2023-10-30T10:45:35-05:00 2022-12-31 363168081 SIKICH LLP 17335 GOLF PARKWAY SUITE 500 BROOKFIELD WI 53045 990 2022-01-01 391789197 CHILDREN'S MEDICAL GROUP INC CHIL 4142665420 PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 MARC A CADIEUX TREASURER 4142665420 2023-10-25 1 MARC CADIEUX 999009999 0 JILL M BOYLE CPA P01246734 2627549400 2023-10-25 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z SEE SCHEDULE O MICHAEL GUTZEIT MD PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 102284979 0 X WWW.CHILDRENSWI.ORG X 1994 WI PROVIDE QUALITY, ACCESSIBLE PRIMARY HEALTH CARE TO CHILDREN IN THE COMMUNITY. 13 0 668 0 0 0 24124586 23860127 71728162 78395255 -32117 -20 35183 24102 95855814 102279464 0 0 0 0 55352447 57946767 0 0 0 40503367 44332697 95855814 102279464 0 0 31763307 33585744 31763307 33585744 0 0 X TO PROVIDE QUALITY, ACCESSIBLE PRIMARY HEALTH CARE SERVICES TO ALL CHILDREN IN OUR COMMUNITY, ADVOCATE FOR THE WELL-BEING OF ALL CHILDREN, EDUCATE CHILDREN, FAMILIES, HEALTH CARE PROFESSIONALS AND OUR COMMUNITY REGARDING THE HEALTH OF CHILDREN. 0 0 69081829 71970941 CHILDREN'S MEDICAL GROUP, INC. ("CMG") IS ORGANIZED AS A NON STOCK NON PROFIT CORPORATION WITH A SOLE MEMBER, CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. ("CHHS"), A SECTION 501(C)(3) ORGANIZATION. CMG IS AFFILIATED WITH CHILDREN'S HOSPITAL OF WISCONSIN, INC. ("CHW"), A SECTION 501(C)(3) ORGANIZATION WHICH IS THE ONLY HOSPITAL IN WISCONSIN DEVOTED SOLELY TO THE PROVISION OF MEDICAL SERVICES TO CHILDREN. THE PRIMARY PURPOSE OF CMG IS TO PROVIDE QUALITY PRIMARY CARE MEDICAL SERVICES TO CHILDREN IN THE COMMUNITY, STATE, AND REGION. THE AFFILIATED GROUP IS ONE OF ONLY A HANDFUL OF ORGANIZATIONS THROUGHOUT THE U.S. THAT FOCUSES SOLELY ON THE CRITICAL MEDICAL NEEDS OF CHILDREN AND THE SPECIAL CARE THEY REQUIRED. THE PRINCIPAL FUNCTION OF CMG IS TO PROVIDE PRIMARY MEDICAL DIAGNOSIS, TREATMENT SERVICES, AND PREVENTATIVE CARE THROUGH OUTPATIENT CLINICS AND COMMUNITY HEALTH SCREENING AND EDUCATION SERVICES. CMG ALSO PARTICIPATES IN PRIMARY CARE MEDICAL EDUCATION AND TRAINING THROUGH THE MEDICAL COLLEGE OF WISCONSIN AND GRADUATE MEDICAL EDUCATION PROGRAMS ALREADY ESTABLISHED AT CHW. CMG PROVIDES CARE TO CHILDREN WHO ARE RESIDENTS OF SOUTHEASTERN WISCONSIN AT LOCATIONS WHERE THERE IS A DEMONSTRATED COMMUNITY NEED FOR MEDICAL DIAGNOSIS AND TREATMENT. IN 2022, CMG HAD 22 PHYSICIAN OFFICES WITH APPROXIMATELY 170 PROVIDERS. AS A GROUP THERE WERE 357,160 PEDIATRIC OFFICE VISITS, HEALTH CHECKS AND IMMUNIZATIONS PROVIDED IN 2022. INCLUDED IN THIS NUMBER ARE 40,909 PEDIATRIC OFFICE VISITS, HEALTH CHECKS AND IMMUNIZATIONS DESCRIBED IN LINE 4B.IN RESPONSE TO THE CHANGING NEEDS OF THE COMMUNITY FOR MEDICAL SERVICES, ADVANCES IN PEDIATRIC MEDICINE AND THE INCREASING EMPHASIS ON PREVENTIVE MEDICAL CARE, CMG PROVIDES SERVICES IN FURTHERANCE OF THE MISSION OF CHW AND OTHER MEMBERS OF THE AFFILIATED GROUP. INCREASINGLY, PATIENTS HAVE BEEN SEEKING PRIMARY MEDICAL CARE THROUGH THE EMERGENCY ROOM FACILITIES OF HOSPITALS. THE EMERGENCY ROOM IS THE MOST COSTLY AND INEFFICIENT METHOD OF PROVIDING SUCH CARE TO PATIENTS. BY MAKING PRIMARY CARE AVAILABLE TO A GREATER PORTION OF THE GENERAL PUBLIC, CMG PROVIDES QUALITY, EFFICIENT PRIMARY PEDIATRIC CARE AT A LOWER COST. CMG IS STRUCTURED TO BETTER SERVE THE RESIDENTS OF SOUTHEASTERN WISCONSIN BY PROVIDING INCREASED ACCESS TO QUALITY MEDICAL CARE, EXPANDING COMMUNITY MEDICAL EDUCATION EFFORTS AND IMPROVING THE QUALITY OF PEDIATRIC CARE.CMG HAS MADE INTEGRATED MENTAL BEHAVIORAL HEALTH (IMBH) A STRATEGIC PART OF ITS PROVISION OF QUALITY HEALTH CARE. IMBH BRINGS BEHAVIORAL HEALTH SERVICES INTO THE PRIMARY CARE SETTING BY INCORPORATING LICENSED MENTAL HEALTH PROVIDERS, BEHAVIORAL HEALTH CONSULTANTS (BHCS), INTO THE TEAM. BHCS AND ALL MEMBERS OF THE PRIMARY CARE TEAM WORK TOGETHER TO PROVIDE COMPREHENSIVE, WHOLE-CHILD HEALTH CARE BY ADDRESSING EVERY ASPECT OF A CHILD'S PHYSICAL AND MENTAL WELLBEING. TYPICAL BHC SERVICES INCLUDE CHRONIC HEALTH CONDITION MANAGEMENT, ANTICIPATORY GUIDANCE, EARLY INTERVENTION FOR COMMON CHILDHOOD CONCERNS, AND ROUTINE BEHAVIORAL HEALTH SCREENING. BHCS PROVIDE MENTAL HEALTH ASSESSMENT AND TREATMENT, BRIEF EVIDENCE-BASED THERAPY, AND PHYSICIAN AND TEAM CONSULTATION. BHCS PROVIDE IMMEDIATE ACCESS TO MENTAL HEALTH AND PREVENTION SERVICES. THIS WHOLE-CHILD APPROACH ENSURES KIDS WILL GET THE CARE THEY NEED, WHEN THEY NEED IT AND WHERE THEY NEED IT.DURING THE COVID-19 PANDEMIC, CHILDREN'S PIVOTED TO PROVIDE THE CARE KIDS AND FAMILIES NEED AS SAFELY AS POSSIBLE. THIS INCLUDED A SIGNIFICANT INCREASE IN USE OF TELEHEALTH (INCLUDING FOR MENTAL AND BEHAVIORAL HEALTH NEEDS) AND SUPPORTING OUR COMMUNITY THROUGH TESTING, VACCINATION AND PEDIATRIC HEALTH AND SAFETY ADVICE AND RECOMMENDATIONS. 12940276 6448416 CMG OPERATES CLINICS IN UNDERSERVED AREAS IN THE MILWAUKEE AREA, INCLUDING A SITE LOCATED ON THE NEXT DOOR FOUNDATION CAMPUS IN MILWAUKEE'S CENTRAL CITY, IN ADDITION TO THE MIDTOWN HEALTH CENTER AND COMMUNITY CLINICS. THESE CLINICS PROVIDE PRIMARY CARE SERVICES INCLUDING PREVENTIVE CARE, PHYSICALS, IMMUNIZATIONS AND TREATMENT FOR ILLNESSES TO AREAS THAT PREVIOUSLY DID NOT HAVE PEDIATRIC PRACTICES AVAILABLE TO ATTEND TO THE COMMUNITY'S NEEDS. ADDITIONALLY, TO MEET THE DENTAL NEEDS OF UNDERSERVED CHILDREN IN THE CITY OF MILWAUKEE, CMG HAS A PEDIATRIC DENTAL PRACTICE, DENTAL CENTER MIDTOWN. THESE CLINICS OPERATE AT A LOSS, WHICH WAS FUNDED BY CHW OR CONTRIBUTIONS RECEIVED VIA THE CHILDREN'S HOSPITAL OF WISCONSIN FOUNDATION, INC. THESE CLINICS HAD 40,909 PEDIATRIC OFFICE VISITS, HEALTH CHECKS AND IMMUNIZATIONS PROVIDED IN 2022, AND APPROXIMATELY 83% OF THE GROSS CHARGES WERE FROM PATIENTS ENROLLED IN MEDICAID. 82022105 1 1 0 0 0 0 0 0 0 0 1 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 0 668 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 0 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X MS SARAH KAFKA 4142661887 PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 MARGARET TROY DIRECTOR/PRESIDENT & CEO CHHS 0.00 40.00 X 0 1973534 58792 SMRITI KHARE MD SVP AND CHIEF MENTAL & BHO 0.00 40.00 X X 0 751881 139020 KATHRYNN FEE MD PEDIATRIC PHYSICIAN 40.00 0.00 X 278114 0 13172 BARBARA CALKINS MD PEDIATRIC PHYSICIAN/CHAIR 30.00 0.00 X X 236487 0 9777 CHRISTEN MCALPINE-TESFAI MD PEDIATRIC PHYSICIAN/VICE CHAIR 40.00 0.00 X X 279059 0 10904 CYNTHIA RUNNING MD PEDIATRIC PHYSICIAN 30.00 0.00 X 217838 0 44203 MICHAEL GUTZEIT MD PRESIDENT CMG & BOARD CHAIR 40.00 0.00 X X 0 729623 61844 AMY ROMASHKO MD URGENT CARE MED/PROGRAM DIRECTOR 0.00 40.00 X 0 338678 58883 AMANDA KOTOWSKI APNP NURSE PRACTITIONER 14.00 10.00 X 79570 58548 23916 JASON JARZEMBOWSKI MD DIRECTOR 1.00 0.00 X 0 0 0 MATT LEVY MD DIRECTOR 1.00 0.00 X 0 0 0 AARON HANSON MD PEDIATRIC PHYSICIAN 40.00 0.00 X 413951 0 51967 DAVID OGREN MD PEDIATRIC PHYSICIAN 40.00 0.00 X 270901 0 45490 BRILLIANT NIMMER MD PEDIATRIC PHYSICIAN 40.00 0.00 X 185155 0 34300 MARC CADIEUX TREASURER/CORP VP & CFO 0.00 40.00 X 0 993812 126962 MICHELLE METTNER END 123122 SECRETARY/CORP VP GOV & LEGAL AFFAIRS 0.00 40.00 X 0 703637 111779 CHRISTOPHER SCHWAKE MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 40.00 0.00 X 363743 0 49776 STEVEN JEREB MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 40.00 0.00 X 312322 0 57621 BOYD MILLER MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 40.00 0.00 X 337572 0 50281 YOLANDA WOLFF MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 40.00 0.00 X 311985 0 52308 MARY SISNEY VP PRIMARY CARE 40.00 0.00 X 273667 0 60469 SHERYN ABRAHAM MD PEDIATRIC PHYSICIAN 40.00 0.00 X 515058 0 39193 PATTI-MARIE YOUNG MD PEDIATRIC PHYSICIAN 40.00 0.00 X 415255 0 10958 ROXANNE KANE MD PEDIATRIC PHYSICIAN 40.00 0.00 X 332139 2504 48036 DAVID MEULER MD PEDIATRIC PHYSICIAN 36.00 4.00 X 314909 32623 44259 JAYA IYER MD PEDIATRIC PHYSICIAN 40.00 0.00 X 374368 0 11481 AMY HERBST MD VP BEHAVIORAL & MENTAL HEALTH 0.00 40.00 X 0 343817 61132 5512093 5928657 1276523 125 1 1 0 THE MEDICAL COLLEGE OF WISCONSIN 8701 WATERTOWN PLANK RD MILWAUKEE WI 53226 PHYSICIANS AND NURSE PRACTITIONERS 1105971 IMAGINE MEDICAL GROUP PA 228 PARK AVE S NEW YORK NY 10003 PHYSICIANS AND LICENSED CLINICIAL SOCIAL 869850 GOODWILL TALENTBRIDGE LLC BOX 78695 MILWAUKEE WI 53278 PATIENT SERVICES REPRESENTATIVES 545728 STAFFENCY LLC 221 W COLLEGE AVE FL 2 APPLETON WI 54911 TEMP HELP SERVICES 504862 TRIAGE 4 PEDIATRICS PO BOX 261923 PLANO TX 75026 ANSWERING SERVICES 393463 10 23168498 691629 23860127 NET PATIENT SVC REV 621110 78184414 78184414 RENTAL INCOME 532000 169549 169549 SALARY SUPPORT 900099 41292 41292 78395255 5495 5495 5515 -5515 -5515 -5515 OTHER MISCELLANEOUS 900099 24102 24102 24102 102279464 78419357 0 -20 4064549 3281578 782971 44366046 41528577 2837469 1792545 1699651 92894 4779183 4467357 311826 2944444 2719555 224889 15725694 15725694 4180328 4131467 48861 1418 1418 75589 75406 183 3517 3413 104 6753446 6634887 118559 11747 6245 5502 140113 125455 14658 1771054 1730566 40488 223062 216204 6858 MEDICAL SUPPLIES 14608998 14608998 OTHER EXPENSES 837731 791328 46403 102279464 82022105 20257359 0 462426 460549 4317845 6027420 48629 56713 1431736 1614071 567790 529689 18775330 11257994 8261921 7517336 16672960 17379966 31763307 33585744 7156009 7740232 3334832 3249832 21272466 22595680 31763307 33585744 X 0 0 31763307 33585744 0 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11811530 7519924 4291606 6957027 3738070 3218957 6773 6773 7517336 DEFERRED COMPENSATION PLAN ASSETS 8644907 LEASE ASSETS 8730629 RECEIVABLE FROM AFFILIATES 4430 17379966 DEFERRED COMPENSATION PLAN LIABILITIES 8644907 DUE TO AFFILIATES 4991405 LEASE LIABILITY AND OTHER 8959368 22595680 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 MARGARET TROY DIRECTOR/PRESIDENT & CEO CHHS 0 1134014 0 410825 0 428695 0 22450 0 36342 0 2032326 0 0 MARC CADIEUX TREASURER/CORP VP & CFO 0 635957 0 162297 0 195558 0 123257 0 3705 0 1120774 0 133747 SMRITI KHARE MD SVP AND CHIEF MENTAL & BHO 0 520478 0 117964 0 113439 0 105475 0 33545 0 890901 0 93159 MICHELLE METTNER END 123122 SECRETARY/CORP VP GOV & LEGAL AFFAIR 0 469771 0 92214 0 141652 0 82467 0 29312 0 815416 0 93242 MICHAEL GUTZEIT MD PRESIDENT CMG & BOARD CHAIR 0 497022 0 107937 0 124664 0 25500 0 36344 0 791467 0 0 SHERYN ABRAHAM MD PEDIATRIC PHYSICIAN 478716 0 14600 0 21742 0 10250 0 28943 0 554251 0 0 0 AARON HANSON MD PEDIATRIC PHYSICIAN 259881 0 132360 0 21710 0 10250 0 41717 0 465918 0 0 0 PATTI-MARIE YOUNG MD PEDIATRIC PHYSICIAN 393998 0 18935 0 2322 0 10250 0 708 0 426213 0 0 0 CHRISTOPHER SCHWAKE MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 351933 0 11000 0 810 0 14778 0 34998 0 413519 0 0 0 AMY HERBST MD VP BEHAVIORAL & MENTAL HEALTH 0 282425 0 42330 0 19062 0 25500 0 35632 0 404949 0 0 AMY ROMASHKO MD URGENT CARE MED/PROGRAM DIRECTOR 0 301913 0 19790 0 16975 0 22450 0 36433 0 397561 0 0 DAVID MEULER MD PEDIATRIC PHYSICIAN 304799 32623 9300 0 810 0 11229 0 33030 0 359168 32623 0 0 BOYD MILLER MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 303845 0 17919 0 15808 0 19400 0 30881 0 387853 0 0 0 JAYA IYER MD PEDIATRIC PHYSICIAN 340076 0 12550 0 21742 0 10250 0 1231 0 385849 0 0 0 ROXANNE KANE MD PEDIATRIC PHYSICIAN 290580 616 20050 0 21509 1888 10375 0 37661 0 380175 2504 0 0 STEVEN JEREB MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 282748 0 16774 0 12800 0 22450 0 35171 0 369943 0 0 0 YOLANDA WOLFF MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 281162 0 16362 0 14461 0 22450 0 29858 0 364293 0 0 0 MARY SISNEY VP PRIMARY CARE 240895 0 29565 0 3207 0 24376 0 36093 0 334136 0 0 0 DAVID OGREN MD PEDIATRIC PHYSICIAN 217073 0 31921 0 21907 0 10250 0 35240 0 316391 0 0 0 KATHRYNN FEE MD PEDIATRIC PHYSICIAN 244228 0 12900 0 20986 0 10250 0 2922 0 291286 0 0 0 CHRISTEN MCALPINE-TESFAI MD PEDIATRIC PHYSICIAN/VICE CHAIR 252465 0 26057 0 537 0 10250 0 654 0 289963 0 0 0 CYNTHIA RUNNING MD PEDIATRIC PHYSICIAN 185258 0 31590 0 990 0 9156 0 35047 0 262041 0 0 0 BARBARA CALKINS MD PEDIATRIC PHYSICIAN/CHAIR 224294 0 11150 0 1043 0 9418 0 359 0 246264 0 0 0 BRILLIANT NIMMER MD PEDIATRIC PHYSICIAN 179673 0 5110 0 372 0 2923 0 31377 0 219455 0 0 0 AMANDA KOTOWSKI APNP NURSE PRACTITIONER 77738 53948 1100 4600 732 0 11315 0 12601 0 103486 58548 0 0 PART I, LINE 3 CMG RELIED UPON CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. ("CHHS"), THE CORPORATE MEMBER OF CMG, TO ESTABLISH THE COMPENSATION OF CMG'S PRESIDENT. CHHS USED ITS INDEPENDENT COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, THE FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEYS, AND APPROVAL BY THE COMPENSATION COMMITTEE TO DETERMINE THE COMPENSATION. PART I, LINE 4B IN 2022, THERE WAS A CHHS EXECUTIVE FLEXIBLE BENEFIT PLAN IN PLACE WHICH WAS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN (457(F) PLAN). THE CORPORATION CONTRIBUTES 10% OF EACH PARTICIPATING EXECUTIVE'S SALARY. THE AMOUNTS OF EMPLOYER CONTRIBUTIONS TO THIS PLAN FOR PARTICIPATING EXECUTIVES IN 2022 WERE AS FOLLOWS: M. CADIEUX, $100,807, S. KHARE, M.D., $79,975, AND M. METTNER, $60,017. AFTER A VESTING PERIOD, PARTICIPANTS MAY ELECT TO WITHDRAW AMOUNTS PREVIOUSLY CONTRIBUTED AND REPORTED. AMOUNTS WITHDRAWN BY PARTICIPANTS IN 2022 WERE: M. CADIEUX, $133,747; S. KHARE, M.D, $93,159; AND M. METTNER, $93,242. 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. FORM 990, PART VII, COLUMN E & SCHEDULE J, PART II: SALARIES PAID BY RELATED ORGANIZATIONS: 1. SMRITI KHARE, M.D., SVP AND CHIEF MENTAL & BEHAVIORAL HEALTH OFFICER AND FORMER PRESIDENT OF CMG AND BOARD CHAIR 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 CMG. THESE AMOUNTS WERE PAID BY CHHS. SERVICES BY DR. KHARE AS A MEMBER OF THE BOARD OF DIRECTORS WERE PROVIDED ON A PART-TIME VOLUNTARY BASIS. 2. DRS. CALKINS, FEE, MCALPINE-TESFAI, RUNNING, HANSON, OGREN, NIMMER, ROMASHKO AND NURSE PRACTITIONER KOTOWSKI- COMPENSATION AND BENEFITS LISTED WERE FOR SERVICES PROVIDED AS FULL-TIME EMPLOYEES OF CMG. SERVICES AS MEMBERS OF THE BOARD OF DIRECTORS WERE PROVIDED ON A PART-TIME VOLUNTARY BASIS. 3. MARGARET TROY, PRESIDENT & CEO OF CHHS, MARC CADIEUX, TREASURER OF CMG AND TREASURER & CFO OF CHHS, AND MICHELLE METTNER, SECRETARY OF CMG AND CORP VP GOVT & LEGAL AFFAIRS - 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 AS A MEMBER OF THE BOARD OF DIRECTORS OF CMG WERE PROVIDED ON A PART-TIME VOLUNTARY BASIS. 4. MICHAEL GUTZEIT, M.D., PRESIDENT OF CMG AND BOARD CHAIR 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 CMG. THESE AMOUNTS WERE PAID BY CHHS AND CHILDREN'S HOSPITAL OF WISCONSIN, INC. SERVICES BY DR. GUTZEIT AS A MEMBER OF THE BOARD OF DIRECTORS WERE PROVIDED ON A PART-TIME VOLUNTARY BASIS. FORM 990, BOX C, DOING BUSINESS AS: CHILDREN'S WISCONSIN - PRIMARY CARE 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 A RELATED ENTITY, CHILDREN'S HOSPITAL OF WISCONSIN, INC. ("CHW"), WITH APPROPRIATE INTERCOMPANY ARRANGEMENTS BETWEEN THE ORGANIZATION AND CHW. THE FORMS 1099 FOR SUCH PAYMENTS WERE ISSUED BY CHW, AS THE ENTITY THAT PROCESSED AND MADE THE PAYMENTS TO THE INDEPENDENT CONTRACTORS. FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS EXIST BETWEEN THE FOLLOWING BOARD MEMBERS: TROY AND LEVY, AND TROY AND JARZEMBOWSKI. FORM 990, PART VI, SECTION A, LINE 4 BYLAWS: ARTICLE III BOARD OF DIRECTORS SECTION 2 - NUMBER AND QUALIFICATIONS OF DIRECTORS - NUMBER: INCREASED THE NUMBER OF CMG DIRECTORS FROM ELEVEN (11) TO FIFTEEN (15) - QUALIFICATIONS: REVISED THE QUALIFICATIONS FOR CMG TO INCLUDE ONE (1) PHYSICIAN APPOINTED BY CMG BOARD AND APPROVED BY THE MEMBER WHO MAY BE EMPLOYED BY A PERSON OTHER THAN THE CORPORATION, TO INCLUDE (1) ADVANCE PRACTICE PROVIDER ("APP"), AND NINE (9) DIRECTORS THAT SHALL BE PHYSICIANS - EX OFFICIO DIRECTORS: UPDATED THE EX OFFICIO DIRECTORS TO INCLUDE THE CHILDREN'S URGENT CARE MEDICAL DIRECTOR SECTION 17 - COMMITTEES - OTHER COMMITTEE: ALLOWS FOR OTHER COMMITTEES, NOT HAVING NOR EXERCISING THE AUTHORITY OF THE BOARD OF DIRECTORS, TO BE DESIGNATED BY RESOLUTION OF THE BOARD OF DIRECTORS. COMMITTEES CREATED BY ACTION OF THE BOARD OF DIRECTORS FROM TIME TO TIME SHALL OPERATE UNDER SUCH RULES AND DIRECTIVES AS MAY BE ESTABLISHED BY THE BOARD OF DIRECTORS AN IN A MANNER CONSISTENT WITH ALL APPLICABLE STATE AND FEDERAL LAWS, INCLUDING WIS. STAT. 181.0825. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A SOLE CORPORATE MEMBER WHICH IS CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. (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; AND APPROVAL OF THE ANNUAL BUDGET AND ANY DEBT. THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF CHHS SELECTS THE PRESIDENT. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 OF CMG WAS REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE OF CHHS BOARD OF DIRECTORS, AND PRIOR TO FILING, A COPY WAS PROVIDED TO ALL DIRECTORS OF CMG. 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 COMPENSATION OF THE ORGANIZATION'S OFFICERS 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 KEY EMPLOYEE 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 CMG ARE AVAILABLE TO THE PUBLIC UPON REQUEST THROUGH THE CHHS MARKETING AND COMMUNICATION DEPARTMENT. FORM 990, PART I, LINE 4 AND PART VI, LINE 1B CHILDREN'S MEDICAL GROUP, INC. ("CMG") IS A WISCONSIN NONSTOCK CORPORATION. CMG IS AN AFFILIATE OF CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. ("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 AND SURROUNDING AREAS. AS THE CORPORATE MEMBER OF CMG, CHHS HOLDS VARIOUS RESERVE POWERS IN RELATION TO CMG, INCLUDING AUTHORITY TO APPOINT CMG'S BOARD OF DIRECTORS. THE BOARD OF DIRECTORS OF CMG CONSISTS OF CERTAIN PHYSICIANS WHO ARE EMPLOYED BY CMG, ALONG WITH REPRESENTATIVES OF CHHS'S EXECUTIVE LEADERSHIP. AS EMPLOYEES OF EITHER CMG OR CHHS, NONE OF THESE DIRECTORS MAY 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. CMG MEETS THIS STANDARD BECAUSE IT IS A CONTROLLED SUBSIDIARY OF CHHS, AND CHHS'S GOVERNING BOARD INCLUDES INDEPENDENT COMMUNITY MEMBERS AS A MAJORITY THEREOF. CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 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 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 0 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 0 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 0 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 0 CHILDREN'S SPECIALTY GROUP INC PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 391990012 PEDIATRIC PHYSICIAN SERVICES WI 501(C)(3) LINE 12A, I N/A 0 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 1 0 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1