2017-11-15T09:00:16-06:00 2016-12-31 350921680 CROWE HORWATH LLP 135 N Pennsylvania Street Suite 200 Indianapolis IN 46204 990 2016-01-01 351931354 MDWise Inc MDWI 3178227100 1200 MADISON AVENUE 400 INDIANAPOLIS IN 46225 ROBERT KOMULA CHIEF FINANCIAL OFFICER 2017-11-15 true Rachel Spurlock P00520729 3176321100 2016 2017-02-10 21:41:12Z ROBERT KOMULA 1200 MADISON AVENUE 400 INDIANAPOLIS IN 46225 1472816588 false X WWW.MDWISE.ORG X 1994 IN MDWise is a not-for-profit health maintenance organization contracting with healthcare providers to provide services to its members for three state programs: Hoosier Healthwise, Healthy Indiana Plan & Hoosier Care Connect (HCC). 9 9 604 9 0 0 0 0 1034618527 1435604329 537095 1269619 9816921 12166987 1044972543 1449040935 269059 117949 0 0 18878921 20598252 0 0 0 1012059357 1398834450 1031207337 1419550651 13765206 29490284 339854114 310489675 265804035 206949312 74050079 103540363 MDwise is a not-for-profit health maintenance organization contracting with healthcare providers to provide healthcare services to its Indiana members for four state programs: Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect (HCC). MDwise accomplished its core values through a five-fold mission: 1. Delivering consistent, high quality care. 2. Focusing on families and community in a culturally competent way. 3. Shaping health policy and promoting innovation in medicaid managed care. 4. Ensuring financial viability through efficient and cost effective operations. 5. Involving providers in key decision making and nurturing local governance of the MDwise product. false false 1411966325 117949 1447771316 Beginning January 1, 2011, MDwise was granted a four-year contract with the State of Indiana (the "State"), through the Family and Social Service Administration ("FSSA") and Office of Medicaid Policy and Planning ("OMPP"), to arrange for and administer two risk-based managed care programs ("Hoosier Healthwise" and "Healthy Indiana Plan") for certain Indiana Medicaid enrollees. MDwise contracts with various delivery networks including the affiliated MDwise Medicaid Network ("Excel"). Excel and the other delivery networks accept the medical service risk for enrollees who choose a primary care provider after selecting the MDwise network. There were approximately 233,000 and 238,000 members enrolled in the Hoosier Healthwise product at December 31, 2016 and 2015, respectively. There were approximately 151,000 and 99,000 members enrolled in the Healthy Indiana product at December 31, 2016 and 2015, respectively. The increase in members is related to the expansion of the program by the State. On January 1, 2017, the contract with the State of Indiana was renewed and is now scheduled to expire on December 31, 2022. Beginning October 1, 2007, MDwise was granted a four-year contract with the State, through OMPP, to conduct certain care management and prior authorization functions, including care coordination, disease management, utilization management, and disposition of prior authorization requests, for the Indiana Care Select Program ("Care Select"). In September 2013, the contract was amended to carve out prior authorization functions from the program, effective October 30, 2013 and extended the expiration date of all other services to January 31, 2014. MDwise was granted a new four-year contract in January 2014 to participate in Care Select beginning February 1, 2014 and was to expire January 31, 2018. During 2014, the State released a request for proposal to replace the newly granted four-year contract with Risk-Based Managed Care Services in the form of a new program called Hoosier Care Connect ("HCC"). MDwise was selected to begin contract negotiations on the replacement program on November 26, 2014. As a part of this transition the HCC program began April 1, 2015 while the Care Select contract was phased out during 2015. The new HCC agreement will be effective for a 4 year period ending March 30, 2019. At the discretion of the State, there may be two one year renewals. In no event shall the term exceed a total of six years. Subsequent to 2016, the Company's contract with the State was terminated on March 31, 2017. The Company collaborated with the State to transition those members to alternate managed health plans. The Company was responsible for approximately 39,000 and 42,000 members at December 31, 2016 and 2015, respectively. 1411966325 false false false false false false false false false true false false false false true true false false false false false false false false false false true false true false false false false false false false false false false false false false false false false true 487 0 true 604 true false false false false false false X 9 9 true false false false true true true true true false false false true true true true true true true false IN X MARK IVORY 3178227467 1200 MADISON AVENUE SUITE 400 INDIANAPOLIS IN 46225 James T Parker Chairman of the Board 1.0 X X 0 0 0 Daniel Edward Sellers Director 1.0 X 0 0 0 Christopher Scott Weaver MD Director 1.0 X 0 0 0 John Francis Fitzgerald MD Director 1.0 X 0 0 0 Ryan Christopher Kitchell Director 1.0 X 0 0 0 Tavonna Shenise Harris Askew Director 1.0 X 0 0 0 Joan Victoria Castor Director 1.0 X 0 0 0 Jennifer Marie Alvey Director 1.0 X 0 0 0 Mike Edwards Director (partial year) 1.0 X 0 0 0 Dr LIsa Harris Director 1.0 X 0 0 0 Cesar David Martinez President & CEO 40.0 X 554822 0 30564 Patricia Ann Hebenstreit Secretary (Sr VP General Counsel) 40.0 X 378581 0 22842 Michael Victor Cutroni Treasurer (Chief Financial Officer) 40.0 X 248744 0 6141 Jeremy Tyson Sullivan MD Sr VP Chief Medical Officer 40.0 X 317567 0 14886 Terry Cole Treasurer (partial year) 1.0 X 94654 0 0 Gary Phillips Vice President of Information Services 40.0 X 243888 0 28488 Lindsey Lux Vice President of Operations 40.0 X 394428 0 25761 Barbara Wilder VP Quality Improvement 40.0 X 189449 0 15012 Brian Arrowood Sr VP Chief Information OFC 40.0 X 224711 0 17720 Robert Armbruster VP of Buiness Intelligence 40.0 X 175519 0 8326 Christopher Callahan VP of Pharmacy and Med Econ 40.0 X 177636 0 29222 Eric Essley VP Assistant General Counsel, Legal 40.0 X 159968 0 16248 Janet Edwards Director of Care Management 40.0 X 128516 0 8414 Marcia Shively Sr Director of Business Services 40.0 X 134466 0 14023 Wendi Powell Director Clinical Pharmacy 40.0 X 144866 0 14902 Marc Baker VP of Provider Relations 40.0 X 145712 0 9362 Roanne Osborne-Gaskin Sr Medical Director 40.0 X 204107 0 19419 3917634 0 281330 27 false true false Medimpact 10181 Scripps Gateway Court San Diego CA 92131 Pharmacy Services 885957323 DST 13804 Collection Center Drive Chicago IL 60693 Technology Services 70790702 Bucher and Christian Consulting PO Box 71495 Chicago IL 606941495 Consulting 46788551 Ride Right 16 Hawk Ridge Drive Lake St Louis MO 63367 Transportation 26370759 Healthedge PO Box 347589 Pittsburgh PA 152514816 Technology Services 17485123 89 0 0 0 0 0 0 0 0 Captitation Premiums 900000 1004030014 1004030014 Care Select 900000 9 9 Hoosier Care Connect Capitation 900000 431574306 431574306 0 0 0 0 1435604329 1290272 1290272 0 0 23755000 23775653 -20653 0 -20653 -20653 Net, Transportation 900000 12166987 12166987 0 0 0 0 12166987 1449040935 1447771316 0 1269619 117949 117949 0 0 0 0 0 0 3779254 3212366 566888 0 0 0 9751832 8289057 1462775 924697 785992 138705 4201063 3570904 630159 1941406 1650195 291211 0 0 0 0 90560 76976 13584 292135 248315 43820 103359 87855 15504 0 0 142389 121031 21358 3981638 3384392 597246 0 5550788 4718170 832618 1526280 1297338 228942 5239917 4453929 785988 0 0 1584575 1346889 237686 310028 263524 46504 0 0 106335 90385 15950 0 0 0 0 2196689 1867186 329503 360154 306131 54023 Delivery System Payments 1346251511 1346251511 Reinsurance 10452044 10452044 Transportation 12166987 12166987 Claims Processing Administration 6026878 5122846 904032 2452183 2084353 367830 0 1419550651 1411966325 7584326 0 65894553 114028588 0 0 201549287 128459446 0 0 0 0 0 28720 23270 1244394 1762102 14868451 7416138 8972651 7452313 58496770 55347841 0 0 3667739 3416115 339854114 310489675 242175765 206949312 5250000 0 18378270 0 265804035 206949312 X 74050079 103540363 74050079 103540363 339854114 310489675 29490284 0 X false true X true false 1427059 728966 698093 13441392 6687172 6754220 7452313 Due to Affiliate 0 0 X 1433206092 0 0 1433206092 15834843 15834843 1449040935 1403715808 0 0 1403715808 15834843 15834843 1419550651 Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote The Plan is tax exempt under Section 501(c)(4) of the Internal Revenue Code. Accordingly, the financial statements include no provision or liability for federal or state income taxes. A tax position is recognized as a benefit only if it is "more likely than not" that the tax position would be sustained in a tax examination, with a tax examination being presumed to occur. The amount recognized is the largest amount of tax benefit that is greater than 50% likely of being realized on examination. For tax positions not meeting the "more likely than not" test, no tax benefit is recorded. The Company does not expect the total amount of unrecognized tax benefits to significantly change in the next 12 months. The Company recognizes interest and/or penalties related to income tax matters in general administrative expenses. The Company did not have any amounts accrued for interest or penalties at December 31, 2016 and 2015. Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements RECLASS REV SHOWN EXP OFFSET -TRANSPORTAION - 12166987 RECLASS REV SHOWN EXP OFFSET-UTILZ, CASE MGT & TPL - 3667856 Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements RECLASS REV SHOWN EXP OFFSET -TRANSPORTATION - 12166987 RECLASS REV SHOWN EXP OFFSET-UTILZ, CASE MGT & TPL - 3667856 true Health and Hospital Corporation of Marion County 3838 N Rural St Indianapolis IN 46205 356005697 Government 10000 0 General Support Eskenazi Health Foundation 720 Eskenazi Ave Indianapolis IN 46202 356005697 501(c)(3) 6000 0 General Support Indiana State Department of Health 2 North Meridian St Indianapolis IN 46204 356000158 Government 7000 0 General Support Indiana Perinatal Network 1991 East 56th St Indianapolis IN 46220 351771516 501(c)(3) 11500 0 General Support Methodist Health Foundation PO Box 7168 Indianapolis IN 46207 356043086 501(c)(3) 8000 0 General Support 5 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. MDWise has a corporate giving committee that requests certain information from each grantee organization in order to evaluate and measure impact to see how members of MDWise benefit from the grantee organization. MDWise does not have a formal procedure to follow-up with the grantee organizations after funds are awarded but uses informal communications to understand how contributions are used. X X false false false false false false false true false Cesar David Martinez President & CEO 504234 0 50088 0 500 0 19409 0 11155 0 585386 0 0 0 Patricia Ann Hebenstreit Secretary (Sr VP General Counsel) 277887 0 99770 0 924 0 15362 0 7480 0 401423 0 0 0 Michael Victor Cutroni Treasurer (Chief Financial Officer) 247244 0 1000 0 500 0 0 0 6141 0 254885 0 0 0 Jeremy Tyson Sullivan MD Sr VP Chief Medical Officer 306067 0 11000 0 500 0 9414 0 5472 0 332453 0 0 0 Gary Phillips Vice President of Information Services 221372 0 22300 0 216 0 17176 0 11312 0 272376 0 0 0 Lindsey Lux Vice President of Operations 296824 0 96950 0 654 0 23120 0 2641 0 420189 0 0 0 Barbara Wilder VP Quality Improvement 171806 0 16000 0 1643 0 12426 0 2586 0 204461 0 0 0 Brian Arrowood Sr VP Chief Information OFC 223211 0 1000 0 500 0 7661 0 10059 0 242431 0 0 0 Robert Armbruster VP of Buiness Intelligence 174019 0 1000 0 500 0 5805 0 2521 0 183845 0 0 0 Christopher Callahan VP of Pharmacy and Med Econ 164703 0 12433 0 500 0 12323 0 16899 0 206858 0 0 0 Eric Essley VP Assistant General Counsel, Legal 153468 0 6000 0 500 0 10679 0 5569 0 176216 0 0 0 Wendi Powell Director Clinical Pharmacy 142366 0 2500 0 0 0 9943 0 4959 0 159768 0 0 0 Marc Baker VP of Provider Relations 138462 0 6750 0 500 0 9362 0 0 0 155074 0 0 0 Roanne Osborne-Gaskin Sr Medical Director 204107 0 0 0 0 0 6750 0 12669 0 223526 0 0 0 Schedule J, Part I, Line 7 Non-fixed payments Interested persons receive discretionary bonuses based on overall performance of the individuals. Form 990, Part VI, Line 1a Delegate broad authority to a committee The Articles of Incorporation allows for the creation of the Executive Committee composed of one or more members of the Board of Directors which, to the extent provided in the bylaws or such resolution and consistent with applicable law, shall have and exercise all of the authority of the Board of Directors in the management of the Corporation's affairs during intervals between the meetings of the Board of Directors. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons DAN SELLERS - Business relationship, JOHN FITZGERALD - Business relationship Form 990, Part VI, Line 6 Classes of members or stockholders The members of MDWise, Inc. are IU Health and Health and Hospital Corporation of Marion County. Each Member has the right to elect 5 individuals to the governing body. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body The Members each have the right to appoint 5 individuals to the governing body. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The following corporate actions require approval by the members: A. To amend, alter, change or repeal the articles of incorporation B. To amend, alter, change or repeal the bylaws C. To merge or consolidate the corporation with another entity or entities D. To sell, lease, or exchange more than 50% of the property or assets of the corporation ,whether or not such sale, lease, or exchange occurs in the regular course of business E. To appoint and elect the directors of the corporation and the chairman of the corporation's board of directors F. To elect each officer of the corporation, to change the title, duties, salary or other compensation of any such officer, and (with consideration of any recommendation of the board of directors) to remove any such officer G. Upon the consideration of any recommendation of the board of directors, to approve or amend the corporation's annual budget and the making and timing of grants on behalf of the corporation H. To incur any corporate indebtedness in excess of $100,000, or to enter into any business transaction or financial commitment in excess of $100,000 I. To approve any conflict-of-interest business transaction J. To dissolve the corporation Form 990, Part VI, Line 11b Review of form 990 by governing body The CFO reviewed a final draft of the Form 990 prior to filing with the IRS. A final copy of the form 990 was sent to every member of the governing body after it was filed with the IRS. Form 990, Part VI, Line 12c Conflict of interest policy MDwise requires that all board members, officers, and key employees sign a conflict of interest disclosure statement annually. The compliance officer of the organization reviews each completed statement and is present at board meetings to enforce compliance with the conflict of interest policy. If an issue with a potential conflict is brought to the table at a board meeting, the person with the potential conflict abstains from voting on the issues. Form 990, Part VI, Line 15a Process to establish compensation of top management official The executive committee of the board meets in June of each year to conduct a performance review of the CEO and to review compensation. The executive committee uses compensation surveys to determine appropriate compensation for the CEO. The compensation setting process and the determination is documented in the committee minutes. This process was last undertaken in 2016. Form 990, Part VI, Line 15b Process to establish compensation of other employees THE HUMAN RESOURCES DEPARTMENT DETERMINES THE COMPENSATION OF THE OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. THE DEPARTMENT USES COMPENSATION SURVEYS IN ITS REVIEW PROCESS. THE DECISIONS ARE DOCUMENTED IN EACH INDVIVIDUALS' EMPLOYMENT FILES. THIS PROCESS WAS LAST UNDERTAKEN IN 2016. Form 990, Part VI, Line 19 Required documents available to the public These documents are made available upon request.