MY CHOICE WISCONSIN HEALTH PLAN INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
MY CHOICE WISCONSIN HEALTH PLAN INC (EIN 27-0093404)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-13
IRS object ID
201213189349301701
Schema version
2011v1.2
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

FieldValueIRS element (for citing)
Timestamp2012-11-13T10:02:55-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN390758449EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line110000 INNOVATION DRIVE SUITE 250AddressLine1
CityMILWAUKEECity
StateWIState
ZIP Code532264837ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN270093404EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CARE WISCONSIN HEALTH PLAN INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCARENameControl
Phone6082400020Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 14017AddressLine1
CityMADISONCity
StateWIState
ZIP Code537080017ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameKAREN MUSSERName
TitlePRESIDENT, CEOTitle
Phone6082400020Phone
Date Signed2012-11-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJAY ADKISSON CPAName
PTINP01360892PTIN
Phone4144319300Phone
Date Prepared2012-11-13DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKAREN MUSSERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 14017AddressLine1
CityMADISONCity
StateWIState
ZIP Code537080017ZIPCode
FieldValueIRS element (for citing)
Gross Receipts95215416GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CAREWISCONSINHEALTHPLAN.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2004YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionCARE WISCONSIN HEALTH PLAN, INC. IS A HEALTH MAINTENANCE ORGANIZATION. ITS PRIMARY PURPOSE IS PROVIDING HEALTH AND LONG-TERM MANAGEMENT AND CARE SERVICES TO ELIGIBLE MEMBERS.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year70713147ProgramServiceRevenuePriorYear
Program Service Revenue CY79423175ProgramServiceRevenueCY
Investment Income Prior Year934300InvestmentIncomePriorYear
Investment Income Current Year579419InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year71647447TotalRevenuePriorYear
Total Revenue Current Year80002594TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year57788162BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY64633573BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year10507538OtherExpensePriorYear
Other Expenses Current Year18346459OtherExpensesCurrentYear
Total Expenses Prior Year68295700TotalExpensesPriorYear
Total Expenses Current Year82980032TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3351747RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-2977438RevenuesLessExpensesCY
Total Assets BOY39748154TotalAssetsBOY
Total Assets EOY20697967TotalAssetsEOY
Total Liabilities BOY23781656TotalLiabilitiesBOY
Total Liabilities EOY10453737TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY15966498NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY10244230NetAssetsOrFundBalancesEOY
Mission DescriptionCARE WISCONSIN HEALTH PLAN, INC. (CWHP) PROVIDES HEALTH AND LONG-TERM MAINTENANCE ORGANIZATION INSURANCE TO NURSING HOME ELIGIBLE MEMBERS UNDER THE STATE OF WISCONSIN FAMILY CARE PARTNERSHIP PROGRAM. CWHPS' ENROLLMENT AT THE END OF 2011 WAS 1,307 MEMBERS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense81487175Expense
Revenue79423175Revenue
DescriptionCARE WISCONSIN HEALTH PLAN, INC. (CWHP) IS A HEALTH MAINTENANCE ORGANIZATION UNDER SECTION 613 OF THE WISCONSIN STATUTES. IT HAS BEEN FORMED FOR THE PRIMARY PURPOSE OF PROVIDING HEALTH AND LONG-TERM MANAGEMENT AND CARE SERVICES TO THE ELDERLY AND ADULTS WITH DISABILITIES UNDER A HEALTH MAINTENANCE ORGANIZATION LICENSE ISSUED BY THE WISCONSIN OFFICE OF THE COMMISSIONER OF INSURANCE. CHWP'S ENROLLMENT AT THE END OF 2011 WAS 1,307 MEMBERS.Description
Total Program Service Expense81487175TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096302NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonTERRY METZGERNamePerson
Telephone Number6082453066TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 14017AddressLine1
CityMADISONCity
StateWIState
ZIP Code537080017ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
KAREN MUSSER
PRESIDENT1.00XX024732021560
KEN EIMERS
SECRETARY1.00XX018619719769
TERRY METZGER
TREASURER1.00XX000
BOB MUCCI
DIRECTOR1.00X000
DENNIS CARLSON
DIRECTOR1.00X000
PEG SMELSER
DIRECTOR1.00X000
STEVE CABLE
DIRECTOR1.00X000
MICHAEL TEGLER
TREASURER (FORMER)1.00X013039414696
REBECCA DORSCHEID
TREASURER (FORMER)1.00X01103024283
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs674213TotalReportableCompFrmRltdOrgs
Total Other Compensation60308TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
UNIVERSITY OF WISCONSIN HOSPITALS AND CL
600 HIGHLAND AVEMADISONWI53792ACUTE AND PRIMARY SERVICES5735338
COMMUNITY LIVING ALLIANCE INC
1414 MACARTHUR ROADMADISONWI53714LONG TERM CARE SERVICES3606887
ST MARY'S HOSPITAL
PO BOX 681090MILWAUKEEWI53268ACUTE AND PRIMARY SERVICES3557617
MERITER HOSPITAL INC
202 S PARK STREETMADISONWI53715ACUTE AND PRIMARY SERVICES2561441
UNIVERSITY OF WISCONSIN MEDICAL FOUNDATI
7974 UW HEALTH COURTMIDDLETONWI53562ACUTE AND PRIMARY SERVICES1584281
FieldValueIRS element (for citing)
Number Of Contractors GT100 K89NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICARE/MEDICAID6241007526535975265359
WI FAMILY CARE PARTNER62410038539793853979
INSURANCE PREMIUMS624100303837303837
FieldValueIRS element (for citing)
Total Program Service Revenue79423175TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column449670TotalRevenueColumn
Exclusion$449,670ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities15342571Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities15212822Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities129749Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column129749TotalRevenueColumn
Exclusion$129,749ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column80002594TotalRevenueColumn
Related Or Exempt Function Income79423175RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$579,419ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total64633573Total
Program Services64633573ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total222596Total
Management And General222596ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total46890Total
Management And General46890ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total33773Total
Management And General33773ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total65404Total
Management And General65404ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total196725Total
Program Services6670ProgramServices
Management And General190055ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total13401Total
Program Services13401ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total16Total
Management And General16ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total261222Total
Program Services23845ProgramServices
Management And General237377ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
ALLOCATED ADMINSTRATION1729994916796248503701
OTHER EXPENSES36636313438352925
BAD DEBT EXPENSE3488334883
DEFERRED TAX EXPENSE-194763-194763

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total82980032Total
Program Services81487175ProgramServices
Management And General1492857ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY24889051BOY
EOY5746929EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1162636BOY
EOY547739EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY185070BOY
EOY0EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY13018608BOY
EOY13938721EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY492789BOY
EOY464578EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY39748154BOY
EOY20697967EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY9869400BOY
EOY10448997EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY13912256BOY
EOY4740EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY23781656BOY
EOY10453737EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY15966498BOY
EOY10244230EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY15966498BOY
EOY10244230EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY39748154BOY
EOY20697967EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-2977438ReconcilationRevenueExpenses
Reconcilation Other Changes-2744830ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years41832655CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years57465779CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years67378340CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year70713147CurrentTaxYearMinus1Year
Current Tax Year79423175CurrentTaxYear
Total316813096Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years41832655CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years57465779CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years67378340CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year70713147CurrentTaxYearMinus1Year
Current Tax Year79423175CurrentTaxYear
Total316813096Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total509316813096PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years732855CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years691250CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years591307CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year517442CurrentTaxYearMinus1Year
Current Tax Year449670CurrentTaxYear
Total2982524Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years732855CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years691250CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years591307CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year517442CurrentTaxYearMinus1Year
Current Tax Year449670CurrentTaxYear
Total2982524Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years42565510CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years58157029CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years67969647CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year71230589CurrentTaxYearMinus1Year
Current Tax Year79872845CurrentTaxYear
Total319795620Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99070PublicSupportPercentage509
Prior Year Support Percentage0.98820PriorYearSupportPercentage
Investment Income Percentage0.00930InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.01180PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$33,773OtherActivitiesAmount
Total Lobbying Expenditures IIB33773TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationAMOUNTS PAID TO NATIONAL HEALTH POLICY GROUP, BLUMENFELD & ASSOCAIATES, AND UCARE.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings
Total Revenue80002594TotalRevenue
Total Expenses82980032TotalExpenses
Excess Or Deficit For Year-2977438ExcessOrDeficitForYear
Net Unrealized GL On Investments255172NetUnrealizedGLOnInvestments
Other-$3,000,002OtherAmount
Total Adjustments-2744830TotalAdjustments
Excess Or Deficit Per FS-5722268ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt231266891TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments255172NetUnrealizedGainsInvestments
Other Revenues151074529OtherRevenues
Revenue Not Rptd F990151329701RevenueNotRptdF990
Revenue Subtotal79937190RevenueSubtotal
Investment Expenses Not Included65404InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt65404RevenueNotRptdOnFinStmt
Total Revenue Per Form99080002594TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt225847913TotExpensesEtcAuditedFinclStmt
Other Expenses Included142933285OtherExpensesIncluded
Expenses Not Rptd F990142933285ExpensesNotRptdF990
Expenses Subtotal82914628ExpensesSubtotal
Investment Expenses Not Included265404InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt65404ExpensesNotRptdOnFinStmt
Total Expenses Per Form99082980032TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE COMPANY DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE COMPANY RECORED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS IN 2011 OR 2010.
PART XI, LINE 8 - OTHER ADJUSTMENTS:RETURN OF CAPITAL -3,000,000. ROUNDING -2. TOTAL TO SCHEDULE D, PART XI, LINE 8: -3,000,002.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RELATED ORGANIZATION REVENUE 151,074,529.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:RELATED ORGANIZATION EXPENSES 142,933,285.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
KAREN MUSSER
0246280000104007553014007026888000
KEN EIMERS
018547600072105691014078020596600

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE CHIEF FINANCIAL OFFICER PERFORMS AN EXTENSIVE REVIEW PRIOR TO FILING THE FORM 990 WITH THE INTERNAL REVENUE SERVICE. PRIOR TO FILING THE 990 WITH THE IRS, THE FORM IS MADE AVAILABLE TO THE MEMBERS OF THE BOARD. AT THE NEXT BOARD MEETING KEY COMPONENTS OF THE 990 RETURN ARE DISCUSSED.
FORM 990, PART VI, SECTION B, LINE 12CEACH YEAR, ALL BOARD MEMBERS AND EXECUTIVE TEAM MEMBERS MUST SIGN THE CONFLICT OF INTEREST DOCUMENT TO CERTIFY THAT THEY ARE IN COMPLIANCE.
FORM 990, PART VI, SECTION B, LINE 15ALL 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 FOR SIMILAR ORGANIZATIONS FOR DETERMINING THE APPROPRIATE PAY RANGES AND PAY RATES FOR THE INCUMBENTS. THE CONSULTANT WILL MAKE THE RECOMMENDATION FOR THE COMPENSATION TO 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 19RECORDS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST BY MAILING TO CARE WISCONSIN HEALTH PLAN, INC. C/O TERRY METZGER, PO BOX 14017, MADISON, WI 53708-0017.
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 255,172. RETURN OF CAPITAL -3,000,000. ROUNDING -2. TOTAL TO FORM 990, PART XI, LINE 5: -2,744,830.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1CARE WISCONSIN FIRST INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 14017AddressLine1
CityMADISONCity
StateWIState
ZIP Code53708ZIPCode
FieldValueIRS element (for citing)
EIN391245329EIN
Primary ActivitiesCARE MANAGEMENTPrimaryActivities
Legal Domicile StateWILegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusLINE 9PublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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