2025-11-17T10:51:45-06:00 2024-12-31 331498605 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2024-01-01 270093404 MY CHOICE WISCONSIN HEALTH PLAN INC MYCH 4144058034 5400 S 60TH STREET GREENDALE WI 53129 MARIA LEDGER CHIEF EXECUTIVE OFFICER 4144058034 2025-11-16 1 1 DAVID LOWENTHAL P00378651 3122071040 2025-11-15 2024 2025-03-06 01:10:19Z X X MARIA LEDGER 5400 S 60TH STREET GREENDALE WI 53129 7992170 0 X N/A X 2004 WI PROMOTE THE QUALITY OF LIFE OF OUR COMMUNITIES BY EMPOWERING OTHERS' LONG TERM CARE NEEDS. X 9 9 0 0 0 0 0 0 136460285 0 1857089 2467159 2073484 0 140390858 2467159 0 0 113582892 0 0 106933 0 0 0 25933468 186069 139516360 293002 874498 2174157 59548184 0 0 0 59548184 0 X MY CHOICE WISCONSIN HEALTH PLAN, INC. IS A NONPROFIT MANAGED CARE ORGANIZATION THAT MATCHES FRAIL SENIORS AND PEOPLE WITH PHYSICAL AND INTELLECTUAL DISABILITIES TO THE HEALTH CARE AND LONG-TERM SUPPORTS AND SERVICES THEY NEED. WE OFFER GOVERNMENT-FUNDED (MEDICARE AND MEDICAID) PROGRAMS AND PARTNER WITH PROVIDER TO CREATE STRONG, LOCAL PROVIDER NETWORKS. WE ARE DEDICATED TO OUR MISSIONS AND VALUES TO PROMOTE THE QUALITY OF LIFE OF OUR COMMUNITIES BY EMPOWERING OTHERS AND WORKING TOGETHER TO CREATIVELY SOLVE UNIQUE HEALTH AND LONG-TERM CARE NEEDS. 0 0 0 0 MY CHOICE WISCONSIN HEALTH PLAN, INC (MCWHP) OFFERED THE PARTNERSHIP PROGRAM, WHICH PROVIDED HEALTH AND LONG-TERM MANAGEMENT AND CARE SERVICES TO THE ELDERLY AND ADULTS WITH DISABILITIES. MCWHP'S PARTNERSHIP PROGRAM HAD APPROXIMATELY 1,400 MEMBERS. IN 2023, MY CHOICE WISCONSIN HEALTH PLAN, INC. SOLD ITS OPERATIONS TO MOLINA HEALTHCARE, INC. AND AS SUCH HAS DISSOLVED AS OF 12/31/2024. ALL REMAINING ASSETS HAVE BEEN TRANSFERRED TO A RELATED ORGANIZATION, THE TRILLIUM FOUNDATION, INC. MY CHOICE WISCONSIN HEALTH PLAN, INC BEGAN OFFERING A MEDICARE DUAL ADVANTAGE PROGRAM ON JANUARY 1, 2017, FOR INDIVIDUALS WHO HAVE BOTH MEDICARE AND MEDICAID. THE MEDICARE DUAL ADVANTAGE PROGRAM HAD APPROXIMATELY 800 MEMBERS. 1 0 0 0 0 0 0 0 0 0 0 0 0 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 1 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X MARIA LEDGER 4144058034 5400 S 60TH ST GREENDALE WI 53129 MARIA LEDGER DIRECTOR AND CEO 5.00 35.00 X X 0 949167 0 THOMAS ORENDORFF DIRECTOR AND CHAIR 1.00 4.00 X X 3334 6666 0 MICHAEL MAYO SR DIRECTOR AND VICE CHAIR 1.00 4.00 X X 3334 6666 0 MARIA RODRIGUEZ DIRECTOR AND TREASURER 1.00 2.00 X X 3334 6666 0 KENNETH BYOM DO DIRECTOR AND SECRETARY 1.00 2.00 X X 3333 6667 0 LYNDA KRELLWITZ DIRECTOR 1.00 2.00 X 3333 6667 0 LEE S SEESE DIRECTOR 1.00 4.00 X 3333 6667 0 THOMAS BERGERUD DIRECTOR 1.00 2.00 X 3333 6667 0 KATHRYN BRIETZMAN DIRECTOR 1.00 2.00 X 3333 6667 0 JOHN HINTZE DIRECTOR 1.00 2.00 X 3333 6667 0 JAMES HODSON CFO/COO 10.00 30.00 X 0 984000 0 KEVIN COLLINS FORMER CHIEF COMPLIANCE OFFICER 0.00 0.00 X 0 780000 0 BETSY VAN HEESCH FORMER CHIEF OPERATIONS OFFICER 0.00 0.00 X 0 750000 0 BRION BEAUCHENE FORMER CHIEF INFORMATION OFFICER 0.00 0.00 X 0 474490 0 30000 3997657 0 0 1 1 0 0 1249971 1249971 6742199 5525011 1217188 1217188 1217188 2467159 0 0 2467159 105833 105833 1100 1100 109547 109547 45089 45089 12580 12580 5336 5336 SURPLUS LINE TAX 9536 9536 NAIC 3561 3561 OCI FILING FEE 420 420 293002 0 293002 0 0 0 0 0 0 0 0 0 0 0 59548184 0 0 0 0 0 59548184 0 0 0 X 59548184 0 59548184 0 59548184 0 X 2174157 -61722341 X 0 0 0 X 211437893 198676131 202747795 136460283 0 749322102 211437893 198676131 202747795 136460283 749322102 0 0 0 749322102 1109523 763852 954952 1933765 1249971 6012063 1109523 763852 954952 1933765 1249971 6012063 19656 27617 22209 30870 0 100352 212567072 199467600 203724956 138424918 1249971 755434517 0.99190 0.99310 0.00800 0.00680 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER NON-OPERATING - 2020 AMOUNT: $ 19,656. 2021 AMOUNT: $ 27,617. 2022 AMOUNT: $ 22,209. 2023 AMOUNT: $ 30,870. 2024 AMOUNT: $ 0. 1 0 0 0 0 0 0 0 0 JAMES HODSON CFO/COO 0 100000 0 0 0 884000 0 0 0 0 0 984000 0 0 MARIA LEDGER DIRECTOR AND CEO 0 116667 0 0 0 832500 0 0 0 0 0 949167 0 0 KEVIN COLLINS FORMER CHIEF COMPLIANCE OFFICER 0 0 0 0 0 780000 0 0 0 0 0 780000 0 0 BETSY VAN HEESCH FORMER CHIEF OPERATIONS OFFICER 0 0 0 0 0 750000 0 0 0 0 0 750000 0 0 BRION BEAUCHENE FORMER CHIEF INFORMATION OFFICER 0 0 0 0 0 474490 0 0 0 0 0 474490 0 0 PART I, LINE 3 THE CEO 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 PART I, LINE 4A THE FOLLOWING INDIVIDUALS RECEIVED A CHANGE-OF-CONTROL PAYMENT RESULTING FROM THE SALE OF OPERATIONS OF RELATED ORGANIZATION, MY CHOICE WISCONSIN, INC. TO MOLINA HEALTHCARE, INC. IN SEPTEMBER 2023. CHANGE-OF-CONTROL PAYMENTS WERE PAID AND TREATED AS REPORTABLE COMPENSATION IN 2024. JAMES HODSON: $884,000 MARIA LEDGER: $832,500 KEVIN COLLINS: $780,000 BETSY VAN HEESCH: $750,000 BRION BEAUCHENE: $474,490 CASH AND INVESTMENT SECURITIES 2024-12-31 61722341 FMV AS PROVIDED BY INVESTMENT STATEMENTS 871303591 THE TRILLIUM FOUNDATION INC 5400 S 60TH ST GREENDALE WI 53129 501(C)(3) 1 0 0 0 0 1 1 1 0 PART I, LINE 2E: EXPLANATION OF INVOLVEMENT: CERTAIN DIRECTORS OR EMPLOYEES OF MY CHOICE WISCONSIN HEALTH PLAN, INC. WERE ALSO DIRECTORS OR EMPLOYEES OF THE TRILLIUM FOUNDATION, INC (FKA MY CHOICE FOUNDATION HOLDINGS) BEFORE AND AFTER THE TRANSFER OF ASSETS TO THE TRILLIUM FOUNDATION, INC. FORM 990, PART VI, SECTION A, LINE 6 MY CHOICE WISCONSIN, INC. A WISCONSIN NONPROFIT 501(C)(3) CORPORATION IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A EACH YEAR AT ITS ANNUAL MEETING, MY CHOICE WISCONSIN, INC., AS THE SOLE MEMBER OF THE ORGANIZATION, SHALL ELECT THE DIRECTORS ACCORDING TO THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS REQUIRE THE PRIOR AUTHORIZATION OR APPROVAL OF MY CHOICE WISCONSIN, INC. AS ITS SOLE MEMBER: A. MERGER, CONVERSION INTO A STOCK OR MUTUAL CORPORATION, OR VOLUNTARY DISSOLUTION OF THE CORPORATION; B. AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OF THE CORPORATION OR OF THE BYLAWS, EXCEPT AS PROVIDED IN ARTICLE XIII; C. A TRANSFER OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE CORPORATION; OR, D. THE ESTABLISHMENT, FORMATION, ACQUISITION, MERGER, CONSOLIDATION OR DISSOLUTION OF ANY SUBSIDIARY CORPORATION OF THE CORPORATION. E. ANY ACTION THAT WOULD AFFECT THE TAX-EXEMPT STATUS OF EITHER THE CORPORATION OR THE VOTING MEMBER. F. ACTION ON ANY MATTER THAT IS DETERMINED TO BE UNDER THE CONTROL OF THE VOTING MEMBER UNDER THE ARTICLES OF INCORPORATION, THE BYLAWS, OR CHAPTER 613 OF THE WISCONSIN STATUTES. FORM 990, PART VI, SECTION B, LINE 11B THE CHIEF FINANCIAL OFFICER PERFORMS A 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 COMPENSATION REPORTED IN FORM 990, PART VII, SECTION A, COLUMN (E) WERE PAID BY RELATED ORGANIZATION, MY CHOICE WISCONSIN, INC., FOR SERVICES PROVIDED TO MY CHOICE WISCONSIN HEALTH PLAN, INC. AND MY CHOICE WISCONSIN, INC. COMPENSATION REPORTED ON THE 2024 990 IS NOT FOR SERVICES PROVIDED IN 2024 BUT RATHER SEPARATION PAYMENTS RESULTING FROM THE SALE OF MY CHOICE HEALTH PLAN, INC. AND MY CHOICE WISCONSIN, INC TO MOLINA HEALTH. HISTORICALLY, FOR COMPENSATION PAID BY MY CHOICE WISCONSIN, INC. THE FINANCE COMMITTEE (THE COMMITTEE) OF THE BOARD OF DIRECTORS OF MY CHOICE WISCONSIN, INC WAS RESPONSIBLE FOR THE ANNUAL REVIEW OF THE COMPENSATION OF THE PRESIDENT/CEO OF THE ORGANIZATION. ALL MEMBERS OF THE COMMITTEE WERE INDEPENDENT IN DETERMINING THE COMPENSATION OF THE PRESIDENT/CEO. THE COMMITTEE EVALUATED THE CEO'S PERFORMANCE AGAINST PREVIOUSLY AGREED UPON CRITERIA, CONSIDERED COMPARABLE MARKET DATA, THEN DEBATEDAND DOCUMENTED ITS RECOMMENDATION OF REASONABLE COMPENSATION. THE PROCESS FOR DETERMINING COMPENSATION OF OFFICERS INCLUDED A MARKET ANALYSIS OF COMPARABLE POSITIONS FROM SIMILAR ORGANIZATIONS FOR BENCHMARKING PURPOSES. THIS INFORMATION WAS REVIEWED BY INTERNAL HUMAN RESOURCES PROFESSIONALS AND THE CEO. THE CEO EVALUATED THE OFFICERS PERFORMANCE AGAINST PREVIOUSLY AGREED UPON CRITERIA AND A DECISION IS MADE ON THE OFFICERS' SALARY. 2024 WAS THE FINAL YEAR IN WHICH REPORTABLE COMPENSATION WOULD BE PAID AND REPORTED BY MY CHOICE WISCONSIN, INC. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: RELATED PARTY ASSET TRANSFERS -61,722,341. MY CHOICE WISCONSIN INC 5400 S 50TH ST FRANKLIN WI 53132 811970070 CARE MGMT WI 501(C)(3) LINE 10 N/A 0 THE TRILLIUM FOUNDATION INC 5400 S 50TH ST FRANKLIN WI 53132 871303591 SUPPORTING ORG WI 501(C)(3) LINE 12A, I MY CHOICE WISCONSIN INC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0