2012-11-13T10:02:55-06:00 2011-12-31 390758449 WIPFLI LLP 10000 INNOVATION DRIVE SUITE 250 MILWAUKEE WI 532264837 990 2011-01-01 270093404 CARE WISCONSIN HEALTH PLAN INC CARE 6082400020 PO BOX 14017 MADISON WI 537080017 KAREN MUSSER 6082400020 2012-11-13 1 JAY ADKISSON CPA P01360892 4144319300 2012-11-13 2011 2016-02-24 21:20:13Z KAREN MUSSER PO BOX 14017 MADISON WI 537080017 95215416 0 X WWW.CAREWISCONSINHEALTHPLAN.ORG X 2004 WI CARE 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. 7 5 0 0 0 0 0 0 70713147 79423175 934300 579419 0 0 71647447 80002594 0 0 57788162 64633573 0 0 0 0 0 10507538 18346459 68295700 82980032 3351747 -2977438 39748154 20697967 23781656 10453737 15966498 10244230 CARE 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. 0 0 81487175 79423175 CARE 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. 81487175 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 302 0 1 0 0 0 0 0 0 0 0 0 0 0 X 7 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X TERRY METZGER 6082453066 PO BOX 14017 MADISON WI 537080017 KAREN MUSSER 1.00 X X 0 247320 21560 KEN EIMERS 1.00 X X 0 186197 19769 TERRY METZGER 1.00 X X 0 0 0 BOB MUCCI 1.00 X 0 0 0 DENNIS CARLSON 1.00 X 0 0 0 PEG SMELSER 1.00 X 0 0 0 STEVE CABLE 1.00 X 0 0 0 MICHAEL TEGLER 1.00 X 0 130394 14696 REBECCA DORSCHEID 1.00 X 0 110302 4283 0 674213 60308 0 0 1 0 UNIVERSITY OF WISCONSIN HOSPITALS AND CL 600 HIGHLAND AVE MADISON WI 53792 ACUTE AND PRIMARY SERVICES 5735338 COMMUNITY LIVING ALLIANCE INC 1414 MACARTHUR ROAD MADISON WI 53714 LONG TERM CARE SERVICES 3606887 ST MARY'S HOSPITAL PO BOX 681090 MILWAUKEE WI 53268 ACUTE AND PRIMARY SERVICES 3557617 MERITER HOSPITAL INC 202 S PARK STREET MADISON WI 53715 ACUTE AND PRIMARY SERVICES 2561441 UNIVERSITY OF WISCONSIN MEDICAL FOUNDATI 7974 UW HEALTH COURT MIDDLETON WI 53562 ACUTE AND PRIMARY SERVICES 1584281 89 MEDICARE/MEDICAID 624100 75265359 75265359 WI FAMILY CARE PARTNER 624100 3853979 3853979 INSURANCE PREMIUMS 624100 303837 303837 79423175 449670 449670 15342571 15212822 129749 129749 129749 80002594 79423175 0 579419 64633573 64633573 222596 222596 46890 46890 33773 33773 65404 65404 196725 6670 190055 13401 13401 16 16 261222 23845 237377 ALLOCATED ADMINSTRATION 17299949 16796248 503701 OTHER EXPENSES 366363 13438 352925 BAD DEBT EXPENSE 34883 34883 DEFERRED TAX EXPENSE -194763 -194763 82980032 81487175 1492857 0 24889051 5746929 1162636 547739 185070 0 13018608 13938721 492789 464578 39748154 20697967 9869400 10448997 13912256 4740 23781656 10453737 X 15966498 10244230 15966498 10244230 39748154 20697967 X -2977438 -2744830 X 0 1 1 X 1 1 X 41832655 57465779 67378340 70713147 79423175 316813096 41832655 57465779 67378340 70713147 79423175 316813096 0 0 0 316813096 732855 691250 591307 517442 449670 2982524 732855 691250 591307 517442 449670 2982524 42565510 58157029 67969647 71230589 79872845 319795620 0.99070 0.98820 0.00930 0.01180 X 0 0 0 0 0 0 0 0 1 33773 33773 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: AMOUNTS PAID TO NATIONAL HEALTH POLICY GROUP, BLUMENFELD & ASSOCAIATES, AND UCARE. 0 80002594 82980032 -2977438 255172 -3000002 -2744830 -5722268 231266891 255172 151074529 151329701 79937190 65404 65404 80002594 225847913 142933285 142933285 82914628 65404 65404 82980032 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. X X X 0 0 0 0 0 0 0 0 0 KAREN MUSSER 0 246280 0 0 0 1040 0 7553 0 14007 0 268880 0 0 KEN EIMERS 0 185476 0 0 0 721 0 5691 0 14078 0 205966 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE 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 12C EACH 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 15 ALL WAGES ARE PAID BY CARE WISCONSIN FIRST INC. WHICH IS THEN REIMBURSED BY CARE WISCONSIN HEALTH PLAN, INC. THE FOLLOWING DESCRIBES HOW CARE WISCONSIN FIRST, INC. DETERMINES ITS SALARY AND WAGES. FOR THE EXECUTIVE TEAM, A CONSULTANT HELPS WITH REVIEWING THE MARKET DATA 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 19 RECORDS 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. CHANGES IN NET ASSETS OR FUND BALANCES: 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. CARE WISCONSIN FIRST INC PO BOX 14017 MADISON WI 53708 391245329 CARE MANAGEMENT WI 501(C)(3) LINE 9 N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0