2020-11-16T16:31:55-06:00 2019-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2019-01-01 270093404 CARE WISCONSIN HEALTH PLAN INC CARE 6082400020 1617 SHERMAN AVENUE MADISON WI 53704 JAMES HODSON CHIEF FINANCIAL OFFICER 6082400020 2020-11-15 1 DAVID LOWENTHAL P00378651 3122071040 2020-11-15 99.137.156.52 2020-11-15 23:44:14 CS P C4C82B026CB168FDB3C9EDE2154EF414E0A5E327 23D9C3BAD3C11415BCA5E3AEE50D281DF37E870F 2019 2021-01-29 14:40:06Z MARIA LEDGER 10201 W INNOVATION DR NO 100 WAUWATOSA WI 532264822 163804847 0 X WWW.CAREWISCONSINHEALTHPLAN.ORG X 2004 WI PROMOTE THE QUALITY OF LIFE OF OUR COMMUNITIES BY EMPOWERING OTHERS' LONG TERM CARE NEEDS. 5 4 0 5 0 0 0 0 154735248 154656250 1245619 1497811 4073130 0 160053997 156154061 0 0 110845059 111165461 0 0 0 0 0 45734432 45727804 156579491 156893265 3474506 -739204 59849900 55339233 24948409 18028250 34901491 37310983 X CARE 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 122053843 130162014 CARE WISCONSIN HEALTH PLAN, INC. (CWHP) OFFERS THE PARTNERSHIP PROGRAM, WHICH PROVIDES HEALTH AND LONG-TERM MANAGEMENT AND CARE SERVICES TO THE ELDERLY AND ADULTS WITH DISABILITIES. CWHP'S PARTNERSHIP PROGRAM ENROLLMENT AT THE END OF 2019 WAS 1,919 MEMBERS. 17455542 15251115 CARE WISCONSIN HEALTH PLAN, INC. (CWHP) OFFERS THE MEDICAID SSI PROGRAM, A HEALTH INSURANCE PROGRAM FOR INDIVIDUALS WITH A DISABILITY WHO QUALIFY FOR A FEDERAL SSI. THE SSI PROGRAM HAD 2,951 MEMBERS AT THE END OF 2019. 8113182 9243121 CARE WISCONSIN HEALTH PLAN, INC. (CWHP) 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 533 MEMBERS AT THE END OF 2019. 147622567 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 1 456 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 4 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 NO 100 WAUWATOSA WI 532664822 APRIL GOLENOR PRESIDENT, CEO (THRU 4/19) 10.00 30.00 X X 0 495347 16444 KEVIN PARK INTERIM PRESIDENT, CEO (THRU 3/20) 10.00 30.00 X X 0 397177 43207 ERIC QUIVERS SR MEDICAL DIRECTOR 30.00 10.00 X 0 309228 26936 KEN EIMERS CHIEF OPERATING OFFICER (THRU 7/19) 10.00 30.00 X 0 238599 37726 AMY ACKERMAN INTERIM CEO (THRU 1/20) 10.00 30.00 X X 0 210091 35130 SUSAN CROWLEY SR VP, GOVT SERVICES (THRU 03/19) 10.00 30.00 X 0 191982 8436 ANGELA SEIDL COMPLIANCE OFFICER 30.00 10.00 X 0 175517 20685 JANETTE TOWNSEND CHIEF FINANCIAL OFFICER (THRU 4/19) 10.00 30.00 X 0 167765 20238 KAREN HITCHCOCK CHIEF OPERATING OFFICER (THRU 1/20) 10.00 30.00 X 0 167801 16696 JAY HEIN PROVIDER PROGRAMM. DIR. (THRU 11/19) 10.00 30.00 X 0 148331 24940 GARY PRIEM CHIEF FINANCIAL OFFICER (THRU 3/20) 10.00 30.00 X 0 139423 26157 GINA GROSKOPF SR. DIRECTOR PROG. SUPP. (THRU 2/20) 10.00 30.00 X 0 146715 16504 CHRISTINE BRIESKE DIRECTOR CLINICAL OPS (THRU 2/20) 30.00 10.00 X 0 143631 18468 SARAH WAY MESSER DIRECTOR, QUALITY 10.00 30.00 X 0 129008 22975 JEFF WOBIG SR. DIRECTOR, PROGRAM OPERATIONS 30.00 10.00 X 0 138808 10631 TOM BERGERUD DIRECTOR 1.00 1.00 X 0 0 0 JOHN HINTZE DIRECTOR 1.00 1.00 X 0 0 0 GLENN JOHNSTON DIRECTOR 1.00 1.00 X 0 0 0 ROLF HANSON DIRECTOR 1.00 1.00 X 0 0 0 ROBERT MUCCI DIRECTOR 1.00 0.00 X 0 0 0 0 3199423 345173 0 0 1 0 UNIVERSITY OF WISCONSIN HOSPITALS AND CL 600 HIGHLAND AVE MADISON WI 53792 MEDICAL 13985659 SSM HEALTH CARE OF WISCOSIN INC 700 S PARK ST MADISON WI 53715 MEDICAL 8750519 MERITER HOSPITAL INC 202 S PARK ST MADISON WI 53715 MEDICAL 7608572 FISCAL ASSISTANCE EMPLOYER AGENT 4646 S BILTMORE LN MADISON WI 53718 FISCAL AGENT 4196213 UNIVERSITY OF WISCONSIN MEDICAL FOUNDATI PO BOX 44287 MADISON WI 53744 MEDICAL 3538840 205 MEDICARE/MEDICAID REVENUE 624100 144973214 144973214 FAMILY CARE REVENUE 624100 9518343 9518343 INSURANCE RECOVERIES 624100 164693 164693 154656250 1417787 1417787 7730810 7650786 80024 80024 80024 156154061 154656250 0 1497811 111165461 111165461 357241 357241 75897 75897 60732 60732 1313134 1313134 607456 607456 MEDICAID EQUIP/SUPPLIES 22797208 22797208 ALLOCATED ADMIN 20046241 13659898 6386343 BAD DEBT EXPENSE 270545 270545 199350 199350 156893265 147622567 9270698 0 30699525 24347070 2593222 1209087 845734 1240392 25586419 28542684 125000 0 59849900 55339233 20906945 17959024 26733 26226 4014731 43000 24948409 18028250 X 34901491 37310983 34901491 37310983 59849900 55339233 X -739204 1220035 1928660 X 0 1 X 1 0 X 119137950 125440558 132638298 154735248 154656258 686608312 119137950 125440558 132638298 154735248 154656258 686608312 0 0 0 686608312 481109 485740 688880 929297 1417787 4002813 481109 485740 688880 929297 1417787 4002813 4073130 4073130 119619059 125926298 133327178 159737675 156074045 694684255 0.98840 0.98890 0.00580 0.00470 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CLOSE OUT PYMT FROM CLSD PLAN - 2018 AMOUNT: $ 4,073,130. 2019 AMOUNT: $ 0. 0 0 0 0 0 0 0 0 1 32473 32473 0 LOBBYING ACTIVITIES B (SCHEDULE C, PART II-B SNP ALLIANCE ($24,810) REPRESENTS SNP MEMBERS AND THE UNIQUE NEEDS OF SNP MEMBERS; AND THE WISCONSIN ASSOCIATION OF HEALTH PLANS ($7,663) 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 156541215 1220035 1220035 155321180 60732 772149 832881 156154061 152131724 -3928660 -3928660 156060384 60732 772149 832881 156893265 PART XI, LINE 4B - OTHER ADJUSTMENTS: REINSURANCE RECOVERIES NETTED AGAINST EXPENSE 164,693. REINSURANCE PREMIUMS NETTED AGAINST REVENUES 607,456. PART XII, LINE 2D - OTHER ADJUSTMENTS: PREMIUM DEFICIENCY RESERVE -3,928,660. PART XII, LINE 4B - OTHER ADJUSTMENTS: REINSURANCE RECOVERIES NETTED AGAINST EXPENSE 164,693. REINSURANCE PREMIUMS NETTED AGAINST REVENUES 607,456. 1 0 0 0 0 0 0 0 0 APRIL GOLENOR PRESIDENT, CEO (THRU 4/19) 0 157847 0 0 0 337500 0 4729 0 11715 0 511791 0 0 KEVIN PARK INTERIM PRESIDENT, CEO (THRU 3/20) 0 397177 0 0 0 0 0 25637 0 17570 0 440384 0 0 ERIC QUIVERS SR MEDICAL DIRECTOR 0 309228 0 0 0 0 0 9275 0 17661 0 336164 0 0 KEN EIMERS CHIEF OPERATING OFFICER (THRU 7/19) 0 192537 0 0 0 46062 0 25000 0 12726 0 276325 0 0 AMY ACKERMAN INTERIM CEO (THRU 1/20) 0 210091 0 0 0 0 0 24945 0 10185 0 245221 0 0 SUSAN CROWLEY SR VP, GOVT SERVICES (THRU 03/19) 0 52402 0 0 0 139580 0 3135 0 5301 0 200418 0 0 ANGELA SEIDL COMPLIANCE OFFICER 0 175517 0 0 0 0 0 19000 0 1685 0 196202 0 0 JANETTE TOWNSEND CHIEF FINANCIAL OFFICER (THRU 4/19) 0 96383 0 0 0 71382 0 10887 0 9351 0 188003 0 0 KAREN HITCHCOCK CHIEF OPERATING OFFICER (THRU 1/20) 0 167801 0 0 0 0 0 6692 0 10004 0 184497 0 0 JAY HEIN PROVIDER PROGRAMM. DIR. (THRU 11/19) 0 132284 0 0 0 16047 0 23743 0 1197 0 173271 0 0 GARY PRIEM CHIEF FINANCIAL OFFICER (THRU 3/20) 0 139423 0 0 0 0 0 25000 0 1157 0 165580 0 0 GINA GROSKOPF SR. DIRECTOR PROG. SUPP. (THRU 2/20) 0 146715 0 0 0 0 0 14628 0 1876 0 163219 0 0 CHRISTINE BRIESKE DIRECTOR CLINICAL OPS (THRU 2/20) 0 143631 0 0 0 0 0 8592 0 9876 0 162099 0 0 SARAH WAY MESSER DIRECTOR, QUALITY 0 129008 0 0 0 0 0 21867 0 1108 0 151983 0 0 PART I, LINE 3 THE CEO/EXECUTIVE DIRECTOR IS PAID BY A RELATED ORGANIZATION, CARE WISCONSIN FIRST, 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 2019: JAY HEIN - $16,047 APRIL GOLENOR - $337,500 FORM 990, PART VI, SECTION A, LINE 6 CARE WISCONSIN FIRST, 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, CARE WISCONSIN FIRST, 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 CARE WISCONSIN FIRST, 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 CARE WISCONSIN FIRST, INC. WHICH IS THEN REIMBURSED BY CARE WISCONSIN HEALTH PLAN, INC. THE FOLLOWING DESCRIBES HOW CARE WISCONSIN FIRST, 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. FORM 990, PART XI, LINE 9: PREMIUM DEFICIENCY RESERVE 3,928,660. TRANSFER OF CAPITAL TO CARE WISCONSIN FIRST, INC. -2,000,000. CARE WISCONSIN FIRST INC 1617 SHERMAN AVENUE MADISON WI 53708 391245329 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 1 0