2023-09-20T09:57:01-05:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 200 EAST WASHINGTON STREET APPLETON WI 549115481 990 2022-01-01 454681563 CATALPA HEALTH INC CATA 9207507000 4635 WEST COLLEGE AVENUE APPLETON WI 54914 TRACY GUIOU PRESIDENT AND CEO 9207507000 2023-09-14 1 TRACY GUIOU 999009999 1 MICHAEL VANDENHOGEN P00499282 9207318111 2023-09-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z TRACY GUIOU 4635 WEST COLLEGE AVENUE APPLETON WI 54914 11504456 0 X WWW.CATALPAHEALTH.ORG X 2012 WI HELPING CHILDREN AND FAMILIES IMPROVE THEIR MENTAL HEALTH AND WELLNESS. 8 8 0 63 0 0 3039105 3797577 8599698 7626368 164457 49359 -98394 -108144 11704866 11365160 0 0 0 0 7857527 9292719 0 0 183642 3411495 2672311 11269022 11965030 435844 -599870 11171079 9451883 5798964 5119526 5372115 4332357 HELPING CHILDREN AND FAMILIES IMPROVE THEIR MENTAL HEALTH AND WELLNESS. 0 0 9964576 7626368 CATALPA PROVIDES OUTPATIENT SERVICES, INCLUDING INDIVIDUAL AND GROUP THERAPY, PSYCHOLOGICAL AND NEUROPSYCHOLOGICAL TESTING, AND MEDICAL MANAGEMENT AND PREVENTION SERVICES FOR THE LOCAL PUBLIC SCHOOLS. 9964576 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 15 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 X 8 8 1 0 0 0 1 1 1 1 0 0 0 0 1 1 1 1 1 1 1 0 WI X TRACY GUIOU 9307507000 4635 WEST COLLEGE AVENUE APPLETON WI 54914 AMY HERBST MEMBER 2.00 X 0 0 0 ANNETTE LECHNIR MEMBER LEFT IN 2022 3.00 X 0 0 0 DAVID VANDER ZANDEN MEMBER 2.00 X 0 0 0 GAIL OSTRANDER SECRETARY 2.00 X X 0 0 0 JULIE MEYER TREASURER 4.00 X X 0 0 0 MICHAEL BERGMANN MEMBER 2.00 X 0 0 0 SHAUN GUNDERSON CHAIR 3.00 X X 0 0 0 WENDY BARTON MEMBER 2.00 X 0 0 0 HEATHER HOEFFLER MEMBER 2.00 X 0 0 0 PAUL KLISTER MEMBER LEFT IN 2022 2.00 X 0 0 0 CARRIE PENOVICH COO & FINANCIAL LEADER LEFT IN 2022 40.00 X 71881 0 2329 MARY DOWNS CEO LEFT IN 2022 40.00 X 33571 0 654 SCOTT RADTKE CHIEF CLINICAL OFFICER 40.00 X 173602 0 48788 TRACY GUIOU PRESIDENT AND CEO 40.00 X 218889 0 33560 BRENDA GLODOWSKI FINANCIAL LEADER 40.00 X 54000 0 0 ERIN VANDERLANGENBERG PSYCHOLOGIST 40.00 X 170057 0 47702 JANELLE JENSON ADV PRACTICE NURSE PRESCRIBER 40.00 X 207048 0 33747 JILLIAN SCHUH PEDIATRIC NEUROPSYCHOLOGIS 40.00 X 147773 0 52136 LISA ENGELHARDT ADV PRACTICE NURSE PRESCRIBER 40.00 X 165866 0 43943 MARK ROVICK PSYCHIATRIST 40.00 X 287990 0 47641 1530677 0 310500 12 0 1 0 INSPERITY PEO SERVICES LP 19001 CRESCENT SPRINGS DRIVE KINGWOOD TX 77339 CO-EMPLOYER & PAYROLL SERVICES 8725543 ENSEMBLE HEALTH PARTNERS 11511 REED HARTMAN HIGHWAY CINCINNATI OH 45241 BILLING SERVICES 335257 2 148872 2707208 251554 100441 589502 16245 3797577 OUTPATIENT REVENUE 621400 7626368 7626368 7626368 49018 49018 7228 6887 341 341 341 24265 251554 132409 -108144 -108144 11365160 7626368 0 -58785 637274 637274 7154608 6983518 47176 123914 184904 174573 9759 572 746464 684964 37920 23580 569469 505108 53779 10582 17954 17954 178062 178062 8837 8837 1057659 407243 634397 16019 43511 253 42479 779 155693 95012 59118 1563 108738 108738 655284 641220 10524 3540 29504 11677 17482 345 179092 174457 3469 1166 31396 27929 2728 739 MEDICAL SUPPLIES 69246 69246 EDUCATION 67226 42897 24014 315 REPAIRS AND MAINTENANCE 37099 36451 485 163 DUES AND SUBSCRIPTIONS 22151 86 21700 365 10859 1204 9655 11965030 9964576 1816812 183642 1811516 1034389 880322 888835 317407 319543 527397 632620 122600 73025 1531078 1277421 352994 253657 2963294 2522050 4195549 3727764 11171079 9451883 1237945 1371088 289753 0 4271266 3748438 5798964 5119526 X 4027730 3167955 1344385 1164402 5372115 4332357 11171079 9451883 X -599870 -488978 49090 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 244125 226679 17446 1286953 1050742 236211 253657 OPERATING RIGHT-OF-USE ASSET 3727764 3727764 OPERATING LEASE LIABILITIES 3748438 3748438 X 10999754 -488978 -488978 11488732 8837 -132409 -123572 11365160 12039512 83319 83319 11956193 8837 8837 11965030 PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE ORGANIZATION'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THE ORGANIZATION HAD NO UNRELATED BUSINESS TAXABLE INCOME FOR THE YEARS ENDED DECEMBER 31, 2022 AND 2021. IN ADDITION, THE ORGANIZATION QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A) AND HAS BEEN CLASSIFIED AS AN ORGANIZATION OTHER THAN A PRIVATE FOUNDATION UNDER SECTION 509(A)(2). THE ORGANIZATION IS ALSO EXEMPT FROM WISCONSIN INCOME TAXES. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES -132,409. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 132,409. BAD DEBT RECOVERIES, NET -49,090. POP! 275819 251554 24265 1500 27418 3382 100109 275819 251554 24265 1500 27418 3382 100109 132409 -108144 X X X X 0 0 0 0 0 0 0 1 0 MARK ROVICK PSYCHIATRIST 218004 0 69101 0 885 0 0 0 47641 0 335631 0 0 0 TRACY GUIOU PRESIDENT AND CEO 218889 0 0 0 0 0 5192 0 28368 0 252449 0 0 0 JANELLE JENSON ADV PRACTICE NURSE PRESCRIBER 101903 0 105145 0 0 0 8238 0 25509 0 240795 0 0 0 SCOTT RADTKE CHIEF CLINICAL OFFICER 135487 0 22890 0 15225 0 7378 0 41410 0 222390 0 0 0 ERIN VANDERLANGENBERG PSYCHOLOGIST 125834 0 40271 0 3952 0 6445 0 41257 0 217759 0 0 0 LISA ENGELHARDT ADV PRACTICE NURSE PRESCRIBER 88588 0 71333 0 5945 0 6913 0 37030 0 209809 0 0 0 JILLIAN SCHUH PEDIATRIC NEUROPSYCHOLOGIS 118376 0 25503 0 3894 0 5557 0 46579 0 199909 0 0 0 PART I, LINE 7 THE CEO DETERMINED THE BONUS AMOUNT FOR THE OTHER OFFICERS (NONFIXED PAYMENTS) BASED ON SET BENCHMARKS APPROVED BY THE BOARD. HIGHLY COMPENSATED EMPLOYEES RECEIVED BONUSES DURING THE YEAR BASED ON FORMULAS WHICH CONSIDER WORK RELATIVE VALUE UNITS (WRVU) EXCEEDING PRODUCTION BENCHMARKS. FORM 990, PART V, LINE 2A: THE ORGANIZATION HAD A CO-EMPLOYMENT AGREEMENT WITH INSPERITY PEO SERVICES, L.P. THE ORGANIZATION REPORTED NO EMPLOYEES ON 2022'S FORM W-3, AS THE ORGANIZATION'S EMPLOYEES WERE REPORTED AS EMPLOYEES OF INSPERITY PEO SERVICES, L.P. THE COMPENSATION PAID TO INSPERITY PEO SERVICES, L.P. FOR THESE EMPLOYEES IS INCLUDED IN THE FORM 990, PART VII, SECTION B. FORM 990, PART VI, SECTION A, LINE 1A THE BOARD IS COMPRISED OF SIX CLASS A DIRECTORS AND THREE CLASS B DIRECTORS. CLASS B DIRECTORS MAY NOT BE AN EMPLOYEE OF A MEMBER AND MAY NOT OTHERWISE BE UNDER THE CONTROL OF A MEMBER. A SIMPLE MAJORITY OF ALL DIRECTORS SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF BUSINESS AT ANY MEETING OF THE BOARD, PROVIDED, THAT AT LEAST ONE CLASS A DIRECTOR APPOINTED BY EACH MEMBER IS IN ATTENDANCE. FORM 990, PART VI, SECTION A, LINE 2 ANNETTE LECHNIR, HEATHER HOEFFLER, AND MICHAEL BERGMANN HAVE A BUSINESS RELATIONSHIP. GAIL OSTRANDER AND AMY HERBST HAVE A BUSINESS RELATIONSHIP. WENDY BARTON AND JULIE MEYER HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION HAS TWO CLASSES OF MEMBERS WITH MEMBERSHIP INTEREST IN THE CORPORATION. EACH CLASS HAS THE DESIGNATIONS, QUALIFICATIONS, REQUIREMENTS, VOTING RIGHTS AND OTHER RIGHTS OF MEMBERSHIP AS SET FORTH IN THE CORPORATION'S ARTICLES OF INCORPORATION AND ITS BYLAWS. AFFINITY HEALTH SYSTEM IS THE SOLE MEMBER IN THE MAJORITY MEMBERSHIP CLASS AND HOLDS A 70% MEMBERSHIP INTEREST. CHILDREN'S HOSPITAL OF WISCONSIN, INC. AND THEDACARE, INC. COMBINE TO MAKE UP THE MINORITY MEMBERSHIP CLASS AND EACH HOLDS A 15% MEMBERSHIP INTEREST. EACH MEMBER SHALL CONTRIBUTE FUNDS IN PROPORTION TO THEIR MEMBERSHIP INTEREST TO THE EXTENT THE CORPORATION SHOULD HAVE AN OPERATING LOSS IN ANY GIVEN YEAR. THE MAXIMUM CONTRIBUTION MEMBERS ARE OBLIGATED TO COLLECTIVELY CONTRIBUTE IS MUTALLY AGREED UPON BY THE MEMBERS. SEE FORM 990, PART VI, LINE 7A AND 7B FOR MEMBERS' RIGHTS TO ELECT BOARD MEMBERS AND MATTERS REQUIRING MEMBERS' APPROVAL. FORM 990, PART VI, SECTION A, LINE 7A EACH MEMBER SHALL HAVE A CONTINUING RIGHT TO APPOINT TWO CLASS A DIRECTORS. EACH MEMBER MAY NOMINATE A CLASS B DIRECTOR SUBJECT TO APPROVAL BY THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS SHALL REQUIRE UNANIMOUS APPROVAL OF THE MEMBERS: 1) MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION, 2) PARTICIPATION IN ANY JOINT VENTURE OR AFFILIATION BY THE CORPORATION, 3) AMENDMENT, RESTATEMENT, ALTERATION OR REPEAL OF THE ARTICLES OF INCORPORATION, 4) AMENDMENT, RESTATEMENT, ALTERATION OR REPEAL OF THE BYLAWS, 5) A SALE, LEASE, EXCHANGE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY OR ASSETS OF THE CORPORATION, 6) THE CALL FOR CONTRIBUTIONS FROM MEMBERS TO THE CORPORATION OR ASSESSMENTS AGAINST THE MEMBERS, OTHER THAN ANNUAL CONTRIBUTIONS DESCRIBED IN FORM 990, PART VI, LINE 6 EXPLANATION, 7) THE INCURRING BY THE CORPORATION OF INDEBTEDNESS FOR BORROWED FUNDS AND THE AMOUNT OF ANY SUCH INDEBTEDNESS, 8) ANY DISTRIBUTION OF ASSETS OF THE CORPORATION TO ONE OR MORE MEMBERS, 9) EXECUTION, AMENDMENT, OR TERMINATION OF ANY AGREEMENT BETWEEN THE CORPORATION AND ANY MEMBER, EXCEPT ANY AGREEMENT FOR ACCOUNTING SERVICES AS DESCRIBED IN #3 BELOW , 10) AN INCREASE OR DECREASE IN THE NUMBER OF DIRECTORS ON THE BOARD, 11) THE ADDITION OF NEW MEMBERS. ADDITIONALLY, THE FOLLOWING MATTERS REQUIRE APPROVAL BY THE MAJORITY MEMBER: 1) THE ESTABLISHMENT, FORMATION, ACQUISITION, MERGER, CONSOLIDATION OR DISSOLUTION OF ANY SUBSIDIARY OF THE CORPORATION; 2) THE SELECTION, APPOINTMENT AND REMOVAL OF PERSONS TO SERVE AS THE CORPORATION'S PRESIDENT, AND APPROVAL OF THE PRESIDENT'S EVALUATION; 3) THE SELECTION, APPOINTMENT AND REMOVAL OF THE CORPORATION'S AUDITORS, EXCEPT TO THE EXTENT THAT THE CORPORATION IS CONSIDERING APPOINTING OR HAS APPOINTED THE MAJORITY MEMBER AND/OR ONE OF THE MAJORITY MEMBER'S PARENTS, SUBSIDIARIES, AFFILIATES, OR RELATED COMPANIES TO PROVIDE ACCOUNTING SERVICES, IN WHICH CASE, THE APPROVAL OF THE MINORITY MEMBERS SHALL BE REQUIRED TO SELECT AND APPOINT SUCH ENTITY AS AUDITOR, AND THE MINORITY MEMBERS SHALL HAVE THE AUTHORITY TO, WITHOUT MAJORITY MEMBER APPROVAL: (I) REMOVE SUCH ENTITY AS AUDITOR; (II) INSPECT THE BOOKS AND RECORDS OF THE CORPORATION UPON REQUEST; (III) APPROVE THE CORPORATION'S AUDIT REPORT; AND/OR (IV) REQUIRE ANY BOARD MEMBER DEEMED BY THE MINORITY MEMBERS TO BE ASSOCIATED WITH THE MAJORITY MEMBER TO RECUSE HERSELF OR HIMSELF DURING DISCUSSIONS RELATED TO ACCOUNTING SERVICES; 4) THE ADOPTION OF THE OPERATING AND CAPITAL BUDGETS AND STRATEGIC PLANS FOR THE CORPORATION; 5) CAPITAL EXPENDITURES IN EXCESS OF FIFTY THOUSAND DOLLARS NOT ACCOUNTED FOR IN THE CAPITAL AND OPERATING BUDGETS OF THE CORPORATION; 6) THE SALE, LEASE, TRANSFER OR OTHER DISPOSITION OR ENCUMBERANCE OF ANY ASSET WITH A FAIR MARKET VALUE THAT EXCEEDS FIFTY THOUSAND DOLLARS THAT IS NOT PROVIDED FOR IN THE CAPITAL OR OPERATING BUDGETS OF THE CORPORATION; 7) THE ADDITION OF ANY NEW PROGRAM OR SERVICE IF THE NEW PROGRAM OR SERVICE MAY CONFLICT WITH THE DIRECTIVES; 8) THE MAJORITY MEMBER MAY REQUIRE THE CORPORATION TO DISCONTINUE ANY PROGRAM OR SERVICE THAT VIOLATES THE DIRECTIVES. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE A COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO THE FINANCIAL LEADER AND CEO FOR REVIEW AND APPROVAL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EMPLOYED OFFICERS ARE REQUIRED TO FILL OUT A CONFLICT OF INTEREST FORM THAT IS REVIEWED BY MANAGEMENT. BOARD MEMBERS ARE REQUIRED TO DISCLOSE THE EXISTENCE OF POSSIBLE CONFLICTS OF INTEREST. ANY POSSIBLE CONFLICTS ARE DISCUSSED AT THE BOARD LEVEL. BOARD MEMBERS WITH POSSIBLE CONFLICTS OF INTEREST DO NOT PARTICIPATE IN DISCUSSION NOR VOTE ON TRANSACTIONS THAT INVOLVE POSSIBLE CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 L15A.) THE COMPENSATION COMMITTEE REVIEWED THE CEO'S PERFORMANCE AND SALARY COMPARABILITY DATA. THE COMMITTEE'S CONCLUSIONS WERE THEN REVIEWED WITH THE BOARD. THE BOARD AGREED ON A SALARY ADJUSTMENT BASED ON THAT DIALOGUE, WHICH WAS CONTEMPORANEOUSLY SUBSTANTIATED. L15B.) INSPERITY COMPENSATION SERVICES WERE USED TO DETERMINE APPROPRIATE PAY GRADES WITHIN THE SURROUNDING COMPETITIVE MARKET. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2022. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES COPIES OF ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: BAD DEBT RECOVERIES, NET 49,090. MOSAIC FAMILY HEALTH INC 229 S MORRISON ST APPLETON WI 54911 473298660 FAMILY MEDICINE RESIDENCY CLINIC WI 501(C)(3) LINE 3 N/A 0 GOLD CROSS AMBULANCE SERVICES INC 1055 WITTMANN DR MENASHA WI 54952 391702433 AMBULANCE SERVICES WI 501(C)(3) LINE 10 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0