECTOR OF CLINICAL SERVICES 0 155448 0 8235 0 0 0 6538 0 20261 0 190482 0 0 STACY HACH DIRECTOR OF BUSINESS ANALYTICS 0 125314 0 57293 0 0 0 7384 0 91 0 190082 0 0 KIMBERLY KUNZ REGIONAL DIRECTOR 0 121486 0 54900 0 0 0 7043 0 20 0 183449 0 0 DR KEVIN PARK FORMER OFFICER 0 96220 0 0 0 29317 0 1524 0 4710 0 131771 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) INDEPENDENT COMPENSATION CONSULTANT (2) COMPENSATION SURVEY OR STUDY AND (3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4A THE FOLLOWING INDIVIDUALS RECEIVED A SEVERANCE PAYMENT FROM A RELATED ORGANIZATION DURING 2020: ENZO CIARLETTA - $101,322 FORM 990, PART III, LINE 2 TRILOGY HEALTH INSURANCE, A BADGERCARE PLUS LINE OF BUSINESS, MERGED WITH MY CHOICE WISCONSIN HEALTH PLAN, INC. EFFECTIVE JANUARY 1, 2020. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION AMENDED ITS ARTICLES TO MAKE MY CHOICE WISCONSIN, INC. THE SOLE MEMBER. FURTHERMORE, THE ORGANIZATION AMENDED ITS ARTICLES TO CHANGE ITS NAME FROM CARE WISCONSIN HEALTH PLAN, INC. TO CARE WISCONSIN HEALTH PLAN - TRILOGY HEALTH INSURANCE, INC. THE ORGANIZATION AMENDED ITS ARTICLES A SECOND TIME TO CHANGE ITS NAME TO THE CURRENT NAME, MY CHOICE WISCONSIN HEALTH PLAN, INC., EFFECTIVE JANUARY 1, 2021. 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. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER FROM MERGER 9,526,701. 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 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 MY CHOICE WISCONSIN INC P 18616717 COST