2025-07-30T15:03:00-05:00 2023-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-01-01 813565570 INCLUSA FOUNDATION INC INCL 7153434111 2801 HOOVER ROAD 1J STEVENS POINT WI 54481 CANDISE MILLER EXECUTIVE DIRECTOR 7153434111 2025-07-29 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-07-29 2023 2025-03-06 01:10:19Z X CANDISE MILLER 2801 HOOVER ROAD 1J STEVENS POINT WI 54481 592229793 0 X WWW.INCLUSAFOUNDATION.ORG X 2016 WI INCLUSA FOUNDATION'S MISSION IS TO ENHANCE THE HEALTH OF WISCONSINITES BY BUILDING DIVERSE AND INCLUSIVE COMMUNITIES WHERE ALL PEOPLE LIVE MORE CONNECTED LIVES THROUGH INNOVATION, PROGRAMS, AND PARTNERSHIPS THAT IMPACT OVERALL HEALTH AND WELL BEING. X 12 12 1576 13 0 0 6150 2745 805182768 341137570 1525345 97565390 16795 306195 806731058 439011900 0 0 0 0 100840442 44170604 0 0 0 695422578 303147086 796263020 347317690 10468038 91694210 206621989 209516984 91562117 90325 115059872 209426659 X IN ORDER TO MAXIMIZE HEALTH OUTCOMES, INCLUSA PROACTIVELY PARTNERS WITH OTHERS TO BUILD VIBRANT AND INCLUSIVE COMMUNITIES THAT OFFER PEOPLE DIGNITY, CHOICE, AND CONNECTIONS. 1 1 335049406 0 341137570 INCLUSA FOUNDATION, INC. (FKA INCLUSA) 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 APPROXIMATELY 17,000 ELDERS AND PEOPLE WITH PHYSICAL AND INTELLECTUAL/DEVELOPMENTAL DISABILITIES IN WISCONSIN. 335049406 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 1 573 0 1576 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 1 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X CANDISE MILLER 7153434111 2801 HOOVER ROAD 1J STEVENS POINT WI 54481 KEN DAY PRESIDENT 2.00 X X 8800 0 0 JOAN FORDHAM VICE PRESIDENT 1.00 X X 2200 0 0 RON CARNEY SECRETARY/TREASURER 1.00 X X 2200 0 0 BETH ARIMOND DIRECTOR 1.00 X 2200 0 0 KEN CORNISH DIRECTOR 1.00 X 2200 0 0 JOHN HALBEIB DIRECTOR 1.00 X 2200 0 0 JOHN KRIESEL DIRECTOR 1.00 X 2200 0 0 KAREN LUMB DIRECTOR 1.00 X 2200 0 0 STEVE MCCARTHY DIRECTOR 1.00 X 2200 0 0 GARY RANUM DIRECTOR 1.00 X 2200 0 0 JANIS RIBBENS DIRECTOR 1.00 X 2000 0 0 TARA JOHNSON DIRECTOR 1.00 X 0 0 0 MARK HILLIKER CHIEF EXECUTIVE OFFICER 40.00 X 615081 0 57322 TIM GARRITY CHIEF INNOVATION OFFICER 40.00 X 361001 0 55158 PATRICK HENNEGER CHIEF LEGAL OFFICER 40.00 X 354936 0 53877 JOSHUA JANDRAIN CHIEF INFORMATION OFFICER 40.00 X 343902 0 58577 JANNA DUFFY CHIEF OPERATIONS OFFICER 40.00 X 364675 0 14556 JASON TAYLOR CHIEF FINANCIAL OFFICER 40.00 X 363675 0 12929 KRISTOPHER KUBNICK CHIEF COMMUNITY RESOURCES (TERM AUG) 40.00 X 254171 0 46826 CANDISE MILLER FOUNDATION EXECUTIVE DIRECTOR 40.00 X 123427 0 48837 BRIAN BRADLEY EXECUTIVE DIRECTOR OF OPERATIONS 40.00 X 209068 0 41621 KELLY SAMPLE EXECUTIVE DIRECTOR OF OPERATIONS 40.00 X 188491 0 48692 KEVIN KNOPE DIRECTOR OF IT APPLICATIONS & DATA ENGINEERING 40.00 X 170977 0 40733 AMY SWANSON DIRECTOR PROJECT MANAGEMENT & BUSINESS ANALYSIS 40.00 X 149058 0 51604 STACEY WARGOWSKY SR. DIRECTOR OF CR/PR AND CARE MANAGEMENT SUPPORT 40.00 X 152372 0 45886 3681434 0 576618 13 0 1 0 MCKESSON MEDICAL-SURGICAL PO BOX 204786 PLYMOUTH TX 75320 MEMBER SUPPLIES 4699204 WPS 1717 W BROADWAY MADISON WI 53713 ADMINISTRATIVE (TPA) 3842416 RSM US LLP 5155 PAYSPHERE CIRCLE CHICAGO IL 60674 IT CONSULTATION 1893935 REM WISCONSIN III INC 2005 W BELTLINE HWY STE 203 MADISON WI 53713 DIRECT CARE WORKFORCE, CRISIS DIVERSION, 1130775 RUNNING INC 318 W DECKER ST VIROQUA WI 54665 MEMBER TRANSPORTATION 921331 5 2745 2745 CAPITATION FEE REVENUE 624100 317866627 317866627 ROOM AND BOARD REIMBURSEMENT 623000 23270943 23270943 341137570 3694508 3694508 306195 0 306195 306195 306195 105083775 142005000 104744910 48472983 338865 93532017 93870882 93870882 439011900 341137570 0 97871585 2956685 2377470 579215 28301027 22756856 5544171 1039169 835596 203573 9660431 7767953 1892478 2213292 1757076 456216 46665 46665 107393 107393 2141639 246847 1894792 162437 2601 159836 493652 332926 160726 1485282 1361707 123575 1139086 981384 157702 838197 764735 73462 969 969 1725170 1038799 686371 218134 154656 63478 CAPITATION PAYOUT 294668257 294668257 120205 1574 118631 347317690 335049406 12268284 0 -4956280 840633 174293382 20908305 5262460 106500000 1463628 77286 6878034 457314 17680931 6420720 6676642 74770040 6201226 0 206621989 209516984 75939842 58161 10001040 32164 5621235 0 91562117 90325 X 115059872 209426659 115059872 209426659 206621989 209516984 91694210 2672577 0 X 0 0 0 X 49297 47676 8734 6150 2745 114602 646214344 659084122 695834461 805182768 341137570 3147453265 646263641 659131798 695843195 805188918 341140315 3147567867 0 0 0 3147567867 688202 1105773 275535 1542140 3694508 7306158 688202 1105773 275535 1542140 3694508 7306158 646951843 660237571 696118730 806731058 344834823 3154874025 0.99770 0.99890 0.00230 0.00110 X 0 0 0 0 0 0 0 0 1 19250 19250 0 PART II-B, LINE 1: 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. 274944 274944 6246743 360497 5886246 356347 96817 259530 6420720 X X 0 0 0 0 0 0 0 0 0 MARK HILLIKER CHIEF EXECUTIVE OFFICER 386517 0 225000 0 3564 0 13200 0 44122 0 672403 0 0 0 TIM GARRITY CHIEF INNOVATION OFFICER 243679 0 115000 0 2322 0 13200 0 41958 0 416159 0 0 0 PATRICK HENNEGER CHIEF LEGAL OFFICER 239126 0 115000 0 810 0 13200 0 40677 0 408813 0 0 0 JOSHUA JANDRAIN CHIEF INFORMATION OFFICER 228094 0 115000 0 808 0 13200 0 45377 0 402479 0 0 0 JANNA DUFFY CHIEF OPERATIONS OFFICER 247433 0 116000 0 1242 0 14556 0 0 0 379231 0 0 0 JASON TAYLOR CHIEF FINANCIAL OFFICER 247433 0 115000 0 1242 0 12929 0 0 0 376604 0 0 0 KRISTOPHER KUBNICK CHIEF COMMUNITY RESOURCES (TERM AUG) 163835 0 10000 0 80336 0 7205 0 39621 0 300997 0 0 0 BRIAN BRADLEY EXECUTIVE DIRECTOR OF OPERATIONS 158361 0 50500 0 207 0 8396 0 33225 0 250689 0 0 0 KELLY SAMPLE EXECUTIVE DIRECTOR OF OPERATIONS 138047 0 50000 0 444 0 7867 0 40825 0 237183 0 0 0 KEVIN KNOPE DIRECTOR OF IT APPLICATIONS & DATA E 140482 0 30000 0 495 0 6949 0 33784 0 211710 0 0 0 AMY SWANSON DIRECTOR PROJECT MANAGEMENT & BUSINE 118823 0 30000 0 235 0 6427 0 45177 0 200662 0 0 0 STACEY WARGOWSKY SR. DIRECTOR OF CR/PR AND CARE MANAG 132086 0 20000 0 286 0 6353 0 39533 0 198258 0 0 0 CANDISE MILLER FOUNDATION EXECUTIVE DIRECTOR 123338 0 0 0 89 0 5288 0 43549 0 172264 0 0 0 SEE SUPPLEMENTAL INFORMATION 2023-06-01 150500000 THE TRANSACTION WAS BETWEEN TWO UNRELATED PARTIES AND THEY UTILIZED A COMBINATION OF SOURCES TO DETERMINE THE VALUE FOR THE ACQUISITION. HUMANA INC (XX-XXX7538) PO BOX LEXINGTON KY 40512 N/A 0 1 0 0 PART II, LINE 2E: PERSON(S) INVOLVED: THE FOLLOWING INDIVIDUALS BECAME EMPLOYEES OF HUMANA AFTER THE ACQUISITION: MARK HILLIKERTIM GARRITYPATRICK HENNEGERJOSHUA JANDRAINJANNA DUFFYJASON TAYLOR PART II, LINE 2E: EXPLANATION OF INVOLVEMENT: THE OFFICERS LISTED ABOVE, AS APART OF THE ACQUISITION CONTINUED THEIR ROLES UNDER HUMANA. PART II, LINE 1(A): THE ORGANIZATION HAD THEIR OPERATIONS AND OPERATING ASSETS ACQUIRED IN 2023. CONSIDERATION WAS PAID FOR THESE OPERATIONS AND SOME CURRENT ASSETS AND CURRENT LIABILITIES. THE SALES PRICE WAS $150,000,000 WITH $44,000,000 RECEIVED IN 2023 AND $106,500,000 DUE IN EQUAL INSTALLMENTS OF $35,500,000 IN 2024, 2025 AND 2026. IN ADDITION TO THOSE PROCEEDS, HUMANA INC. WILL PAY INCLUSA FOUNDATION APPROPRIATE INTEREST ON EACH INSTALLMENT. FORM 990, PART I, B, AMENDED RETURN: THE ORGANIZATION HAD SPECIFIC AUDIT PROCEDURES PERFORMED FOR THEIR POST SALE TRANSACTION OF THE LAST 7 MONTHS OF THE CALENDAR YEAR ENDED 12/31/2023. AS A RESULT OF THAT COMPLETED AUDIT THERE WERE SOME ADJUSTMENTS TO THE REPORTING OF INCOME AND BALANCE SHEET FOR WHICH AN AMENDED RETURN IS MERITED. THE FOLLOWING PARTS AND SECTIONS WERE AMENDED FROM THE ORIGINAL FILING: PART I, REVENUE PART I, EXPENSES PART I, NET ASSETS PART III, LINE 4A & 4E PART VIII, LINE 3 & 7 PART XI, LINE 7, 9,11G, 23, 24E PART X, LINE 2, 4, 9, 11, 17, 27 PART XI, LINE 3, 5, 9, 10 SCHEDULE A, PART III SCHEDULE N, PART II, COLUMN C SCHEDULE N, PART III FORM 990, PART III, LINE 2 IN 2023, OPERATIONS AS REFLECTED ON THE FORM 990 FOR INCLUSA FOUNDATION (FKA INCLUSA) REPRESENTS HISTORICAL OR TYPICAL OPERATIONS. HOWEVER, TO CLOSE OUT 2023 AND ENTERING 2024, THE ORGANIZATION WILL BE TRANSITIONING FROM THEIR MANAGED LONG TERM SERVICES AND SUPPORT TO A FOUNDATION. THE INCLUSA FOUNDATION WILL FOCUS ITS WORK PRIMARILY WITHIN THE STATE OF WISCONSIN. SUCCESSFUL APPLICATIONS SHOULD BE ORIENTED AROUND THE UNIQUE POLICY CONTEXT OF WISCONSIN'S LTSS ECOSYSTEM. WE ARE NOT SEEKING TO SUPPORT PROGRAMMING THAT IS ALREADY FINANCED VIA THE FAMILY CARE OR IRIS PROGRAMS, THOUGH WE ARE OPEN TO SUPPORTING THE PILOTING OF INNOVATIVE PROGRAM MODELS THAT MAY BE SUPPORTED OVER TIME BY FAMILY CARE/IRIS IN THE FUTURE. WE CONSIDER OURSELVES STEWARDS OF WISCONSIN'S LTSS ECOSYSTEM AND ARE ALSO INTERESTED IN INVESTING IN LEADERSHIP DEVELOPMENT AND POLICY EDUCATION ACTIVITIES THAT WILL HELP WISCONSIN'S LTSS PROGRAMS CONTINUE TO EXCEL IN THE DECADES TO COME. FORM 990, PART III, LINE 3 DURING 2023, THE ORGANIZATION ENTERED INTO AN AGREEMENT WITH HUMANA TO PURCHASE THE ASSETS AND OPERATIONS OF INCLUSA. AS A RESULT OF THE PURCHASE THERE WOULD BE FUNDING BACK INTO INCLUSA TO FORM "INCLUSA FOUNDATION" WHICH WILL UTILIZE THE PROCEEDS TO TRANSITION INTO A FOUNDATION SUPPORTING LONG-TERM SERVICES AND SUPPORT AND HOME AND COMMUNITY BASED SERVICES NETWORKS AND THE ECOSYSTEM IN WISCONSIN. BY THE END OF 2023, INCLUSA FOUNDATION (FKA INCLUSA) CEASED ITS OPERATION OF THE MANAGED LONG TERM CARE SERVICES. FORM 990, PART VI, SECTION A, LINE 4 THE BOARD CONTINUED TO OVERSEE FAMILY CARE OPERATIONS DURING THE TRANSITIONAL PERIOD WITH HUMANA WHICH LASTED UNTIL MID-DECEMBER 2023. THE BOARD THEN PROCEEDED TO DEVELOP NEW GOVERNING DOCUMENTS RELATED TO THE INCLUSA FOUNDATION EFFORTS TO REFLECT THE CHANGES ELSEWHERE RECORDED ON THIS RETURN. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND THE EXECUTIVE OFFICER AND EXECUTIVE DIRECTOR. A COPY OF THE 990 IS PROVIDED TO THE GOVERNING BODY AFTER 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. ANNOVA INC 2801 HOOVER ROAD UNIT 1J STEVENS POINT WI 54481 842123943 (DISOLVED 2023) CONSULTING SERVICES WI INCLUSA INC C 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0