Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
A For the 2015 calendar year, or tax year beginning 01-01-2015 , and ending 12-31-2015
BCheck if applicable:
CName of organization
Group Health Cooperative of South Central WI
 
% ROGER SNEATH
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
PO BOX 44971
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Madison, WI537444971
D Employer identification number

39-1199466
E Telephone number

G Gross receipts $ 416,836,322
F Name and address of principal officer:
Mark Huth
1265 John Q Hammons Dr
Madison,WI53717
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.ghcscw.com
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1972
M State of legal domicile: WI
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: To provide accessible,comprehensive, high quality health care and outstanding service in an efficient and personalized manner on a prepaid basis in GHC-SCW's service area.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 11
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 9
5 Total number of individuals employed in calendar year 2015 (Part V, line 2a) ...... 5 931
6 Total number of volunteers (estimate if necessary) ............. 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 0
9 Program service revenue (Part VIII, line 2g) ......... 382,899,736 398,429,893
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 3,547,162 1,199,513
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 27,709 113,006
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 386,474,607 399,742,412
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 418,239 452,370
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 275,403,580 281,444,106
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 68,278,303 62,552,091
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 61,286,533 55,255,017
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 405,386,655 399,703,584
19 Revenue less expenses. Subtract line 18 from line 12....... -18,912,048 38,828
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 122,708,925 119,242,329
21 Total liabilities (Part X, line 26)............. 75,696,115 73,458,960
22 Net assets or fund balances. Subtract line 21 from line 20..... 47,012,810 45,783,369
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet
Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2015)
Form 990 (2015)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: THE MISSION OF GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN (GHC-SCW) IS TO PROVIDE ACCESSIBLE, COMPREHENSIVE, HIGH QUALITY HEALTH CARE AND OUTSTANDING SERVICE IN AN EFFICIENT AND PERSONALIZED MANNER. IN SUPPORT OF THIS MISSION, GROUP HEALTH COOPERATIVE HAS THE FOLLOWING RESPONSIBILITIES: 1.TO PROMOTE THE NOT-FOR-PROFIT AND COOPERATIVE NATURE OF GHC-SCW WHICH ALLOWS MEMBERSHIP PARTICIPATION IN POLICY DECISIONS AFFECTING THE DELIVERY OF HEALTH CARE. 2.TO FOSTER A PARTNERSHIP BETWEEN MEMBERS AND PRACTITIONERS THAT ENCOURAGES MEMBERS TO ASSUME RESPONSIBILITY FOR THEIR HEALTH, EMPHASIZING HEALTH EDUCATION AND PREVENTIVE MEDICINE. 3.SATISFY THE NEEDS OF GHC-SCW MEMBERS BY OPERATING GHC-SCW ON A SOUND FINANCIAL BASIS, MAINTAINING A COST EFFICIENT HEALTH CARE DELIVERY ORGANIZATION, AND EXCEEDING MINIMUM RESERVES AS REQUIRED BY THE OFFICE OF THE COMMISSIONER OF INSURANCE, STATE OF WISCONSIN. 4.TO MAINTAIN A PRACTICE SETTING THAT IS MEDICALLY AND PERSONALLY SATISFYING TO GHC-SCW MEMBERS,
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 368,730,031 including grants of $ 452,370 ) (Revenue $ 398,542,899 )
Group Health Cooperative of South Central Wisconsin (GHC) contracts with business organizations and individuals in the State of Wisconsin to provide comprehensive medical care benefits in exchange for prepaid premiums. Services as defined by the Secretary of the U.S. Department of Health and Human Services are provided to subscribers as needed, and generally without limitation as to time and cost. GHC is a staff-model HMO, whereby the clinic-based physicians are employees of and work exclusively for GHC. GHC operates six clinics in the Madison metropolitan area. GHC's enrollment as of December 31, 2015 was 78,228. In addition to providing HMO benefits and daily patient care, GHC's mission is to contribute to and aid community organizations, perform good deeds and to make Dane County a better place to live. See Also Schedule O for additional program descriptions.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet368,730,031
Form 990 (2015)
Form 990 (2015)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? ...
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment..............
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment.................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment..................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment.............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2015)
Form 990 (2015)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I ...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II ................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV ........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II ...........
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ........
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................
34
 
No
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
3,161
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
931
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2015)
Form 990 (2015)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
11
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
9
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletROGER SNEATH1265 JOHN Q HAMMONS DR   Madison,WI53717 (608) 251-4156
Form 990 (2015)
Form 990 (2015)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Kenneth Machtan......................................................................
President
 6.0
.................
0.0 		X   X       64,208 0 0
(2) Mary Wright......................................................................
Vice President
 4.0
.................
0.0 		X   X       26,393 0 0
(3) Carol Winkler......................................................................
Secretary
 4.0
.................
0.0 		X   X       27,030 0 0
(4) William Oemichen......................................................................
Treasurer - As of 7/2015
 5.0
.................
0.0 		X   X       8,968 0 0
(5) Bret Clostermery......................................................................
Treasurer - Thru 6/2015
 5.0
.................
0.0 		X   X       28,450 0 0
(6) James Driscoll......................................................................
Board member
 4.0
.................
0.0 		X           26,605 0 0
(7) Patricia Gadow......................................................................
Board member - Thru 6/2015
 4.0
.................
0.0 		X           19,592 0 0
(8) Ann Hoyt......................................................................
Board member - As of 7/2015
 4.0
.................
0.0 		X           7,820 0 0
(9) Michael Mullee......................................................................
Board member
 4.0
.................
0.0 		X           22,355 0 0
(10) Henry Sanders......................................................................
Board member
 4.0
.................
0.0 		X           25,415 0 0
(11) Judy Ziewacz......................................................................
Board member - As of 7/2015
 4.0
.................
0.0 		X           7,055 0 0
(12) Christian Kastman......................................................................
Medical Director - Informatics
 50.0
.................
0.0 		X           250,387 0 40,739
(13) Donna Twining......................................................................
CHE MGR/Diabetes RN Specialist
 50.0
.................
0.0 		X           101,019 0 28,236
(14) Kevin Hayden......................................................................
CEO - Thru 5/2015
 50.0
.................
0.0 		    X       288,673 0 28,944
(15) Mark Huth......................................................................
CMO; Interim CEO-As of 5/2015
 50.0
.................
0.0 		    X       325,974 0 40,384
(16) Jeanan Yasiri-Moe......................................................................
Chief Plan&Innov - Thru 6/2015
 50.0
.................
0.0 		    X       231,236 0 22,025
(17) Thomas Kimble......................................................................
CFO - Thru 5/2015
 50.0
.................
0.0 		    X       130,482 0 5,635
Form 990 (2015)
Form 990 (2015)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Roger Sneath........................................................................
Interim CFO - As of 5/2015
 50.0
.......................0.0 		    X       145,700 0 0
(19) Robert Matthew........................................................................
CMO - As of 7/2015
 50.0
.......................0.0 		    X       243,931 0 38,189
(20) Jeffrey Huebner........................................................................
Med Dir-Quality Care-Thru 9/15
 50.0
.......................0.0 		    X       186,363 0 27,544
(21) Nancy Hagan........................................................................
Chief Nursing Officer
 50.0
.......................0.0 		    X       181,734 0 28,515
(22) Allan Wearing........................................................................
Chief Ins Services Officer
 50.0
.......................0.0 		    X       265,893 0 18,342
(23) Mark Dalebroux........................................................................
Chief Human Resources Officer
 50.0
.......................0.0 		    X       215,207 0 37,704
(24) Bruce Quade........................................................................
Chief Information Officer
 50.0
.......................0.0 		    X       218,517 0 36,711
(25) Christine Tock........................................................................
Physician
 50.0
.......................0.0 		        X   408,586 0 61,548
(26) Leah Ederer........................................................................
Physician
 50.0
.......................0.0 		        X   244,997 0 42,076
(27) Stephanie Skladzien........................................................................
Physician
 50.0
.......................0.0 		        X   240,033 0 37,795
(28) Ralph Froelich........................................................................
Psychiatrist
 50.0
.......................0.0 		        X   224,087 0 21,444
(29) Eric Hilquist........................................................................
Physician
 50.0
.......................0.0 		        X   223,719 0 37,842


1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 4,390,429 0 553,673
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet98
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Unv of WIS Hospital and Clinic Auth,
600 Highland Ave
MADISON,WI53792 		Medical Services 85,667,533
University of WIS Medical Foundatio,
7974 UW Health Court
MIDDLETON,WI53562 		Medical Services 48,150,181
Navitus Health Solutions,
2601 W Beltline Highway Ste 600
MADISON,WI53713 		Medical Services 36,587,633
McKesson Drug Company,
ONE Post Street
SAN FRANCISCO,CA94104 		Medical Services 22,592,990
St Marys Hospital,
700 S Park Street
MADISON,WI53715 		Medical Services 13,185,950
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet215
Form 990 (2015)
Form 990 (2015)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a-1f:$  
h Total.Add lines 1a-1f.......MediumBullet 0
Program Service RevenueAmt Business Code
2a SUBSCRIBER PREMIUM 524114 368,371,439 368,371,439    
b MEDICARE/MEDICAID PAYMENTS 524292 15,046,750 15,046,750    
c HEALTH CARE SERVICES 621400 15,011,704 15,011,704    
d
e
f All other program service revenue.        
g Total.Add lines 2a–2f.....MediumBullet 398,429,893
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ..........MediumBullet 1,120,119     1,120,119
4 Income from investment of tax-exempt bond proceedsMediumBullet 0      
5 Royalties...........MediumBullet 0      
(ii) Personal (i) Real
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss)......MediumBullet 0      
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory   17,173,304
b Less: cost or other basis and sales expenses   17,093,910
c Gain or (loss)   79,394
d Net gain or (loss).....MediumBullet 79,394     79,394
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities..MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances ..
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Business Code Miscellaneous Revenue
11a WELLNESS & OUTREACH REVENUE 621400 96,116 96,116    
b MISCELLANEOUS REVENUE 900099 16,890 16,890    
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 113,006
12 Total revenue. See Instructions......MediumBullet 399,742,412 398,542,899   1,199,513
Form 990 (2015)
Form 990 (2015)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 452,370 452,370
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 281,444,106 281,444,106
5 Compensation of current officers, directors, trustees, and key employees .... 3,401,975 2,618,974 783,001  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 39,549,328 30,350,436 9,198,892  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 1,105,884 854,271 251,613  
9 Other employee benefits ....... 15,366,332 12,306,514 3,059,818  
10 Payroll taxes ........... 3,128,572 2,421,351 707,221  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 1,348,588 176,137 1,172,451  
c Accounting ........... 116,288 15,188 101,100  
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 1,495,919 607,576 888,343  
12 Advertising and promotion .... 6,370,522 54,027 6,316,495  
13 Office expenses ....... 25,743,853 23,176,154 2,567,699  
14 Information technology ...... 3,356,069 2,517,052 839,017  
15 Royalties .. 0      
16 Occupancy ........... 2,086,551 1,785,970 300,581  
17 Travel ............ 183,009 76,458 106,551  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials . 0      
19 Conferences, conventions, and meetings .... 440,600 337,729 102,871  
20 Interest ........... 52,065 52,065    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization .. 5,086,637 1,910,633 3,176,004  
23 Insurance ... 486,241 232,536 253,705  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a TAXES LICENSES & FEES 7,575,624 7,089,338 486,286  
b BOARDS, BUREAUS, ASSOC. FEES 548,958 49,701 499,257  
c RECRUITING 133,240 52,477 80,763  
d WHEFA EXPENSES 72,879 72,879    
e All other expenses 157,974 76,089 81,885  
25 Total functional expenses. Add lines 1 through 24e 399,703,584 368,730,031 30,973,553 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2015)
Form 990 (2015)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 6,125 1 13,291,313
2 Savings and temporary cash investments ......... 499,574 2 348,337
3 Pledges and grants receivable, net ...... 0 3 0
4 Accounts receivable, net ............. 33,114,247 4 35,377,514
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net .... 0 7 0
8 Inventories for sale or use ........ 1,594,292 8 1,556,778
9 Prepaid expenses and deferred charges ...... 1,220,742 9 1,259,411
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 59,338,367
b Less: accumulated depreciation 10b 34,680,258 28,231,083 10c 24,658,109
11 Investments—publicly traded securities . 56,792,107 11 41,590,528
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 1,250,755 15 1,160,339
16 Total assets. Add lines 1 through 15 (must equal line 34)... 122,708,925 16 119,242,329
Liabilities 17 Accounts payable and accrued expenses ..... 38,836,172 17 39,824,657
18 Grants payable ... 0 18 0
19 Deferred revenue ......... 31,795,156 19 29,134,303
20 Tax-exempt bond liabilities ......... 5,000,000 20 4,500,000
21 Escrow or custodial account liability. Complete Part IV of Schedule D 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.. 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .. 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D 64,787 25 0
26 Total liabilities. Add lines 17 through 25.. 75,696,115 26 73,458,960
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets 47,012,810 27 45,783,369
28 Temporarily restricted net assets ........... 0 28 0
29 Permanently restricted net assets 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund ...   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 47,012,810 33 45,783,369
34 Total liabilities and net assets/fund balances ........ 122,708,925 34 119,242,329
Form 990 (2015)
Form 990 (2015)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
399,742,412
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
399,703,584
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
38,828
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
47,012,810
5
Net unrealized gains (losses) on investments ...............
5
-1,268,269
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
 
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
45,783,369
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2015)
Form 990 (2015)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
Group Health Cooperative of South Central WI
 
Employer identification number

39-1199466
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4


5
6
7
8
9
10
11
a
b
c
d
e
f
Enter the number of supported organizations ..............  

g
Provide the following information about the supported organization(s).
(i)Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total      

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support. Add lines 7 through 10.  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513...            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support. (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    

Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    

Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity		  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions		  
9 Distributable amount for 2015 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  

Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2015 		(iii)
Distributable
Amount for 2015
1 Distributable amount for 2015 from Section C, line
6 		 
2 Underdistributions, if any, for years prior to 2015
(reasonable cause required--see instructions)		  
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......  
e From 2014.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2015 distributable amount  
i Carryover from 2010 not applied (see
instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2015 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2015 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2015, if any. Subtract lines 3g and 4a from line 2
(if amount greater than zero, see instructions)		  
6 Remaining underdistributions for 2015. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)		  
7 Excess distributions carryover to 2016. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a
b
c Excess from 2013.......  
d From 2014.......  
e From 2015.......  
Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Reason for Public Charity Status Schedule A, Part I, Line 3 & Schedule H Group Health Cooperative of South Central Wisconsin is not required to be licensed, registered or similarily recognized by the state of Wisconsin as a hospital and therefore has no Schedule H filing requirement.
Schedule A (Form 990 or 990-EZ) 2015


Additional Data


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SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below. SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd BulletInformation about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Group Health Cooperative of South Central WI
 
Employer identification number

39-1199466
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ......................................................................................................................SchCMd Bullet
$  
3
Volunteer hours .............................................................................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2015

Schedule C (Form 990 or 990-EZ) 2015
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................    
b Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................    
c Total lobbying expenditures (add lines 1a and 1b) .......................................................................    
d Other exempt purpose expenditures .........................................................................................    
e Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ..............................................................................................................

4-Year Averaging Period Under section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2012 (b) 2013 (c) 2014 (d) 2015 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))		  
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2015


Schedule C (Form 990 or 990-EZ) 2015
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
46,393
j
Total. Add lines 1c through 1i ....................................................................................................
46,393
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Lobbying Expense Form 990, Schedule C, Part II-B, Line 1i GHC pays dues to Wisconsin Association of Health Plans, Cooperative Network, and Alliance of Community Health Plans. All of these organizations advocate for their members with various legislative parties for policy development.
Schedule C (Form 990 or 990EZ) 2015


Additional Data


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SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
Group Health Cooperative of South Central WI
 
Employer identification number

39-1199466
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year ....    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ....    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................
Part II
Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a)Current year (b)Prior year (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations .................
3a(i)
 
 
(ii) related organizations .................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment) 		(b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ...   3,801,780 3,801,780
b Buildings   28,288,099 12,321,101 15,966,998
c Leasehold improvements   4,298,870 3,155,319 1,143,551
d Equipment ...   15,276,592 13,538,695 1,737,897
e Other ...   7,673,026 5,665,143 2,007,883
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 24,658,109
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c)Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes 0
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 0
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1 398,474,143
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a -1,268,269
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e -1,268,269
3 Subtract line 2e from line 1.................. 3 399,742,412
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 399,742,412
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1 399,703,584
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities ......... 2a  
b Prior year adjustments ............ 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d.................... 2e  
3 Subtract line 2e from line 1................... 3 399,703,584
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 399,703,584

Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
SCHEDULE D, PART X, LINE 2 FIN 48 - Accounting for uncertainty in income taxes As required by the accounting and financial reporting standards for uncertain tax positions, GHC-SCW recognizes the financial statement benefit of a tax position only after determining that the relevant tax authority would more likely than not sustain the position following an audit. For tax positions meeting the more likely than not threshold, the amount recognized in the financial statements is the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement with the relevant tax authority. There are no material unrecognized tax benefits taken or expected to be taken in a tax return that have been recorded on GHC-SCWs financial statements for the years ended December 31, 2015 and 2014, as it was determined that all tax positions taken meet the more likely than not threshold.
Schedule D (Form 990) 2015


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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
Group Health Cooperative of South Central WI
 
Employer identification number
39-1199466
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) Edgewood College
1000 Edgewood College Drive
Madison,WI53711 		39-0806202 501(c)(3) 100,000       Nursing Sponsor
(2) United Way of Dane County
2059 Atwood Avenue
Madison,WI53707 		39-0817532 501(c)(3) 12,000       Sponsorship
(3) Access Community Health Center
2901 W Beltline Hwy 120
Madison,WI53713 		39-1391134 501(C)(3) 200,000       Employment Endowment to an Edgewood nursing student
(4) American Heart Association
PO Box 50035
Prescott,AZ86304 		13-5613797 501(C)(3) 9,000       Sponsorship
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
4
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2015

Schedule I (Form 990) 2015
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
non-cash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of non-cash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
Schedule I, Part I, Line 2 Procedure for Monitoring Use of Grant Funds Inside U.S. The use of grant funds is monitored through the application of a proposal process. Grant-seekers must provide key details of the opportunity, a list of sponsors who have committed to date, a comprehensive list of benefits including how they relate to GHC, a timeline including important deadlines, and credentials of the organization and key subcontractors (publicist, event producer, etc.)
Schedule I (Form 990) 2015



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Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
Group Health Cooperative of South Central WI
 
Employer identification number

39-1199466
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization?
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization?
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2015

Schedule J (Form 990) 2015
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation in column(B) reported as deferred on prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1Christian KastmanMedical Director - Informatics (i)

(ii)		 226,945
-------------
0 		23,144
-------------
0 		298
-------------
0 		14,905
-------------
0 		25,834
-------------
0 		291,126
-------------
0 		0
-------------
0
2Kevin HaydenCEO - Thru 5/2015 (i)

(ii)		 177,475
-------------
0 		0
-------------
0 		111,198
-------------
0 		10,467
-------------
0 		18,477
-------------
0 		317,617
-------------
0 		0
-------------
0
3Mark HuthCMO; Interim CEO-As of 5/2015 (i)

(ii)		 321,012
-------------
0 		0
-------------
0 		4,962
-------------
0 		15,637
-------------
0 		24,747
-------------
0 		366,358
-------------
0 		0
-------------
0
4Jeanan Yasiri-MoeChief Plan&Innov - Thru 6/2015 (i)

(ii)		 126,545
-------------
0 		0
-------------
0 		104,691
-------------
0 		4,760
-------------
0 		17,265
-------------
0 		253,261
-------------
0 		0
-------------
0
5Robert MatthewCMO - As of 7/2015 (i)

(ii)		 238,068
-------------
0 		1,167
-------------
0 		4,696
-------------
0 		13,930
-------------
0 		24,259
-------------
0 		282,120
-------------
0 		0
-------------
0
6Jeffrey HuebnerMed Dir-Quality Care-Thru 9/15 (i)

(ii)		 182,914
-------------
0 		80
-------------
0 		3,369
-------------
0 		9,598
-------------
0 		17,946
-------------
0 		213,907
-------------
0 		0
-------------
0
7Nancy HaganChief Nursing Officer (i)

(ii)		 176,060
-------------
0 		88
-------------
0 		5,586
-------------
0 		9,227
-------------
0 		19,288
-------------
0 		210,249
-------------
0 		0
-------------
0
8Allan WearingChief Ins Services Officer (i)

(ii)		 258,189
-------------
0 		0
-------------
0 		7,704
-------------
0 		15,218
-------------
0 		3,124
-------------
0 		284,235
-------------
0 		0
-------------
0
9Mark DalebrouxChief Human Resources Officer (i)

(ii)		 208,735
-------------
0 		88
-------------
0 		6,384
-------------
0 		11,746
-------------
0 		25,958
-------------
0 		252,911
-------------
0 		0
-------------
0
10Bruce QuadeChief Information Officer (i)

(ii)		 213,567
-------------
0 		0
-------------
0 		4,950
-------------
0 		12,015
-------------
0 		24,696
-------------
0 		255,228
-------------
0 		0
-------------
0
11Christine TockPhysician (i)

(ii)		 408,119
-------------
0 		0
-------------
0 		467
-------------
0 		15,637
-------------
0 		45,911
-------------
0 		470,134
-------------
0 		0
-------------
0
12Leah EdererPhysician (i)

(ii)		 199,300
-------------
0 		45,421
-------------
0 		276
-------------
0 		14,614
-------------
0 		27,462
-------------
0 		287,073
-------------
0 		0
-------------
0
13Stephanie SkladzienPhysician (i)

(ii)		 199,790
-------------
0 		39,993
-------------
0 		250
-------------
0 		13,972
-------------
0 		23,823
-------------
0 		277,828
-------------
0 		0
-------------
0
14Ralph FroelichPsychiatrist (i)

(ii)		 221,520
-------------
0 		0
-------------
0 		2,567
-------------
0 		12,419
-------------
0 		9,025
-------------
0 		245,531
-------------
0 		0
-------------
0
15Eric HilquistPhysician (i)

(ii)		 198,590
-------------
0 		24,817
-------------
0 		312
-------------
0 		12,819
-------------
0 		25,023
-------------
0 		261,561
-------------
0 		0
-------------
0
Schedule J (Form 990) 2015

Schedule J (Form 990) 2015
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
Schedule J, Part I, Line 1a Health or Social Club Dues Madison Club - GHC has a membership at the Madison Club which is used for GHC functions such as the annual Board Planning Retreat and Employee Recognition dinners. GHC also occasionally uses the Club for physician recruiting purposes. Although the membership is in the name of the Interim CEO, Mark Huth, he did not make personal use of the club in 2015. In 2015, GHC paid $2,190 ($180-185 per month, half year increase) in dues and annual member assessment.
Schedule J, Part I, Line 4A Severance Payments Individuals left the organization and received a severance payment during 2015. Due to confidentality agreements, neither the persons nor the amounts will be listed. The amounts have been properly included in Schedule J, Part II, Column B(III).
Schedule J (Form 990) 2015
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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletInformation about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
Group Health Cooperative of South Central WI
 
Employer identification number
39-1199466
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A WIS HEALTH AND EDUCATION FACILITIES AUTHORITY
  		97710VUC0 07-29-2004 12,000,000 CLINIC CONSTRUCTION   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired .................. 8,000,000      
2 Amount of bonds legally defeased .............. 0      
3 Total proceeds of issue .................. 12,000,000      
4 Gross proceeds in reserve funds ............. 0      
5 Capitalized interest from proceeds ............. 0      
6 Proceeds in refunding escrows ............... 0      
7 Issuance costs from proceeds ............... 0      
8 Credit enhancement from proceeds ............. 0      
9 Working capital expenditures from proceeds ............. 0      
10 Capital expenditures from proceeds ............. 12,000,000      
11 Other spent proceeds ............. 0      
12 Other unspent proceeds ............. 0      
13 Year of substantial completion ............. 2004
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? ....   X            
15 Were the bonds issued as part of an advance refunding issue? .....   X            
16 Has the final allocation of proceeds been made? .......... X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X            
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2015

Schedule K (Form 990) 2015
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............   X            
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?                
c Are there any research agreements that may result in private business use of bond-financed property? .............   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet 0 %      
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet        
6 Total of lines 4 and 5 .............        
7 Does the bond issue meet the private security or payment test? ...   X            
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X            
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............   X            
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X            
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......                
b Exception to rebate? ........ X              
c No rebate due? .........                
If "Yes" to line 2c, provide in Part VI the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? ..... X              
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue? X              
b Name of provider .......... BMO Harris
  		 
  		 
  		 
 
c Term of hedge ......... 10 %      
d Was the hedge superintegrated? ......   X            
e Was the hedge terminated? ........   X            
Schedule K (Form 990) 2015

Schedule K (Form 990) 2015
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X            
b Name of provider .......... 0
  		 
  		 
  		 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X            
7 Has the organization established written procedures to monitor the requirements of section 148? ...   X            
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?   X            
Part VI
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
Hedge: Schedule J, Part IV, Line 4 Hedge The hedge term with BMO Harris is 10 years and ended June 16, 2015. The hedge is also collateralized by a CD with BMO Harris bank that is renewed annually.
Schedule K (Form 990) 2015

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SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
Group Health Cooperative of South Central WI
 
Employer identification number

39-1199466
Return Reference Explanation
Statement of Program Service Accomplishments Form 990, Part III, Line 4 2015 Group Health Cooperative of South Central Wisconsin Report of Community Giving Summary Group Health Cooperative of South Central Wisconsin cares deeply for our community. Group Health Cooperative of South Central Wisconsin (GHCSCW) takes pride in community involvement personally and we work together with community partners to find ways to provide real and compassionate care. As one of our most honored values, caring for our community means pushing beyond the walls of our clinics and into homes, schools, community centers, worksites, neighborhoods, and places far and between. We build upon approaches that have proven successful in addressing health care needs and the individual needs of our community. We create, foster and strengthen community partnerships to make a real difference. We combine resources and work together with others in the community to make an impact where we can. The 2015 Community Giving Report is our way of sharing our role in the community. More importantly, it showcases the capacity for positive change that is only possible when community partners work together. To meet the need and make the biggest difference in our community, we focus on four strategic pillars: STRENGTHEN ACCESS TO HEALTH CARE We help create, support, and strengthen a pathway to health care for the most vulnerable in our community. SPREAD HEALTH KNOWLEDGE We increase quality of life by sharing critical clinical, technical, and general health knowledge with people living in our community. SERVE THROUGH VOLUNTEERISM We embrace volunteerism in our community to put our expertise, skills, talent, and time to use where it's needed most. SPONSOR HEALTH AND COMMUNITY INITIATIVES We provide financial sponsorships to a variety of organizations that promote health activities and initiatives that make our community better. I. STRENGTHEN ACCESS TO HEALTH CARE BADGERCARE PLUS One of the most pressing issues in our community is the role that poverty plays on the health and well-being of individuals and families. In Dane County, 12.9% of the population lives below the poverty level according to the most recent U.S. Census data. With the help of the state of Wisconsin's Medicaid program, BadgerCare Plus, eligible families can get the medical care they need. In 2015, we proudly served nearly 6,000 BadgerCare Plus members. In addition, we provided approximately $1 million in care to our BadgerCare Plus members in 2015. BRIDGES TO ACCESS Many families in the Madison area do not have a safe, warm place to call home. Combine that situation with a lack of medical care and suddenly the picture gets terrible. So in 2009, we developed the Bridges to Access program with the fundamental idea that improved access to medical care can bridge the gap between homelessness and stable housing. For up to three months, Bridges to Access provides immediate medical care to those in need, including coverage for primary care service, important medications, and assistance with transportation. And to keep them on the pathway to health care, program participants got help applying for permanent medical coverage through BadgerCare Plus. Through this program we helped 30 adults and their children receive real and compassionate medical care in their hour of greatest need when there was nowhere else to turn. That amounted to $40,190 in crucial health care services and medications. Throughout the year we also provided medical supplies to area shelters in the form of cold medicine, tissues, and sanitation items.
Statement of Program Service Accomplishments (Continued) Form 990, Part III, Line 4 EVENING CLINICS To accommodate the busy lives of parents with children enrolled in BadgerCare Plus, we hosted one evening clinic in 2015. These convenient clinics are a proven way to get kids in for their checkups without having to miss school or having their parents miss work. Three of our medical providers, nine of our nursing staff, along with nurses from the Madison Metropolitan School District, were on hand to care for kids. Eleven other staff helped families share a warm, nutritious meal after their appointment, enjoy complementary giveaways such as movie passes, school supplies and books and fun activities for kids. Families also were able to learn about valuable resources, such as food share, food pantries, afterschool clubs, libraries and housing information and movie passes. In 2015, a total of 32 children received immunizations and preventive health exams through these clinics. Making health care easier for families makes us Better Together. HEALTHCARE ACCESS PROGRAM Throughout our community, people face the harsh reality of being uninsured on a daily basis. For a variety of reasons, access to the most basic form of primary care is out of reach. With a goal of promoting healthy outcomes for folks in our community, we partnered with the Dane County Health Council and other health care organizations to create the Healthcare Access Program in 2005. The Healthcare Access Program gave uninsured individuals a place to call their medical home and access to a compassionate medical provider - all at no cost. Patients were also able to receive needed medications that many had gone years without. In 2015, GHCSCW delivered over $28,388 in health care, including medications to uninsured individuals living in our community. PRIMARY ACCESS FOR KIDS Parents should spend time helping their kids grow and learn, not worrying about how to get their kids needed health care. Unfortunately, there are hundreds of kids in our schools that do not have insurance to get basic care for checkups, immunizations, or medications. To tackle this issue head-on, the Dane County Health Council helped to bring together a network of health care organizations in the Madison-area and the Primary Access for Kids program was born. In 2015, we were proud to continue providing health care services to uninsured kids in the Madison Metropolitan School District. We worked with eleven of Madison's schools to connect these kids to the health care they deserved. GHCSCW provided 93 children with $85,725 in primary care services and medications, and over $2,452 in eyewear through this program in 2015. REFUGEE ASSISTANCE PROGRAM Fewer things in life are more challenging than escaping your home country in search of a better life, let alone trying to navigate a new health care system. To help ease the burden, GHCSCW created the Refugee Assistance Program. Through the program, our new neighbors receive hours of one-on-one assistance from GHCSCW staff whose help connected them to needed care. We served as their advocates in 2015 by setting up numerous appointments for care and follow-up care. Working with our partners from the public health department, we helped 65 refugees establish roots here in our community. STAY HEALTHY Without proper insurance coverage, folks can't get the most basic health services like access to a regular doctor and medications. It's the kind of preventive care that would otherwise help avoid a trip to the hospital or help manage expensive and damaging illness. So in 2009, GHCSCW created the Stay Healthy program to invest in our members who have fallen on hard times so their health issues could be detected and addressed sooner, rather than later. The Stay Healthy Program covered one physical exam, lab work, follow-up appointments, and medications related to the physical - all at no cost for qualified, uninsured adults who had lost their insurance coverage because of unemployment or other reasons. GHCSCW provided primary care for uninsured individuals in our community, amounting to $8,037 in medical services and medications.
Statement of Program Service Accomplishments (Continued) Form 990, Part II, Line 4 II. SPREAD HEALTH KNOWLEDGE ADOPT A SCHOOL As an avid promoter of health knowledge, we adopted five local schools in need of health resources in 2015. Our commitment to schoolchildren was demonstrated in many ways throughout the year. To help build up the future leaders of our community, we provided medical supplies to school nurse offices. We donated $15,000 to help establish a new library/media center for one of our Adopt-A-School partners to help further at-risk youth in the community. We also bought new snow pants to keep kids warm, gift cards to promote healthy activities, and gift baskets full of healthy food and educational books for local families. For eleven years we've worked together with the Foundation for Madison's Public Schools to bring this service to our community. ALPHA KAPPA ALPHA, WALK IT OUT Walk It Out, a community event held at Madison College promotes physical activity among African American women. The event was focused around a 2-mile walk and 3-mile run and we provided health education opportunities for healthy cooking and variety of healthy activities like Zumba, Yoga, and Cardio. For seven years we've worked together with the Alpha Kappa Alpha Sorority and the 100 Black Men organization to bring this service to our community. ENGLISH FOR HEALTH Literacy skills are a strong predictor of an individual's health status. In fact, low literacy may contribute to serious health problems - problems that tend to compound for those with English as their second language. To improve health literacy, we co-sponsored the "English for Health" course for adults in our community. Students learned from our health care professionals about a variety of health topics, from how to use emergency rooms and urgent care clinics to healthy lifestyle choices. Then they practiced communicating health care decisions in a mock clinic staffed by health care professionals. For the past five years GHCSCW has worked with the Literacy Network to bring this service to our community. FARM FRESH PRODUCE We all know that locally grown food makes sense. But too often, low-income kids don't get the fresh fruits and vegetables they need on their plates. And getting kids to eat those vegetables can be tricky. So we brought a regular supply of fresh, nutritious, and locally grown organic vegetables to kids at four community centers. We also taught them about where their food comes from through fun gardening activities. In total, more than 1.5 tons of fresh produce was distributed in 2015. And our commitment didn't stop there. We helped provide technical assistance with meal preparation so the centers were trained on how to handle and store fresh foods. For eight years we've worked together with Community GroundWorks, the Fair Share CSA Coalition, the Public Health Department of Madison and Dane County, and Second Harvest to bring this service to our community. HEALTHCARE ADMINISTRATIVE TRAINING We believe in helping people succeed through education. That's why we gave financial backing to the Healthcare Administrative Training Program, a 12-week course designed to provide real-world job training for people seeking employment. Our health care staff trained students on EPIC medical software, medical terminology, health insurance concepts, and basic work skills. Graduates of the program have enjoyed job placement in the health care community for positions like clinic reception and medical billing. For over eight years we've worked together with the Urban League of Greater Madison to bring this service to our community. HEALTHY SELF OLYMPICS Being healthy can be fun and rewarding! That's the message behind the Healthy Self Olympics, an innovative program first introduced by GHCSCW for kids in our community. Dr. Steven Lo, GHC-SCW Pediatrician, community school nurses, and recreational specialists used active learning to teach kids the importance of healthy eating, positive self-esteem, and fun exercise. The year-long program culminated at Madison's Marlborough Park, where kids from area schools were invited to compete in a variety of "Olympic" games, including an obstacle course race, parachute games, a jump rope contest and more. For the past 13 years we've worked together with the Madison School & Community Recreation (MSCR) department and the Madison Metropolitan School District to bring this service to our community. Kids from MSCR's Safe Haven after-school program at Emerson, Falk, and Glendale Elementary schools, along with children from the Allied Learning Center, participated in 2015. HMONG NEW YEAR Each year, members of the local Hmong community gather for a weekend celebration during the Hmong New Year. Members of the Hmong community donned their traditional dress, enjoyed delicious food, and had the opportunity to receive health check screenings for blood pressure and asthma from our health care staff. For six years GHCSCW has worked together with the Southern Wisconsin Hmong Association to bring this event to our community. INFOSHARE InfoShare is a great way for people with and without developmental disabilities to meet new people, make new friends, and learn something new along the way. We understand the importance of finding happiness in our daily lives and how that can impact health. Thats why for 2015, InfoShare celebrated humor and happiness. Participants were treated to stand-up comedians, laughter yoga, a performance by Encore Studio for the Performing Arts, a performance and a learning session from Madison's own improvisation group, Monkey Business, and more! Participants were given opportunities to express happiness through art and other interactive workshops. For years we have worked together with the UW-Madison Waisman Center Community Training and Consultation Program, the Dane County Human Services department, and other community organizations to bring this event to our community. LATINO HEALTH COUNCIL We helped promote the health and wellbeing of our Latino neighbors by serving on the Latino Health Council in 2015. Along with our participation on the council, we were deeply involved in efforts throughout the year to spread health knowledge to the community: we sponsored Zumba classes to encourage fun and fitness; we were present at health fairs to give health checks and screenings for skin cancer; we co-hosted a nutrition class in Spanish at Centro Hispano, Madison's Latino community center; and we sponsored an event to educate Latino teens about mental health and other health topics. For ten years we've served on the Latino Health Council in our community. REACH OUT AND READ Fewer things are more important to a child's cognitive, emotional, and social health than the simple act of reading. In fact, research clearly proves how important the first years of a child's life are for healthy brain development and their long-term success. So GHCSCW has embraced the Reach Out and Read Program, championed by local pediatrician, Dr. Dipesh Navsaria. Our medical staff make substantial time commitments towards the program, making it a standard part of our pediatric primary care. At each primary care visit, providers give each child a book during their well child visit to help assess childhood development and encourage the parent or guardian to read to their child. Through this program, a total of 10 books are distributed between the ages of six months and five years of age. In 2015, GHC-SCW chose to also include babies two to four months of age in the Reach Out and Read program as National research continues to show the importance of reading to children in early childhood brain development. In 2015 we proudly paid for 5,741 age and culturally appropriate books to be distributed to children through the Reach Out and Read Program. The value of these books was $12,917. 2015 was the fourth year that GHCSCW participated in the Reach Out and Read Program. We value this initiative as it aligns with the United Way's Born Learning Agenda focusing on early childhood literacy and preparing children for entering kindergarten in our community schools. BLACK WOMENS WELLNESS DAY Black Womens Wellness Day is an event that raises awareness of issues facing black women in our community. We offered therapeutic massage and information on stress to the attendees. 2015 was the third year GHCSCW participated in this event.
Statement of Program Service Accomplishments (Continued) Form 990, Part III, Line 4 III. SERVE THROUGH VOLUNTEERISM COOPERATIVE TEAM COMMUNITY EVENTS Our employees were involved in the causes our community cared about all year long. We sponsored or voluntarily participated in a variety of community races that promoted health and wellbeing. We believe when each of us does our part, the entire community benefits. UNITED WAY DAYS OF CARING While still on the clock at work, 28 of our employees volunteered at four different community projects around the Madison area. Together, they helped canvas the community for the River Food Pantry, they provided yard/ground maintenance to the Lake View Elementary School Outdoor Classroom and the home of a senior through the North/Eastside Senior Coalition, and they cleaned the Linda and Gene Farley Center for Peace, Justice & Sustainability helping with the Land Beautifier Project. TEAM COMMUNITY EVENTS Our employees were involved in the causes our community cared about all year long. We sponsored or voluntarily participated in a variety of community races that promoted health and wellbeing. Below are listed events that our employees were involved in 2015: - Alzheimers & Dementia Alliance of Wisconsin - Alzheimers Walk - Alzheimers Association of South Central Wisconsin - Walk to End Alzheimers - American Heart Association - Heart Walk - Henry Vilas Zoo Foundation Zoo Run - Juvenile Diabetes Research Foundation Walk to Cure Diabetes - Literacy Network Run/Walk for Literacy - March of Dimes March for Babies - National Alliance on Mental Illness of Wisconsin NAMI Walk - National Kidney Foundation of Wisconsin Capital City 5k - Safe Harbor Run and Tot Trot - Susan G. Komen Race for the Cure COOPERATIVE COMMUNITY FUNDRAISERS All year long, our employees organized and supported a variety of fundraisers for local charities and health initiatives. Below is a listing of community fundraisers our employees organized in 2015: $33,260 donated through our Cooperative's Charitable Giving Campaign. Our largest fundraiser throughout the year, all proceeds raised from our generous employees went to one of three programs of the employee's choice: United Way of Dane County, Community Shares of Wisconsin, or the Russell Hess School Nurse Emergency Fund. $1,500 donated to fight breast cancer on behalf of the Susan G. Komen Foundation. $500 donated to support organ, tissue, and eye donations on behalf of the National Kidney Foundation of Wisconsin. $350 to support Alzheimers Association of South Central Wisconsin Chapter $385 to support Hopes of Wisconsin (Hospice Organization and Palliative Experts) $200 to support National Brain Tumor $325 to support the Juvenile Diabetes Research Foundation COOPERATIVE BLOOD DONATIONS Generosity comes in many forms, and one of them is through the gift of life. With our "one donation a week club" efforts and blood drives held in our clinics, our staff, along with family and friends donated a total of 65 pints of blood in 2015. According to the American Red Cross, three lives are saved for every one-pint of blood donated. HOLIDAY GIFT GIVING Families with limited financial means can have a tough time getting through the holidays. That's why we developed the Holiday Gift Giving Program. In 2015, we selected 10 families though our Adopt-A-School Program Partners with the help of the school Social Workers. We helped ease the burden by providing these families with gas cards and with fun activities like board games or gift cards, helped them keep warm with new socks, slippers and cozy blankets and provide some healthy snacks to fill hungry tummies. We then bought gifts on the family's wish lists and hand delivered them in time for the holidays. IV. SPONSOR HEALTH AND COMMUNITY INITIATIVES Throughout the year, we provided corporate financial sponsorships to a variety of important causes. In total we contributed $452,370. The largest contributions were $200,000 to Access Community Health Center and $100,000 to the Edgewood College School of Nursing. We helped support and sponsor organizations that worked to promote health activities and initiatives that made our community better: ARTHRITIS FOUNDATION UPPER MIDWEST REGION BRAVA BREASTFEEDING COALITION OF SOUTH CENTRAL WISCONSIN CATHOLIC CHARITIES OF MADISON CHILDREN'S THEATER OF MADISON COMMUNITY SHARES OF WISCONSIN DANE BUY LOCAL DOWNTOWN MADISON, INC. FIRE ON THE RIVER HEALTH WATCH WISCONSIN HOPES OF WISCONSIN JDRF WESTERN WISCONSIN CHAPTER MADISON SCHOOL AND COMMUNITY RECREATION MADISON SYMPHONY ORCHESTRA MONONA TERRACE NATIONAL KIDNEY FOUNDATION OLBRICH BOTANICAL GARDENS PLANNED PARENTHOOD OF WISCONSIN, INC. SUNSHINE PLACE THE ROAD HOME DANE COUNTY UNITED WAY OF DANE COUNTY URBAN LEAGUE OF GREATER MADISON WISCONSIN WOMEN'S HEALTH FOUNDATION Number Reported in Box 3 of Form 1096 Form 990, Part V, Line 1a GHC-SCW reported 3,102 of the 3,161 forms in Box 6 of Form 1099-MISC for medical and health care payments.
Governing Body Voting Rights Form 990, Part VI, Section A, Line 1A Members of the governing body do not all have the same voting rights. The GHC Board of Directors includes two practitioner directors. These two practitioner directors are precluded from voting on matters pertaining to that member's compensation. Further, they are precluded from membership on any committee that has jurisdiction over compensation matters. In 2015, these employee board members were Christian Kastman, MD and Donna Twining. The compensation and hours listed for these individuals are for their services as employees of the organization and not as members of the board.
Members or Stockholders Form 990, Part VI, Section A, Line 6 GHC-SCW is a member owned cooperative. Members of the GHC-SCW Board of Directors are voted into office by the members of the cooperative.
Members Electing Governing Body Form 990, Part VI, Section A, Line 7a Each voting member of GHC-SCW has a vote and is eligible to vote in person or by absentee ballot for each Board of Director. Board of Directors serve a term of three years.
Governing Body Decisions Approved Form 990, Part VI, Section A, Line 7b Changes to the organizational by-laws are subject to approval by the voting members. Further, voting members approve the meeting minutes from each prior membership meeting.
Filing Process Form 990, Part VI, Section B, Line 11 After the Form 990 is prepared by the GHC-SCW's accounting firm and prior to filing the Form 990, the Chief Financial Officer performs an extensive review of the return. A copy is made available to the finance committee of the governing board during a board meeting and major points are discussed. Once approved by the committee, a copy of the return is made available to the rest of the governing body and the Form 990 is electronically filed with the Internal Revenue Service.
Conflict of Interest Monitoring Form 990, Part VI, Section B, Line 12c The Interim Chief Financial Officer annually reviews a Conflict of Interest Questionnaire that is to be provided to the Board, Officers, and Key Employees. The Interim Chief Financial Officer then has the Organization's CPAs and Attorneys review and provide commentary regarding the questionnaire. Next, the Board, Officers, and Key Employees are provided a copy of the questionnaire to read and sign during a meeting. The meeting provides these persons the opportunity to walk through the questionnaire with knowledgeable facilitators who guide them to pertinent areas and respond to any questions.
Process for Determining Compensation Form 990, Part VI, Section B, Line 15a & 15b Human Resources reviews the pay plan of GHC-SCW employees' compensation and benefits and compares various aspects to researched compensation and benefits provided by similar organizations. Executive compensation is reviewed by third party consultants who make recommendations to the Board of Directors and CEO. Approximately every three years, consultants are hired to review physician compensation. Consultant recommendations are typically presented to the GHC HR committee for review, discussion and approval. The annual employee pay plan is presented to the HR Committee at its November meeting and is also a part of the annual budget that is reviewed by the Finance/Audit Committee and approved by the Board of Directors.
Publicly Available Forms Form 990, Part VI, Section C, Line 18 GHC-SCW's Form 1023 is made available to those submitting a request form. GHC-SCW's Form 990 is made available at www.guidestar.org, and to those submitting a request form.
Publicly Dislosed Documents Form 990, Part VI, Section C, Line 19 GHC-SCW responds to requests for information on a case-by-case basis.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2015


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