2025-01-15T11:44:55-06:00 2023-12-31 331498605 PLANTE & MORAN PLLC 3000 TOWN CENTER SUITE 100 SOUTHFIELD MI 48075 990 2023-01-01 351931354 MDWISE INC MDWI 3178227100 2955 N MERIDIAN STREET INDIANAPOLIS IN 46208 DAVID MAZURKIEWICZ SENIOR VICE PRESIDENT & CFO 3178227100 2025-01-14 1 1 AMY CIMINELLO P00796388 2483522500 2025-01-14 2023 2024-10-15 13:58:12Z X JESSICA CROMER 2955 N MERIDIAN STREET INDIANAPOLIS IN 46208 1962990873 0 X WWW.MDWISE.ORG X 1994 IN MDWISE IS A NOT-FOR-PROFIT HEALTH MAINTENANCE ORGANIZATION CONTRACTING WITH HEALTHCARE PROVIDERS TO PROVIDE SERVICES TO ITS MEMBERS FOR TWO STATE MEDICAID PROGRAMS: HOOSIER HEALTHWISE (HHW) AND HEALTHY INDIANA PLAN (HIP) AS WELL AS THE MEDICARE ADVANTAGE PROGRAM WITHIN SELECT COUNTIES IN THE STATE OF INDIANA. 5 0 0 4 0 0 0 0 1869778925 1954249787 3350004 8741086 1631 0 1873130560 1962990873 434375 507631 0 0 23627479 27841044 0 0 0 1796157767 1874905675 1820219621 1903254350 52910939 59736523 686951288 693759619 412302310 455455582 274648978 238304037 TO PROVIDE HIGH-QUALITY, AFFORDABLE HEALTHCARE AND IMPROVE THE WELL-BEING OF OUR MEMBERS BY ENGAGING EXCEPTIONAL ASSOCIATES, COMMUNITY LEADERS AND HEALTHCARE PROFESSIONALS. 0 0 1886394561 507631 1953820290 BEGINNING JANUARY 1, 2023, MDWISE WAS GRANTED A FOUR-YEAR CONTRACT WITH THE STATE OF INDIANA THROUGH THE FAMILY AND SOCIAL SERVICE ADMINISTRATION ("FSSA") AND OFFICE OF MEDICAID POLICY AND PLANNING ("OMPP"), TO ARRANGE FOR AND ADMINISTER TWO RISK-BASED MANAGED CARE PROGRAMS (HOOSIER HEALTHWISE AND THE HEALTHY INDIANA PLAN) FOR CERTAIN INDIANA MEDICAID ENROLLEES. MDWISE CONTRACTS WITH VARIOUS DELIVERY NETWORKS INCLUDING THE AFFILIATED MDWISE MEDICAID NETWORK ("MDWISE EXCEL"). EXCEL AND THE OTHER DELIVERY NETWORKS ACCEPT THE MEDICAL SERVICE RISK FOR ENROLLEES WHO CHOOSE A PRIMARY CARE PROVIDER AFTER SELECTING THE MDWISE NETWORK. 5897600 429497 BEGINNING JANUARY 1, 2022, MDWISE WAS GRANTED A ONE-YEAR CONTRACT WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES ("CMS") TO ARRANGE FOR AND ADMINISTER THE MEDICARE ADVANTAGE PROGRAMS IN SELECT COUNTIES WITHIN THE STATE OF INDIANA. THIS CONTRACT HAS BEEN RENEWED FOR 2023. 1892292161 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 3416 0 1 0 0 0 0 0 0 0 0 0 X 5 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IN X TRICIA BRUNTON 3178227116 2955 N MERIDIAN STREET INDIANAPOLIS IN 46208 X JESSICA CROMER PRESIDENT, CEO 25.00 25.00 X X 0 569690 27569 DAVID MAZURKIEWICZ TREASURER 0.50 49.50 X X 0 1729965 40372 KATHLEEN KENDALL SECRETARY 1.00 49.00 X X 0 1285315 50711 BRIAN BROWN CHAIRMAN 0.50 42.50 X X 0 329876 29423 KEVIN TOMPKINS CHAIRMAN - PART YEAR 0.50 43.50 X X 0 869202 49070 CHERYL DIEHL ASSISTANT TREASURER AND CFO 1.00 49.00 X X 0 345907 57387 PATRICIA HEBENSTREIT VP GENERAL COUNSEL 40.00 0.00 X 0 388864 25752 TRICIA BRUNTON VP FINANCE 40.00 0.00 X 0 235402 22877 CHASITY HOWELL VP PROVIDER SERVICES 40.00 0.00 X 0 216563 32821 BRITTNEY MULLANEY VP HEALTH SERVICES 40.00 0.00 X 0 217160 31414 TORRIAUN EVERETT VP HEALTH PLAN OPERATIONS 40.00 0.00 X 0 173514 17403 0 6361458 384799 0 0 1 0 MODIVCARE SOLUTIONS LLC 6900 LAYTON AVE STE 1200 DENVER CO 80237 TRANSPORTATION 7290190 ROBAILEY CONSULTING LLC 5556 E 74TH PL INDIANAPOLIS IN 46250 CONSULTING 1813253 COTIVITI INC PO BOX 5459 NEW YORK NY 10087 DATA ANALYTICS 1220022 WILLIAMS RANDALL MARKETING 21 VIRGINIA AVE STE 400 INDIANAPOLIS IN 46204 CONSULTING 952762 SUMMIT MANAGED SOLUTIONS 10502 POKAGON WAY INDIANAPOLIS IN 46239 CONSULTING 896908 16 HEALTHY INDIANA PLAN 900099 1253468303 1253468303 HOOSIER HEALTHWISE 900099 700351987 700351987 MEDICARE ADVANTAGE 900099 429497 429497 1954249787 8741086 8741086 1962990873 1954249787 0 8741086 507631 507631 22215588 18883250 3332338 880980 748833 132147 3473044 2952087 520957 1271432 1080717 190715 28254 24016 4238 137628 116984 20644 108680 108680 132055 132055 17410992 14799343 2611649 2992198 2992198 3023092 2569628 453464 9039070 7683209 1355861 1200899 1020764 180135 79254 67366 11888 1477 1255 222 10470977 8900330 1570647 1115964 948570 167394 32164 32164 DELIVERY SYSTEM PAYMENT 1825019436 1825019436 CHANGE IN PREMIUM DEFIC 2190741 2190741 CORPORATE ALLOCATIONS 1184742 1007031 177711 MEDICARE MEDICAL EXPENS 284985 284985 453067 385107 67960 1903254350 1892292161 10962189 0 225886974 203700948 394799586 417968551 7435935 7435935 28740 0 66235988 72090120 686951288 693759619 57828949 73853537 0 30 354473361 381602015 412302310 455455582 X 274648978 238304037 274648978 238304037 686951288 693759619 X 59736523 3492951 -99574415 X X 0 1 X 1 0 7435935 7435935 0 0 PAYABLE TO IN FOR CAPITATION 65336399 PAYABLE TO DELIVERY SYSTEMS 262104499 DUE TO DELIVERY SYSTEMS 48178815 ACCOUNTS PAYABLE - PFAC 264452 UNPAID CLAIM ADJUSTMENT PAYABLE 1516329 PREMIUM DEFICIENCY RESERVES 4128971 MEDICAL CLAIMS PAYABLE 39255 PAY TO CMS - MEDICARE ADVANTAGE 33295 381602015 1962855201 0 1962855201 135672 135672 1962990873 1903118683 0 1903118683 135667 135667 1903254350 PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUE NET WITH EXPENSES FOR FINANCIAL STATEMENT REPORTING 135,672. PART XII, LINE 4B - OTHER ADJUSTMENTS: REVENUE NET WITH EXPENSES FOR FINANCIAL STATEMENT REPORTING 135,667. 1 ABOUT SPECIAL KIDS LLC 7172 GRAHAM RD SUITE 100 INDIANAPOLIS IN 46250 351711669 501(C)3 80000 0 GENERAL SUPPORT ALLEGRA MARKETING PRINT MAIL 2863 JOLLY RD OKEMOS MI 48864 382961436 501(C)3 7830 0 GENERAL SUPPORT DAMIEN CENTER INC 26 N ARESNAL AVE INDIANAPOLIS IN 46201 351711878 501(C)3 7500 0 GENERAL SUPPORT GA FOOD SERVICES OF PINELLAS COUNTY LLC 12200 32ND CT NORTH ST PETERSBURG FL 33716 591485677 501(C)3 23767 0 GENERAL SUPPORT GAINWELL TECHNOLOGIES LLC 355 LEDGELAWN DR CONWAY AR 72034 851850812 501(C)3 6500 0 GENERAL SUPPORT INDIANA BLACK EXPO INIDIANAPOLIS CHAPTER 9511 ANGOLA CT 304 INDIANAPOLIS IN 46268 351902763 501(C)3 7500 0 GENERAL SUPPORT INDIANA COUNCIL OF COMMUNITY MENTAL PO BOX 875 CARMEL IN 46082 351443105 501(C)3 6000 0 GENERAL SUPPORT INDIANA LATINO EXPO 1113 E 86TH STREET STE 111 INDIANAPOLIS IN 46240 453636574 501(C)3 10000 0 GENERAL SUPPORT INDIANA PRIMARY HEALTH CARE ASSOCIATION 150 W MARKET STE 520 INDIANAPOLIS IN 46204 311068777 501(C)3 10000 0 GENERAL SUPPORT INDIANAPOLIS PUBLIC SCHOOLS FOUNDATION 120 E WALNUT ST INDIANAPOLIS IN 46204 311103966 501(C)3 10000 0 GENERAL SUPPORT INDIANAPOLIS ZOO 1200 W WASHINGTON STREET INDIANAPOLIS IN 46222 351074747 501(C)3 25000 0 GENERAL SUPPORT MENTAL HEALTH AMERICA OF INDIANA 1431 N DELAWARE ST INDIANAPOLIS IN 46208 350896905 501(C)3 10000 0 GENERAL SUPPORT MIDWEST URBAN STRATEGIES 890 ELM GROVE RD 110-2 ELM GROVE WI 53122 833892791 501(C)3 50000 0 GENERAL SUPPORT SHALOM HEALTH CARE CENTER 3400 LAFAYETTE RD STE 200 INDIANAPOLIS IN 46222 061645027 501(C)3 12000 0 GENERAL SUPPORT STATE OF INDIANA 302 W WASHINGTON STREET INDIANAPOLIS IN 46204 356000158 115 10200 0 GENERAL SUPPORT TRANS SOLUTIONS RESEARCH AND RESOURCE 104 E 38TH ST INDIANAPOLIS IN 46205 862432078 501(C)3 10000 0 GENERAL SUPPORT WARREN ARTS & EDUCATION FOUNDATION INC 975 N POST RD INDIANAPOLIS IN 46219 351572560 501(C)3 15000 0 GENERAL SUPPORT 17 0 PART I, LINE 2: MDWISE HAS A CORPORATE GIVING COMMITTEE THAT REQUESTS CERTAIN INFORMATION FROM EACH GRANTEE ORGANIZATION IN ORDER TO EVALUATE AND MEASURE IMPACT TO SEE HOW MEMBERS OF MDWISE BENEFIT FROM THE GRANTEE ORGANIZATION. MDWISE DOES NOT HAVE A FORMAL PROCEDURE TO FOLLOW-UP WITH THE GRANTEE ORGANIZATIONS AFTER FUNDS ARE AWARDED BUT USES INFORMAL COMMUNICATIONS TO UNDERSTAND HOW CONTRIBUTIONS ARE USED. 0 1 0 0 0 0 0 0 0 DAVID MAZURKIEWICZ TREASURER 0 1287110 0 404214 0 38641 0 3526 0 36846 0 1770337 0 0 KATHLEEN KENDALL SECRETARY 0 829576 0 400167 0 55572 0 2273 0 48438 0 1336026 0 0 KEVIN TOMPKINS CHAIRMAN - PART YEAR 0 623386 0 207175 0 38641 0 1708 0 47362 0 918272 0 0 JESSICA CROMER PRESIDENT, CEO 0 353944 0 177777 0 37969 0 1134 0 26435 0 597259 0 0 PATRICIA HEBENSTREIT VP GENERAL COUNSEL 0 302635 0 76393 0 9836 0 0 0 25752 0 414616 0 0 CHERYL DIEHL ASSISTANT TREASURER AND CFO 0 279777 0 66130 0 0 0 10784 0 46603 0 403294 0 0 BRIAN BROWN CHAIRMAN 0 286315 0 32470 0 11091 0 1253 0 28170 0 359299 0 0 TRICIA BRUNTON VP FINANCE 0 210162 0 25240 0 0 0 0 0 22877 0 258279 0 0 CHASITY HOWELL VP PROVIDER SERVICES 0 193125 0 23438 0 0 0 0 0 32821 0 249384 0 0 BRITTNEY MULLANEY VP HEALTH SERVICES 0 175306 0 41854 0 0 0 0 0 31414 0 248574 0 0 TORRIAUN EVERETT VP HEALTH PLAN OPERATIONS 0 167778 0 0 0 5736 0 0 0 17403 0 190917 0 0 PART I, LINE 1A THE CEO/EXECUTIVE DIRECTOR WAS COMPENSATED BY A RELATED ORGANIZATION, AND THEREFORE NONE OF THE LINE 1 BOXES HAVE BEEN CHECKED. THE CORPORATE CEO, SUBSIDIARY CEOS AND CORPORATE EXECUTIVE & SENIOR VICE-PRESIDENTS IN SOME INSTANCES HAVE RECEIVED TAX INDEMNIFICATION FOR THE FOLLOWING BENEFITS: VEHICLE COSTS, GROUP TERM LIFE INSURANCE, SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS, AND HEALTH CLUB OR SOCIAL DUES. THESE BENEFITS HAVE BEEN INCLUDED IN TAXABLE COMPENSATION. PART I, LINE 3 THE CEO/EXECUTIVE DIRECTOR WAS COMPENSATED BY A RELATED ORGANIZATION, AND THEREFORE NONE OF THE LINE 3 BOXES HAVE BEEN CHECKED. THE RELATED ORGANIZATION USED THE FOLLOWING METHODOLOGIES TO ESTABLISH THE COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR OF THE FILING ORGANIZATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B MDWISE MAINTAINS TWO SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS FOR A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES (THE "SERPS"). THE OLD SERP WAS CLOSED TO NEW PARTICIPANTS ON OCTOBER 1, 2006, AND THE NEW SERP BECAME EFFECTIVE AS OF JANUARY 1, 2007. NO EMPLOYEE MAY PARTICIPATE IN BOTH OF THE SERPS. THE OLD SERP IS STRUCTURED AS A DEFINED BENEFIT PLAN THAT ESSENTIALLY REPLACES THE BENEFITS THE PARTICIPANT IS NOT PERMITTED TO RECEIVE UNDER MDWISE'S QUALIFIED RETIREMENT PLAN DUE TO IRS LIMITATIONS APPLICABLE TO QUALIFIED PLANS. THE BENEFIT UNDER THE OLD SERP IS PAYABLE IN EITHER THE FORM OF A LUMP SUM DISTRIBUTION OR IN MONTHLY PAYMENTS EQUAL TO THE ACTUARIAL EQUIVALENT OF THE PARTICIPANT'S ACCRUED BENEFIT. THE BENEFIT IS PAID AT AGE 55, AND IF THE PARTICIPANT REMAINS EMPLOYED, THE BENEFIT IS PAID UPON TERMINATION OF EMPLOYMENT, REDUCED TO TAKE INTO ACCOUNT THE BENEFIT PREVIOUSLY PAID. THE NEW SERP IS STRUCTURED AS A DEFINED CONTRIBUTION PLAN, AND MDWISE CONTRIBUTES 15 PERCENT OF EACH PARTICIPANT'S COMPENSATION TO THE PLAN EACH YEAR FOR ALLOCATION TO THE PARTICIPANT'S ACCOUNT. PARTICIPANTS IN THE NEW SERP BECOME VESTED IN THEIR ACCOUNTS UPON THE EARLIER OF FIVE YEARS OF PARTICIPATION IN THE PLAN OR ATTAINMENT OF AGE 60. PARTICIPANTS IN THE NEW SERP SELF-DIRECT THE INVESTMENT OF THEIR ACCOUNTS AND HAVE THE ACTUAL INVESTMENT RETURN CREDITED OR DEBITED TO THEIR ACCOUNTS. THE BENEFIT UNDER THE NEW SERP IS EQUAL TO THE PARTICIPANT'S ACCOUNT BALANCE, AND THE BENEFIT IS PAID IN A SINGLE SUM WITHIN 60 DAYS OF THE PARTICIPANT'S TERMINATION DATE. BENEFITS UNDER BOTH SERPS ARE PROVIDED ON A TAX-NEUTRAL BASIS. BOTH SERPS ARE DESIGNED TO COMPLY WITH INTERNAL REVENUE CODE SECTIONS 457(F) AND 409A. PART I, LINE 7 MDWISE'S PARENT COMPANY, MCLAREN HEALTH CARE (MHC), HAS A LEADERSHIP INCENTIVE PROGRAM FOR LEADERS OF THE CORPORATION, SUBSIDIARY EXECUTIVES AND DIRECTORS, MANAGERS AND SUPERVISORS. THE PURPOSE OF THE PLAN IS TO ENHANCE THE ORGANIZATION'S ABILITY TO ACHIEVE ITS GOALS BY PROVIDING TOP OFFICIALS AND THE BOARD OF DIRECTORS WITH A TOOL FOR (A) CLEARLY COMMUNICATING PERFORMANCE ON THE PART OF KEY LEADERS, (B) STIMULATING AND REWARDING SUPERIOR LEVELS OF PERFORMANCE ON THE PART OF KEY LEADERS WHICH WILL ULTIMATELY BENEFIT THE COMMUNITIES MHC SERVES, AND (C) PROTECTING MHC'S ABILITY TO COMPETE WITH OTHER EMPLOYERS FOR HIGH-TALENT LEADERS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THIS ORGANIZATION IS MCLAREN INTEGRATED HMO GROUP. FORM 990, PART VI, SECTION A, LINE 7A MCLAREN INTEGRATED HMO GROUP, MDWISE'S SOLE MEMBER HAS THE POWER TO APPOINT THE BOARD OF DIRECTORS FORM 990, PART VI, SECTION A, LINE 7B DECISIONS BY THE GOVERNING BODY ARE SUBJECT TO THE POWERS OF THE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY MDWISE'S PRESIDENT & CEO AND ALSO BY THE CFO PRIOR TO FILING. AS PART OF AN INTEGRATED HEALTH SYSTEM, THE PARENT BOARD ALSO REVIEWS THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C EACH MDWISE BOARD MEMBER, OFFICER AND SENIOR MANAGEMENT EXECUTIVE COMPLETES THE MDWISE CONFLICT OF INTEREST DISCLOSURE FORM ANNUALLY. THE BOARD CHAIR AND PRESIDENT/CEO REVIEW ALL COMPLETED FORMS TO IDENTIFY ANY POTENTIAL CONFLICTS. ANY IDENTIFIED POTENTIAL CONFLICT IS INVESTIGATED AND RAISED WITH THE INDIVIDUAL, AS APPROPRIATE, TO RESOLVE THE CONFLICT OR DETERMINE IF ANY ACTION IS NEEDED, UP TO AND INCLUDING, POSSIBLE REMOVAL FROM THE BOARD, OR OFFICER/SENIOR MANAGEMENT POSITION. ANY IDENTIFIED CONFLICTS ARE REPORTED TO THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 ALL OFFICERS OF MDWISE, INC. ARE EMPLOYEES OF AN AFFILIATED ENTITY MCLAREN INTEGRATED HMO GROUP. TO ENSURE A FAIR, COMPETITIVE AND LEGALLY COMPLIANT METHOD OF ADMINISTERING COMPENSATION, MCLAREN INTEGRATED HMO GROUP USES INDEPENDENT COMPENSATION STUDIES AND SURVEY DATA TO ESTABLISH THE COMPENSATION STRUCTURE FOR THE MDWISE CEO AND OFFICERS. COMPENSATION FOR THE CEO AND OFFICERS ARE REVIEWED ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. PART VII AND SCHEDULE J THIS FY 2023 RETURN IS BEING AMENDED TO PROPERLY CATEGORIZE COMPENSATION AND HOURS ON PART VII AND SCHEDULE J. FORM 990, PART XI, LINE 9: CHANGE IN NONADMITTED ASSET -99,574,415. PART XII, LINE 1: MDWISE, INC. USES THE STATUTORY METHOD OF ACCOUNTING. PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS FROM PRIOR YEAR. MCLAREN BAY MEDICAL FOUNDATION 1900 COLUMBUS AVE BAY CITY MI 48708 382156534 FOUNDATION MI 501(C)(3) LINE 12A, I MCLAREN BAY REGION 1 MCLAREN BAY REGION 1900 COLUMBUS AVE BAY CITY MI 48708 381976271 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 BAY REGIONAL MEDICAL CENTER AUXILIARY 1908 COLUMBUS AVENUE BAY CITY MI 48708 386081235 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 12A, I MCLAREN BAY REGION 1 MCLAREN BAY SPECIAL CARE 3250 E MIDLAND ROAD STE 1 BAY CITY MI 48706 383161753 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN BAY REGION 1 MCLAREN CENTRAL MICHIGAN 1221 SOUTH DRIVE MT PLEASANT MI 48858 381420304 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 CHARLEVOIX NURSING HOME CORPORATION DBA BOULDER PARK TERRACE 14676 WEST UPRIGHT CHARLEVOIX MI 49720 383038683 SKILLED NURSING FACILITY MI 501(C)(3) LINE 10 MCLAREN NORTHERN MICHIGAN 1 KARMANOS CANCER FOUNDATION 4100 JOHN R ST DETROIT MI 48201 383584572 FOUNDATION MI 501(C)(3) LINE 7 BARBARA ANN KARMANOS CANCER 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