2023-11-09T09:03:21-06:00 2022-12-31 363168081 SIKICH LLP 17335 GOLF PARKWAY SUITE 500 BROOKFIELD WI 53045 990 2022-01-01 391990012 CHILDREN'S SPECIALTY GROUP INC CHIL 4142665420 PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 JASON JARZEMBOWSKI MD CEO 4142665420 2023-10-25 1 JASON JARZEMBOWSKI MD 999009999 0 JILL M BOYLE CPA P01246734 2627549400 2023-10-25 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JASON JARZEMBOWSKI PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 250628030 0 X WWW.CHILDRENSWI.ORG X 2000 WI PROVIDE THE HIGHEST QUALITY SPECIALTY HEALTH CARE SERVICES TO INFANTS, CHILDREN AND ADOLESCENTS. 2 0 0 13 0 0 0 0 127157929 250628030 25650 0 0 0 127183579 250628030 0 0 0 0 0 0 0 0 0 118804006 248813734 118804006 248813734 8379573 1814296 70971354 108938296 17578021 53730667 53393333 55207629 X THE MISSION OF CHILDREN'S SPECIALTY GROUP, INC. ("CSG") IS TO PROVIDE THE HIGHEST QUALITY SPECIALTY HEALTH CARE SERVICES TO INFANTS, CHILDREN AND ADOLESCENTS AND TO ADVANCE THE EFFECTIVENESS OF HEALTH CARE THROUGH EDUCATION AND THE APPLICATION OF LEADING-EDGE RESEARCH AND INNOVATIVE TECHNOLOGIES. 0 0 220582650 250628030 CSG IS A NON-STOCK, NOT-FOR-PROFIT CORPORATION WITH TWO MEMBERS: CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. ("CHHS") AND THE MEDICAL COLLEGE OF WISCONSIN, INC. ("MCW"), BOTH OF WHICH ARE NON-STOCK, NOT-FOR-PROFIT CORPORATIONS.CSG PROVIDES A CRITICAL LINK BETWEEN THE INTEGRATED PEDIATRIC HEALTH CARE DELIVERY NETWORK OF CHHS AND THE COMMITMENT TO EXCELLENCE IN MEDICAL RESEARCH AND EDUCATION OF MCW. APPROXIMATELY 400 MCW FACULTY MEMBERS, WHO SERVE AS ASSOCIATE OR AFFILIATE PHYSICIANS FOR CSG, AND 200 NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS PROVIDE SPECIALTY AND SUBSPECIALTY PEDIATRIC PATIENT CARE SERVICES THROUGH CHHS' HOSPITAL AND HEALTH SYSTEM LOCATIONS, INCLUDING CHILDREN'S HOSPITAL OF WISCONSIN, INC.CSG OFFERS INPATIENT AND OUTPATIENT SPECIALTY CARE IN MORE THAN 70 MEDICAL SUB-SPECIALTIES. THIS SPECIALTY CARE IS AVAILABLE AT CHHS FACILITIES, INCLUDING ITS HOSPITALS, SURGERY CENTER, AND CLINICS THROUGHOUT WISCONSIN, AND ALSO THROUGH VIRTUAL OR TELEHEALTH APPOINTMENTS TO PROVIDE CARE CLOSER TO HOME.CSG PHYSICIANS AND PROVIDERS CONDUCT LEADING-EDGE SCIENTIFIC RESEARCH AND APPLY THIS RESEARCH AND INNOVATION IN PROVIDING THE BEST AND SAFEST SPECIALTY PEDIATRIC CARE. MANY ARE FACULTY MEMBERS WHO TEACH AT MCW, TRAINING OTHER PEDIATRIC SPECIALISTS. 220582650 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 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 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 2 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X MS SARAH KAFKA 4142661887 PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 CHILDREN'S HOSPITAL AND HEALTH SYSTEM RELATED ORG. 0.00 1.00 X 0 0 0 THE MEDICAL COLLEGE OF WISCONSIN INC RELATED ORG. 0.00 1.00 X 0 0 0 JASON JARZEMBOWSKI MD CEO 34.00 6.00 X 0 543126 54091 AARON KINNEY COO CSG 40.00 0.00 X 0 241610 52219 THOMAS SATO MD FORMER CEO 38.00 2.00 X 0 502202 36829 SHELISA DALTON FORMER CHIEF OPERATING OFFICER 0.00 40.00 X 0 497529 77705 0 1784467 220844 0 1 1 0 0 NET PATIENT SVC REV 621110 207427201 207427201 AFFILIATE HOSPITAL REV 621110 43161796 43161796 39033 39033 250628030 250628030 250628030 0 0 26306628 26306628 7394573 7394573 5677645 5544540 133105 1101773 1089751 12022 LEASED PROVIDER & NON-P 195281399 193984728 1296671 CONTRACTUAL SUPPLIES & 11748350 11265692 482658 RESIDENT SERVICES 1303366 1303366 248813734 220582650 28231084 0 29336498 25566704 41634856 83371592 70971354 108938296 17578021 53730667 17578021 53730667 X 53393333 55207629 53393333 55207629 70971354 108938296 1814296 0 X 0 1 X 1 0 X X 2 THE MEDICAL COLLEGE OF WISCONSIN INC 390806261 2 1 0 0 CHILDREN'S HOSPITAL AND HEALTH SYSTEM INC 391500074 3 1 0 0 2 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 PART IV, SECTION A, LINE 6: THE ORGANIZATION HAS CONTRACTED WITH CERTAIN HOSPITALS TO PROVIDE CLINICAL MANAGEMENT SERVICES AND GRADUATE MEDICAL EDUCATION AT THOSE HOSPITALS. THE MAJORITY OF THESE SERVICES ARE PROVIDED AT CHILDREN'S HOSPITAL OF WISCONSIN, INC., A CLOSELY RELATED AFFILIATE OF CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. THE ORGANIZATION'S INVOLVEMENT IN THESE ACTIVITIES CARRIES OUT AND FURTHERS THE HEALTH CARE AND EDUCATIONAL PURPOSES OF CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. AND THE MEDICAL COLLEGE OF WISCONSIN, INC. PART IV, SECTION B, LINE 1: THE GOVERNING BODY OF THE ORGANIZATION IS COMPRISED OF ITS TWO MEMBERS/SUPPORTED ORGANIZATIONS, CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. AND THE MEDICAL COLLEGE OF WISCONSIN, INC. AND ANY GOVERNANCE DECISIONS REQUIRE THE APPROVAL OF BOTH MEMBERS. 0 DUE FROM AFFILIATES - CHW 61528070 DUE FROM AFFILIATES - MCW 21843522 83371592 DUE TO AFFILIATES - MCW 10174040 DUE TO AFFILIATES - CHW 5500000 DUE TO AFFILIATES - CHS 38056627 53730667 X PART X, LINE 2: 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, 2022 AND 2021. 0 1 0 0 0 0 0 1 0 JASON JARZEMBOWSKI MD CEO 0 464587 0 59682 0 18857 0 24400 0 29691 0 597217 0 0 SHELISA DALTON FORMER CHIEF OPERATING OFFICER 0 421035 0 69540 0 6954 0 47000 0 30705 0 575234 0 0 THOMAS SATO MD FORMER CEO 0 409784 0 90339 0 2079 0 24400 0 12429 0 539031 0 0 AARON KINNEY COO CSG 0 201858 0 38462 0 1290 0 17576 0 34643 0 293829 0 0 PART I, LINE 3 CSG RELIED UPON CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. ("CHHS"), A CORPORATE MEMBER OF CSG, TO ESTABLISH THE COMPENSATION OF CSG'S CHIEF OPERATING OFFICER. COMPENSATION OF THE CHIEF OPERATING OFFICER 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, 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. CSG RELIED UPON THE MEDICAL COLLEGE OF WISCONSIN, INC. ("MCW"), A CORPORATE MEMBER OF CSG, TO ESTABLISH THE COMPENSATION OF CSG'S FORMER AND CURRENT CHIEF EXECUTIVE OFFICER AND FORMER CHIEF OPERATING OFFICER. MCW UTILIZES THE FOLLOWING TO ESTABLISH THE CEO'S COMPENSATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, AND COMPENSATION SURVEY OR STUDY. PART I, LINE 4B BEGINNING IN CALENDAR YEAR 2022, SHELISA DALTON BECAME A PARTICIPANT IN THE SECTION 457(F) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN OF THE MEDICAL COLLEGE OF WISCONSIN, INC. (MCW), A RELATED ORGANIZATION (THE PLAN). UNDER THE PLAN, MCW CONTRIBUTES A DEFINED AMOUNT FOR EACH PARTICIPANT BASED ON A PERCENTAGE OF EACH PARTICIPANT'S BASE SALARY. PARTICIPANTS VEST IN THEIR CONTRIBUTIONS FOR A SPECIFIC PLAN YEAR ON THE LAST DAY OF THE THIRD PLAN YEAR FOLLOWING THAT PLAN YEAR FOR EACH PLAN YEAR THEY ARE A PARTICIPANT. DISTRIBUTIONS ARE MADE TO THE ELIGIBLE PARTICIPANTS IN A SINGLE, LUMP SUM PAYMENT WHEN CONTRIBUTIONS BECOME VESTED. PART I, LINE 7 CERTAIN EXECUTIVES EMPLOYED BY CHHS 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. FORM 990, PART VII, COLUMN E & SCHEDULE J, PART II: SALARIES PAID BY RELATED ORGANIZATIONS: 1. AARON KINNEY, COO - 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 AND CHILDREN'S HOSPITAL OF WISCONSIN, INC. 2. JASON JARZEMBOWSKI, M.D., CHIEF EXECUTIVE OFFICER OF CSG AND SENIOR ASSOCIATE DEAN FOR CLINICAL AFFAIRS-PEDIATRIC PRACTICE AT MCW IS COMPENSATED BY MCW FOR: 1. ADMINISTRATOR ROLES AT BOTH CSG AND MCW 2. CLINICAL MANAGEMENT SERVICES PROVIDED TO CHW IN CONNECTION WITH THE ORGANIZATION'S AFFILIATE HOSPITAL CONTRACTS 3. PROFESSOR OF PATHOLOGY AT MCW AND VICE CHAIR FOR PEDIATRIC PATHOLOGY. 3. SHELISA DALTON, FORMER CHIEF OPERATING OFFICER OF CSG, IS COMPENSATED BY MCW FOR SERVICES PROVIDED AS THE CHIEF FINANCIAL OFFICER OF MCW. 4. THOMAS SATO, M.D., FORMER CHIEF EXECUTIVE OFFICER OF CSG, IS COMPENSATED BY MCW FOR SERVICES PROVIDED AS A PROFESSOR AT MCW AND PRACTICING PEDIATRIC SURGERY SPECIALIST. FORM 990, PART V, LINE 1A THE ORGANIZATION DID NOT FILE ANY FORMS 1099 DURING THE TAXABLE YEAR. ALTHOUGH THE ORGANIZATION DID RETAIN INDEPENDENT CONTRACTORS, THE COMPENSATION AMOUNTS OWED TO SUCH CONTRACTORS WERE PROCESSED AND PAID BY MCW AND CHILDREN'S HOSPITAL OF WISCONSIN, INC. ("CHW"), A RELATED ENTITY OF CHHS, WITH APPROPRIATE INTERCOMPANY ARRANGEMENTS BETWEEN THE ORGANIZATION AND CHW. THE FORMS 1099 FOR SUCH PAYMENTS WERE ISSUED BY CHW AND MCW, AS THE ENTITIES THAT PROCESSED AND MADE THE PAYMENTS TO THE INDEPENDENT CONTRACTORS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS TWO MEMBERS: CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. (CHHS) AND THE MEDICAL COLLEGE OF WISCONSIN, INC. (MCW). FORM 990, PART VI, SECTION A, LINE 7A THE TWO MEMBERS OF THE ORGANIZATION, CHHS AND MCW ARE THE GOVERNING BODY OF THE ORGANIZATION AND ANY GOVERNANCE DECISIONS REQUIRE THE APPROVAL OF BOTH MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE TWO MEMBERS OF THE ORGANIZATION, CHHS AND MCW ARE THE GOVERNING BODY OF THE ORGANIZATION AND ANY GOVERNANCE DECISIONS REQUIRE THE APPROVAL OF BOTH MEMBERS. FORM 990, PART VI, SECTION A, LINE 8B THE GOVERNING BODY OF THE ORGANIZATION DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON ITS BEHALF. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 OF CSG WAS REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE OF CHHS BOARD OF DIRECTORS, AND PRIOR TO FILING, A COPY WAS PROVIDED TO MCW FOR REVIEW, THE OTHER MEMBER OF THE ORGANIZATION. 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 DIRECTOR OF CORPORATE COMPLIANCE. 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 ORGANIZATION RELIES ON MCW, A RELATED ORGANIZATION, TO ESTABLISH THE COMPENSATION OF ITS CHIEF EXECUTIVE OFFICER. COMPENSATION OF THE CHIEF OPERATING OFFICER 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 CSG ARE AVAILABLE TO THE PUBLIC UPON REQUEST THROUGH THE CHHS MARKETING AND COMMUNICATION DEPARTMENT. THE MEDICAL COLLEGE OF WISCONSIN INC 8701 WATERTOWN PLANK ROAD MILWAUKEE WI 53226 390806261 EDUCATION/MEDICAL WI 501(C)(3) LINE 2 N/A 0 CHILDREN'S HOSPITAL AND HEALTH SYSTEM PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 391500074 AMBULATORY SURGERY CTR, URGENT CARE, & OPERATIONAL SUPPT SVCS WI 501(C)(3) LINE 3 N/A 0 CHILDREN'S HOSPITAL OF WISCONSIN INC PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 390812532 PEDIATRIC HOSPITAL WI 501(C)(3) LINE 3 N/A 1 CHILDREN'S HOSPITAL OF WISCONSIN FOUNDATION INC PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 391500075 FUND DEVELOPMENT WI 501(C)(3) LINE 7 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 1 CHILDREN'S MEDICAL GROUP INC PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 391789197 PEDIATRIC PHYSICIAN SERVICES WI 501(C)(3) LINE 3 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 1 CHILDREN'S SERVICE SOCIETY OF WISCONSIN PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 390806380 CHILD WELFARE SERVICES WI 501(C)(3) LINE 7 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 1 CHORUS COMMUNITY HEALTH PLANS INC PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 271494977 WISCONSIN MEDICAID HMO WI 501(C)(3) LINE 10 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 1 WEST ALLIS PRESCRIPTION CENTER INC 6737 W WASHINGTON ST STE 1100 WEST ALLIS WI 53214 463421597 PHARMACY WI N/A C 0 WAUWATOSA PRESCRIPTION CENTER INC SKYWALK PHARMACY 9000 W WISCONSIN AVE WAUWATOSA WI 53226 061654484 PHARMACY WI N/A C 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 1 0