INCLUSA INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- INCLUSA INC (EIN 81-3565570)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-09-29
- IRS object ID
- 202242729349300719
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-09-29T10:04:41-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 813565570 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INCLUSA INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | INCL | BusinessNameControlTxt |
| Phone | 8776226700 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2801 HOOVER ROAD 3 | AddressLine1Txt |
| City | STEVENS POINT | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54481 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JASON TAYLOR | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 8776226700 | PhoneNum |
| Signature | 2022-09-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JASON | PersonFirstNm |
| Person Last | TAYLOR | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2022-09-29 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | MARK HILLIKER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2801 HOOVER ROAD 3 | AddressLine1Txt |
| City | STEVENS POINT | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54481 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $696,118,730 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.INCLUSA.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2016 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | IN ORDER TO MAXIMIZE HEALTH OUTCOMES, INCLUSA PROACTIVELY PARTNERS WITH OTHERS TO BUILD VIBRANT AND INCLUSIVE COMMUNITIES THAT OFFER PEOPLE DIGNITY, CHOICE, AND CONNECTIONS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 1383 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $47,676 | PYContributionsGrantsAmt |
| CY Contributions Grants | $8,734 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $659,084,122 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $695,834,461 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,105,773 | PYInvestmentIncomeAmt |
| CY Investment Income | $275,535 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $660,237,571 | PYTotalRevenueAmt |
| CY Total Revenue | $696,118,730 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $3,488,644 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $88,720,821 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $90,688,375 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $545,250,940 | PYOtherExpensesAmt |
| CY Other Expenses | $581,100,411 | CYOtherExpensesAmt |
| PY Total Expenses | $637,460,405 | PYTotalExpensesAmt |
| CY Total Expenses | $671,788,786 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $22,777,166 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $24,329,944 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $133,376,896 | TotalAssetsBOYAmt |
| Total Assets EOY | $163,276,844 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $52,204,123 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $57,920,743 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $81,172,773 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $105,356,101 | NetAssetsOrFundBalancesEOYAmt |
| Mission | IN ORDER TO MAXIMIZE HEALTH OUTCOMES, INCLUSA PROACTIVELY PARTNERS WITH OTHERS TO BUILD VIBRANT AND INCLUSIVE COMMUNITIES THAT OFFER PEOPLE DIGNITY, CHOICE, AND CONNECTIONS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $647,320,195 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $695,834,461 | RevenueAmt |
| Desc | INCLUSA, INC. PROACTIVELY PARTNERS WITH OTHERS TO BUILD A SHARED VISION OF LONG-TERM CARE THAT OFFERS THE PEOPLE WE SERVE CHOICE, CONNECTIONS, AND DIGNITY; FOSTERING FULL PARTICIPATION IN COMMUNITIES. INCLUSA, INC. PROVIDES MEDICAID MANAGED LONG-TERM CARE SERVICES AND SUPPORT TO NEARLY 16,245 ELDERS AND PEOPLE WITH PHYSICAL AND INTELLECTUAL/DEVELOPMENTAL DISABILITIES IN WISCONSIN. | Desc |
| Total Program Service Expenses | $647,320,195 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 590 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 1383 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JASON TAYLOR | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7152041810 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2801 HOOVER ROAD 3 | AddressLine1Txt |
| City | STEVENS POINT | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54481 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| MARK HILLIKER | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | Yes (X) | $435,897 | $0 | $54,333 | ||
| MICHELLE FELLENZ | |||||||
| CHIEF TLC OFFICER (THRU AUGUST) | 40.00 | Yes (X) | $306,049 | $0 | $41,478 | ||
| KRISTOPHER KUBNICK | |||||||
| CHIEF COMMUNITY RESOURCES | 40.00 | Yes (X) | $267,685 | $0 | $51,663 | ||
| TIM GARRITY | |||||||
| CHIEF INNOVATION OFFICER | 40.00 | Yes (X) | $268,020 | $0 | $45,625 | ||
| JOSHUA JANDRAIN | |||||||
| CHIEF INFORMATION OFFICER | 40.00 | Yes (X) | $257,728 | $0 | $51,148 | ||
| PATRICK HENNEGER | |||||||
| CHIEF LEGAL OFFICER | 40.00 | Yes (X) | $259,875 | $0 | $47,589 | ||
| JASON TAYLOR | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | Yes (X) | $268,110 | $0 | $11,055 | ||
| STACEY WARGOWSKY | |||||||
| EXECUTIVE DIRECTOR OF CM SUPPORT | 40.00 | $169,595 | $0 | $42,228 | Yes (X) | ||
| DANA CYRA | |||||||
| EXECUTIVE DIRECTOR OF QUALITY IMPROVEMENT | 40.00 | $171,488 | $0 | $29,338 | Yes (X) | ||
| KATE NORBY | |||||||
| EXECUTIVE DIRECTOR OF MEMBER EXPERIENCE | 40.00 | $171,637 | $0 | $28,577 | Yes (X) | ||
| JANNA DUFFY | |||||||
| EXECUTIVE DIRECTOR OF FINANCE | 40.00 | $183,494 | $0 | $7,688 | Yes (X) | ||
| ERIN SMITH | |||||||
| EXECUTIVE DIRECTOR OF CR/PR | 40.00 | $172,950 | $0 | $7,285 | Yes (X) | ||
| KEN DAY | |||||||
| PRESIDENT | 2.00 | Yes (X) | $8,800 | $0 | $0 | Yes (X) | |
| JOAN FORDHAM | |||||||
| VICE PRESIDENT | 1.00 | Yes (X) | $2,200 | $0 | $0 | Yes (X) | |
| RON CARNEY | |||||||
| SECRETARY/TREASURER | 1.00 | Yes (X) | $2,200 | $0 | $0 | Yes (X) | |
| BETH ARIMOND | |||||||
| DIRECTOR | 1.00 | $2,200 | $0 | $0 | Yes (X) | ||
| KEN CORNISH | |||||||
| DIRECTOR | 1.00 | $2,200 | $0 | $0 | Yes (X) | ||
| JOHN HALBEIB | |||||||
| DIRECTOR | 1.00 | $2,200 | $0 | $0 | Yes (X) | ||
| TARA JOHNSON | |||||||
| DIRECTOR | 1.00 | $2,200 | $0 | $0 | Yes (X) | ||
| JOHN KRIESEL | |||||||
| DIRECTOR | 1.00 | $2,200 | $0 | $0 | Yes (X) | ||
| LARRY LAEHN | |||||||
| DIRECTOR | 1.00 | $2,200 | $0 | $0 | Yes (X) | ||
| GARY RANUM | |||||||
| DIRECTOR | 1.00 | $2,200 | $0 | $0 | Yes (X) | ||
| JANIS RIBBENS | |||||||
| DIRECTOR | 1.00 | $2,200 | $0 | $0 | Yes (X) | ||
| KAREN LUMB | |||||||
| DIRECTOR | 1.00 | $1,200 | $0 | $0 | Yes (X) | ||
| STEVE MCCARTHY | |||||||
| DIRECTOR | 1.00 | $1,200 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,965,728 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $418,007 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 21 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WPS | |||||
| 1717 W BROADWAY | MADISON | WI | 53713 | ADMINISTRATIVE | $3,474,564 |
| RSM US LLP | |||||
| 5155 PAYSPHERE CIRCLE | CHICAGO | IL | 60674 | IT CONSULTATION | $2,990,081 |
| MCKESSON MEDICAL-SURGICAL | |||||
| PO BOX 204786 | PLYMOUTH | TX | 75320 | MEMBER GOODS | $2,086,340 |
| REM WISCONSIN III INC | |||||
| 2005 W BELTLINE HWY STE 203 | MADISON | WI | 53713 | DIRECT CARE WORKFORCE, CRISIS DIVERSION, | $1,919,150 |
| SKYLINE TECHNOLOGIES INC | |||||
| 1400 LOMBARDI AVE STE 104N | GREEN BAY | WI | 54304 | NEW SOFTWARE CREATION | $1,452,524 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 99 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $8,734 | GovernmentGrantsAmt |
| Total Contributions | $8,734 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| CAPITATION FEE REVENUE | 624100 | $647,905,556 | $647,905,556 |
| ROOM AND BOARD REIMBURSEMENT | 623000 | $47,928,905 | $47,928,905 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $695,834,461 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $275,535 | TotalRevenueColumnAmt |
| Exclusion | $275,535 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $696,118,730 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $695,834,461 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $275,535 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,091,988 | TotalAmt |
| Program Services | $1,676,728 | ProgramServicesAmt |
| Management And General | $415,260 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,585,118 | TotalAmt |
| Program Services | $50,416,704 | ProgramServicesAmt |
| Management And General | $13,168,414 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,428,092 | TotalAmt |
| Program Services | $1,915,666 | ProgramServicesAmt |
| Management And General | $512,426 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,877,058 | TotalAmt |
| Program Services | $14,376,243 | ProgramServicesAmt |
| Management And General | $3,500,815 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,706,119 | TotalAmt |
| Program Services | $3,755,063 | ProgramServicesAmt |
| Management And General | $951,056 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,387 | TotalAmt |
| Management And General | $82,387 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,764 | TotalAmt |
| Management And General | $80,764 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,487,581 | TotalAmt |
| Program Services | $468,835 | ProgramServicesAmt |
| Management And General | $4,018,746 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $221,441 | TotalAmt |
| Program Services | $6,809 | ProgramServicesAmt |
| Management And General | $214,632 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $754,124 | TotalAmt |
| Program Services | $432,951 | ProgramServicesAmt |
| Management And General | $321,173 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,719,179 | TotalAmt |
| Program Services | $3,709,235 | ProgramServicesAmt |
| Management And General | $9,944 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,428,130 | TotalAmt |
| Program Services | $2,253,136 | ProgramServicesAmt |
| Management And General | $174,994 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,218,765 | TotalAmt |
| Program Services | $1,160,258 | ProgramServicesAmt |
| Management And General | $58,507 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,398,857 | TotalAmt |
| Program Services | $802,679 | ProgramServicesAmt |
| Management And General | $596,178 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $390,548 | TotalAmt |
| Program Services | $259,209 | ProgramServicesAmt |
| Management And General | $131,339 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DIRECT MEMBER CARE EXPE | $565,965,796 | $565,965,796 | |
| OPERATING SUPPLIES | $150,086 | $78,096 | $71,990 |
| EMPLOYEE TRAINING | $126,752 | $35,604 | $91,148 |
| BOARD EXPENSES | $35,212 | $35,212 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,789 | TotalAmt |
| Program Services | $7,183 | ProgramServicesAmt |
| Management And General | $33,606 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $671,788,786 | TotalAmt |
| Program Services | $647,320,195 | ProgramServicesAmt |
| Management And General | $24,468,591 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $372,975 | BOYAmt |
| EOY | $10,950 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $105,894,040 | BOYAmt |
| EOY | $125,353,960 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,505,470 | BOYAmt |
| EOY | $17,772,095 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,159,628 | BOYAmt |
| EOY | $1,121,532 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $17,280,738 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,833,693 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,661,902 | BOYAmt |
| EOY | $11,447,045 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,434,164 | BOYAmt |
| EOY | $6,966,184 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $348,717 | BOYAmt |
| EOY | $605,078 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,376,896 | BOYAmt |
| EOY | $163,276,844 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,973,494 | BOYAmt |
| EOY | $57,920,743 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $230,629 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,204,123 | BOYAmt |
| EOY | $57,920,743 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $81,172,773 | BOYAmt |
| EOY | $105,356,101 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $81,172,773 | BOYAmt |
| EOY | $105,356,101 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,376,896 | BOYAmt |
| EOY | $163,276,844 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $24,329,944 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$146,616 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $44,639 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $42,884 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $49,297 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $47,676 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,734 | CurrentTaxYearAmt |
| Total | $193,230 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $609,812,068 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $624,400,324 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $646,214,344 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $659,084,122 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $695,834,461 | CurrentTaxYearAmt |
| Total | $3,235,345,319 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $609,856,707 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $624,443,208 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $646,263,641 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $659,131,798 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $695,843,195 | CurrentTaxYearAmt |
| Total | $3,235,538,549 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $3,235,538,549 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $231,890 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $273,349 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $688,202 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,105,773 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $275,535 | CurrentTaxYearAmt |
| Total | $2,574,749 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $231,890 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $273,349 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $688,202 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,105,773 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $275,535 | CurrentTaxYearAmt |
| Total | $2,574,749 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $610,088,597 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $624,716,557 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $646,951,843 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $660,237,571 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $696,118,730 | CurrentTaxYearAmt |
| Total | $3,238,113,298 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First5 Years509 | Yes (X) | First5Years509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $17,500 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $17,500 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | INCLUSA, INC. PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE NATIONAL MLTSS HEALTH PLAN ASSOCIATION. THE NATIONAL MLTSS ASSOCIATION IS COMPRISED OF A NUMBER OF HEALTH PLANS THAT PROVIDE SUPPORTS TO MEDICARE/MEDICAID POPULATIONS ACROSS THE U.S. THE DUES PAID TO THE ASSOCIATION ON AN ANNUAL BASIS SUPPORT STAFF HIRED BY THE ASSOCIATION TO ADVANCE ITS POLICY AGENDA AND TO CONTRACT WITH OUTSIDE EXPERTS WHO PROVIDE SUPPORT THROUGH POLICY ANALYSIS, MEETING WITH LEGISLATORS AND STAFF MEMBERS AT THE FEDERAL LEVEL, ATTENDING CONFERENCE AND COMMITTEE HEARINGS, DEVELOPING POLICY BRIEFS AND STATEMENTS ALIGNED WITH MLTSS ASSOCIATION GOALS, AND SECURING SUPPORT FROM OTHER LIKE-MINDED ORGANIZATIONS. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $274,944 | OtherCostOrOtherBasisAmt |
| Book Value | $274,944 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,459,566 | OtherCostOrOtherBasisAmt |
| Depreciation | $22,180 | DepreciationAmt |
| Book Value | $3,437,386 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,962,699 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,377,050 | DepreciationAmt |
| Book Value | $585,649 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,456,406 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,777,500 | DepreciationAmt |
| Book Value | $678,906 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,127,123 | OtherCostOrOtherBasisAmt |
| Depreciation | $656,963 | DepreciationAmt |
| Book Value | $6,470,160 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $11,447,045 | TotalBookValueLandBuildingsAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARK HILLIKER | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $392,333 | $0 | $40,000 | $0 | $3,564 | $0 | $11,600 | $0 | $42,733 | $0 | $490,230 | $0 | $0 | $0 |
| MICHELLE FELLENZ | ||||||||||||||
| CHIEF TLC OFFICER (THRU AUGUST) | $282,299 | $0 | $23,000 | $0 | $750 | $0 | $7,508 | $0 | $33,970 | $0 | $347,527 | $0 | $0 | $0 |
| KRISTOPHER KUBNICK | ||||||||||||||
| CHIEF COMMUNITY RESOURCES | $244,145 | $0 | $23,000 | $0 | $540 | $0 | $11,017 | $0 | $40,646 | $0 | $319,348 | $0 | $0 | $0 |
| TIM GARRITY | ||||||||||||||
| CHIEF INNOVATION OFFICER | $243,789 | $0 | $23,000 | $0 | $1,231 | $0 | $10,892 | $0 | $34,733 | $0 | $313,645 | $0 | $0 | $0 |
| JOSHUA JANDRAIN | ||||||||||||||
| CHIEF INFORMATION OFFICER | $233,947 | $0 | $23,000 | $0 | $781 | $0 | $10,604 | $0 | $40,544 | $0 | $308,876 | $0 | $0 | $0 |
| PATRICK HENNEGER | ||||||||||||||
| CHIEF LEGAL OFFICER | $236,375 | $0 | $23,000 | $0 | $500 | $0 | $10,256 | $0 | $37,333 | $0 | $307,464 | $0 | $0 | $0 |
| JASON TAYLOR | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $243,901 | $0 | $23,000 | $0 | $1,209 | $0 | $10,691 | $0 | $364 | $0 | $279,165 | $0 | $0 | $0 |
| STACEY WARGOWSKY | ||||||||||||||
| EXECUTIVE DIRECTOR OF CM SUPPORT | $149,995 | $0 | $19,600 | $0 | $0 | $0 | $6,056 | $0 | $36,172 | $0 | $211,823 | $0 | $0 | $0 |
| DANA CYRA | ||||||||||||||
| EXECUTIVE DIRECTOR OF QUALITY IMPROV | $146,509 | $0 | $23,000 | $0 | $1,979 | $0 | $6,918 | $0 | $22,420 | $0 | $200,826 | $0 | $0 | $0 |
| KATE NORBY | ||||||||||||||
| EXECUTIVE DIRECTOR OF MEMBER EXPERIE | $147,347 | $0 | $23,000 | $0 | $1,290 | $0 | $6,921 | $0 | $21,656 | $0 | $200,214 | $0 | $0 | $0 |
| JANNA DUFFY | ||||||||||||||
| EXECUTIVE DIRECTOR OF FINANCE | $159,749 | $0 | $23,000 | $0 | $745 | $0 | $7,324 | $0 | $364 | $0 | $191,182 | $0 | $0 | $0 |
| ERIN SMITH | ||||||||||||||
| EXECUTIVE DIRECTOR OF CR/PR | $149,651 | $0 | $23,000 | $0 | $299 | $0 | $6,921 | $0 | $364 | $0 | $180,235 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND THE CHIEF EXECUTIVE OFFICER. A COPY OF THE 990 IS PROVIDED TO THE GOVERNING BODY BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD OF DIRECTORS SHALL ADOPT AND ALWAYS MAINTAIN A WRITTEN CONFLICT OF INTEREST POLICY ("THE POLICY") THAT IS CONSISTENT WITH BEST PRACTICES FOR CHARITABLE ORGANIZATIONS. ALL DIRECTORS, OFFICERS, AND COMMITTEE MEMBERS SHALL SIGN, AS A CONDITION TO SERVING THE CORPORATION IN HIS OR HER RESPECTIVE ROLE, A STATEMENT AGREEING TO BE BOUND BY THE TERMS OF THE POLICY. PURSUANT TO THE POLICY, ANY DIRECTOR, OFFICER, OR COMMITTEE MEMBER HAVING A MATERIAL FINANCIAL INTEREST IN A CONTRACT OR OTHER TRANSACTION PRESENTED TO THE BOARD OF DIRECTORS OR A COMMITTEE THEREOF FOR AUTHORIZATION, APPROVAL, OR RATIFICATION SHALL MAKE A PROMPT, FULL AND FRANK DISCLOSURE OF SUCH PERSON'S INTEREST TO THE BOARD OF DIRECTORS OR COMMITTEE PRIOR TO ITS ACTING ON SUCH CONTRACT OR TRANSACTION. IF THE CONFLICT IS CONFIRMED BY THE BOARD OF DIRECTORS, THE OFFICER OR COMMITTEE MEMBER IS NOT ALLOWED TO PARTICIPATE IN THE DISCUSSION OR VOTE ON THE MATTER. EACH DIRECTOR OF THE BOARD MUST ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: (A) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY (B) HAS READ AND UNDERSTANDS THE POLICY (C) HAS AGREED TO COMPLY WITH THE POLICY AND, (D) UNDERSTANDS THE CORPORATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. |
| FORM 990, PART VI, SECTION B, LINE 15 | INITIAL OFFICER COMPENSATION WAS ESTABLISHED USING THE SUPPORT OF A CONTRACTED EXPERT IN EXECUTIVE COMPENSATION. THE CONTRACTED EXPERT DEVELOPED SALARY RANGE INFORMATION FOR THE ORGANIZATION'S EXECUTIVES AND PROVIDED COMPENSATION RECOMMENDATIONS TO THE INCLUSA, INC. BOARD OF DIRECTORS. THE BOARD OF DIRECTORS SET THE CHIEF EXECUTIVE OFFICER'S SALARY BASED ON THIS RECOMMENDATION. THE CHIEF EXECUTIVE OFFICER WAS CHARGED WITH SETTING THE COMPENSATION FOR THE REMAINING EXECUTIVES, USING THE RECOMMENDATIONS PROVIDED BY THE CONTRACTED EXPERT. IN SUCCESSIVE YEARS, THE INCLUSA BOARD OF DIRECTORS HAS SET CHIEF EXECUTIVE OFFICER ANNUAL COMPENSATION USING INDUSTRY COMPARISONS AND OTHER MARKET INFORMATION TO AUGMENT THEIR DECISION PROCESS. THE CHIEF EXECUTIVE OFFICER USES SIMILAR INDUSTRY AND MARKET INFORMATION TO MAKE ANY ANNUAL CHANGES TO THE REMAINING EXECUTIVE STAFF MEMBERS. |
| FORM 990, PART VI, SECTION C, LINE 19 | INCLUSA MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
Schedule R IRS990ScheduleR
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANNOVA INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2801 HOOVER ROAD UNIT 3 | AddressLine1Txt |
| City | STEVENS POINT | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54481 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 842123943 | EIN |
| Primary Activities | CONSULTING SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INCLUSA INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | $7,569 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $277,739 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ANNOVA INC | ||
| D | $49,570 | COST |
| ANNOVA INC | ||
| Q | $497,552 | COST |