2020-10-29T08:38:21-05:00 2019-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2019-01-01 813565570 INCLUSA INC INCL 8776226700 3349 CHURCH ST STE 1 STEVENS POINT WI 54481 JASON TAYLOR CHIEF FINANCIAL OFFICER 8776226700 2020-10-28 1 MICHAEL J PETERSON CPA P01833529 2187224705 2020-09-21 216.54.158.12 2020-10-28 16:27:13 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 2019 2021-01-29 14:40:06Z MARK HILLIKER 3349 CHURCH STREET SUITE 1 STEVENS POINT WI 54481 646951843 0 X WWW.INCLUSA.ORG X 2016 WI IN ORDER TO MAXIMIZE HEALTH OUTCOMES, INCLUSA PROACTIVELY PARTNERS WITH OTHERS TO BUILD VIBRANT AND INCLUSIVE COMMUNITIES THAT OFFER PEOPLE DIGNITY, CHOICE, AND CONNECTIONS. 12 12 1289 11 0 0 42884 49297 624400324 646214344 273349 688202 0 0 624716557 646951843 0 0 0 0 82577852 86323984 0 0 0 524804511 541176050 607382363 627500034 17334194 19451809 95162877 114460594 55949564 56045472 39213313 58415122 IN ORDER TO MAXIMIZE HEALTH OUTCOMES, INCLUSA PROACTIVELY PARTNERS WITH OTHERS TO BUILD VIBRANT AND INCLUSIVE COMMUNITIES THAT OFFER PEOPLE DIGNITY, CHOICE, AND CONNECTIONS. 0 0 603674638 646214344 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 14,800 ELDERS AND PEOPLE WITH PHYSICAL AND INTELLECTUAL/DEVELOPMENTAL DISABILITIES IN WISCONSIN. 603674638 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 345 0 1289 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 1 1 1 1 1 1 1 1 0 WI X JASON TAYLOR 7152041810 3349 CHURCH ST STE 1 STEVENS POINT WI 54481 PATRICK HENNEGER GENERAL COUNSEL 40.00 X 237773 0 38521 JANNA DUFFY VP OF CARE MANAGEMENT SUPP 40.00 X 161245 0 6781 DANA CYRA VP OF QUALITY IMPROVEMENT 40.00 X 146366 0 27552 ERIN SMITH EXEC DIRECTOR CR/PR 40.00 X 150601 0 6374 KATE NORBY EXEC DIRECTOR MEMBR EXPER 40.00 X 148463 0 24879 MARK HILLIKER CHIEF EXECUTIVE OFFICER 40.00 X 425762 0 40059 TIM GARRITY CHIEF INNOVATION OFFICER 40.00 X 241818 0 40558 KRISTOPHER KUBNICK CHIEF COMMUNITY RESOURCES 40.00 X 247661 0 38913 MICHELLE FELLENZ CHIEF TLC OFFICER 40.00 X 238426 0 38521 JOSHUA JANDRAIN CHIEF INFORMATION OFFICER 40.00 X 236102 0 40193 JASON TAYLOR CHIEF FINANCIAL OFFICER 40.00 X 255824 0 10563 KEN DAY PRESIDENT 2.00 X X 9600 0 0 JOAN FORDHAM VICE PRESIDENT 1.00 X X 2400 0 0 RON CARNEY SECRETARY/TREASURER 1.00 X X 2400 0 0 BETH ARIMOND DIRECTOR 1.00 X 2400 0 0 LORI BINA THRU JUNE DIRECTOR 1.00 X 1400 0 0 KEN CORNISH DIRECTOR 1.00 X 2400 0 0 WADE DULL DIRECTOR 1.00 X 2400 0 0 JOHN HALBEIB DIRECTOR 1.00 X 1000 0 0 TARA JOHNSON DIRECTOR 1.00 X 0 0 0 JOHN KRIESEL DIRECTOR 1.00 X 2400 0 0 LARRY LAEHN DIRECTOR 1.00 X 1000 0 0 GARY RANUM DIRECTOR 1.00 X 2400 0 0 JANIS RIBBENS DIRECTOR 1.00 X 2400 0 0 2522241 0 312914 16 0 1 0 WPS 1717 W BROADWAY MADISON WI 53713 ADMINISTRATIVE FEES 3306149 CDW GOVERNMENT INC 75 REMITTANCE DR STE 1515 CHICAGO IL 606751515 IT EQUIPMENT AND SERVICES 784954 RUNNING INC 318 WEST DECKER STREET VIROQUA WI 54665 MEMBER TRANSPORTATION 680288 REM WISCONSIN III INC 2005 BELTLINE HWY STE 203 MADISON WI 53713 DIRECT CARE WORKFORCE 562006 ULTIMATE SOFTWARE GROUP INC PO BOX 930953 ATLANTA GA 31193 HRIS SYSTEM 522948 40 43397 5900 49297 CAPITATION FEE REVENUE 624100 600222913 600222913 ROOM AND BOARD REIMBURSEMENT 623000 45991431 45991431 646214344 688202 688202 646951843 646214344 0 688202 1900482 1498704 401778 61036356 48131961 12904395 2298125 1812519 485606 16638560 13348174 3290386 4450461 3544614 905847 141684 10 141674 70962 70962 3977453 284816 3692637 155532 494 155038 553389 426306 127083 2814464 2814464 3060956 2875737 185219 2191939 1749653 442286 909536 210204 699332 294402 196854 97548 DIRECT MEMBER CARE EXPE 526603370 526603370 EMPLOYEE TRAINING 238817 79586 159231 OPERATING SUPPLIES 95296 93585 1711 BOARD EXPENSES 39980 39980 28270 3587 24683 627500034 603674638 23825396 0 1055 230 70399499 85127179 22039782 25958498 701513 1055407 10710101 8390821 2021028 2319280 95162877 114460594 55949564 56045472 55949564 56045472 X 39213313 58415122 39213313 58415122 95162877 114460594 X 19451809 -250000 X 0 1 X 1 0 X 44639 42884 49297 136820 609812067 624400324 646214344 1880426735 609856706 624443208 646263641 1880563555 0 0 0 1880563555 231890 273349 688202 1193441 231890 273349 688202 1193441 610088596 624716557 646951843 1881756996 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 480171 424622 55549 9074561 7966199 1108362 1155369 1155369 2319280 X X 0 0 0 0 0 0 0 0 0 PATRICK HENNEGER GENERAL COUNSEL 229772 0 7500 0 501 0 9662 0 28859 0 276294 0 0 0 JANNA DUFFY VP OF CARE MANAGEMENT SUPP 152539 0 8000 0 706 0 6435 0 346 0 168026 0 0 0 DANA CYRA VP OF QUALITY IMPROVEMENT 137149 0 8000 0 1217 0 6028 0 21524 0 173918 0 0 0 ERIN SMITH EXEC DIRECTOR CR/PR 142346 0 8000 0 255 0 6028 0 346 0 156975 0 0 0 KATE NORBY EXEC DIRECTOR MEMBR EXPER 139822 0 8000 0 641 0 6028 0 18851 0 173342 0 0 0 MARK HILLIKER CHIEF EXECUTIVE OFFICER 383849 0 15000 0 26913 0 11200 0 28859 0 465821 0 0 0 TIM GARRITY CHIEF INNOVATION OFFICER 233135 0 7500 0 1183 0 9869 0 30689 0 282376 0 0 0 KRISTOPHER KUBNICK CHIEF COMMUNITY RESOURCES 239580 0 7500 0 581 0 10054 0 28859 0 286574 0 0 0 MICHELLE FELLENZ CHIEF TLC OFFICER 229772 0 7500 0 1154 0 9662 0 28859 0 276947 0 0 0 JOSHUA JANDRAIN CHIEF INFORMATION OFFICER 228100 0 7500 0 502 0 9662 0 30531 0 276295 0 0 0 JASON TAYLOR CHIEF FINANCIAL OFFICER 233693 0 7500 0 14631 0 10217 0 346 0 266387 0 0 0 FORM 990, PART VI, SECTION A, LINE 4 THE NUMBER OF MEMBERS WAS EXPANDED FROM 11 TO 13. 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. FORM 990, PART XI, LINE 9: TRANSFER TO SUBSIDIARY -250,000. ANNOVA INC 3349 CHURCH ST STE 1 STEVENS POINT WI 54481 842123943 CONSULTING SERVICES WI INCLUSA INC C -7457 458088 1.00000 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 ANNOVA INC D 215441 COST ANNOVA INC R 250000 CASH ANNOVA INC Q 158878 COST