2024-11-14T16:16:44-06:00 2023-12-31 363168081 SIKICH LLC 17335 GOLF PARKWAY SUITE 500 BROOKFIELD WI 53045 990 2023-01-01 391789197 CHILDREN'S MEDICAL GROUP INC CHIL 4142665420 PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 MARC A CADIEUX TREASURER 4142665420 2024-11-13 1 0 JILL M BOYLE CPA P01246734 2627549400 2024-11-13 2023 2024-10-15 13:58:12Z SEE SCHEDULE O MICHAEL GUTZEIT MD PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 109054138 0 X WWW.CHILDRENSWI.ORG X 1994 WI PROVIDE QUALITY, ACCESSIBLE PRIMARY HEALTH CARE TO CHILDREN IN THE COMMUNITY. 12 0 0 0 0 0 23860127 26079028 78395255 82880086 -20 -37054 24102 93098 102279464 109015158 0 0 0 0 57946767 61414790 0 0 0 44332697 47600368 102279464 109015158 0 0 33585744 37579820 33585744 37579820 0 0 X TO PROVIDE QUALITY, ACCESSIBLE PRIMARY HEALTH CARE SERVICES TO ALL CHILDREN IN OUR COMMUNITY, ADVOCATE FOR THE WELL-BEING OF ALL CHILDREN, EDUCATE CHILDREN, FAMILIES, HEALTH CARE PROFESSIONALS AND OUR COMMUNITY REGARDING THE HEALTH OF CHILDREN. 0 0 72260303 75598455 CHILDREN'S MEDICAL GROUP, INC. ("CMG") IS ORGANIZED AS A NON STOCK NON PROFIT CORPORATION WITH A SOLE MEMBER, CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. ("CHHS"), A SECTION 501(C)(3) ORGANIZATION. CMG IS AFFILIATED WITH CHILDREN'S HOSPITAL OF WISCONSIN, INC. ("CHW"), A SECTION 501(C)(3) ORGANIZATION WHICH IS THE ONLY HOSPITAL IN WISCONSIN DEVOTED SOLELY TO THE PROVISION OF MEDICAL SERVICES TO CHILDREN. THE PRIMARY PURPOSE OF CMG IS TO PROVIDE QUALITY PRIMARY CARE MEDICAL SERVICES TO CHILDREN IN THE COMMUNITY, STATE, AND REGION. THE AFFILIATED GROUP IS ONE OF ONLY A HANDFUL OF ORGANIZATIONS THROUGHOUT THE U.S. THAT FOCUSES SOLELY ON THE CRITICAL MEDICAL NEEDS OF CHILDREN AND THE SPECIAL CARE THEY REQUIRE. THE PRINCIPAL FUNCTION OF CMG IS TO PROVIDE PRIMARY MEDICAL DIAGNOSIS, TREATMENT SERVICES, AND PREVENTATIVE CARE THROUGH OUTPATIENT CLINICS AND COMMUNITY HEALTH SCREENING AND EDUCATION SERVICES. CMG ALSO PARTICIPATES IN PRIMARY CARE MEDICAL EDUCATION AND TRAINING THROUGH THE MEDICAL COLLEGE OF WISCONSIN AND GRADUATE MEDICAL EDUCATION PROGRAMS ALREADY ESTABLISHED AT CHW. CMG PROVIDES CARE TO CHILDREN WHO ARE RESIDENTS OF SOUTHEASTERN WISCONSIN AT LOCATIONS WHERE THERE IS A DEMONSTRATED COMMUNITY NEED FOR MEDICAL DIAGNOSIS AND TREATMENT. IN 2023, CMG HAD 22 PHYSICIAN OFFICES WITH APPROXIMATELY 183 PROVIDERS. AS A GROUP THERE WERE 356,908 PEDIATRIC OFFICE VISITS, HEALTH CHECKS AND IMMUNIZATIONS PROVIDED IN 2023. INCLUDED IN THIS NUMBER ARE 44,434 PEDIATRIC OFFICE VISITS, HEALTH CHECKS AND IMMUNIZATIONS DESCRIBED IN LINE 4B.IN RESPONSE TO THE CHANGING NEEDS OF THE COMMUNITY FOR MEDICAL SERVICES, ADVANCES IN PEDIATRIC MEDICINE AND THE INCREASING EMPHASIS ON PREVENTIVE MEDICAL CARE, CMG PROVIDES SERVICES IN FURTHERANCE OF THE MISSION OF CHW AND OTHER MEMBERS OF THE AFFILIATED GROUP. INCREASINGLY, PATIENTS HAVE BEEN SEEKING PRIMARY MEDICAL CARE THROUGH THE EMERGENCY ROOM FACILITIES OF HOSPITALS. THE EMERGENCY ROOM IS THE MOST COSTLY AND INEFFICIENT METHOD OF PROVIDING SUCH CARE TO PATIENTS. BY MAKING PRIMARY CARE AVAILABLE TO A GREATER PORTION OF THE GENERAL PUBLIC, CMG PROVIDES QUALITY, EFFICIENT PRIMARY PEDIATRIC CARE AT A LOWER COST. CMG IS STRUCTURED TO BETTER SERVE THE RESIDENTS OF SOUTHEASTERN WISCONSIN BY PROVIDING INCREASED ACCESS TO QUALITY MEDICAL CARE, EXPANDING COMMUNITY MEDICAL EDUCATION EFFORTS AND IMPROVING THE QUALITY OF PEDIATRIC CARE.CMG HAS MADE INTEGRATED MENTAL BEHAVIORAL HEALTH (IMBH) A STRATEGIC PART OF ITS PROVISION OF QUALITY HEALTH CARE. IMBH BRINGS BEHAVIORAL HEALTH SERVICES INTO THE PRIMARY CARE SETTING BY INCORPORATING LICENSED MENTAL HEALTH PROVIDERS, BEHAVIORAL HEALTH CONSULTANTS (BHCS), INTO THE TEAM. BHCS AND ALL MEMBERS OF THE PRIMARY CARE TEAM WORK TOGETHER TO PROVIDE COMPREHENSIVE, WHOLE-CHILD HEALTH CARE BY ADDRESSING EVERY ASPECT OF A CHILD'S PHYSICAL AND MENTAL WELLBEING. TYPICAL BHC SERVICES INCLUDE CHRONIC HEALTH CONDITION MANAGEMENT, ANTICIPATORY GUIDANCE, EARLY INTERVENTION FOR COMMON CHILDHOOD CONCERNS, AND ROUTINE BEHAVIORAL HEALTH SCREENING. BHCS PROVIDE MENTAL HEALTH ASSESSMENT AND TREATMENT, BRIEF EVIDENCE-BASED THERAPY, AND PHYSICIAN AND TEAM CONSULTATION. BHCS PROVIDE IMMEDIATE ACCESS TO MENTAL HEALTH AND PREVENTION SERVICES. IN ADDITION, CMG HAS EXPANDED ITS MENTAL BEHAVIORAL HEALTH OFFERINGS TO INCLUDE THE CRAIG YABUKI MENTAL HEALTH WALK-IN CLINIC, WHICH PROVIDES SAME-DAY CARE FOR CHILDREN AND TEENS EXPERIENCING URGENT MENTAL HEALTH ISSUES, AND A BRIDGE CLINIC TO ADDRESS THE LONG WAIT FOR OUTPATIENT THERAPY SERVICES BY OFFERING SHORT-TERM SUPPORT WHILE PATIENTS WAIT FOR APPOINTMENTS TO BECOME AVAILABLE. THIS WHOLE-CHILD APPROACH ENSURES CHILDREN WILL GET THE CARE THEY NEED, WHEN THEY NEED IT AND WHERE THEY NEED IT.DURING THE COVID-19 PANDEMIC, CMG PIVOTED TO PROVIDE THE CARE CHILDREN AND FAMILIES NEED AS SAFELY AS POSSIBLE. THIS INCLUDED A SIGNIFICANT INCREASE IN USE OF TELEHEALTH (INCLUDING FOR MENTAL AND BEHAVIORAL HEALTH NEEDS) AND SUPPORTING OUR COMMUNITY THROUGH TESTING, VACCINATION AND PEDIATRIC HEALTH AND SAFETY ADVICE AND RECOMMENDATIONS. WITH THE CONCLUSION OF THE PANDEMIC IN MAY 2023, CMG HAS CONTINUED TO INCLUDE TELEHEALTH SERVICES IN ITS EVERYDAY CARE OFFERINGS MAKING PRIMARY CARE MORE CONVENIENT AND ACCESSIBLE. 14223075 7374729 CMG OPERATES CLINICS IN UNDERSERVED AREAS IN THE MILWAUKEE AREA, WHICH INCLUDES A SITE LOCATED ON THE NEXT DOOR FOUNDATION CAMPUS IN MILWAUKEE'S CENTRAL CITY, THE MIDTOWN HEALTH CENTER, AND THE FOREST HOME, RIVER GLEN AND GOOD HOPE CLINICS. THESE CLINICS PROVIDE PRIMARY CARE SERVICES INCLUDING PREVENTIVE CARE, PHYSICALS, IMMUNIZATIONS AND TREATMENT FOR ILLNESSES TO AREAS THAT PREVIOUSLY DID NOT HAVE PEDIATRIC PRACTICES AVAILABLE TO ATTEND TO THE COMMUNITY'S NEEDS. ADDITIONALLY, TO MEET THE DENTAL NEEDS OF UNDERSERVED CHILDREN IN THE CITY OF MILWAUKEE, CMG HAS A PEDIATRIC DENTAL PRACTICE, DENTAL CENTER MIDTOWN. THESE CLINICS OPERATE AT A LOSS, WHICH WAS FUNDED BY CHW OR CONTRIBUTIONS RECEIVED VIA THE CHILDREN'S HOSPITAL OF WISCONSIN FOUNDATION, INC. THESE CLINICS HAD 44,434 PEDIATRIC OFFICE VISITS, HEALTH CHECKS AND IMMUNIZATIONS PROVIDED IN 2023, AND APPROXIMATELY 82% OF THE GROSS CHARGES WERE FROM PATIENTS ENROLLED IN MEDICAID. 86483378 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 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 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 0 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X MS SARAH KAFKA 4142668976 PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 BARBARA CALKINS MD DIRECTOR/PEDIATRIC PHYSICIAN,CHAIR 30.00 0.00 X X 247143 0 11091 KATHRYNN FEE MD DIRECTOR/PEDIATRIC PHYSICIAN 40.00 0.00 X 325807 0 15628 AARON HANSON MD DIRECTOR/PEDIATRIC PHYSICIAN 40.00 0.00 X 388241 0 79284 AMANDA KOTOWSKI DIRECTOR/NURSE PRACTITIONER 30.00 0.00 X 127223 0 68774 CHRISTEN MCALPINE-TESFAI MD DIR./PEDIATRIC PHYSICIAN,VICE CHAIR 40.00 0.00 X X 267540 0 4862 BRILLIANT NIMMER MD DIRECTOR/PEDIATRIC PHYSICIAN 40.00 0.00 X 202048 0 57791 DAVID OGREN MD DIRECTOR/PEDIATRIC PHYSICIAN 40.00 0.00 X 296310 0 72535 CYNTHIA RUNNING MD DIRECTOR/PEDIATRIC PHYSICIAN 30.00 0.00 X 220910 0 69669 MARGARET TROY DIRECTOR/PRESIDENT AND CEO CHHS 0.00 40.00 X 0 2192619 74552 MICHAEL GUTZEIT MD DIRECTOR/PRESIDENT CMG AND SVP 0.00 40.00 X X 0 841469 84612 AMY ROMASHKO MD DIRECTOR/URGENT CARE MED/PROGRAM DIR 0.00 40.00 X 0 374131 86564 JASON JARZEMBOWSKI MD DIRECTOR 1.00 0.00 X 0 0 0 MATT LEVY MD END 82123 DIRECTOR 1.00 0.00 X 0 0 0 MARC CADIEUX TREASURER/CORP VP & CFO 0.00 40.00 X 0 1036005 132135 LESLIE TECTOR JD SECRETARY/VP GENERAL COUNSEL 0.00 40.00 X 0 611392 103581 JAYA IYER MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 40.00 0.00 X 364854 0 21078 STEVEN JEREB MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 40.00 0.00 X 303494 0 72258 BOYD MILLER MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 40.00 0.00 X 356412 0 75202 CHRISTOPHER SCHWAKE MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 40.00 0.00 X 418873 0 85764 MARY SISNEY VP PRIMARY CARE 40.00 0.00 X 285901 0 90965 YOLANDA WOLFF MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 40.00 0.00 X 330783 0 80014 SHERYN ABRAHAM MD PEDIATRIC PHYSICIAN 40.00 0.00 X 515635 0 65644 KRISTIN BENCIK BOUDREAU MD PEDIATRIC PHYSICIAN 40.00 0.00 X 351506 0 25210 DAVID MELBYE MD PHYSICIAN PEDIATRICIAN 40.00 0.00 X 345393 0 72308 SADOUN OMARI MD PEDIATRIC PHYSICIAN 40.00 0.00 X 359503 0 70707 PATTI-MARIE YOUNG MD PEDIATRIC PHYSICIAN 40.00 0.00 X 419022 0 13911 SMRITI KHARE MD END 41022 FORMER OFFICER/SVP AND CHIEF MBH OFF 0.00 40.00 X 0 567769 53322 MICHELLE METTNER END 123122 FORMER SEC/CORP VP GOV & LEGAL AFF. 0.00 40.00 X 0 411893 7319 AMY HERBST FORMER KEY EMP/VP BEHAV.&MENTAL HEALTH 0.00 40.00 X 0 362212 89746 6126598 6397490 1684526 125 1 1 0 IMAGINE MEDICAL GROUP PA 228 PARK AVE S NEW YORK NY 10003 PHYSICIANS AND LICENSED CLINICAL SOCIAL 1931708 MEDICAL COLLEGE OF WISCONSIN 8701 WATERTOWN PLANK RD MILWAUKEE WI 53226 PHYSICIANS AND NURSE PRACTITIONERS 1175224 STAFFENCY LLC 221 W COLLEGE AVE FL 2 APPLETON WI 54911 TEMP HELP SERVICES 1168216 GOODWILL TALENTBRIDGE LLC BOX 78695 MILWAUKEE WI 532780695 PATIENT SERVICES REPRESENTATIVES 555770 TRIAGE 4 PEDIATRICS PO BOX 261923 PLANO TX 75026 ANSWERING SERVICES 283646 6 24454492 1624536 26079028 NET PATIENT SVC REV 621110 82634242 82634242 RENTAL INCOME 532000 143595 143595 SALARY SUPPORT 900099 102249 102249 82880086 1926 1926 38980 -38980 -38980 -38980 OTHER MISCELLANEOUS 900099 93098 93098 93098 109015158 82973184 0 -37054 5866535 5022596 843939 45568791 42538647 3030144 1829366 1711894 117472 5015250 4635676 379574 3134848 2851715 283133 17623101 17623101 5451268 5444057 7211 500 500 79864 79864 477 477 7390624 7271690 118934 24486 18985 5501 174344 157584 16760 1892879 1855503 37376 MEDICAL SUPPLIES 14090188 14090188 OTHER EXPENSES 872637 804002 68635 109015158 86483378 22531780 0 460549 513370 6027420 7226694 56713 40207 1614071 1935544 529689 571319 21889149 12714655 7517336 9174494 17379966 18118192 33585744 37579820 7740232 5909484 3249832 2448000 22595680 29222336 33585744 37579820 X 0 0 33585744 37579820 0 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 14529225 8846646 5682579 7340286 3866911 3473375 19638 1098 18540 9174494 DEFERRED COMPENSATION PLAN ASSETS 9527177 LEASE ASSETS 8591015 18118192 DEF. COMPENSATION PLAN LIABILITIES 9527177 DUE TO AFFILIATES 10702291 LEASE LIABILITY AND OTHER 8992868 29222336 X PART X, LINE 2: FOOTNOTE 2 INCOME TAXES: CHHS EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED FOR THE YEARS ENDED DECEMBER 31, 2023 AND 2022. 0 1 0 0 0 0 0 1 0 MARGARET TROY DIRECTOR/PRESIDENT AND CEO CHHS 0 1284168 0 476756 0 431695 0 24450 0 50102 0 2267171 0 0 MARC CADIEUX TREASURER/CORP VP & CFO 0 677156 0 181050 0 177799 0 130298 0 1837 0 1168140 0 126916 MICHAEL GUTZEIT MD DIRECTOR/PRESIDENT CMG AND SVP 0 560408 0 129933 0 151128 0 27750 0 56862 0 926081 0 0 LESLIE TECTOR JD SECRETARY/VP GENERAL COUNSEL 0 533754 0 76396 0 1242 0 81150 0 22431 0 714973 0 0 SMRITI KHARE MD END 41022 FORMER OFFICER/SVP AND CHIEF MBH OFF 0 231795 0 119643 0 216331 0 27750 0 25572 0 621091 0 127542 SHERYN ABRAHAM MD PEDIATRIC PHYSICIAN 488586 0 14650 0 12399 0 11280 0 54364 0 581279 0 0 0 CHRISTOPHER SCHWAKE MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 364216 0 53847 0 810 0 24450 0 61314 0 504637 0 0 0 AARON HANSON MD DIRECTOR/PEDIATRIC PHYSICIAN 268678 0 95677 0 23886 0 11250 0 68034 0 467525 0 0 0 AMY ROMASHKO MD DIRECTOR/URGENT CARE MED/PROGRAM DIR 0 327075 0 29644 0 17412 0 24450 0 62114 0 460695 0 0 AMY HERBST FORMER KEY EMP/VP BEHAV.&MENTAL HEAL 0 299844 0 42445 0 19923 0 27750 0 61996 0 451958 0 0 PATTI-MARIE YOUNG MD PEDIATRIC PHYSICIAN 386500 0 30200 0 2322 0 11250 0 2661 0 432933 0 0 0 BOYD MILLER MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 316334 0 23811 0 16267 0 21150 0 54052 0 431614 0 0 0 SADOUN OMARI MD PEDIATRIC PHYSICIAN 269743 0 60432 0 29328 0 14025 0 56682 0 430210 0 0 0 MICHELLE METTNER END 123122 FORMER SEC/CORP VP GOV & LEGAL AFF. 0 316519 0 93526 0 1848 0 0 0 7319 0 419212 0 0 DAVID MELBYE MD PHYSICIAN PEDIATRICIAN 292371 0 51312 0 1710 0 11250 0 61058 0 417701 0 0 0 YOLANDA WOLFF MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 293293 0 22237 0 15253 0 24450 0 55564 0 410797 0 0 0 JAYA IYER MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 323886 0 17226 0 23742 0 18865 0 2213 0 385932 0 0 0 MARY SISNEY VP PRIMARY CARE 252686 0 28751 0 4464 0 25953 0 65012 0 376866 0 0 0 KRISTIN BENCIK BOUDREAU MD PEDIATRIC PHYSICIAN 276785 0 50979 0 23742 0 11250 0 13960 0 376716 0 0 0 STEVEN JEREB MD MEDICAL DIRECTOR/PEDIATRIC PHYSICIAN 250723 0 22251 0 30520 0 11250 0 61008 0 375752 0 0 0 DAVID OGREN MD DIRECTOR/PEDIATRIC PHYSICIAN 214422 0 57981 0 23907 0 11250 0 61285 0 368845 0 0 0 KATHRYNN FEE MD DIRECTOR/PEDIATRIC PHYSICIAN 241823 0 60944 0 23040 0 11250 0 4378 0 341435 0 0 0 CYNTHIA RUNNING MD DIRECTOR/PEDIATRIC PHYSICIAN 177894 0 42129 0 887 0 9305 0 60364 0 290579 0 0 0 CHRISTEN MCALPINE-TESFAI MD DIR./PEDIATRIC PHYSICIAN,VICE CHAIR 254000 0 13000 0 540 0 4022 0 840 0 272402 0 0 0 BRILLIANT NIMMER MD DIRECTOR/PEDIATRIC PHYSICIAN 182156 0 19520 0 372 0 3482 0 54309 0 259839 0 0 0 BARBARA CALKINS MD DIRECTOR/PEDIATRIC PHYSICIAN,CHAIR 216500 0 29600 0 1043 0 9844 0 1247 0 258234 0 0 0 AMANDA KOTOWSKI DIRECTOR/NURSE PRACTITIONER 124770 0 1710 0 743 0 11307 0 57467 0 195997 0 0 0 PART I, LINE 3 CMG RELIED UPON CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. ("CHHS"), THE CORPORATE MEMBER OF CMG, TO ESTABLISH THE COMPENSATION OF CMG'S PRESIDENT. CHHS USED ITS INDEPENDENT COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, THE FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEYS, AND APPROVAL BY THE COMPENSATION COMMITTEE TO DETERMINE THE COMPENSATION. PART I, LINE 4B IN 2023, THERE WAS A CHHS EXECUTIVE FLEXIBLE BENEFIT PLAN IN PLACE WHICH WAS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN (457(F) PLAN). THE CORPORATION CONTRIBUTES 10% OF EACH PARTICIPATING EXECUTIVE'S SALARY. THE AMOUNTS OF EMPLOYER CONTRIBUTIONS TO THIS PLAN FOR PARTICIPATING EXECUTIVES IN 2023 WERE AS FOLLOWS: M. CADIEUX, $105,848, AND L. TECTOR, $60,000. AFTER A VESTING PERIOD, PARTICIPANTS MAY ELECT TO WITHDRAW AMOUNTS PREVIOUSLY CONTRIBUTED AND REPORTED. AMOUNTS WITHDRAWN BY PARTICIPANTS IN 2023 WERE: M. CADIEUX, $126,916; AND S. KHARE, M.D, $127,542. PART I, LINE 7 CERTAIN EXECUTIVES PARTICIPATE IN AN ANNUAL BONUS PLAN THAT PROVIDES COMPENSATION BASED ON ACHIEVING SPECIFIC PRE-DEFINED GOALS. BONUS CRITERIA ARE COMPRISED OF BOTH SYSTEM LEVEL AND EXECUTIVE SPECIFIC COMPONENTS. SUCH CRITERIA PERTAIN TO MATTERS WITHIN THE EXECUTIVE'S AREA OF RESPONSIBILITY, AS WELL AS ACHIEVEMENT OF OVERALL STRATEGIC OBJECTIVES OF THE ORGANIZATION AND ITS AFFILIATES IN ALIGNMENT WITH SYSTEM-WIDE BALANCED MEASURES. FORM 990, PART VII, COLUMN E & SCHEDULE J, PART II: SALARIES PAID BY RELATED ORGANIZATIONS: 1. SMRITI KHARE, M.D., SVP AND CHIEF MENTAL & BEHAVIORAL HEALTH OFFICER AND FORMER PRESIDENT OF CMG AND BOARD CHAIR REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS AND OTHER COMPENSATION LISTED IN PART VII AND SCHEDULE J WERE PAID FOR SERVICES PROVIDED (40 HOURS PER WEEK) TO CHHS AND AFFILIATES. THESE AMOUNTS WERE PAID BY CHHS. 2. DRS. CALKINS, FEE, MCALPINE-TESFAI, RUNNING, HANSON, OGREN, NIMMER, AND NURSE PRACTITIONER KOTOWSKI- COMPENSATION AND BENEFITS LISTED WERE FOR SERVICES PROVIDED AS FULL-TIME EMPLOYEES OF CMG. SERVICES AS MEMBERS OF THE BOARD OF DIRECTORS WERE PROVIDED ON A PART-TIME VOLUNTARY BASIS. 3. MARGARET TROY, PRESIDENT & CEO OF CHHS, MARC CADIEUX, TREASURER OF CMG AND TREASURER & CFO OF CHHS, MICHELLE METTNER, FORMER SECRETARY/VP GENERAL COUNSEL, AMY HERBST, FORMER KEY EMPLOYEE/VP BEHAVIORAL & MENTAL HEALTH, AMY ROMASHKO, MD, URGENT CARE MEDICAL/PROGRAM DIRECTOR, AND LESLIE TECTOR, SECRETARY OF CMG AND VP GENERAL COUNSEL - REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS AND OTHER COMPENSATION LISTED IN PART VII AND SCHEDULE J WERE PAID FOR SERVICES PROVIDED (40 HOURS PER WEEK) TO CHHS AND ITS AFFILIATES. THESE AMOUNTS WERE PAID BY CHHS. SERVICES BY MS. TROY AS A MEMBER OF THE BOARD OF DIRECTORS OF CMG WERE PROVIDED AS PART OF HER POSITION OF CHHS. 4. MICHAEL GUTZEIT, M.D., PRESIDENT OF CMG AND BOARD CHAIR REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS AND OTHER COMPENSATION LISTED IN PART VII AND SCHEDULE J WERE PAID FOR SERVICES PROVIDED (40 HOURS PER WEEK) TO CMG. THESE AMOUNTS WERE PAID BY CHHS. SERVICES BY DR. GUTZEIT AS A MEMBER OF THE BOARD OF DIRECTORS WERE PROVIDED AS PART OF HIS POSITION OF CHHS. FORM 990, BOX C, DOING BUSINESS AS: CHILDREN'S WISCONSIN - PRIMARY CARE FORM 990, PART V, LINE 1A THE ORGANIZATION DID NOT FILE ANY FORMS 1099 DURING THE TAXABLE YEAR. ALTHOUGH THE ORGANIZATION DID RETAIN INDEPENDENT CONTRACTORS, THE COMPENSATION AMOUNTS OWED TO SUCH CONTRACTORS WERE PROCESSED AND PAID BY A RELATED ENTITY, CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. ("CHS"), WITH APPROPRIATE INTERCOMPANY ARRANGEMENTS BETWEEN THE ORGANIZATION AND CHS. THE FORMS 1099 FOR SUCH PAYMENTS WERE ISSUED BY CHS, AS THE ENTITY THAT PROCESSED AND MADE THE PAYMENTS TO THE INDEPENDENT CONTRACTORS. FORM 990, PART V, LINE 2A THE ORGANIZATION DID NOT FILE FORM W-3 DURING THE TAXABLE YEAR. ALTHOUGH THE ORGANIZATION DID RETAIN EMPLOYEES AND REPORTED SALARIES ON PART IX OF THE FORM 990, THE COMPENSATION AMOUNTS PAID TO EMPLOYEES OF CMG WERE PROCESSED AND PAID BY A RELATED ENTITY, CHHS, WITH APPROPRIATE INTERCOMPANY ARRANGEMENTS BETWEEN THE ORGANIZATION AND CHHS. THE FORM W-3 WAS ISSUED BY CHHS, AS THE ENTITY THAT PROCESSED AND MADE THE PAYMENTS TO THE EMPLOYEES. FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS EXIST BETWEEN THE FOLLOWING BOARD MEMBERS: TROY AND LEVY, TROY AND JARZEMBOWSKI, CALKINS AND LEVY, AND CALKINS AND JARZEMBOWSKI. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A SOLE CORPORATE MEMBER WHICH IS CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. (CHHS). FORM 990, PART VI, SECTION A, LINE 7A CHHS, THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, ELECTS THE ORGANIZATION'S GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE CORPORATE MEMBER, CHHS, HAS CERTAIN RESERVE POWERS OVER THE CORPORATION, INCLUDING AMENDMENT OF THE ARTICLES OF INCORPORATION AND BYLAWS; APPROVAL OF MERGER, CONSOLIDATION OR THE CREATION OF ANY SUBSIDIARIES BY THE CORPORATION; AND APPROVAL OF THE ANNUAL BUDGET AND ANY DEBT. THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF CHHS SELECTS THE PRESIDENT. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 OF CMG WAS REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE OF CHHS BOARD OF DIRECTORS, AND PRIOR TO FILING, A COPY WAS PROVIDED TO ALL DIRECTORS OF CMG. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE REQUESTED TO SUBMIT A CONFLICT OF INTEREST DISCLOSURE TO THE DIRECTOR OF CORPORATE COMPLIANCE. THE COMPLIANCE DEPARTMENT MONITORS AND PERIODICALLY REVIEWS TRANSACTIONS BETWEEN THE ORGANIZATION AND BOARD MEMBERS OR ENTITIES WITH WHICH THEY ARE AFFILIATED. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE ORGANIZATION'S OFFICERS WAS REVIEWED AND APPROVED BY THE INDEPENDENT COMPENSATION COMMITTEE OF CHHS (THE ORGANIZATION'S CORPORATE MEMBER). WITH THE ASSISTANCE OF AN INDEPENDENT COMPENSATION CONSULTANT AND INFORMATION FROM A VARIETY OF EXTERNAL SOURCES (AS INDICATED ON SCHEDULE J), THE COMMITTEE CONFIRMED THAT TOTAL COMPENSATION AMOUNTS TO BE PAID WERE REASONABLE AND COMPARABLE TO AMOUNTS PAID BY SIMILARLY SITUATED ORGANIZATIONS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. COMPENSATION OF THE KEY EMPLOYEES WAS SET BY SUPERVISORY EXECUTIVES IN CONSULTATION WITH CHHS HUMAN RESOURCES LEADERS. THE PROCESS INCLUDED REVIEW BY INDEPENDENT PERSONS WHO, USING A VARIETY OF EXTERNAL SOURCES (AS INDICATED ON SCHEDULE J), CONFIRMED THAT TOTAL COMPENSATION AMOUNTS TO BE PAID WERE REASONABLE AND COMPARABLE TO AMOUNTS PAID BY SIMILARLY SITUATED ORGANIZATIONS. THE PROCESS AND DATA RELIED ON WERE THOROUGHLY AND TIMELY DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL INFORMATION OF CMG ARE AVAILABLE TO THE PUBLIC UPON REQUEST THROUGH THE CHHS MARKETING AND COMMUNICATION DEPARTMENT. FORM 990, PART I, LINE 4 AND PART VI, LINE 1B CHILDREN'S MEDICAL GROUP, INC. ("CMG") IS A WISCONSIN NONSTOCK CORPORATION. CMG IS AN AFFILIATE OF CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. ("CHHS"), A TAX-EXEMPT WISCONSIN CORPORATION SERVING AS THE PARENT ENTITY OF AN INTEGRATED SYSTEM OF PROVIDER ORGANIZATIONS ADDRESSING THE HEALTH CARE NEEDS OF CHILDREN IN SOUTHEASTERN WISCONSIN AND SURROUNDING AREAS. AS THE CORPORATE MEMBER OF CMG, CHHS HOLDS VARIOUS RESERVE POWERS IN RELATION TO CMG, INCLUDING AUTHORITY TO APPOINT CMG'S BOARD OF DIRECTORS. THE BOARD OF DIRECTORS OF CMG CONSISTS OF CERTAIN PHYSICIANS WHO ARE EMPLOYED BY CMG, ALONG WITH REPRESENTATIVES OF CHHS'S EXECUTIVE LEADERSHIP. AS EMPLOYEES OF EITHER CMG OR CHHS, NONE OF THESE DIRECTORS MAY BE CONSIDERED "INDEPENDENT" FOR PURPOSES OF FORM 990. HOWEVER, AS ACKNOWLEDGED BY THE IRS IN ITS CPE TEXT FOR FISCAL YEAR 1997, IN A MULTI ENTITY HOSPITAL SYSTEM, THE BOARD OF A SUBSIDIARY NON-PROFIT HEALTH CARE ORGANIZATION IS CONSIDERED TO BE COMPRISED OF INDEPENDENT COMMUNITY MEMBERS IF IT IS CONTROLLED BY AN EXEMPT ORGANIZATION WHOSE BOARD IS COMPRISED OF A MAJORITY OF VOTING MEMBERS WHO ARE INDEPENDENT COMMUNITY MEMBERS. CMG MEETS THIS STANDARD BECAUSE IT IS A CONTROLLED SUBSIDIARY OF CHHS, AND CHHS'S GOVERNING BOARD INCLUDES INDEPENDENT COMMUNITY MEMBERS AS A MAJORITY THEREOF. CHILDREN'S HOSPITAL & HEALTH SYSTEM INC PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 391500074 AMBULATORY SURGERY CTR, URGENT CARE, & OPERATIONAL SUPPT SVCS WI 501(C)(3) LINE 3 N/A 0 CHILDREN'S HOSPITAL OF WISCONSIN INC PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 390812532 PEDIATRIC HOSPITAL WI 501(C)(3) LINE 3 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 0 CHILDREN'S HOSPITAL OF WISCONSIN FOUNDATION INC PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 391500075 FUND DEVELOPMENT WI 501(C)(3) LINE 7 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 0 CHILDREN'S SERVICE SOCIETY OF WISCONSIN PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 390806380 CHILD WELFARE SERVICES WI 501(C)(3) LINE 7 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 0 CHORUS COMMUNITY HEALTH PLANS INC PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 271494977 WISCONSIN MEDICAID HMO & COMMERCIAL EXCHANGE PLAN WI 501(C)(3) LINE 10 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 0 CHILDREN'S SPECIALTY GROUP INC PO BOX 1997 FINANCE DEPT MILWAUKEE WI 532011997 391990012 PEDIATRIC PHYSICIAN SERVICES WI 501(C)(3) LINE 12A, I N/A 0 WEST ALLIS PRESCRIPTION CENTER INC 6737 W WASHINGTON ST STE 1100 WEST ALLIS WI 53214 463421597 PHARMACY WI N/A C 0 WAUWATOSA PRESCRIPTION CENTER INC SKYWALK PHARMACY 9000 W WISCONSIN AVE WAUWATOSA WI 53226 061654484 PHARMACY WI N/A C 0 1 0 1 0 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1