2022-11-01T12:09:11-05:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 200 EAST WASHINGTON STREET PO BOX 1739 APPLETON WI 54912 990 2021-01-01 454681563 CATALPA HEALTH INC CATA 9207507000 4635 WEST COLLEGE AVENUE APPLETON WI 54914 TRACY GUIOU CEO AND FINANCIAL LEADER 9207507000 2022-09-27 1 TRACY GUIOU 999009999 MICHAEL VANDENHOGEN P00499282 9207318111 2022-09-27 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z TRACY GUIOU 4635 WEST COLLEGE AVENUE APPLETON WI 54914 11998268 0 X WWW.CATALPAHEALTH.ORG X 2012 WI HELPING CHILDREN AND FAMILIES IMPROVE THEIR MENTAL HEALTH AND WELLNESS. 9 9 0 77 0 0 2816946 3039105 8357643 8599698 49696 164457 -63104 -98394 11161181 11704866 0 0 0 0 7430989 7857527 0 0 163779 4252869 3411495 11683858 11269022 -522677 435844 6045523 11171079 1290821 5798964 4754702 5372115 HELPING CHILDREN AND FAMILIES IMPROVE THEIR MENTAL HEALTH AND WELLNESS. 0 0 8776431 8599698 CATALPA PROVIDES OUTPATIENT SERVICES, INCLUDING INDIVIDUAL AND GROUP THERAPY, PSYCHOLOGICAL AND NEUROPSYCHOLOGICAL TESTING, AND MEDICAL MANAGEMENT AND PREVENTION SERVICES FOR THE LOCAL PUBLIC SCHOOLS. 8776431 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 14 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 9 9 1 0 0 0 1 1 1 1 0 0 0 0 1 1 1 1 1 1 1 0 WI X TRACY GUIOU 9207507000 4635 WEST COLLEGE AVENUE APPLETON WI 54914 AMY HERBST MEMBER 2.00 X 0 0 0 ANNETTE LECHNIR MEMBER 3.00 X 0 0 0 CAROL OPGENORTH MEMBER LEFT IN 2021 2.00 X 0 0 0 DAVID VANDER ZANDEN CHAIR 2.00 X X 0 0 0 GAIL OSTRANDER SECRETARY 2.00 X X 0 0 0 JULIE MEYER TREASURER 4.00 X X 0 0 0 MICHAEL BERGMANN MEMBER 2.00 X 0 0 0 SHAUN GUNDERSON MEMBER 2.00 X 0 0 0 TOM SCHMIDT VICE CHAIR 2.00 X X 0 0 0 WENDY BARTON MEMBER 2.00 X 0 0 0 CARRIE PENOVICH COO AND FINANCIAL LEADER 40.00 X 126223 0 5805 MARY DOWNS CEO 40.00 X 162308 0 7394 SCOTT RADTKE CHIEF CLINICAL OFFICER 40.00 X 102856 0 33187 TRACY GUIOU PRESIDENT 40.00 X 20979 0 6432 ERIN VANDERLANGENBERG PSYCHOLOGIST 40.00 X 147001 0 34198 JANELLE JENSON ADV PRACTICE NURSE PRESCRI 40.00 X 177791 0 18986 JILLIAN SCHUH PEDIATRIC NEUROPSYCHOLOGIS 40.00 X 150597 0 33740 LISA ENGELHARDT ADV PRACTICE NURSE PRESCRI 40.00 X 175256 0 17267 MARK ROVICK PSYCHIATRIST 40.00 X 283031 0 31258 1346042 0 188267 10 0 1 0 INSPERITY PEO SERVICES LP 19001 CRESCENT SPRINGS DRIVE KINGWOOD TX 77339 CO-EMPLOYER & PAYROLL SERVICES 7533101 ENSEMBLE HEALTH PARTNERS 11511 REED HARTMAN HIGHWAY CINCINNATI OH 45241 BILLING SERVICES 362655 2 245343 1682092 332932 187173 591565 5864 3039105 OUTPATIENT REVENUE 621400 8599698 8599698 8599698 91134 91134 245000 171677 73323 73323 73323 23331 332932 121725 -98394 -98394 11704866 8599698 0 66063 X 465184 465184 5991012 5701802 174326 114884 167241 161826 1607 3808 704052 637183 51874 14995 530038 466132 52936 10970 24804 24804 187377 187377 8826 8826 1335560 701721 619498 14341 63679 63679 156072 125460 29764 848 111055 111055 641433 570773 68236 2424 7246 2506 4740 190251 169293 20239 719 31472 27678 3143 651 BAD DEBTS EXPENSE 539513 539513 REPAIRS AND MAINTENANCE 35106 31238 3735 133 DUES AND SUBSCRIPTIONS 27055 25296 1759 EDUCATION 22651 18110 4541 29395 26358 3031 6 11269022 8776431 2328812 163779 618239 1811516 600088 880322 403548 317407 1216143 527397 82174 122600 1475973 1122979 432989 352994 2692342 2963294 0 4195549 6045523 11171079 1224090 1237945 289753 66731 4271266 1290821 5798964 X 3712555 4027730 1042147 1344385 4754702 5372115 6045523 11171079 435844 181569 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 238101 194563 43538 1237872 928416 309456 352994 OPERATING RIGHT-OF-USE ASSET 4195549 4195549 OPERATING LEASE LIABILITIES 4235037 REFUNDABLE ADVANCE 36229 4271266 X 12007466 181569 8132 189701 11817765 8826 -121725 -112899 11704866 11390053 8132 121725 129857 11260196 8826 8826 11269022 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. POP! 356263 332932 23331 600 21143 99982 356263 332932 23331 600 21143 99982 121725 -98394 X X 0 0 0 0 0 0 0 1 0 MARK ROVICK PSYCHIATRIST 215240 0 67791 0 0 0 0 0 31258 0 314289 0 0 0 JANELLE JENSON ADV PRACTICE NURSE PRESCRI 100280 0 77511 0 0 0 7329 0 11657 0 196777 0 0 0 LISA ENGELHARDT ADV PRACTICE NURSE PRESCRI 103466 0 71790 0 0 0 7165 0 10102 0 192523 0 0 0 JILLIAN SCHUH PEDIATRIC NEUROPSYCHOLOGIS 124998 0 25599 0 0 0 5575 0 28165 0 184337 0 0 0 ERIN VANDERLANGENBERG PSYCHOLOGIST 120023 0 26978 0 0 0 6079 0 28119 0 181199 0 0 0 MARY DOWNS CEO 162308 0 0 0 0 0 6492 0 902 0 169702 0 0 0 PART I, LINE 7 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). ASCENSION NE WI SUBSTANTIAL CONTRIBUTOR/CREATOR REFUNDABLE ADVANCE X 0 242521 0 1 1 CHILDREN'S HOSPITAL OF WISCONSIN INC SUBSTANTIAL CONTRIBUTOR/CREATOR REFUNDABLE ADVANCE X 0 47232 0 1 1 289753 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. MOSAIC FAMILY HEALTH INC 229 S MORRISON ST APPLETON WI 54911 473298660 FAMILY MEDICINE RESIDENCY CLINIC WI 501(C)(3) LINE 3 N/A 0 GOLD CROSS AMBULANCE SERVICES INC 1055 WITTMANN DR MENASHA WI 54952 391702433 AMBULANCE SERVICES WI 501(C)(3) LINE 10 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0