CATALPA HEALTH INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- CATALPA HEALTH INC (EIN 45-4681563)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-01
- IRS object ID
- 202233059349301813
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-01T12:09:11-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 EAST WASHINGTON STREET PO BOX | AddressLine1Txt |
| Address Line2 | 1739 | AddressLine2Txt |
| City | APPLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54912 | 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 | 454681563 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CATALPA HEALTH INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CATA | BusinessNameControlTxt |
| Phone | 9207507000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4635 WEST COLLEGE AVENUE | AddressLine1Txt |
| City | APPLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54914 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TRACY GUIOU | PersonNm |
| Person Title | CEO AND FINANCIAL LEADER | PersonTitleTxt |
| Phone | 9207507000 | PhoneNum |
| Signature | 2022-09-27 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | TRACY | PersonFirstNm |
| Person Last | GUIOU | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL VANDENHOGEN | PreparerPersonNm |
| PTIN | P00499282 | PTIN |
| Phone | 9207318111 | PhoneNum |
| Preparation | 2022-09-27 | 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) |
|---|---|---|
| Principal Officer | TRACY GUIOU | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4635 WEST COLLEGE AVENUE | AddressLine1Txt |
| City | APPLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54914 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $11,998,268 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CATALPAHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2012 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | HELPING CHILDREN AND FAMILIES IMPROVE THEIR MENTAL HEALTH AND WELLNESS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 77 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,816,946 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,039,105 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $8,357,643 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,599,698 | CYProgramServiceRevenueAmt |
| PY Investment Income | $49,696 | PYInvestmentIncomeAmt |
| CY Investment Income | $164,457 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$63,104 | PYOtherRevenueAmt |
| CY Other Revenue | -$98,394 | CYOtherRevenueAmt |
| PY Total Revenue | $11,161,181 | PYTotalRevenueAmt |
| CY Total Revenue | $11,704,866 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | 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 | $7,430,989 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,857,527 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $163,779 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,252,869 | PYOtherExpensesAmt |
| CY Other Expenses | $3,411,495 | CYOtherExpensesAmt |
| PY Total Expenses | $11,683,858 | PYTotalExpensesAmt |
| CY Total Expenses | $11,269,022 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$522,677 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $435,844 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,045,523 | TotalAssetsBOYAmt |
| Total Assets EOY | $11,171,079 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,290,821 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,798,964 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,754,702 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,372,115 | NetAssetsOrFundBalancesEOYAmt |
| Mission | HELPING CHILDREN AND FAMILIES IMPROVE THEIR MENTAL HEALTH AND WELLNESS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,776,431 | ExpenseAmt |
| Revenue | $8,599,698 | RevenueAmt |
| Desc | CATALPA PROVIDES OUTPATIENT SERVICES, INCLUDING INDIVIDUAL AND GROUP THERAPY, PSYCHOLOGICAL AND NEUROPSYCHOLOGICAL TESTING, AND MEDICAL MANAGEMENT AND PREVENTION SERVICES FOR THE LOCAL PUBLIC SCHOOLS. | Desc |
| Total Program Service Expenses | $8,776,431 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | 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 | Yes (1) | 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 14 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| 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 | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | 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 | TRACY GUIOU | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9207507000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4635 WEST COLLEGE AVENUE | AddressLine1Txt |
| City | APPLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54914 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| AMY HERBST | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| ANNETTE LECHNIR | |||||||
| MEMBER | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| CAROL OPGENORTH | |||||||
| MEMBER LEFT IN 2021 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID VANDER ZANDEN | |||||||
| CHAIR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| GAIL OSTRANDER | |||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| JULIE MEYER | |||||||
| TREASURER | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| MICHAEL BERGMANN | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| SHAUN GUNDERSON | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| TOM SCHMIDT | |||||||
| VICE CHAIR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| WENDY BARTON | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| CARRIE PENOVICH | |||||||
| COO AND FINANCIAL LEADER | 40.00 | $126,223 | $0 | $5,805 | Yes (X) | ||
| MARY DOWNS | |||||||
| CEO | 40.00 | $162,308 | $0 | $7,394 | Yes (X) | ||
| SCOTT RADTKE | |||||||
| CHIEF CLINICAL OFFICER | 40.00 | $102,856 | $0 | $33,187 | Yes (X) | ||
| TRACY GUIOU | |||||||
| PRESIDENT | 40.00 | $20,979 | $0 | $6,432 | Yes (X) | ||
| ERIN VANDERLANGENBERG | |||||||
| PSYCHOLOGIST | 40.00 | $147,001 | $0 | $34,198 | Yes (X) | ||
| JANELLE JENSON | |||||||
| ADV PRACTICE NURSE PRESCRI | 40.00 | $177,791 | $0 | $18,986 | Yes (X) | ||
| JILLIAN SCHUH | |||||||
| PEDIATRIC NEUROPSYCHOLOGIS | 40.00 | $150,597 | $0 | $33,740 | Yes (X) | ||
| LISA ENGELHARDT | |||||||
| ADV PRACTICE NURSE PRESCRI | 40.00 | $175,256 | $0 | $17,267 | Yes (X) | ||
| MARK ROVICK | |||||||
| PSYCHIATRIST | 40.00 | $283,031 | $0 | $31,258 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,346,042 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $188,267 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| INSPERITY PEO SERVICES LP | |||||
| 19001 CRESCENT SPRINGS DRIVE | KINGWOOD | TX | 77339 | CO-EMPLOYER & PAYROLL SERVICES | $7,533,101 |
| ENSEMBLE HEALTH PARTNERS | |||||
| 11511 REED HARTMAN HIGHWAY | CINCINNATI | OH | 45241 | BILLING SERVICES | $362,655 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $245,343 | FederatedCampaignsAmt |
| Membership Dues | $1,682,092 | MembershipDuesAmt |
| Fundraising | $332,932 | FundraisingAmt |
| Government Grants | $187,173 | GovernmentGrantsAmt |
| All Other Contributions | $591,565 | AllOtherContributionsAmt |
| Noncash Contributions | $5,864 | NoncashContributionsAmt |
| Total Contributions | $3,039,105 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OUTPATIENT REVENUE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $8,599,698 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,599,698 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,599,698 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $91,134 | TotalRevenueColumnAmt |
| Exclusion | $91,134 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $245,000 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $171,677 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $73,323 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $73,323 | TotalRevenueColumnAmt |
| Exclusion | $73,323 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $23,331 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $332,932 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $121,725 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$98,394 | TotalRevenueColumnAmt |
| Exclusion | -$98,394 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,704,866 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,599,698 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $66,063 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $465,184 | TotalAmt |
| Management And General | $465,184 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,991,012 | TotalAmt |
| Program Services | $5,701,802 | ProgramServicesAmt |
| Management And General | $174,326 | ManagementAndGeneralAmt |
| Fundraising | $114,884 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,241 | TotalAmt |
| Program Services | $161,826 | ProgramServicesAmt |
| Management And General | $1,607 | ManagementAndGeneralAmt |
| Fundraising | $3,808 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $704,052 | TotalAmt |
| Program Services | $637,183 | ProgramServicesAmt |
| Management And General | $51,874 | ManagementAndGeneralAmt |
| Fundraising | $14,995 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $530,038 | TotalAmt |
| Program Services | $466,132 | ProgramServicesAmt |
| Management And General | $52,936 | ManagementAndGeneralAmt |
| Fundraising | $10,970 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,804 | TotalAmt |
| Management And General | $24,804 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $187,377 | TotalAmt |
| Management And General | $187,377 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,826 | TotalAmt |
| Management And General | $8,826 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,335,560 | TotalAmt |
| Program Services | $701,721 | ProgramServicesAmt |
| Management And General | $619,498 | ManagementAndGeneralAmt |
| Fundraising | $14,341 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,679 | TotalAmt |
| Management And General | $63,679 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,072 | TotalAmt |
| Program Services | $125,460 | ProgramServicesAmt |
| Management And General | $29,764 | ManagementAndGeneralAmt |
| Fundraising | $848 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,055 | TotalAmt |
| Program Services | $111,055 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $641,433 | TotalAmt |
| Program Services | $570,773 | ProgramServicesAmt |
| Management And General | $68,236 | ManagementAndGeneralAmt |
| Fundraising | $2,424 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,246 | TotalAmt |
| Program Services | $2,506 | ProgramServicesAmt |
| Management And General | $4,740 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $190,251 | TotalAmt |
| Program Services | $169,293 | ProgramServicesAmt |
| Management And General | $20,239 | ManagementAndGeneralAmt |
| Fundraising | $719 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,472 | TotalAmt |
| Program Services | $27,678 | ProgramServicesAmt |
| Management And General | $3,143 | ManagementAndGeneralAmt |
| Fundraising | $651 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| BAD DEBTS EXPENSE | $539,513 | $539,513 | ||
| REPAIRS AND MAINTENANCE | $35,106 | $3,735 | $31,238 | $133 |
| DUES AND SUBSCRIPTIONS | $27,055 | $1,759 | $25,296 | |
| EDUCATION | $22,651 | $4,541 | $18,110 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,395 | TotalAmt |
| Program Services | $26,358 | ProgramServicesAmt |
| Management And General | $3,031 | ManagementAndGeneralAmt |
| Fundraising | $6 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,269,022 | TotalAmt |
| Program Services | $8,776,431 | ProgramServicesAmt |
| Management And General | $2,328,812 | ManagementAndGeneralAmt |
| Fundraising | $163,779 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $618,239 | BOYAmt |
| EOY | $1,811,516 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $600,088 | BOYAmt |
| EOY | $880,322 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $403,548 | BOYAmt |
| EOY | $317,407 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,216,143 | BOYAmt |
| EOY | $527,397 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,174 | BOYAmt |
| EOY | $122,600 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,475,973 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,122,979 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $432,989 | BOYAmt |
| EOY | $352,994 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,692,342 | BOYAmt |
| EOY | $2,963,294 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $4,195,549 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,045,523 | BOYAmt |
| EOY | $11,171,079 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,224,090 | BOYAmt |
| EOY | $1,237,945 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $289,753 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $66,731 | BOYAmt |
| EOY | $4,271,266 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,290,821 | BOYAmt |
| EOY | $5,798,964 | 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 | $3,712,555 | BOYAmt |
| EOY | $4,027,730 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,042,147 | BOYAmt |
| EOY | $1,344,385 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,754,702 | BOYAmt |
| EOY | $5,372,115 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,045,523 | BOYAmt |
| EOY | $11,171,079 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $435,844 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $181,569 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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 D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $238,101 | OtherCostOrOtherBasisAmt |
| Depreciation | $194,563 | DepreciationAmt |
| Book Value | $43,538 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,237,872 | OtherCostOrOtherBasisAmt |
| Depreciation | $928,416 | DepreciationAmt |
| Book Value | $309,456 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $352,994 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OPERATING RIGHT-OF-USE ASSET | Desc |
| Book Value | $4,195,549 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $4,195,549 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| OPERATING LEASE LIABILITIES | $4,235,037 |
| REFUNDABLE ADVANCE | $36,229 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,271,266 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $12,007,466 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $181,569 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $8,132 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $189,701 | RevenueNotReportedAmt |
| Revenue Subtotal | $11,817,765 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $8,826 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | -$121,725 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$112,899 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $11,704,866 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $11,390,053 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $8,132 | DonatedServicesUseFcltsAmt |
| Other Expenses Included | $121,725 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $129,857 | ExpensesNotReportedAmt |
| Expenses Subtotal | $11,260,196 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $8,826 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $8,826 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $11,269,022 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 2020 AND 2019. 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 -121,725. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EVENT EXPENSES 121,725. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | POP! | Event1Nm |
| Gross Receipts Event1 | $356,263 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $332,932 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $23,331 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $600 | NonCashPrizesEvent1Amt |
| Food And Beverage Event1 | $21,143 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $99,982 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $356,263 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $332,932 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $23,331 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $600 | NonCashPrizesTotalEventsAmt |
| Food And Beverage Total Events | $21,143 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $99,982 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $121,725 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$98,394 | NetIncomeSummaryAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| 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 | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 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 ROVICK | ||||||||||||||
| PSYCHIATRIST | $215,240 | $0 | $67,791 | $0 | $0 | $0 | $0 | $0 | $31,258 | $0 | $314,289 | $0 | $0 | $0 |
| JANELLE JENSON | ||||||||||||||
| ADV PRACTICE NURSE PRESCRI | $100,280 | $0 | $77,511 | $0 | $0 | $0 | $7,329 | $0 | $11,657 | $0 | $196,777 | $0 | $0 | $0 |
| LISA ENGELHARDT | ||||||||||||||
| ADV PRACTICE NURSE PRESCRI | $103,466 | $0 | $71,790 | $0 | $0 | $0 | $7,165 | $0 | $10,102 | $0 | $192,523 | $0 | $0 | $0 |
| JILLIAN SCHUH | ||||||||||||||
| PEDIATRIC NEUROPSYCHOLOGIS | $124,998 | $0 | $25,599 | $0 | $0 | $0 | $5,575 | $0 | $28,165 | $0 | $184,337 | $0 | $0 | $0 |
| ERIN VANDERLANGENBERG | ||||||||||||||
| PSYCHOLOGIST | $120,023 | $0 | $26,978 | $0 | $0 | $0 | $6,079 | $0 | $28,119 | $0 | $181,199 | $0 | $0 | $0 |
| MARY DOWNS | ||||||||||||||
| CEO | $162,308 | $0 | $0 | $0 | $0 | $0 | $6,492 | $0 | $902 | $0 | $169,702 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 7 | FormAndLineReferenceDesc |
| Explanation | THE CEO DETERMINED THE BONUS AMOUNT FOR THE OTHER OFFICERS (NONFIXED PAYMENTS). HIGHLY COMPENSATED EMPLOYEES RECEIVED BONUSES DURING THE YEAR BASED ON FORMULAS WHICH CONSIDER WORK RELATIVE VALUE UNITS (WRVU) EXCEEDING PRODUCTION BENCHMARKS OR BASED ON AN AMOUNT RELATIVE TO THEIR SALARY FOR THE PURPOSE OF RETENTION (FIXED PAYMENTS). | ExplanationTxt |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (2 entries)
| Relationship With OrgRelationshipWithOrgTxt | Loan PurposeLoanPurposeTxt | Loan To OrganizationLoanToOrganizationInd | Original PrincipalOriginalPrincipalAmt | Balance DueBalanceDueAmt | DefaultDefaultInd | Board Or Committee ApprovalBoardOrCommitteeApprovalInd | Written AgreementWrittenAgreementInd |
|---|---|---|---|---|---|---|---|
| ASCENSION NE WI | |||||||
| SUBSTANTIAL CONTRIBUTOR/CREATOR | REFUNDABLE ADVANCE | Yes (X) | $0 | $242,521 | 0 | Yes (1) | Yes (1) |
| CHILDREN'S HOSPITAL OF WISCONSIN INC | |||||||
| SUBSTANTIAL CONTRIBUTOR/CREATOR | REFUNDABLE ADVANCE | Yes (X) | $0 | $47,232 | 0 | Yes (1) | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $289,753 | TotalBalanceDueAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 2021'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, CAROL OPGENORTH, 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 COO 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 AND BONUS BASED ON THAT DIALOGUE, WHICH WAS CONTEMPORANEOUSLY SUBSTANTIATED. L15B.) INSPERITY COMPENSATION SERVICES WERE USED TO DETERMINE APPROPRIATE PAY GRADES WITHIN THE SURROUNDING COMPETITIVE MARKET. |
| 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 IX, LINE 11G | VARIOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 373,502. MANAGEMENT AND GENERAL EXPENSES 221,192. FUNDRAISING EXPENSES 14,341. TOTAL EXPENSES 609,035. CONTRACTED PSYCHOLOGISTS: PROGRAM SERVICE EXPENSES 328,219. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 328,219. BILLING SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 398,306. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 398,306. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
| 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 | 0 | 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 | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |