2023-11-07T11:59:39-06:00 2022-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2022-01-01 871303591 MY CHOICE FOUNDATION HOLDINGS INC MYCH 4142877600 10201 WEST INNOVATION DRIVE 100 WAUWATOSA WI 53226 MARIA LEDGER CHIEF EXECUTIVE OFFICER 4142877600 2023-11-06 1 MARIA LEDGER 999009999 1 DAVID LOWENTHAL P00378651 3122071040 2023-11-06 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MARIA LEDGER 10201 WEST INNOVATION DRIVE 100 WAUWATOSA WI 53226 0 0 X WWW.MYCHOICEWI.ORG X 2021 WI TO SUPPORT RELATED 501(C)(3) ORGANIZATIONS, MY CHOICE WISCONSIN, INC AND MY CHOICE WISCONSIN HEALTH PLAN, INC. X 5 4 0 4 0 0 0 0 0 0 112695 0 0 0 112695 0 0 0 0 0 0 0 0 0 0 5217 0 5217 0 107478 0 9987705 0 2260 0 9985445 0 WE INSPIRE PEOPLE TO EXPERIENCE LIFE AT ITS FULLEST BY ENCOURAGING OWNERSHIP OF HEALTH, FOSTERING INDEPENDENCE, AND SERVING THE WHOLE PERSON; AND DO SO WITH AN UNWAVERING COMMITMENT AS STEWARDS OF MEDICAID FUNDING. 0 0 THE PURPOSE OF THE ORGANIZATION IS TO SUPPORT RELATED 501(C)(3) ORGANIZATIONS, MY CHOICE WISCONSIN, INC AND MY CHOICE WISCONSIN HEALTH PLAN, INC. 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 1 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 4 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X MARIA LEDGER CEO 4142877600 10201 WEST INNOVATION DRIVE STE 100 WAUWATOSA WI 53226 MARIA LEDGER CHIEF EXECUTIVE OFFICER 1.00 49.00 X X 0 555972 13265 THOMAS ORENDORFF DIRECTOR AND CHAIR 1.00 3.00 X X 0 1800 0 MICHAEL MAYO SR DIRECTOR AND VICE CHAIR 1.00 2.00 X X 0 1800 0 LEE S SEESE DIRECTOR AND TREASURER 1.00 2.00 X X 0 1400 0 KENNETH BYOM DO DIRECTOR AND SECRETARY 1.00 2.00 X X 0 400 0 DAVID POELLMANN DIRECTOR ACCOUNTING/FINANCE 2.00 48.00 X 0 170894 29891 KEVIN COLLINS CHIEF COMPLIANCE OFFICER 2.00 48.00 X 0 416367 20735 0 1148633 63891 0 0 1 0 0 0 0 0 0 0 0 0 0 9910411 0 77294 0 9987705 0 2260 0 2260 0 X 9985445 0 9985445 0 9987705 0 X 0 -9985445 X 0 1 X 1 0 X X X 2 MY CHOICE WISCONSIN INC 811970070 10 1 0 0 MY CHOICE WISCONSIN HEALTH PLAN INC 270093404 10 1 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 MARIA LEDGER CHIEF EXECUTIVE OFFICER 0 555972 0 0 0 0 0 12627 0 638 0 569237 0 0 KEVIN COLLINS CHIEF COMPLIANCE OFFICER 0 416367 0 0 0 0 0 12726 0 8009 0 437102 0 0 DAVID POELLMANN DIRECTOR ACCOUNTING/FINANCE 0 170894 0 0 0 0 0 7213 0 22678 0 200785 0 0 PART I, LINE 3 THE CEO/EXECUTIVE DIRECTOR IS PAID BY A RELATED ORGANIZATION, MY CHOICE WISCONSIN, INC., WHICH USES THE FOLLOWING METHODS TO DETERMINE COMPENSATION: (1) COMPENSATION COMMITTEE (2) COMPENSATION SURVEY OR STUDY AND (3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE CASH AND INVESTMENTS 2022-05-20 9985885 FMV ON DATE OF TRANSFER 811970070 MY CHOICE WISCONSIN INC 10201 W INNOVATION DR STE 100 WAUWATOSA WI 53226 501(C)(3) 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE CHIEF EXECUTIVE OFFICER PERFORMS AN EXTENSIVE REVIEW PRIOR TO FILING THE FORM 990 WITH THE INTERNAL REVENUE SERVICE. THE FORM IS MADE AVAILABLE TO THE MEMBERS OF THE BOARD AFTER FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY FOR INTERESTED PERSONS THAT ADDRESSES TRANSACTIONS BETWEEN THE ORGANIZATION AND ANY CURRENT OR FORMER OFFICERS, DIRECTORS, COMMITTEE MEMBERS, KEY EMPLOYEE, STAFF MEMBERS, ANY PERSON IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION, FAMILY MEMBERS, AND OTHER RELATED ENTITIES. CONFLICTS DISCLOSED ARE ADDRESSED IN ACCORDANCE WITH POLICY SUMMARIZED BELOW. IF AN INTERESTED PERSON HAS ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST, THAT INTERESTED PERSON SHALL NOTIFY THE BOARD CHAIR OF SUCH CONFLICT IN WRITING, OR IN THE CASE OF A COMMITTEE MEMBER, THE COMMITTEE CHAIR. THE INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF HIS OR HER FINANCIAL INTEREST AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS OR MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS, WHO ARE CONSIDERING THE PROPOSED MATTER THAT PRESENTS THE POTENTIAL CONFLICT. IF ANY STAFF MEMBER HAS ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, HE/SHE SHALL NOTIFY THE CHIEF EXECUTIVE OFFICER OF SUCH CONFLICT IN THE CONTEXT OF HER/HIS SUPERVISORY ROLE OR SHALL HAVE THE DISCRETION TO REFER THE MATTER TO THE BOARD. IF THE BOARD OR COMMITTEE DECIDES A CONFLICT OF INTEREST EXISTS, THE FOLLOWING PROCEDURES SHALL APPLY: 1. AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. 2. IF THE CONFLICT IS NOT RESOLVED BY RECUSAL OF THE INTERESTED PERSON, THE CHAIRPERSON OF THE BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, IF APPLICABLE. AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. 3. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OF COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. ALL CONFLICT OF INTEREST DETERMINATIONS WILL BE REFLECTED IN THE MINUTES OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 ALL WAGES AND DIRECTOR FEES ARE PAID BY MY CHOICE WISCONSIN, INC, A RELATED COMPANY. THE FINANCE COMMITTEE (THE COMMITTEE) OF THE BOARD OF DIRECTORS OF MY CHOICE WISCONSIN, INC IS RESPONSIBLE FOR THE ANNUAL REVIEW OF THE COMPENSATION OF THE PRESIDENT/CEO OF THE ORGANIZATION. ALL MEMBERS OF THE COMMITTEE ARE INDEPENDENT IN DETERMINING THE COMPENSATION OF THE PRESIDENT/CEO. THE COMMITTEE EVALUATES THE CEO'S PERFORMANCE AGAINST PREVIOUSLY AGREED UPON CRITERIA, CONSIDERS COMPARABLE MARKET DATA, THEN DEBATES AND DOCUMENTS ITS RECOMMENDATION OF REASONABLE COMPENSATION. THE PROCESS FOR DETERMINING COMPENSATION OF OFFICERS INCLUDES A MARKET ANALYSIS OF COMPARABLE POSITIONS FROM SIMILAR ORGANIZATIONS FOR BENCHMARKING PURPOSES. THIS INFORMATION IS REVIEWED BY INTERNAL HUMAN RESOURCES PROFESSIONALS AND THE CEO. THE CEO EVALUATES THE OFFICERS PERFORMANCE AGAINST PREVIOUSLY AGREED UPON CRITERIA AND A DECISION IS MADE ON THE OFFICERS' SALARY. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. SUMMARY FINANCIAL INFORMATION IS AVAILABLE ON THE STATE OF WISCONSIN DEPARTMENT OF HEALTH SERVICES WEBSITE. FORM 990, PART XI, LINE 9: TRANSFER TO MY CHOICE WISCONSIN INC -9,985,445. MY CHOICE WISCONSIN INC 10201 W INNOVATION DR WAUWATOSA WI 532264822 811970070 CARE MGMT WI 501(C)(3) LINE 10 N/A 0 MY CHOICE HEALTH PLAN INC 10201 W INNOVATION DR WAUWATOSA WI 532264822 270093404 HEALTH CARE WI 501(C)(3) LINE 10 MY CHOICE WISCONSIN INC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 MY CHOICE WISCONSIN INC R 9985445 COST