Form990


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)
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OMB No. 1545-0047
2021
Open to Public Inspection
A For the 2021 calendar year, or tax year beginning 01-01-2022 , and ending 12-31-2022
BCheck if applicable:
CName of organization
MDWISE INC
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
2955 N MERIDIAN STREET
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
INDIANAPOLIS, IN46208
D Employer identification number

35-1931354
E Telephone number

G Gross receipts $ 1,873,638,548
F Name and address of principal officer:
CHERYL DIEHL
2955 N MERIDIAN STREET
INDIANAPOLIS,IN46208
I
Tax-exempt status: ( 4 ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.MDWISE.ORG
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: 1994
M State of legal domicile: IN
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: MDWISE IS A NOT-FOR-PROFIT HEALTH MAINTENANCE ORGANIZATION CONTRACTING WITH HEALTHCARE PROVIDERS TO PROVIDE SERVICES TO ITS MEMBERS FOR TWO STATE MEDICAID PROGRAMS: HOOSIER HEALTHWISE (HHW) AND HEALTHY INDIANA PLAN (HIP) AS WELL AS THE MEDICARE ADVANTAGE PROGRAM WITHIN SELECT COUNTIES IN THE STATE OF INDIANA.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 5
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 0
5 Total number of individuals employed in calendar year 2021 (Part V, line 2a) ...... 5 0
6 Total number of volunteers (estimate if necessary) ............. 6 4
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, Part I, line 11 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 0
9 Program service revenue (Part VIII, line 2g) ......... 1,571,665,182 1,869,778,925
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 2,263,681 3,350,004
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 1,631
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 1,573,928,863 1,873,130,560
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 168,920 434,375
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 22,581,277 23,627,479
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).... 1,505,259,469 1,796,157,767
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 1,528,009,666 1,820,219,621
19 Revenue less expenses. Subtract line 18 from line 12....... 45,919,197 52,910,939
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 465,353,374 686,951,288
21 Total liabilities (Part X, line 26)............. 256,850,721 412,302,310
22 Net assets or fund balances. Subtract line 21 from line 20..... 208,502,653 274,648,978
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 (2021)
Form 990 (2021)
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: TO PROVIDE HIGH-QUALITY, AFFORDABLE HEALTHCARE AND IMPROVE THE WELL-BEING OF OUR MEMBERS BY ENGAGING EXCEPTIONAL ASSOCIATES, COMMUNITY LEADERS AND HEALTHCARE PROFESSIONALS.
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 $ 1,807,276,460 including grants of $ 434,375 ) (Revenue $ 1,869,723,090 )
BEGINNING JANUARY 1, 2011, MDWISE WAS GRANTED A FOUR-YEAR CONTRACT WITH THE STATE OF INDIANA (THE "STATE"), THROUGH THE FAMILY AND SOCIAL SERVICE ADMINISTRATION ("FSSA") AND OFFICE OF MEDICAID POLICY AND PLANNING ("OMPP"), TO ARRANGE FOR AND ADMINISTER TWO RISK-BASED MANAGED CARE PROGRAMS ("HOOSIER HEALTHWISE AND "HEALTHY INDIANA PLAN") FOR CERTAIN INDIANA MEDICAID ENROLLEES. MDWISE CONTRACTS WITH VARIOUS DELIVERY NETWORKS INCLUDING THE AFFILIATED MDWISE MEDICAID NETWORK ("EXCEL"). EXCEL AND THE OTHER DELIVERY NETWORKS ACCEPT THE MEDICAL SERVICE RISK FOR ENROLLEES WHO CHOOSE A PRIMARY CARE PROVIDER AFTER SELECTING THE MDWISE NETWORK. ON JANUARY 1, 2017, THE CONTRACT WITH THE STATE OF INDIANA WAS RENEWED AND IS NOW SCHEDULED TO EXPIRE ON DECEMBER 31, 2022.
4b (Code:   ) (Expenses $ 2,297,305 including grants of $   ) (Revenue $ 57,466 )
BEGINNING JANUARY 1, 2022, MDWISE WAS GRANTED A ONE-YEAR CONTRACT WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES ("CMS") TO ARRANGE FOR AND ADMINISTER THE MEDICARE ADVANTAGE PROGRAMS IN SELECT COUNTIES WITHIN THE STATE OF INDIANA. THIS CONTRACT HAS BEEN RENEWED FOR 2023.
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet1,809,573,765
Form 990 (2021)
Form 990 (2021)
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 A.....................
1
 
No
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 I.............
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 II.........
4
 
 
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 Rev. Proc. 98-19? If "Yes," complete Schedule C, Part III..
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
List of Attached Documents:
// Content
.........................
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
List of Attached Documents:
// Content
....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D,
Part IIIClick to see attachment
List of Attached Documents:
// Content
..............
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
List of Attached Documents:
// Content
..............
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 V......
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
List of Attached Documents:
// Content
...................
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
List of Attached Documents:
// Content
.......
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
List of Attached Documents:
// Content
.......
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
List of Attached Documents:
// Content
............
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
List of Attached Documents:
// Content
11e
Yes
 
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
List of Attached Documents:
// Content
11f
 
No
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
List of Attached Documents:
// Content
......................
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
List of Attached Documents:
// Content
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
 
 
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
List of Attached Documents:
// Content
21
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
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
List of Attached Documents:
// Content
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
List of Attached Documents:
// Content
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...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
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
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
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 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) 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 the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....
28b
 
No
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? 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............Click to see attachment
List of Attached Documents:
// Content
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.........................Click to see attachment
List of Attached Documents:
// Content
34
Yes
 
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
 
 
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 VIClick to see attachment
List of Attached Documents:
// Content
37
 
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
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
3,480
b
Enter the number of Forms W-2G included on 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
 
Form 990 (2021)
Form 990 (2021)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
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
0
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
 
 
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
 
 
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
 
 
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
 
 
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
 
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
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
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
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
17
Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.
17
 
 
Form 990 (2021)
Form 990 (2021)
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
5
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
0
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 on 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 on 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
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process on 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
IN
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 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:
MediumBulletTRICIA BRUNTON2955 N MERIDIAN STREET   INDIANAPOLIS,IN46208 (317) 822-7116
Form 990 (2021)
Form 990 (2021)
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 the 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, Form 1099-MISC, and/or box 1 of Form 1099-NEC) 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.

See the instructions for the order in which to list the persons above.
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/1099-NEC)
(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(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) JESSICA CROMER......................................................................
PRESIDENT AND CEO
25.00
.................
25.00
X   X       0 554,790 117,152
(2) DAVID E MAZURKIEWICZ......................................................................
TREASURER
1.00
.................
49.00
X   X       0 1,956,528 33,460
(3) KATHLEEN KENDALL......................................................................
SECRETARY
1.00
.................
49.00
X   X       0 1,564,624 44,020
(4) KEVIN B TOMPKINS......................................................................
CHAIRMAN
1.00
.................
48.30
X   X       0 1,178,342 43,741
(5) CHERYL DIEHL......................................................................
ASSISTANT TREASURER AND CFO
1.00
.................
49.00
X   X       0 322,241 43,935
(6) PATRICIA HEBENSTREIT......................................................................
SVP GENERAL COUNSEL
40.00
.................
0.00
      X     0 371,048 37,007
(7) TORRIAUN EVERETT......................................................................
VP HEALTH PLAN OPERATIONS
40.00
.................
0.00
      X     0 212,855 16,698
(8) TRICIA BRUNTON......................................................................
VP FINANCE
40.00
.................
0.00
      X     0 155,635 12,031
(9) BRITTNEY MULLANEY......................................................................
VP HEALTH SERVICES
40.00
.................
0.00
      X     0 179,063 28,887
















Form 990 (2021)
Form 990 (2021)
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/1099-NEC)
(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(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;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 0 6,495,126 376,931
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 MediumBullet0
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
MODIVCARE SOLUTIONS LLC

6900 LAYTON AVE STE 1200
DENVER,CO80237
TRANSPORTATION 8,559,120
ROBAILEY CONSULTING LLC

5556 E 74TH PL
INDIANAPOLIS,IN46250
CONSULTING 1,578,010
COTIVITI INC

PO BOX 5459
NEW YORK,NY10087
DATA ANALYTICS 1,187,221
PALLAS CONSULTING SERVICES LLC

533 E KERRY LN
PHOENIX,AZ85024
BUSINESS MANAGEMENT 1,107,756
OTAVA LLC

PO BOX 3261
INDIANAPOLIS,IN46206
INFORMATION SERVICES CONSULTING 853,006
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet13
Form 990 (2021)
Form 990 (2021)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, Grants, and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet  
 Program Service RevenueAmt Business Code
2a HEALTHY INDIANA PLAN 900000 1,206,972,703 1,206,972,703    
b HOOSIER HEALTHWISE 900000 662,748,756 662,748,756    
c MEDICARE ADVANTAGE 900000 57,466 57,466    
d
e
f All other program service revenue.        
g Total. Add lines 2a–2f .....MediumBullet 1,869,778,925
 OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 3,077,992     3,077,992
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents     6a
b Less: rental expenses     6b
c Rental income or (loss)     6c
d Net rental income or (loss).......MediumBullet        
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory   780,000 7a
b Less: cost or other basis and sales expenses   507,988 7b
c Gain or (loss)   272,012 7c
d Net gain or (loss).........MediumBullet 272,012     272,012
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a  
b Less: direct expenses ... 8b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a  
b Less: direct expenses ... 9b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
10a  
b Less: cost of goods sold .. 10b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a CLAIMS RECOVERY INTEREST 900000 1,631 1,631    
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 1,631
12 Total revenue. See instructions.....MediumBullet 1,873,130,560 1,869,780,556 0 3,350,004
Form 990 (2021)
Form 990 (2021)
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 .... 434,375 434,375
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ...........    
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............    
4 Benefits paid to or for members .......    
5 Compensation of current officers, directors, trustees, and key employees ...........        
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........        
7 Other salaries and wages........ 19,487,381 16,564,274 2,923,107  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 937,302 796,707 140,595  
9 Other employee benefits ....... 2,234,304 1,899,158 335,146  
10 Payroll taxes ........... 968,492 823,218 145,274  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 160,554 136,471 24,083  
c Accounting ........... 133,705 113,649 20,056  
d Lobbying ........... 77,492 77,492    
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 117,112   117,112  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 19,039,425 16,183,511 2,855,914  
12 Advertising and promotion .... 1,684,099 1,684,099    
13 Office expenses ....... 2,051,375 1,743,669 307,706  
14 Information technology ...... 8,274,641 7,033,445 1,241,196  
15 Royalties ..        
16 Occupancy ........... 2,036,928 1,731,389 305,539  
17 Travel ............ 51,735 43,975 7,760  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings ....        
20 Interest ........... 10,471,512 8,900,785 1,570,727  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 934,787 794,569 140,218  
23 Insurance ... 46,848   46,848  
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 DELIVERY SYSTEM PAYMENT 1,746,751,122 1,746,751,122    
b CORPORATE ALLOCATIONS 1,229,279 1,229,279    
c
d
e All other expenses 3,097,153 2,632,578 464,575  
25 Total functional expenses. Add lines 1 through 24e 1,820,219,621 1,809,573,765 10,645,856 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 (2021)
Form 990 (2021)
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 ........   1  
2 Savings and temporary cash investments ......... 189,500,172 2 225,886,974
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 205,054,349 4 394,799,586
5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
  6  
7 Notes and loans receivable, net ...........   7  
8 Inventories for sale or use ............   8  
9 Prepaid expenses and deferred charges ......   9  
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 154,142
b Less: accumulated depreciation 10b 125,402 32,897 10c 28,740
11 Investments—publicly traded securities . 70,765,956 11 66,235,988
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ...........   15  
16 Total assets. Add lines 1 through 15 (must equal line 33)... 465,353,374 16 686,951,288
Liabilities 17 Accounts payable and accrued expenses ..... 252,177,503 17 57,828,949
18 Grants payable ...   18  
19 Deferred revenue .........   19  
20 Tax-exempt bond liabilities .........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
  22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ..   24  
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 4,673,218 25 354,473,361
26 Total liabilities. Add lines 17 through 25.. 256,850,721 26 412,302,310
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 208,502,653 27 274,648,978
28 Net assets with donor restrictions ...........   28  
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... 208,502,653 32 274,648,978
33 Total liabilities and net assets/fund balances ........ 465,353,374 33 686,951,288
Form 990 (2021)
Form 990 (2021)
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
1,873,130,560
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
1,820,219,621
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
52,910,939
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
208,502,653
5
Net unrealized gains (losses) on investments ...............
5
-6,072,189
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
19,307,575
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
274,648,978
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: STATUTORY
If the organization changed its method of accounting from a prior year or checked "Other," explain on
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 (2021)
Form 990 (2021)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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.
SchDMd Bullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
MDWISE INC
 
Employer identification number

35-1931354
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 7/25/06, 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 FASB 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 FASB 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 FASB 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) 2021

Schedule D (Form 990) 2021
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
Term 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 .....      
b Buildings ....        
c Leasehold improvements        
d Equipment ....   154,142 125,402 28,740
e Other .....        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 28,740
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
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  
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 354,473,361
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) 2021

Schedule D (Form 990) 2021
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 1,875,609,689
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d 2,596,872
e Add lines 2a through 2d ..................... 2e 2,596,872
3 Subtract line 2e from line 1.................. 3 1,873,012,817
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 117,743
c Add lines 4a and 4b.................... 4c 117,743
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 1,873,130,560
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 1,820,101,878
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 0
3 Subtract line 2e from line 1................... 3 1,820,101,878
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 117,743
c Add lines 4a and 4b..................... 4c 117,743
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 1,820,219,621
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
PART XI, LINE 2D - OTHER ADJUSTMENTS: REVERSAL OF BAD DEBT 2,596,872.
PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUE NET WITH EXPENSES FOR FINANCIAL STATEMENT REPORTING 117,743.
PART XII, LINE 4B - OTHER ADJUSTMENTS: REVENUE NET WITH EXPENSES FOR FINANCIAL STATEMENT REPORTING 117,743.
Schedule D (Form 990) 2021


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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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2022
Open to Public
Inspection
Name of the organization
MDWISE INC
 
Employer identification number
35-1931354
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
noncash assistance
(h) Purpose of grant
or assistance
(1) HEALTH & HOSPITAL CORP OF MARION COUNTY
3838 N RURAL ST
INDIANAPOLIS,IN46208
35-6005697 115 97,500 0     GENERAL SUPPORT
(2) ABOUT SPECIAL KIDS LLC
7172 GRAHAM RD SUITE 100
INDIANAPOLIS,IN46250
35-1711669 501(C)(3) 93,333 0     GENERAL SUPPORT
(3) STATE OF INDIANA
302 W WASHINGTON STREET
INDIANAPOLIS,IN46204
35-6000158 115 20,000 0     GENERAL SUPPORT
(4) DAMIEN CENTER INC
26 N ARESNAL AVE
INDIANAPOLIS,IN46201
35-1711878 501(C)(3) 15,000 0     GENERAL SUPPORT
(5) HEALTHVISIONS MIDWEST INC
3700 179TH ST
HAMMOND,IN46323
35-2064919 501(C)(3) 10,600 0     GENERAL SUPPORT
(6) SHALOM HEALTH CARE CENTER
3400 LAFAYETTE RD STE 200
INDIANAPOLIS,IN46222
06-1645027 501(C)(3) 10,000 0     GENERAL SUPPORT
(7) MENTAL HEALTH AMERICA OF INDIANA
1431 N DELAWARE ST
INDIANAPOLIS,IN46208
35-0896905 501(C)(3) 10,000 0     GENERAL SUPPORT
(8) TRANS SOLUTIONS RESEARCH AND RESEARCH
104 E 38TH ST
INDIANAPOLIS,IN46205
86-2432078 501(C)(3) 10,000 0     GENERAL SUPPORT
(9) INDIANAPOLIS PUBLIC SCHOOLS FOUNDATION
120 E WALNUT ST 104B
INDIANAPOLIS,IN46202
31-1103966 501(C)(3) 10,000 0     GENERAL SUPPORT
(10) INDIANA UNIVERSITY FOUNDATION
301 UNIVERSITY BLVD SUITE 1031
INDIANAPOLIS,IN46202
35-6018940 501(C)(3) 10,000 0     GENERAL SUPPORT
(11) COVERING KIDS & FAMILIES OF INDIANA INC
1100 W 42TH ST STE 317
INDIANAPOLIS,IN46208
61-1520892 501(C)(3) 8,000 0     GENERAL SUPPORT
(12) SUPER SHOT INC
1515 HOBSON RD
FORT WAYNE,IN46805
35-2122575 501(C)(3) 6,329 0     GENERAL SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
12
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2022

Schedule I (Form 990) 2022
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
noncash assistance
(e) Method of valuation (book,
FMV, appraisal, other)
(f) Description of noncash 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
PART I, LINE 2: MDWISE HAS A CORPORATE GIVING COMMITTEE THAT REQUESTS CERTAIN INFORMATION FROM EACH GRANTEE ORGANIZATION IN ORDER TO EVALUATE AND MEASURE IMPACT TO SEE HOW MEMBERS OF MDWISE BENEFIT FROM THE GRANTEE ORGANIZATION. MDWISE DOES NOT HAVE A FORMAL PROCEDURE TO FOLLOW-UP WITH THE GRANTEE ORGANIZATIONS AFTER FUNDS ARE AWARDED BUT USES INFORMAL COMMUNICATIONS TO UNDERSTAND HOW CONTRIBUTIONS ARE USED.
Schedule I (Form 990) 2022



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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 Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public Inspection
Name of the organization
MDWISE INC
 
Employer identification number

35-1931354
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 on 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
 
 
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 on Line 1a? ....
2
 
 
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
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
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 nonfixed
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) 2022

Schedule J (Form 990) 2022
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, 1099-MISC compensation, and/or 1099-NEC (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
1DAVID E MAZURKIEWICZ
TREASURER
(i)

(ii)
0
-------------
1,025,619
0
-------------
739,629
0
-------------
191,280
0
-------------
0
0
-------------
33,460
0
-------------
1,989,988
0
-------------
0
2KATHLEEN KENDALL
SECRETARY
(i)

(ii)
0
-------------
800,333
0
-------------
323,944
0
-------------
440,347
0
-------------
0
0
-------------
44,020
0
-------------
1,608,644
0
-------------
0
3KEVIN B TOMPKINS
CHAIRMAN
(i)

(ii)
0
-------------
636,233
0
-------------
386,284
0
-------------
155,825
0
-------------
0
0
-------------
43,741
0
-------------
1,222,083
0
-------------
0
4JESSICA CROMER
PRESIDENT AND CEO
(i)

(ii)
0
-------------
380,157
0
-------------
174,633
0
-------------
0
0
-------------
92,325
0
-------------
24,827
0
-------------
671,942
0
-------------
0
5PATRICIA HEBENSTREIT
SVP GENERAL COUNSEL
(i)

(ii)
0
-------------
305,340
0
-------------
56,159
0
-------------
9,549
0
-------------
11,520
0
-------------
25,487
0
-------------
408,055
0
-------------
0
6CHERYL DIEHL
ASSISTANT TREASURER AND CFO
(i)

(ii)
0
-------------
273,363
0
-------------
48,878
0
-------------
0
0
-------------
0
0
-------------
43,935
0
-------------
366,176
0
-------------
0
7TORRIAUN EVERETT
VP HEALTH PLAN OPERATIONS
(i)

(ii)
0
-------------
183,345
0
-------------
23,774
0
-------------
5,736
0
-------------
0
0
-------------
16,698
0
-------------
229,553
0
-------------
0
8BRITTNEY MULLANEY
VP HEALTH SERVICES
(i)

(ii)
0
-------------
163,574
0
-------------
15,489
0
-------------
0
0
-------------
0
0
-------------
28,887
0
-------------
207,950
0
-------------
0
9TRICIA BRUNTON
VP FINANCE
(i)

(ii)
0
-------------
145,385
0
-------------
10,250
0
-------------
0
0
-------------
0
0
-------------
12,031
0
-------------
167,666
0
-------------
0
Schedule J (Form 990) 2022

Schedule J (Form 990) 2022
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
PART I, LINE 1A THE CEO/EXECUTIVE DIRECTOR WAS COMPENSATED BY A RELATED ORGANIZATION, AND THEREFORE NONE OF THE LINE 1 BOXES HAVE BEEN CHECKED. THE CORPORATE CEO, SUBSIDIARY CEOS AND CORPORATE EXECUTIVE & SENIOR VICE-PRESIDENTS IN SOME INSTANCES HAVE RECEIVED TAX INDEMNIFICATION FOR THE FOLLOWING BENEFITS: VEHICLE COSTS, GROUP TERM LIFE INSURANCE, SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS, AND HEALTH CLUB OR SOCIAL DUES. THESE BENEFITS HAVE BEEN INCLUDED IN TAXABLE COMPENSATION.
PART I, LINE 3 THE CEO/EXECUTIVE DIRECTOR WAS COMPENSATED BY A RELATED ORGANIZATION, AND THEREFORE NONE OF THE LINE 3 BOXES HAVE BEEN CHECKED. THE RELATED ORGANIZATION USED THE FOLLOWING METHODOLOGIES TO ESTABLISH THE COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR OF THE FILING ORGANIZATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
PART I, LINE 4B MDWISE MAINTAINS TWO SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS FOR A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES (THE "SERPS"). THE OLD SERP WAS CLOSED TO NEW PARTICIPANTS ON OCTOBER 1, 2006, AND THE NEW SERP BECAME EFFECTIVE AS OF JANUARY 1, 2007. NO EMPLOYEE MAY PARTICIPATE IN BOTH OF THE SERPS. THE OLD SERP IS STRUCTURED AS A DEFINED BENEFIT PLAN THAT ESSENTIALLY REPLACES THE BENEFITS THE PARTICIPANT IS NOT PERMITTED TO RECEIVE UNDER MDWISE'S QUALIFIED RETIREMENT PLAN DUE TO IRS LIMITATIONS APPLICABLE TO QUALIFIED PLANS. THE BENEFIT UNDER THE OLD SERP IS PAYABLE IN EITHER THE FORM OF A LUMP SUM DISTRIBUTION OR IN MONTHLY PAYMENTS EQUAL TO THE ACTUARIAL EQUIVALENT OF THE PARTICIPANT'S ACCRUED BENEFIT. THE BENEFIT IS PAID AT AGE 55, AND IF THE PARTICIPANT REMAINS EMPLOYED, THE BENEFIT IS PAID UPON TERMINATION OF EMPLOYMENT, REDUCED TO TAKE INTO ACCOUNT THE BENEFIT PREVIOUSLY PAID. THE NEW SERP IS STRUCTURED AS A DEFINED CONTRIBUTION PLAN, AND MDWISE CONTRIBUTES 15 PERCENT OF EACH PARTICIPANT'S COMPENSATION TO THE PLAN EACH YEAR FOR ALLOCATION TO THE PARTICIPANT'S ACCOUNT. PARTICIPANTS IN THE NEW SERP BECOME VESTED IN THEIR ACCOUNTS UPON THE EARLIER OF FIVE YEARS OF PARTICIPATION IN THE PLAN OR ATTAINMENT OF AGE 60. PARTICIPANTS IN THE NEW SERP SELF-DIRECT THE INVESTMENT OF THEIR ACCOUNTS AND HAVE THE ACTUAL INVESTMENT RETURN CREDITED OR DEBITED TO THEIR ACCOUNTS. THE BENEFIT UNDER THE NEW SERP IS EQUAL TO THE PARTICIPANT'S ACCOUNT BALANCE, AND THE BENEFIT IS PAID IN A SINGLE SUM WITHIN 60 DAYS OF THE PARTICIPANT'S TERMINATION DATE. BENEFITS UNDER BOTH SERPS ARE PROVIDED ON A TAX-NEUTRAL BASIS. BOTH SERPS ARE DESIGNED TO COMPLY WITH INTERNAL REVENUE CODE SECTIONS 457(F) AND 409A.
PART I, LINE 7 MDWISE'S PARENT COMPANY, MCLAREN HEALTH CARE (MHC), HAS A LEADERSHIP INCENTIVE PROGRAM FOR LEADERS OF THE CORPORATION, SUBSIDIARY EXECUTIVES AND DIRECTORS, MANAGERS AND SUPERVISORS. THE PURPOSE OF THE PLAN IS TO ENHANCE THE ORGANIZATION'S ABILITY TO ACHIEVE ITS GOALS BY PROVIDING TOP OFFICIALS AND THE BOARD OF DIRECTORS WITH A TOOL FOR (A) CLEARLY COMMUNICATING PERFORMANCE ON THE PART OF KEY LEADERS, (B) STIMULATING AND REWARDING SUPERIOR LEVELS OF PERFORMANCE ON THE PART OF KEY LEADERS WHICH WILL ULTIMATELY BENEFIT THE COMMUNITIES MHC SERVES, AND (C) PROTECTING MHC'S ABILITY TO COMPETE WITH OTHER EMPLOYERS FOR HIGH-TALENT LEADERS.
Schedule J (Form 990) 2022

Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990)

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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
MDWISE INC
 
Employer identification number

35-1931354
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THIS ORGANIZATION IS MCLAREN INTEGRATED HMO GROUP.
FORM 990, PART VI, SECTION A, LINE 7A MCLAREN INTEGRATED HMO GROUP, MDWISE'S SOLE MEMBER HAS THE POWER TO APPOINT THE BOARD OF DIRECTORS
FORM 990, PART VI, SECTION A, LINE 7B DECISIONS BY THE GOVERNING BODY ARE SUBJECT TO THE POWERS OF THE MEMBER.
FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY MDWISE'S PRESIDENT & CEO AND ALSO BY THE CFO PRIOR TO FILING. AS PART OF AN INTEGRATED HEALTH SYSTEM, THE PARENT BOARD ALSO REVIEWS THE FORM 990.
FORM 990, PART VI, SECTION B, LINE 12C EACH MDWISE BOARD MEMBER, OFFICER AND SENIOR MANAGEMENT EXECUTIVE COMPLETES THE MDWISE CONFLICT OF INTEREST DISCLOSURE FORM ANNUALLY. THE BOARD CHAIR AND PRESIDENT/CEO REVIEW ALL COMPLETED FORMS TO IDENTIFY ANY POTENTIAL CONFLICTS. ANY IDENTIFIED POTENTIAL CONFLICT IS INVESTIGATED AND RAISED WITH THE INDIVIDUAL, AS APPROPRIATE, TO RESOLVE THE CONFLICT OR DETERMINE IF ANY ACTION IS NEEDED, UP TO AND INCLUDING, POSSIBLE REMOVAL FROM THE BOARD, OR OFFICER/SENIOR MANAGEMENT POSITION. ANY IDENTIFIED CONFLICTS ARE REPORTED TO THE FULL BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 15 ALL OFFICERS OF MDWISE, INC. ARE EMPLOYEES OF AN AFFILIATED ENTITY MCLAREN INTEGRATED HMO GROUP. TO ENSURE A FAIR, COMPETITIVE AND LEGALLY COMPLIANT METHOD OF ADMINISTERING COMPENSATION, MCLAREN INTEGRATED HMO GROUP USES INDEPENDENT COMPENSATION STUDIES AND SURVEY DATA TO ESTABLISH THE COMPENSATION STRUCTURE FOR THE MDWISE CEO AND OFFICERS. COMPENSATION FOR THE CEO AND OFFICERS ARE REVIEWED ANNUALLY.
FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9: CHANGE IN NONADMITTED ASSET 16,710,703. REVERSAL OF BAD DEBT 2,596,872.
PART XII, LINE 1: MDWISE, INC. USES THE STATUTORY METHOD OF ACCOUNTING.
PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS FROM PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
MDWISE INC
 
Employer identification number

35-1931354
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income


(e)
End-of-year assets


(f)
Direct controlling
entity











Part II
Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section


(e)
Public charity status
(if section 501(c)(3))

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled entity?
Yes No
(1)MCLAREN BAY MEDICAL FOUNDATION
1900 COLUMBUS AVE

BAY CITY,MI48708
38-2156534
FOUNDATION MI 501(C)(3) LINE 12A, I MCLAREN BAY REGION
 
Yes
 
(2)MCLAREN BAY REGION
1900 COLUMBUS AVE

BAY CITY,MI48708
38-1976271
HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(3)BAY REGIONAL MEDICAL CENTER AUXILIARY
1908 COLUMBUS AVENUE

BAY CITY,MI48708
38-6081235
SUPPORTING ORGANIZATION MI 501(C)(3) LINE 12A, I MCLAREN BAY REGION
 
Yes
 
(4)MCLAREN BAY SPECIAL CARE
3250 E MIDLAND ROAD STE 1

BAY CITY,MI48706
38-3161753
HOSPITAL MI 501(C)(3) LINE 3 MCLAREN BAY REGION
 
Yes
 
(5)MCLAREN CENTRAL MICHIGAN
1221 SOUTH DRIVE

MT PLEASANT,MI48858
38-1420304
HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(6)CHARLEVOIX NURSING HOME CORPORATION DBA BOULDER PARK TERRACE
14676 WEST UPRIGHT

CHARLEVOIX,MI49720
38-3038683
SKILLED NURSING FACILITY MI 501(C)(3) LINE 10 MCLAREN NORTHERN MICHIGAN
 
Yes
 
(7)KARMANOS CANCER FOUNDATION
4100 JOHN R ST

DETROIT,MI48201
38-3584572
FOUNDATION MI 501(C)(3) LINE 7 BARBARA ANN KARMANOS CANCER INSTITUTE
 
Yes
 
(8)MCLAREN GREATER LANSING FOUNDATION
401 W GREENLAWN AVE

LANSING,MI48910
38-2463637
FOUNDATION MI 501(C)(3) LINE 7 MCLAREN GREATER LANSING
 
Yes
 
(9)MCLAREN GREATER LANSING
401 W GREENLAWN AVE

LANSING,MI48910
38-1434090
HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(10)BARBARA ANN KARMANOS CANCER HOSPITAL
4100 JOHN R ST

DETROIT,MI48201
20-1649466
HOSPITAL MI 501(C)(3) LINE 3 BARBARA ANN KARMANOS CANCER INSTITUTE
 
Yes
 
(11)BARBARA ANN KARMANOS CANCER INSTITUTE
4100 JOHN R ST

DETROIT,MI48201
38-1613280
CANCER RESEARCH & CARE CENTER MI 501(C)(3) LINE 7 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(12)MCLAREN LAPEER REGION
1375 N MAIN ST

LAPEER,MI48446
38-2689033
HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(13)MCLAREN LAPEER REGION FOUNDATION
1375 N MAIN ST

LAPEER,MI48446
38-2689603
FOUNDATION MI 501(C)(3) LINE 12A, I MCLAREN LAPEER REGION
 
Yes
 
(14)MARWOOD MANOR NURSING HOME
PO BOX 5011

PORT HURON,MI48060
38-2683251
NURSING HOME MI 501(C)(3) LINE 10 PORT HURON HOSPITAL
 
Yes
 
(15)MCLAREN HEALTH CARE CORPORATION
ONE MCLAREN PARKWAY

GRAND BLANC,MI48439
38-2397643
SUPPORTING ORG MI 501(C)(3) LINE 12A, I N/A
 
No
(16)MCLAREN HEALTH CARE VILLAGE FOUNDATION
401 S BALLENGER HIGHWAY

FLINT,MI48532
26-2693350
SUPPORTING ORG MI 501(C)(3) LINE 12A, I MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(17)MCLAREN HEALTH PLAN COMMUNITY
G-3245 BEECHER ROAD

FLINT,MI48532
27-2204037
INSURANCE MI 501(C)(4)   MCLAREN HEALTH PLAN
 
Yes
 
(18)MCLAREN HEALTH PLAN INC
G-3245 BEECHER ROAD

FLINT,MI48532
38-3252216
HEALTH CARE SERVICES MI 501(C)(4)   MCLAREN INTEGRATED HMO GROUP
 
Yes
 
(19)MCLAREN HOSPICE AND HOME CARE FOUNDATION
1515 CAL DR

DAVISON,MI48423
46-3643089
FOUNDATION MI 501(C)(3) LINE 12A, I MCLAREN HEALTH MANAGEMENT GROUP
 
Yes
 
(20)MCLAREN MEDICAL GROUP
401 S BALLENGER HWY

FLINT,MI48532
38-2988086
MANAGEMENT COMPANY MI 501(C)(3) LINE 12A, I MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(21)MCLAREN NORTHERN MICHIGAN
416 CONNABLE AVENUE

PETOSKEY,MI49770
38-2146751
ACUTE CARE HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(22)MCLAREN NORTHERN MICHIGAN FOUNDATION
360 CONNABLE AVENUE

PETOSKEY,MI49770
38-2445611
FOUNDATION MI 501(C)(3) LINE 7 MCLAREN NORTHERN MICHIGAN
 
Yes
 
(23)MCLAREN PORT HURON
1221 PINE GROVE AVENUE

PORT HURON,MI48060
38-1369611
HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(24)MCLAREN FLINT
401 S BALLENGER HWY

FLINT,MI48532
38-2383119
HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(25)MICHIGAN CANCER SOCIETY
4100 JOHN R ST

DETROIT,MI48201
38-2823451
CANCER RESEARCH MI 501(C)(3) LINE 7 BARBARA ANN KARMANOS CANCER INSTITUTE
 
Yes
 
(26)MOUNT CLEMENS REGIONAL HEALTHCARE FOUNDATION
PO BOX 326

MOUNT CLEMENS,MI48046
38-2578873
FOUNDATION MI 501(C)(3) LINE 10 MCLAREN MACOMB
 
Yes
 
(27)MCLAREN MACOMB
1000 HARRINGTON

MOUNT CLEMENS,MI48043
38-1218516
HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(28)NORTH OAKLAND NORTH MACOMB IMAGING INC
50 NORTH PERRY STREET

PONTIAC,MI48342
38-2807040
MRI IMAGING MI 501(C)(3) LINE 3 MCLAREN OAKLAND
 
Yes
 
(29)NORTHERN MICHIGAN HEMATOLOGY AND ONCOLOGY
416 CONNABLE AVENUE

PETOSKEY,MI49770
32-0020293
PHYSICIAN PRACTICE MI 501(C)(3) LINE 3 MCLAREN NORTHERN MICHIGAN
 
Yes
 
(30)NORTHERN MICHIGAN MEDICAL MANAGEMENT
416 CONNABLE AVENUE

PETOSKEY,MI49770
20-8458840
PHYSICIAN PRACTICE MI 501(C)(3) LINE 12A, I MCLAREN NORTHERN MICHIGAN
 
Yes
 
(31)MCLAREN OAKLAND FOUNDATION
50 NORTH PERRY STREET

PONTIAC,MI48342
20-0442217
FOUNDATION MI 501(C)(3) LINE 12C, III-FI MCLAREN OAKLAND
 
Yes
 
(32)MCLAREN OAKLAND
50 NORTH PERRY STREET

PONTIAC,MI48342
38-1428164
HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(33)PORT HURON HOSPITAL FOUNDATION
PO BOX 5011

PORT HURON,MI48060
38-2777750
FOUNDATION MI 501(C)(3) LINE 12A, I PORT HURON HOSPITAL
 
Yes
 
(34)THE CARDIAC INSTITUTE DBA MICHIGAN HEART & VASCULAR SPECIALISTS
416 CONNABLE AVENUE

PETOSKEY,MI49770
26-2774689
PHYSICIAN PRACTICE MI 501(C)(3) LINE 3 MCLAREN NORTHERN MICHIGAN
 
Yes
 
(35)MCLAREN HEALTH MANAGEMENT GROUP
1515 CAL DRIVE

DAVISON,MI48423
38-3491714
HEALTH CARE SERVICES MI 501(C)(3) LINE 10 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(36)VITALCARE INC
761 LAFAYETTE AVENUE

CHEBOYGAN,MI49721
38-2527255
HOSPICE CARE/HOME HEALTH SERVICES MI 501(C)(3) LINE 10 MCLAREN NORTHERN MICHIGAN
 
Yes
 
(37)MCLAREN FLINT FOUNDATION
401 S BALLENGER HIGHWAY

FLINT,MI48532
38-1358053
SUPPORTING ORGANIZATION MI 501(C)(3) LINE 12A, I MCLAREN FLINT
 
Yes
 
(38)CARO COMMUNITY HOSPITAL
401 N HOOPER ST

CARO,MI48723
38-3426063
HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(39)CARO COMMUNITY HOSPITAL ENDOWMENT FOUNDATION
401 N HOOPER ST

CARO,MI48724
38-2422995
FOUNDATION MI 501(C)(3) LINE 12C, III-FI CARO COMMUNITY HOSPITAL
 
Yes
 
(40)MDWISE MEDICAID NETWORK INC
2955 N MERIDIAN STREET SUITE 201

INDIANAPOLIS,IN46208
47-3192307
INSURANCE IN 501(C)(4)   MCLAREN INTEGRATED HMO GROUP
 
Yes
 
(41)HURON MEMORIAL HOSPITAL
1100 S VAN DYKE ROAD

BAD AXE,MI48413
38-1474929
HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(42)HURON MEMORIAL FOUNDATION
1100 S VAN DYKE ROAD

BAD AXE,MI48413
38-2717147
FOUNDATION MI 501(C)(3) LINE 7 HURON MEMORIAL HOSPITAL
 
Yes
 
(43)MCLAREN INTEGRATED HMO GROUP
G-3245 BEECHER ROAD

FLINT,MI48532
82-4449304
HEALTH CARE SERVICES MI 501(C)(4)   MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(44)ST LUKE'S HOSPITAL
5901 MONCLOVA ROAD

MAUMEE,OH43537
34-4428232
HOSPITAL OH 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(45)ST LUKE'S HOSPITAL FOUNDATION
5901 MONCLOVA ROAD

MAUMEE,OH43537
34-1292849
FOUNDATION OH 501(C)(3) LINE 12A, I ST LUKE'S HOSPITAL
 
Yes
 
(46)LAKE ORION NURSING CENTER CORPORATION
50 NORTH PERRY STREET

PONTIAC,MI48342
38-2895426
NURSING HOME MI 501(C)(3) LINE 10 MCLAREN OAKLAND
 
Yes
 
(47)SPARTAN IMAGING INC
407 GREENLAWN AVE

LANSING,MI48901
85-3196614
HEALTH CARE SERVICES MI 501(C)(3) LINE 10 MCLAREN GREATER LANSING
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?



(k)
Percentage
ownership


Yes No Yes No
(1) MCLAREN - NORTHERN EQUITIES CANCER CENTER PROJECT LLC

39000 COUNTRY CLUB DRIVE
FARMINGTON HILLS,MI48331
26-3112935
RENTAL REAL ESTATE MI N/A
        No   Yes    
(2) MOUNT CLEMENS REGIONAL HEALTH BUILDING HEALTH PARTNERS

1000 HARRINGTON ST
MOUNT CLEMENS,MI48043
26-2524717
BUILDING MANAGEMENT MI N/A
        No   Yes    
(3) SOUTH VAN DYKE MEDICAL COMPLEX-A

125 N HANSELMAN ST
BAD AXE,MI48413
38-3372174
VARIOUS HEALTHCARE ACTIVITIES MI N/A
        No   Yes    
(4) WATERVILLE MEDICAL CENTER LLC

5901 MONCLOVA ROAD
MAUMEE,OH43537
32-0160784
RENTAL REAL ESTATE OH N/A
        No   Yes    
(5) ST LUKES HOSPITAL PAIN MANAGEMENT LLC

5901 MONCLOVA ROAD
MAUMEE,OH43537
83-3639701
PAIN MANAGEMENT OH N/A
        No     No  




Part IV
Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) CLARKSTON PROPERTY ASSOCIATES

50 NORTH PERRY STREET
PONTIAC,MI48342
43-2006072
REAL ESTATE MI N/A
C       Yes  
(2) DELPHINUS INVESTMENT INC

4100 JOHN R ST
DETROIT,MI48075
45-4758176
HOLD PASSIVE INVESTMENT MI N/A
C       Yes  
(3) HEALTH ADVANTAGE INC

G3245 BEECHER ROAD
FLINT,MI48532
91-2141720
INSURANCE MI N/A
C       Yes  
(4) MCLAREN INSURANCE COMPANY LTD

10 MAIN ST
GRAND CAYMAN    
CJ
INSURANCE CJ N/A
C       Yes  
(5) MID-MICHIGAN PHYSICIANS PC

2510 KERRY STREET SUITE 200
LANSING,MI48912
38-3267121
PHYSICIAN PRACTICE MI N/A
C       Yes  
(6) MCLAREN PHYSICIAN PARTNERS

ONE MCLAREN PARKWAY
GRAND BLANC,MI48439
38-3136458
MANAGED CARE MI N/A
C       Yes  
(7) VITALCARE HOME MEDICAL EQUIPMENT INC

761 LAFAYETTE AVENUE
CHEBOYGAN,MI49721
38-2662954
SALE AND RENTAL OF DURABLE MEDICAL EQUIPMENT MI N/A
C       Yes  
(8) HURON CLINIC CONDOMINIUMS OWNERS

125 N HANSELMAN ST
BAD AXE,MI48413
41-2144341
VARIOUS HEALTHCARE ACTIVITIES MI N/A
C       Yes  
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
No
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved





Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference Explanation
Schedule R (Form 990) 2021

Additional Data


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