2019-10-25T07:51:07-05:00 2018-12-31 390758449 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2018-01-01 813565570 INCLUSA INC INCL 8776226700 3349 CHURCH ST STE 1 STEVENS POINT WI 54481 JASON TAYLOR CHIEF FINANCIAL OFFICER 8776226700 2019-09-03 1 KIMBERLY HELLER CPA P00766668 7158453111 2019-09-03 50.50.56.238 2019-09-03 14:16:18 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 FEDE6E2ED2B59B1C13DC36E78E84E5663127854C 2018 2019-02-21 02:37:17Z MARK HILLIKER 3349 CHURCH STREET SUITE 1 STEVENS POINT WI 54481 624716557 0 X WWW.INCLUSA.ORG X 2016 WI INCLUSA, INC. PROACTIVELY PARTNERS WITH OTHERS TO BUILD A SHARED VISION OF LONG-TERM CARE THAT OFFERS THE PEOPLE WE SERVE CHOICE, CONNECTIONS, AND DIGNITY; FOSTERING FULL PARTICIPATION IN COMMUNITIES. INCLUSA, INC. PROVIDES MEDICAID MANAGED LONG-TERM CARE SERVICES AND SUPPORT TO 15,500 ELDERS AND PEOPLE WITH PHYSICAL AND INTELLECTUAL/DEVELOPMENTAL DISABILITIES IN WISCONSIN. 11 11 1327 11 0 0 44639 42884 609812068 624400324 231890 273349 0 0 610088597 624716557 0 0 0 0 91078237 82577852 0 0 0 536649659 524804511 627727896 607382363 -17639299 17334194 76637102 95162877 54757983 55949564 21879119 39213313 X INCLUSA, INC. PROACTIVELY PARTNERS WITH OTHERS TO BUILD A SHARED VISION OF LONG-TERM CARE THAT OFFERS THE PEOPLE WE SERVE CHOICE, CONNECTIONS, AND DIGNITY; FOSTERING FULL PARTICIPATION IN COMMUNITIES. INCLUSA, INC. PROVIDES MEDICAID MANAGED LONG-TERM CARE SERVICES AND SUPPORT TO 15,500 ELDERS AND PEOPLE WITH PHYSICAL AND INTELLECTUAL/DEVELOPMENTAL DISABILITIES IN WISCONSIN. 0 0 584040316 624400324 INCLUSA, INC. PROACTIVELY PARTNERS WITH OTHERS TO BUILD A SHARED VISION OF LONG-TERM CARE THAT OFFERS THE PEOPLE WE SERVE CHOICE, CONNECTIONS, AND DIGNITY; FOSTERING FULL PARTICIPATION IN COMMUNITIES. INCLUSA, INC. PROVIDES MEDICAID MANAGED LONG-TERM CARE SERVICES AND SUPPORT TO 15,500 ELDERS AND PEOPLE WITH PHYSICAL AND INTELLECTUAL/DEVELOPMENTAL DISABILITIES IN WISCONSIN. 584040316 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 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 0 0 0 0 1 387 0 1327 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X JASON TAYLOR 7152041810 3349 CHURCH ST STE 1 STEVENS POINT WI 54481 BETH ARIMOND DIRECTOR 1.00 X 2400 0 0 LORI BINA DIRECTOR 1.00 X 2400 0 0 KEN CORNISH DIRECTOR 1.00 X 2400 0 0 WADE DULL DIRECTOR 1.00 X 2400 0 0 TARA JOHNSON DIRECTOR 1.00 X 0 0 0 JOHN KRIESEL DIRECTOR 1.00 X 2400 0 0 GARY RANUM DIRECTOR 1.00 X 2400 0 0 JANIS RIBBENS DIRECTOR 1.00 X 2400 0 0 KEN DAY PRESIDENT 1.00 X X 9600 0 0 JOAN FORDHAM VICE PRESIDENT 1.00 X X 2400 0 0 RON CARNEY SECRETARY/TREASURER 1.00 X X 2400 0 0 MARK HILLIKER CHIEF EXECUTIVE OFFICER 40.00 X 352498 0 41014 TIM GARRITY CHIEF INNOVATION OFFICER 40.00 X 214962 0 40814 GARY PRIEM CHIEF FINANCIAL OFFICER (THRU JULY) 40.00 X 237898 0 28252 MARYELLEN PAUDLER CHIEF MEM SUPP OFFICER (THRU JULY) 40.00 X 244252 0 27316 KRISTOPHER KUBNICK CHIEF COMMUNITY RESOURCES 40.00 X 208150 0 38491 MICHELLE FELLENZ CHIEF TLC OFFICER 40.00 X 206736 0 38414 JOSHUA JANDRAIN CHIEF INFORMATION OFFICER 40.00 X 204237 0 40414 JASON TAYLOR CHIEF FINANCIAL OFFICER (BEG JULY) 40.00 X 166733 0 39537 PATRICK HENNEGER GENERAL COUNSEL 40.00 X 206149 0 38414 JENIFER HARRISON VP OF CARE MGMT PRAC (THRU JULY) 40.00 X 168694 0 24025 JANNA DUFFY VP OF CARE MANAGEMENT SUPPORT 40.00 X 150104 0 6000 DANA CYRA VP OF QUALITY IMPROVEMENT 40.00 X 135681 0 12359 2527294 0 375050 18 0 1 0 WPS 1717 W BROADWAY MADISON WI 53713 ADMINISTRATIVE FEES 3194590 REM WISCONSIN III INC 2005 W BELTLINE HWY STE 203 MADISON WI 53713 DIRECT CARE WORKFORCE REIMBURSEMENT 554822 RUNNING INC 318 WEST DECKER STREET VIROQUA WI 54665 MEMBER TRANSPORTATION 454098 AURORA RESIDENTIAL ALTERNATIVES INC PO BOX 68 MENOMONIE WI 54751 COMMUNITY SERVICES 310720 TEKSYSTEMS PO BOX 198568 ATLANTA GA 30284 IT CONTRACTED SERVICES 301782 41 42734 150 42884 CAPITATION FEE REVENUE 624100 578100375 578100375 ROOM AND BOARD REIMBURSEMENT 623000 46302840 46302840 MEMBERSHIP PASSTHROUGH SUPPLIES 339110 -2891 -2891 624400324 273349 273349 624716557 624400324 0 273349 2129718 1678214 451504 57134918 45006419 12128499 2264112 1788021 476091 16828695 13466180 3362515 4220409 3351761 868648 94137 94137 139801 139801 4113934 320043 3793891 50113 38199 11914 758239 577596 180643 3574960 3465742 109218 2859454 2688978 170476 1978699 1577612 401087 1204171 234813 969358 274076 189787 84289 DIRECT MEMBER CARE EXPE 509621750 509621750 EMPLOYEE TRAINING 96615 35201 61414 BOARD EXPENSES 38527 38527 35 35 607382363 584040316 23342047 0 1315 1055 64065213 70399499 8353098 22039782 811691 701513 9568092 7547064 3405785 2021028 76637102 95162877 54757983 55949564 54757983 55949564 X 21879119 39213313 21879119 39213313 76637102 95162877 17334194 0 X 0 1 X 1 0 X 44639 42884 87523 609812068 624400324 1234212392 609856707 624443208 1234299915 0 0 0 1234299915 231890 273349 505239 231890 273349 505239 610088597 624716557 1234805154 0.99960 0.00040 X 1955628 403338 1552290 7279594 7143726 135868 332870 332870 2021028 624716557 0 624716557 0 624716557 607382363 0 607382363 0 607382363 X X 1 0 0 0 0 0 0 0 0 MARK HILLIKER CHIEF EXECUTIVE OFFICER 337498 0 15000 0 0 0 11000 0 30014 0 393512 0 0 0 TIM GARRITY CHIEF INNOVATION OFFICER 214962 0 0 0 0 0 8800 0 32014 0 255776 0 0 0 GARY PRIEM CHIEF FINANCIAL OFFICER (THRU JULY) 126224 0 0 0 111674 0 6082 0 22170 0 266150 0 0 0 MARYELLEN PAUDLER CHIEF MEM SUPP OFFICER (THRU JULY) 126841 0 0 0 117411 0 6312 0 21004 0 271568 0 0 0 KRISTOPHER KUBNICK CHIEF COMMUNITY RESOURCES 208150 0 0 0 0 0 8477 0 30014 0 246641 0 0 0 MICHELLE FELLENZ CHIEF TLC OFFICER 206736 0 0 0 0 0 8400 0 30014 0 245150 0 0 0 JOSHUA JANDRAIN CHIEF INFORMATION OFFICER 204237 0 0 0 0 0 8400 0 32014 0 244651 0 0 0 JASON TAYLOR CHIEF FINANCIAL OFFICER (BEG JULY) 166733 0 0 0 0 0 6923 0 32614 0 206270 0 0 0 PATRICK HENNEGER GENERAL COUNSEL 206149 0 0 0 0 0 8400 0 30014 0 244563 0 0 0 JENIFER HARRISON VP OF CARE MGMT PRAC (THRU JULY) 89833 0 500 0 78361 0 5005 0 19020 0 192719 0 0 0 JANNA DUFFY VP OF CARE MANAGEMENT SUPPORT 150104 0 0 0 0 0 6000 0 0 0 156104 0 0 0 PART I, LINE 4A THE FOLLOWING INDIVIDUALS RECEIVED A SEVERANCE PAYMENT DURING FY 18: GARY PRIEM - $88,846 MARYELLEN PAUDLER - $88,846 JENIFER HARRISON - $46,769 FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND THE CHIEF EXECUTIVE OFFICER. A COPY OF THE 990 IS PROVIDED TO THE GOVERNING BODY BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS SHALL ADOPT AND ALWAYS MAINTAIN A WRITTEN CONFLICT OF INTEREST POLICY ("THE POLICY") THAT IS CONSISTENT WITH BEST PRACTICES FOR CHARITABLE ORGANIZATIONS. ALL DIRECTORS, OFFICERS, AND COMMITTEE MEMBERS SHALL SIGN, AS A CONDITION TO SERVING THE CORPORATION IN HIS OR HER RESPECTIVE ROLE, A STATEMENT AGREEING TO BE BOUND BY THE TERMS OF THE POLICY. PURSUANT TO THE POLICY, ANY DIRECTOR, OFFICER, OR COMMITTEE MEMBER HAVING A MATERIAL FINANCIAL INTEREST IN A CONTRACT OR OTHER TRANSACTION PRESENTED TO THE BOARD OF DIRECTORS OR A COMMITTEE THEREOF FOR AUTHORIZATION, APPROVAL, OR RATIFICATION SHALL MAKE A PROMPT, FULL AND FRANK DISCLOSURE OF SUCH PERSON'S INTEREST TO THE BOARD OF DIRECTORS OR COMMITTEE PRIOR TO ITS ACTING ON SUCH CONTRACT OR TRANSACTION. IF THE CONFLICT IS CONFIRMED BY THE BOARD OF DIRECTORS, THE OFFICER OR COMMITTEE MEMBER IS NOT ALLOWED TO PARTICIPATE IN THE DISCUSSION OR VOTE ON THE MATTER. EACH DIRECTOR OF THE BOARD MUST ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: (A) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY (B) HAS READ AND UNDERSTANDS THE POLICY (C) HAS AGREED TO COMPLY WITH THE POLICY AND, (D) UNDERSTANDS THE CORPORATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. FORM 990, PART VI, SECTION B, LINE 15 INITIAL OFFICER COMPENSATION WAS ESTABLISHED USING THE SUPPORT OF A CONTRACTED EXPERT IN EXECUTIVE COMPENSATION. THE CONTRACTED EXPERT DEVELOPED SALARY RANGE INFORMATION FOR THE ORGANIZATION'S EXECUTIVES AND PROVIDED COMPENSATION RECOMMENDATIONS TO THE INCLUSA, INC. BOARD OF DIRECTORS. THE BOARD OF DIRECTORS SET THE CHIEF EXECUTIVE OFFICER'S SALARY BASED ON THIS RECOMMENDATION. THE CHIEF EXECUTIVE OFFICER WAS CHARGED WITH SETTING THE COMPENSATION FOR THE REMAINING EXECUTIVES, USING THE RECOMMENDATIONS PROVIDED BY THE CONTRACTED EXPERT. IN SUCCESSIVE YEARS, THE INCLUSA BOARD OF DIRECTORS HAS SET CHIEF EXECUTIVE OFFICER ANNUAL COMPENSATION USING INDUSTRY COMPARISONS AND OTHER MARKET INFORMATION TO AUGMENT THEIR DECISION PROCESS. THE CHIEF EXECUTIVE OFFICER USES SIMILAR INDUSTRY AND MARKET INFORMATION TO MAKE ANY ANNUAL CHANGES TO THE REMAINING EXECUTIVE STAFF MEMBERS. FORM 990, PART VI, SECTION C, LINE 19 INCLUSA MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.