CHORUS COMMUNITY HEALTH PLANS INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CHORUS COMMUNITY HEALTH PLANS INC (EIN 27-1494977)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-15
- IRS object ID
- 201313199349302126
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2013-11-15T09:04:33-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363168081 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIKICH LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13400 BISHOPS LANE SUITE 300 | AddressLine1 |
| City | BROOKFIELD | City |
| State | WI | State |
| ZIP Code | 53005 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 271494977 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILDREN'S COMMUNITY HEALTH PLAN INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CHIL | NameControl |
| Phone | 4142665420 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9000 W WISCONSIN AVE PO BOX 1997 | AddressLine1 |
| City | MILWAUKEE | City |
| State | WI | State |
| ZIP Code | 53201 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | WELDON GAGE | Name |
| Title | TREASURER | Title |
| Phone | 4142665420 | Phone |
| Date Signed | 2013-11-03 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BRYAN L PAUTSCH CPA | Name |
| PTIN | P00034913 | PTIN |
| Phone | 2627549400 | Phone |
| Date Prepared | 2013-11-01 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | ROBERT DUNCAN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9000 W WISCONSIN AVE PO BOX 1997 | AddressLine1 |
| City | MILWAUKEE | City |
| State | WI | State |
| ZIP Code | 53201 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 79118432 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CHILDRENSCHP.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2009 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE ACCESS TO QUALITY HEALTH CARE AND SERVICE TO MEDICAID BENEFICIARIES IN WI. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 5 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 1 | NbrIndependentVotingMembers |
| Total Nbr Employees | 39 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 68232162 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 74613944 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 200029 | InvestmentIncomePriorYear |
| Investment Income Current Year | 38857 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1800 | OtherRevenuePriorYear |
| Other Revenue Current Year | 540 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 68433991 | TotalRevenuePriorYear |
| Total Revenue Current Year | 74653341 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 33500 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 19185 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 65092873 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 71469771 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 1714054 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 1911303 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8825480 | OtherExpensePriorYear |
| Other Expenses Current Year | 5157150 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 75665907 | TotalExpensesPriorYear |
| Total Expenses Current Year | 78557409 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -7231916 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -3904068 | RevenuesLessExpensesCY |
| Total Assets BOY | 17705541 | TotalAssetsBOY |
| Total Assets EOY | 28264031 | TotalAssetsEOY |
| Total Liabilities BOY | 11132990 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 17813928 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 6572551 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 10450103 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | CHILDREN'S COMMUNITY HEALTH PLAN, INC. ("CCHP"), A SUBSIDIARY OF CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. ("CHHS"), IS A HEALTH MAINTENANCE ORGANIZATION DEDICATED TO PROVIDING ACCESS TO THE HIGHEST QUALITY HEALTH CARE AND SERVICE TO MEDICAID BENEFICIARIES. WITH THE COMBINED RESOURCES OF CHILDREN'S HOSPITAL OF WISCONSIN, INC., CHILDREN'S SERVICE SOCIETY OF WISCONSIN, CHILDREN'S MEDICAL GROUP, INC., AND OUR COMMUNITY PARTNERS, WE ARE COMMITTED TO IMPROVING THE MEDICAL AND SOCIAL WELL-BEING OF OUR MEMBERS AND THE ENTIRE COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 76211326 | Expense |
| Grants | 19185 | Grants |
| Revenue | 74613944 | Revenue |
| Description | CCHP'S PURPOSE IS TO PROMOTE ACCESS TO HEALTHCARE SERVICES FOR LOW-INCOME CHILDREN AND CERTAIN OTHER DISADVANTAGED RESIDENTS OF THE STATE OF WISCONSIN, AND TO PROMOTE OR SPONSOR OTHER PROGRAMS FURTHERING THE HEALTH OF SUCH POPULATIONS AND THE LARGER COMMUNITIES SERVED.CCHP IS AN HMO FOR WISCONSIN BADGERCARE PLUS STANDARD, BENCHMARK, AND CORE ELIGIBLE FAMILIES LIVING IN KENOSHA, MILWAUKEE, OZAUKEE, RACINE, WALWORTH, WASHINGTON, AND WAUKESHA COUNTIES IN WISCONSIN. IN 2012, CCHP ADDED BROWN, CALUMET, OUTAGAMIE, SHEBOYGAN, WAUPACA, AND WINNEBAGO COUNTIES TO ITS SERVICE AREA. THE ENROLLMENT AT THE END OF DECEMBER 2012 WAS 69,868 MEMBERS. THE PLAN ALLOWS EACH FAMILY MEMBER TO CHOOSE FROM A LARGE NETWORK OF PROVIDERS, WHICH INCLUDED MORE THAN 6,231 HEALTH CARE PROVIDERS AND 42 HOSPITALS IN 2012, HOME CARE AND MEDICAL EQUIPMENT PROVIDERS, AND THE CCHP NURSELINE. | Description |
| Total Program Service Expense | 76211326 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 1327 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 39 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 5 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 1 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MS SARAH KAFKA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4142661854 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9000 W WISCONSIN AVENUE | AddressLine1 |
| City | MILWAUKEE | City |
| State | WI | State |
| ZIP Code | 53201 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (9 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| MARK J BACKE | ||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| LARRY A RAMBO | ||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| ROBERT DUNCAN | ||||||||
| DIRECTOR/PRESIDENT | 0.00 | 40.00 | X | 0 | 400496 | 64825 | X | |
| WELDON GAGE | ||||||||
| TREASURER | 0.00 | 40.00 | X | 0 | 362086 | 70172 | X | |
| MARGARET TROY | ||||||||
| DIRECTOR/CHAIR/CHHS PRESIDENT | 0.00 | 40.00 | X | 0 | 1263624 | 291068 | X | |
| SHEILA REYNOLDS | ||||||||
| SECRETARY | 0.00 | 40.00 | 0 | 389028 | 76385 | X | ||
| MARC CADIEUX | ||||||||
| INTERIM TREASURER (JAN 2012) | 0.00 | 40.00 | 0 | 238911 | 22520 | X | ||
| MARK RAKOWSKI | ||||||||
| VICE PRESIDENT, CCHP | 40.00 | 0.00 | 0 | 224542 | 41684 | X | ||
| TIMOTHY BIRKENSTOCK | ||||||||
| FORMER TREASURER | 0.00 | 0.00 | 0 | 232256 | 1866 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3110943 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 568520 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| DEAN HEALTH PLAN INC | |||||
| 1277 DEMING WAY | MADISON | WI | 53717 | CLAIMS ADMINSTRATION /PROCESSOR | 4154894 |
| SOUTHEAST DENTAL ASSOCIATES | |||||
| 3520 W OKLAHOMA AVE | MILWAUKEE | WI | 53215 | CAPITATED DENTAL SERVICES | 3513309 |
| AMERICAN UNITED TAXICAB CO INC | |||||
| 646 S 2ND STREET | MILWAUKEE | WI | 53204 | TRANSPORTATION SERVICES | 1027978 |
| HERSLOF OPTICAL COMPANY INC | |||||
| 12000 W CARMEN AVE | MILWAUKEE | WI | 53225 | CAPITATED VISION SERVICES | 378688 |
| MEDICAL COLLEGE OF WISCONSIN INC | |||||
| 8701 WATERTOWN PLANK RD | MILWAUKEE | WI | 53226 | MEDICAL LEADERSHIP | 197292 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PREMIUM REVENUE | 524114 | 74547352 | 74547352 |
| PRENATAL CARE COORDINATION REV | 624100 | 66592 | 66592 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 74613944 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 97999 | TotalRevenueColumn |
| Exclusion | $97,999 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4405949 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4465091 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -59142 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -59142 | TotalRevenueColumn |
| Exclusion | -$59,142 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 540 | TotalRevenueColumn |
| Exclusion | $540 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 540 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 74653341 | TotalRevenueColumn |
| Related Or Exempt Function Income | 74613944 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $39,397 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19185 | Total |
| Program Services | 19185 | ProgramServices |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71469771 | Total |
| Program Services | 71469771 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1478668 | Total |
| Program Services | 1478668 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 91408 | Total |
| Program Services | 91408 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 233201 | Total |
| Program Services | 233201 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 108026 | Total |
| Program Services | 108026 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1451254 | Total |
| Management And General | 1451254 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26313 | Total |
| Management And General | 26313 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24497 | Total |
| Management And General | 24497 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5033001 | Total |
| Program Services | 4930023 | ProgramServices |
| Management And General | 102978 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39053 | Total |
| Management And General | 39053 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 128398 | Total |
| Management And General | 128398 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 149510 | Total |
| Program Services | 149510 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29876 | Total |
| Management And General | 29876 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4577 | Total |
| Management And General | 4577 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28950 | Total |
| Management And General | 28950 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27840 | Total |
| Management And General | 27840 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | Program ServicesProgramServices |
|---|---|---|---|
| STATE TAX DEF BENEFIT | 477646 | 477646 | |
| HIRSP ASSESSMENT | 414508 | 414508 | |
| SUBCRIPTIONS | 44882 | 44882 | |
| PREMIUM DEFICIENCY | -2800000 | -2800000 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76845 | Total |
| Program Services | 72144 | ProgramServices |
| Management And General | 4701 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78557409 | Total |
| Program Services | 76211326 | ProgramServices |
| Management And General | 2346083 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 360114 | BOY |
| EOY | 10074159 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2739614 | BOY |
| EOY | 8156832 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 48490 | BOY |
| EOY | 184611 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 307394 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 76817 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 203382 | BOY |
| EOY | 230577 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13681143 | BOY |
| EOY | 9450103 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 672798 | BOY |
| EOY | 167749 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17705541 | BOY |
| EOY | 28264031 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8193701 | BOY |
| EOY | 17302920 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5594 | BOY |
| EOY | 353000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2933695 | BOY |
| EOY | 158008 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11132990 | BOY |
| EOY | 17813928 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6572551 | BOY |
| EOY | 10450103 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6572551 | BOY |
| EOY | 10450103 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17705541 | BOY |
| EOY | 28264031 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -3904068 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 81620 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 7700000 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Both | X | FinancialStatementBoth |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 59588886 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 68232162 | CurrentTaxYearMinus1Year |
| Current Tax Year | 74613944 | CurrentTaxYear |
| Total | 202434992 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 59588886 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 68232162 | CurrentTaxYearMinus1Year |
| Current Tax Year | 74613944 | CurrentTaxYear |
| Total | 202434992 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 202434992 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 181870 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 137398 | CurrentTaxYearMinus1Year |
| Current Tax Year | 97999 | CurrentTaxYear |
| Total | 417267 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 181870 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 137398 | CurrentTaxYearMinus1Year |
| Current Tax Year | 97999 | CurrentTaxYear |
| Total | 417267 | Total |
Other Income509 OtherIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 4486 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1800 | CurrentTaxYearMinus1Year |
| Current Tax Year | 540 | CurrentTaxYear |
| Total | 6826 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 59775242 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 68371360 | CurrentTaxYearMinus1Year |
| Current Tax Year | 74712483 | CurrentTaxYear |
| Total | 202859085 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First5 Years509 | X | First5Years509 |
| General Explanation | SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE A, PART III, SECTION B, LINE 12, COLUMN E: 2010 OTHER REVENUE $4,486 2011 OTHER REVENUE $1,800 2012 OTHER REVENUE $ 540 | GeneralExplanation |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 1 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $26,313 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 26313 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | SINCE CHILDREN'S COMMUNITY HEALTH PLAN IS A WISCONSIN MEDICAID HMO, CERTAIN OFFICERS OF CCHP AND CCHP'S PARENT, CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC., MEET WITH OFFICIALS FROM THE STATE OF WISCONSIN DEPARTMENT OF HEALTH SERVICES TO DISCUSS THE MEDICAID PROGRAM IN WISCONSIN. THESE OFFICERS ARE EMPLOYEES OF CHILDREN'S HOSPITAL AND HEALTH SYSTEM AND THUS WERE NOT REPORTED AS EXPENSES ON CCHP'S PART IX. THE AMOUNT REPORTED ON SCHEDULE C PART II-B LINE 1I CONSISTS OF $24,000 PAID TO AN OUTSIDE CONSULTANT WHO IS A REGISTERED LOBBYIST WHO ADVISES CCHP MANAGEMENT. THE REMAINING $2,313 IS THE PORTION OF FEES PAID TO A NATIONAL TRADE ASSOCIATION THAT WERE ATTRIBUTED TO NON DEDUCTIBLE LOBBYING ACTIVITIES BY THE TRADE ASSOCIATION. | Explanation |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 52798 | OtherCostOrOtherBasis |
| Depreciation | 10895 | Depreciation |
| Book Value | 41903 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 56786 | OtherCostOrOtherBasis |
| Depreciation | 27326 | Depreciation |
| Book Value | 29460 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 197810 | OtherCostOrOtherBasis |
| Depreciation | 38596 | Depreciation |
| Book Value | 159214 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 230577 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO AFFILIATES | Description |
| Amount | $158,008 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 158008 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | FOOTNOTE 2 INCOME TAXES: CHHS EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011. | Explanation |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF MILWAUKEE | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 841 N BROADWAY | AddressLine1 |
| City | MILWAUKEE | City |
| State | WI | State |
| ZIP Code | 53202 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 396005532 | EINOfRecipient |
| IRC Section | N/A | IRCSection |
| Amount Of Cash Grant | 10500 | AmountOfCashGrant |
| Method Of Valuation | N/A | MethodOfValuation |
| Description Of Non Cash Assistance | N/A | DescriptionOfNonCashAssistance |
| Purpose Of Grant | PROGRAM SUPPORT | PurposeOfGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | THE AMOUNTS LISTED ON PART IX, COLUMN A, LINE 1 REPRESENT VARIOUS CHARITABLE DONATIONS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT DUNCAN | ||||||||||||||
| DIRECTOR/PRESIDENT | 0 | 267931 | 0 | 82190 | 0 | 50375 | 0 | 37420 | 0 | 27405 | 0 | 465321 | 0 | 20329 |
| WELDON GAGE | ||||||||||||||
| TREASURER | 0 | 336629 | 0 | 25000 | 0 | 457 | 0 | 51785 | 0 | 18387 | 0 | 432258 | 0 | 0 |
| MARGARET TROY | ||||||||||||||
| DIRECTOR/CHAIR/CHHS PRESIDENT | 0 | 759976 | 0 | 376671 | 0 | 126977 | 0 | 259150 | 0 | 31918 | 0 | 1554692 | 0 | 50833 |
| SHEILA REYNOLDS | ||||||||||||||
| SECRETARY | 0 | 259682 | 0 | 78354 | 0 | 50992 | 0 | 48690 | 0 | 27695 | 0 | 465413 | 0 | 18023 |
| MARC CADIEUX | ||||||||||||||
| INTERIM TREASURER (JAN 2012) | 0 | 189232 | 0 | 34000 | 0 | 15679 | 0 | 15814 | 0 | 6706 | 0 | 261431 | 0 | 0 |
| MARK RAKOWSKI | ||||||||||||||
| VICE PRESIDENT, CCHP | 0 | 185591 | 0 | 29046 | 0 | 9905 | 0 | 17291 | 0 | 24393 | 0 | 266226 | 0 | 0 |
| TIMOTHY BIRKENSTOCK | ||||||||||||||
| FORMER TREASURER | 0 | 0 | 0 | 0 | 0 | 232256 | 0 | 0 | 0 | 1866 | 0 | 234122 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 3 | CCHP RELIED UPON CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. ("CHHS"), THE CORPORATE MEMBER OF CCHP, TO ESTABLISH THE COMPENSATION OF CCHP'S PRESIDENT. CHHS USED ITS INDEPENDENT COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, THE FORM 990 OF OTHER ORGANIZATIONS, A COMPENSATION SURVEY, AND APPROVAL BY THE COMPENSATION COMMITTEE TO DETERMINE THE COMPENSATION. | |
| PART I, LINES 4A-B | UNTIL MARCH 2011, TIMOTHY BIRKENSTOCK SERVED AS TREASURER & CFO OF CHHS. BY VIRTUE OF THAT ROLE, MR. BIRKENSTOCK SERVED AS THE TREASURER AND A DIRECTOR OF CCHP. CHHS PAID CERTAIN AMOUNTS AS SEVERANCE TO MR. BIRKENSTOCK PURSUANT TO A WRITTEN AGREEMENT. CASH PAYMENTS MADE TO MR. BIRKENSTOCK IN 2012 TOTALED $234,122. PART I, LINE 4B: IN 2012, THERE WAS A CHHS EXECUTIVE FLEXIBLE BENEFIT PLAN IN PLACE WHICH WAS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN (457(F) PLAN). THE CORPORATION CONTRIBUTES 7% OF EACH PARTICIPATING EXECUTIVE'S SALARY. THE AMOUNTS OF EMPLOYER CONTRIBUTIONS TO THIS PLAN FOR PARTICIPATING EXECUTIVES IN 2012 WERE AS FOLLOWS: R. DUNCAN, $28,920; W. GAGE, $43,852; S. REYNOLDS, $30,190; AND M. TROY, $54,180. AFTER A VESTING PERIOD, PARTICIPANTS MAY ELECT TO WITHDRAW AMOUNTS PREVIOUSLY CONTRIBUTED AND REPORTED. AMOUNTS WITHDRAWN BY PARTICIPANTS IN 2012 WERE: R. DUNCAN, $20,329; S. REYNOLDS $18,023; AND M. TROY $50,833. CHHS HAS REPORTED ADDITIONAL AMOUNTS SET ASIDE FOR A NONQUALIFIED RETIREMENT PLAN ON BEHALF OF ITS PRESIDENT & CEO. THE AMOUNT SET ASIDE IN 2012 WAS $191,470. | |
| PART I, LINE 7 | CERTAIN EXECUTIVES PARTICIPATE IN AN ANNUAL BONUS PLAN THAT PROVIDES COMPENSATION BASED ON ACHIEVING SPECIFIC PRE-DEFINED GOALS. BONUS CRITERIA ARE COMPRISED OF BOTH SYSTEM LEVEL AND EXECUTIVE SPECIFIC COMPONENTS. SUCH CRITERIA PERTAIN TO MATTERS WITHIN THE EXECUTIVE'S AREA OF RESPONSIBILITY, AS WELL AS ACHIEVEMENT OF OVERALL STRATEGIC OBJECTIVES OF THE ORGANIZATION AND ITS AFFILIATES IN ALIGNMENT WITH SYSTEM-WIDE BALANCED MEASURES. | |
| PART III | FORM 990, PART VII, COLUMN E & SCHEDULE J, PART II: SALARIES PAID BY RELATED ORGANIZATIONS: 1. MARGARET TROY, BOARD CHAIR OF CCHP AND PRESIDENT & CEO OF CHHS, WELDON GAGE, TREASURER OF CCHP AND TREASURER & CFO OF CHHS, ROBERT DUNCAN, DIRECTOR & PRESIDENT OF CCHP AND EXECUTIVE VICE PRESIDENT OF COMMUNITY SERVICES OF CHHS, SHEILA REYNOLDS, SECRETARY OF CCHP AND CORPORATE VICE PRESIDENT & GENERAL COUNSEL OF CHHS, AND MARC CADIEUX, INTERIM TREASURER OF CCHP (JANUARY 2012) AND INTERIM TREASURER & CFO OF CHHS (JANUARY 2012) - REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS AND OTHER COMPENSATION LISTED IN PART VII AND SCHEDULE J WERE PAID FOR SERVICES PROVIDED (40 HOURS PER WEEK) TO CHHS AND ITS AFFILIATES. THESE AMOUNTS WERE PAID BY CHHS. SERVICES BY MS. TROY, MR. GAGE, AND MR. DUNCAN AS MEMBERS OF THE BOARD OF DIRECTORS OF CCHP WERE PROVIDED ON A PART-TIME VOLUNTARY BASIS. 2. MARK RAKOWSKI, EXECUTIVE DIRECTOR OF CCHP - REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS AND OTHER COMPENSATION LISTED IN PART VII AND SCHEDULE J WERE PAID FOR SERVICES PROVIDED (40 HOURS PER WEEK) TO CCHP. THESE AMOUNTS WERE PAID BY CHHS. 3. TIMOTHY L. BIRKENSTOCK, FORMER SECRETARY & TREASURER OF CCHP AND FORMER TREASURER & CFO OF CHHS - REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS AND OTHER COMPENSATION LISTED IN PART VII AND SCHEDULE J WERE PAID BY CHHS AS SEVERANCE FOR PREVIOUS SERVICES AS TREASURER & CFO OF CHHS. | SUPPLEMENTAL INFORMATION |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS A SOLE CORPORATE MEMBER WHICH IS CHHS. | |
| FORM 990, PART VI, SECTION A, LINE 7A | CHHS, THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, ELECTS THE ORGANIZATION'S GOVERNING BODY. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE CORPORATE MEMBER, CHHS, HAS CERTAIN RESERVE POWERS OVER THE CORPORATION, INCLUDING AMENDMENT OF THE ARTICLES OF INCORPORATION AND BYLAWS; APPROVAL OF MERGER, CONSOLIDATION OR THE CREATION OF ANY SUBSIDIARIES BY THE CORPORATION; APPROVAL OF THE ANNUAL BUDGET AND ANY DEBT; AND SELECTION OF THE PRESIDENT. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WAS REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE CHHS BOARD OF DIRECTORS, AND PRIOR TO FILING, A COPY WAS PROVIDED TO ALL DIRECTORS OF CCHP. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY, ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES ARE REQUESTED TO SUBMIT A CONFLICT OF INTEREST DISCLOSURE TO THE CORPORATE VICE PRESIDENT AND GENERAL COUNSEL. A LIST OF POTENTIAL CONFLICTS IS PREPARED AND IS AVAILABLE AT EACH BOARD AND COMMITTEE MEETING. THE COMPLIANCE DEPARTMENT MONITORS AND PERIODICALLY REVIEWS TRANSACTIONS BETWEEN THE ORGANIZATION AND BOARD MEMBERS OR ENTITIES WITH WHICH THEY ARE AFFILIATED. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT, CHAIR, TREASURER, AND SECRETARY WAS REVIEWED AND APPROVED BY THE INDEPENDENT COMPENSATION COMMITTEE OF CHHS (THE ORGANIZATION'S CORPORATE MEMBER). WITH THE ASSISTANCE OF AN INDEPENDENT COMPENSATION CONSULTANT AND INFORMATION FROM A VARIETY OF EXTERNAL SOURCES (AS INDICATED ON SCHEDULE J), THE COMMITTEE CONFIRMED THAT TOTAL COMPENSATION AMOUNTS TO BE PAID WERE REASONABLE AND COMPARABLE TO AMOUNTS PAID BY SIMILARLY SITUATED ORGANIZATIONS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. COMPENSATION OF THE INTERIM TREASURER AND THE VICE PRESIDENT WAS SET BY SUPERVISORY EXECUTIVES IN CONSULTATION WITH CHHS HUMAN RESOURCES LEADERS. THE PROCESS INCLUDED REVIEW BY INDEPENDENT PERSONS WHO, USING A VARIETY OF EXTERNAL SOURCES (AS INDICATED ON SCHEDULE J), CONFIRMED THAT TOTAL COMPENSATION AMOUNTS TO BE PAID WERE REASONABLE AND COMPARABLE TO AMOUNTS PAID BY SIMILARLY SITUATED ORGANIZATIONS. THE PROCESS AND DATA RELIED ON WERE THOROUGHLY AND TIMELY DOCUMENTED. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL INFORMATION OF CCHP ARE AVAILABLE TO THE PUBLIC UPON REQUEST TO THE CHHS PUBLIC RELATIONS DEPARTMENT. | |
| FORM 990, PART XI, LINE 9: | NET ASSET/CASH TRANSFER FROM CHHS 7,700,000. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII LINE 2: | CCHP WAS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF CHHS. THE CONSOLIDATED FINANCIAL STATEMENTS OF CHHS WERE PREPARED IN ACCORDANCE WITH ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA AND WERE AUDITED BY AN INDEPENDENT ACCOUNTANT. ADDITIONALLY, CCHP WAS REQUIRED TO PREPARE STATUTORY FINANCIAL STATEMENTS IN ACCORDANCE WITH ACCOUNTING PRACTICES PRESCRIBED OR PERMITTED BY THE OFFICE OF THE COMMISSIONER OF INSURANCE OF THE STATE OF WISCONSIN, WHICH IS A BASIS OF ACCOUNTING OTHER THAN ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA. THE STATUTORY FINANCIAL STATEMENTS WERE ALSO AUDITED BY AN INDEPENDENT ACCOUNTANT, BUT WERE NOT USED TO PREPARE THE FORM 990 SINCE THE STATUTORY STATEMENTS WERE PREPARED USING A BASIS OF ACCOUNTING OTHER THAN ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA. | |
| FORM 990, PART I LINE 4 & PART VI LINE 1B: | CCHP IS A WISCONSIN NONSTOCK CORPORATION AND IS AN AFFILIATE OF CHHS, A TAX-EXEMPT WISCONSIN CORPORATION SERVING AS THE PARENT ENTITY OF AN INTEGRATED SYSTEM OF PROVIDER ORGANIZATIONS ADDRESSING THE HEALTH CARE NEEDS OF CHILDREN IN SOUTHEASTERN WISCONSIN, NORTHERN ILLINOIS AND SURROUNDING AREAS. AS THE CORPORATE MEMBER OF CCHP, CHHS HOLDS VARIOUS RESERVE POWERS IN RELATION TO CCHP, INCLUDING AUTHORITY TO APPOINT CCHP'S BOARD OF DIRECTORS. THE BOARD OF DIRECTORS OF CCHP CONSISTS OF REPRESENTATIVES OF CHHS'S EXECUTIVE LEADERSHIP IN ADDITION TO TWO EXTERNAL DIRECTORS. THESE EMPLOYED DIRECTORS MAY NOT BE CONSIDERED "INDEPENDENT" FOR PURPOSES OF FORM 990. HOWEVER, AS ACKNOWLEDGED BY THE IRS IN ITS CPE TEXT FOR FISCAL YEAR 1997, IN A MULTI-ENTITY HOSPITAL SYSTEM, THE BOARD OF A SUBSIDIARY NON-PROFIT HEALTH CARE ORGANIZATION IS CONSIDERED TO BE COMPRISED OF INDEPENDENT COMMUNITY MEMBERS IF IT IS CONTROLLED BY AN EXEMPT ORGANIZATION WHOSE BOARD IS COMPRISED OF A MAJORITY OF VOTING MEMBERS WHO ARE INDEPENDENT COMMUNITY MEMBERS. CCHP MEETS THIS STANDARD BECAUSE IT IS A CONTROLLED SUBSIDIARY OF CHHS, AND CHHS'S GOVERNING BOARD INCLUDES INDEPENDENT COMMUNITY MEMBERS AS A MAJORITY THEREOF. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CHILDREN'S HOSPITAL & HEALTH SYSTEM INC | |||||||||||
| 9000 W WISCONSIN AVE PO BOX 1997 | MILWAUKEE | WI | 53201 | 391500074 | OPERATIONAL SUPPORT SERVICES | WI | 501(C)(3) | LINE 3 | N/A | 0 | |
| CHILDREN'S HOSPITAL OF WISCONSIN INC | |||||||||||
| 9000 W WISCONSIN AVE PO BOX 1997 | MILWAUKEE | WI | 53201 | 390812532 | PEDIATRIC HOSPITAL | WI | 501(C)(3) | LINE 3 | 0 | CHILDREN'S HOSPITAL & HEALTH SYSTEM INC | |
| CHILDREN'S HOSPITAL OF WISCONSIN FOUNDATION INC | |||||||||||
| 9000 W WISCONSIN AVE PO BOX 1997 | MILWAUKEE | WI | 53201 | 391500075 | FUND DEVELOPMENT | WI | 501(C)(3) | LINE 7 | 0 | CHILDREN'S HOSPITAL & HEALTH SYSTEM INC | |
| CHILDREN'S MEDICAL GROUP INC | |||||||||||
| 9000 W WISCONSIN AVE PO BOX 1997 | MILWAUKEE | WI | 53201 | 391789197 | PEDIATRIC PHYSICIAN SERVICES | WI | 501(C)(3) | LINE 3 | 0 | CHILDREN'S HOSPITAL & HEALTH SYSTEM INC | |
| CHILDREN'S PHYSICIAN GROUP PC | |||||||||||
| 9000 W WISCONSIN AVE PO BOX 1997 | MILWAUKEE | WI | 53201 | 364303682 | PEDIATRIC PHYSICIAN SERVICES | IL | 501(C)(3) | LINE 9 | 0 | CHILDREN'S HOSPITAL & HEALTH SYSTEM INC | |
| CHILDREN'S SERVICE SOCIETY OF WISCONSIN | |||||||||||
| 9000 W WISCONSIN AVE PO BOX 1997 | MILWAUKEE | WI | 53201 | 390806380 | CHILD WELFARE SERVICES | WI | 501(C)(3) | LINE 7 | 0 | CHILDREN'S HOSPITAL & HEALTH SYSTEM INC | |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VIRTUAL PICU SYSTEMS LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 WYTHE STREET SUIT 101 | AddressLine1 |
| City | ALEXANDRIA | City |
| State | VA | State |
| ZIP Code | 22314 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201414664 | EIN |
| Primary Activity | QUALITY/OUTCOMES ANALYSIS | PrimaryActivity |
| Legal Domicile State | DE | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILDREN'S HOSPITAL & HEALTH SYSTEM INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeType |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 0 | GeneralOrManagingPartner |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MED-HEALTH FINANCIAL SERVICES INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9000 W WISCONSIN AVE PO BOX 1997 | AddressLine1 |
| City | MILWAUKEE | City |
| State | WI | State |
| ZIP Code | 53201 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391547907 | EIN |
| Primary Activity | COLLECTION SERVICES | PrimaryActivity |
| Legal Domicile State | WI | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILDREN'S HOSPITAL & HEALTH SYSTEM INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
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