UW HEALTH ACO INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- UW HEALTH ACO INC (EIN 45-5490584)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-14
- IRS object ID
- 201821349349308552
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-05-14T15:44:12-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 S WACKER DRIVE STE 800 | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60606 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 455490584 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UW HEALTH ACO INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | UWHE | BusinessNameControlTxt |
| Phone | 6082657131 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7974 UW HEALTH COURT | AddressLine1Txt |
| City | MIDDLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53562 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR JONATHAN JAFFERY | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 6082657131 | PhoneNum |
| Signature | 2018-05-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WAYNE HARDER | PreparerPersonNm |
| PTIN | P00294296 | PTIN |
| Phone | 3126343400 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 108.171.131.187 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-05-14 | IPDt |
| IP Tm | 15:01:37 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 4B8E1423B9F197D509CCF13AB357181C17C415CB | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 4EC0B96C62AE7F3F798FFAAE8A06701F68EED858 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DR MATTHEW ANDERSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7974 UW HEALTH COURT | AddressLine1Txt |
| City | MIDDLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53562 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $4,960,274 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.UHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2012 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | THE PURPOSE OF THE UW HEALTH ACO INC. IS TO PROVIDE BETTER CARE, IMPROVED HEALTH, AND LOWER PER CAPITA IN EXPENDITURES FOR MEDICARE BENEFICIARIES ASSIGNED TO THE ACO AND PROVIDE SUPPORT TO THE MEMBERS FOR POPULATION HEALTH PROGRAMS AND DEVELOPMENT OF INNOVATIVE NEW CARE MODELS. THE UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE AND PUBLIC HEALTH ("UWSMPH"), THE UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION ("UWMF"), AND UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY ("UW HOSPITALS") ARE EQUAL MEMBERS OF THE ORGANIZATION. THE ORGANIZATION HAS A PARTICIPATION AGREEMENT WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES ("CMS") UNDER THE MEDICARE SHARED SAVINGS PROGRAM ("MSSP"). THE AGREEMENT HAS BEEN RENEWED EFFECTIVE JANUARY 1, 2016 WITH A TERM OF THREE YEARS, ENDING DECEMBER 31, 2018. UWMF SERVES AS MANAGING MEMBER AND PERFORMS ADVISORY AND DELEGATED MANAGEMENT SERVICES FOR THE ORGANIZATION, WHILE UWSMPH AND UW HOSPITALS PROVIDE CERTAIN OTHER SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,399,258 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $4,960,274 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $4,399,258 | PYTotalRevenueAmt |
| CY Total Revenue | $4,960,274 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,894,623 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,576,924 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,504,635 | PYOtherExpensesAmt |
| CY Other Expenses | $2,383,350 | CYOtherExpensesAmt |
| PY Total Expenses | $4,399,258 | PYTotalExpensesAmt |
| CY Total Expenses | $4,960,274 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $0 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $0 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $779,346 | TotalAssetsBOYAmt |
| Total Assets EOY | $838,212 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $513,374 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $572,240 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $265,972 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $265,972 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE PURPOSE OF THE UW HEALTH ACO INC. IS TO PROVIDE BETTER CARE, IMPROVED HEALTH, AND LOWER PER CAPITA IN EXPENDITURES FOR MEDICARE BENEFICIARIES ASSIGNED TO THE ACO AND PROVIDE SUPPORT TO THE MEMBERS FOR POPULATION HEALTH PROGRAMS AND DEVELOPMENT OF INNOVATIVE NEW CARE MODELS. THE UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE AND PUBLIC HEALTH ("UWSMPH"), THE UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION ("UWMF"), AND UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY ("UW HOSPITALS") ARE EQUAL MEMBERS OF THE ORGANIZATION. THE ORGANIZATION HAS A PARTICIPATION AGREEMENT WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES ("CMS") UNDER THE MEDICARE SHARED SAVINGS PROGRAM ("MSSP"). THE AGREEMENT HAS BEEN RENEWED EFFECTIVE JANUARY 1, 2016 WITH A TERM OF THREE YEARS, ENDING DECEMBER 31, 2018. UWMF SERVES AS MANAGING MEMBER AND PERFORMS ADVISORY AND DELEGATED MANAGEMENT SERVICES FOR THE ORGANIZATION, WHILE UWSMPH AND UW HOSPITALS PROVIDE CERTAIN OTHER SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,333,790 | ExpenseAmt |
| Revenue | $4,960,274 | RevenueAmt |
| Desc | TO PROVIDE BETTER CARE, IMPROVED HEALTH, AND LOWER PER CAPITA GROWTH IN EXPENDITURES FOR MEDICARE BENEFICIARIES ASSIGNED TO THE ACO AND PROVIDE SUPPORT TO UNIVERISTY OF WISCONSIN MEDICAL FOUNDATION (UWMF) AND UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY(UW HOSPITAL) FOR POPULATION HEALTH PROGRAMS AND DEVELOPMENT OF INNOVATIVE NEW CARE MODELS. | Desc |
| Total Program Service Expenses | $4,333,790 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROBERT FLANNERY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6082657131 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7974 UW HEALTH COURT | AddressLine1Txt |
| City | MIDDLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53562 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| DR MATTHEW ANDERSON | ||||||||
| CHAIR (AS OF 02/16/17) | 2.00 | 38.00 | Yes (X) | $0 | $237,774 | $90 | ||
| SARAH DAVIS | ||||||||
| DIRECTOR | 2.00 | 38.00 | Yes (X) | $0 | $90,133 | $0 | ||
| DR JENNIFER EDGOOSE | ||||||||
| DIRECTOR (AS OF 02/16/17) | 2.00 | 38.00 | Yes (X) | $0 | $222,401 | $34,408 | ||
| DR MICHAEL SLOAN | ||||||||
| DIRECTOR (AS OF 02/16/17) | 2.00 | 38.00 | Yes (X) | $0 | $397,477 | $53,090 | ||
| DR ROY ALLAN JHAGROO | ||||||||
| DIRECTOR (AS OF 02/16/17) | 2.00 | 38.00 | Yes (X) | $0 | $192,515 | $39,486 | ||
| RONALD SLIWINSKI | ||||||||
| DIRECTOR (UNTIL 02/16/17) | 2.00 | 38.00 | Yes (X) | $0 | $0 | $0 | ||
| DR ROBERT GOLDEN | ||||||||
| DIRECTOR (UNTIL 02/16/17) | 2.00 | 38.00 | Yes (X) | $0 | $0 | $0 | ||
| DR JEFFREY GROSSMAN | ||||||||
| DIRECTOR (UNTIL 10/24/16) | 2.00 | 38.00 | Yes (X) | $0 | $0 | $0 | ||
| DR DAVID KINDIG | ||||||||
| DIRECTOR (UNTIL 02/16/17) | 2.00 | 38.00 | Yes (X) | $0 | $0 | $0 | ||
| KENNETH MOUNT | ||||||||
| DIRECTOR (UNTIL 02/16/17) | 2.00 | 38.00 | Yes (X) | $0 | $0 | $0 | ||
| PETER NEWCOMER | ||||||||
| DIRECTOR (UNTIL 02/16/17) | 2.00 | 38.00 | Yes (X) | $85,985 | $394,891 | $106,326 | ||
| JULIEANNE POFAHL | ||||||||
| PUBLIC MEMBER (AS OF 03/16/17) | 2.00 | 38.00 | Yes (X) | $0 | $0 | $0 | ||
| DR JONATHAN JAFFERY | ||||||||
| PRESIDENT | 2.00 | 38.00 | $0 | $345,809 | $53,090 | Yes (X) | ||
| STEPHANIE BERKSON | ||||||||
| VICE PRESIDENT & SECRETARY | 2.00 | 38.00 | $0 | $189,913 | $47,134 | Yes (X) | ||
| ROBERT FLANNERY | ||||||||
| TREASURER | 2.00 | 38.00 | $0 | $647,067 | $88,578 | Yes (X) | ||
| DAN BRZOZOWKI | ||||||||
| GEN. CNSL./SECRETARY(AS OF 02/16/17) | 2.00 | 38.00 | $0 | $142,483 | $20,933 | Yes (X) | ||
| GRACE FLOOD | ||||||||
| MEDICAL DIRECTOR | 2.00 | 38.00 | $0 | $201,013 | $43,143 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $85,985 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,061,476 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $486,278 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EVOLENT HEALTH LLC | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 N GLEBE ROAD SUITE 500 | AddressLine1Txt |
| City | ARLINGTON | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 22203 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | PROFESSIONAL SERVICES | ServicesDesc |
| Compensation | $151,750 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CASE MANAGEMENT SERVIC | Desc |
| Business | 621500 | BusinessCd |
| Total Revenue Column | $4,960,274 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,960,274 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $4,960,274 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,960,274 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,960,274 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,903,194 | TotalAmt |
| Program Services | $1,671,798 | ProgramServicesAmt |
| Management And General | $231,396 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $152,256 | TotalAmt |
| Program Services | $133,744 | ProgramServicesAmt |
| Management And General | $18,512 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $384,444 | TotalAmt |
| Program Services | $337,702 | ProgramServicesAmt |
| Management And General | $46,742 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $137,030 | TotalAmt |
| Program Services | $120,369 | ProgramServicesAmt |
| Management And General | $16,661 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,219 | TotalAmt |
| Management And General | $21,219 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,141,606 | TotalAmt |
| Program Services | $1,881,223 | ProgramServicesAmt |
| Management And General | $260,383 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,726 | TotalAmt |
| Program Services | $86,723 | ProgramServicesAmt |
| Management And General | $12,003 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,712 | TotalAmt |
| Program Services | $32,248 | ProgramServicesAmt |
| Management And General | $4,464 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,417 | TotalAmt |
| Management And General | $5,417 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,850 | TotalAmt |
| Program Services | $15,680 | ProgramServicesAmt |
| Management And General | $2,170 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NONPHYSICIAN PROF. DEV. | Desc |
| Total | $15,115 | TotalAmt |
| Program Services | $13,277 | ProgramServicesAmt |
| Management And General | $1,838 | ManagementAndGeneralAmt |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,705 | TotalAmt |
| Program Services | $41,026 | ProgramServicesAmt |
| Management And General | $5,679 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,960,274 | TotalAmt |
| Program Services | $4,333,790 | ProgramServicesAmt |
| Management And General | $626,484 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $590,748 | BOYAmt |
| EOY | $626,702 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,930 | BOYAmt |
| EOY | $13,380 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $182,668 | BOYAmt |
| EOY | $198,130 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $779,346 | BOYAmt |
| EOY | $838,212 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,898 | BOYAmt |
| EOY | $27,095 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $489,476 | BOYAmt |
| EOY | $545,145 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $513,374 | BOYAmt |
| EOY | $572,240 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $265,972 | BOYAmt |
| EOY | $265,972 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $265,972 | BOYAmt |
| EOY | $265,972 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $779,346 | BOYAmt |
| EOY | $838,212 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $0 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $750,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,990,304 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,687,384 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,399,258 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,960,274 | CurrentTaxYearAmt |
| Total | $16,787,220 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $750,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,990,304 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,687,384 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,399,258 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,960,274 | CurrentTaxYearAmt |
| Total | $16,787,220 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $16,787,220 | PublicSupportTotal509Amt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $750,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,990,304 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,687,384 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,399,258 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,960,274 | CurrentTaxYearAmt |
| Total | $16,787,220 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First5 Years509 | Yes (X) | First5Years509Ind |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE FROM MEMBERS | Desc |
| Book Value | $198,130 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $198,130 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO MEMBERS | Desc |
| Amt | $545,145 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $545,145 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $4,960,274 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $4,960,274 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $4,960,274 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $4,960,274 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $4,960,274 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $4,960,274 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION IS ALSO EXEMPT FROM STATE INCOME TAX. THE ORGANIZATION FOLLOWS GUIDANCE RELATIVE TO THE UNCERTAINTY IN INCOME TAXES, WHICH ADDRESSES THE DETERMINATION OF WHETHER TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE FINANCIAL STATEMENTS. UNDER THIS GUIDANCE, THE ORGANIZATION MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. EXAMPLES OF TAX POSITIONS INCLUDE THE TAX-EXEMPT STATUS OF THE ORGANIZATION, AND VARIOUS POSITIONS RELATED TO THE POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). ANY TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50 PERCENT LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR MATTHEW ANDERSON | ||||||||||||||
| CHAIR (AS OF 02/16/17) | $0 | $237,774 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $90 | $0 | $237,864 | $0 | $0 |
| DR JENNIFER EDGOOSE | ||||||||||||||
| DIRECTOR (AS OF 02/16/17) | $0 | $222,401 | $0 | $0 | $0 | $0 | $0 | $34,408 | $0 | $0 | $0 | $256,809 | $0 | $0 |
| DR MICHAEL SLOAN | ||||||||||||||
| DIRECTOR (AS OF 02/16/17) | $0 | $397,477 | $0 | $0 | $0 | $0 | $0 | $53,000 | $0 | $90 | $0 | $450,567 | $0 | $0 |
| DR ROY ALLAN JHAGROO | ||||||||||||||
| DIRECTOR (AS OF 02/16/17) | $0 | $192,515 | $0 | $0 | $0 | $0 | $0 | $39,396 | $0 | $90 | $0 | $232,001 | $0 | $0 |
| PETER NEWCOMER | ||||||||||||||
| DIRECTOR (UNTIL 02/16/17) | $85,985 | $394,891 | $0 | $0 | $0 | $0 | $0 | $102,314 | $0 | $4,012 | $85,985 | $501,217 | $0 | $0 |
| DR JONATHAN JAFFERY | ||||||||||||||
| PRESIDENT | $0 | $345,809 | $0 | $0 | $0 | $0 | $0 | $53,000 | $0 | $90 | $0 | $398,899 | $0 | $0 |
| STEPHANIE BERKSON | ||||||||||||||
| VICE PRESIDENT & SECRETARY | $0 | $171,723 | $0 | $14,690 | $0 | $3,500 | $0 | $22,900 | $0 | $24,234 | $0 | $237,047 | $0 | $0 |
| ROBERT FLANNERY | ||||||||||||||
| TREASURER | $0 | $590,225 | $0 | $50,625 | $0 | $6,217 | $0 | $63,247 | $0 | $25,331 | $0 | $735,645 | $0 | $0 |
| DAN BRZOZOWKI | ||||||||||||||
| GEN. CNSL./SECRETARY(AS OF 02/16/17) | $0 | $135,564 | $0 | $6,300 | $0 | $619 | $0 | $11,684 | $0 | $9,249 | $0 | $163,416 | $0 | $0 |
| GRACE FLOOD | ||||||||||||||
| MEDICAL DIRECTOR | $0 | $197,528 | $0 | $0 | $0 | $3,485 | $0 | $19,230 | $0 | $23,913 | $0 | $244,156 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | COMPENSATION IS PAID VIA A LEASING AGREEMENT WITH MEMBERS OF THE ORGANIZATION. EXECUTIVE COMPENSATION IS BASED ON COMPARATIVE DATA WITH LIKE POSITIONS WITHIN THE MARKET. |
| PART I, LINE 4B | UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION PROVIDES CERTAIN EXECUTIVES DISCLOSED ON FORM 990, PART VII AND SCHEDULE J, PART III A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. AMOUNTS ARE CREDITED TO EACH PARTICIPANTS' ACCOUNTS EACH YEAR. PLAN AMOUNTS ARE SUBJECT TO FORFEITURE OR PAYMENT ONLY IF CERTAIN CONDITIONS ARE MET, AS OUTLINED IN THE PLAN AGREEMENT. NO AMOUNTS BECAME VESTED OR WERE PAID IN CALENDAR YEAR 2016. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | DUE TO THE MANAGEMENT SERVICES AGREEMENT ESTABLISHED BETWEEN UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION, INC. (UWMF) AND UW HEALTH ACO, INC., WE HAVE ANSWERED YES TO QUESTION #3 ON PART VI, SECTION A. UWMF IS THE MANAGEMENT COMPANY WITHIN THIS AGREEMENT. UWMF PROVIDES PAYROLL SERVICES (THROUGH A PAYMASTER AGREEMENT), HUMAN RESOURCES, PATIENT BILLING AND COLLECTIONS, ACCOUNTS PAYABLE SERVICES, I/T SERVICES, MONTHLY FINANCIAL STATEMENT PREPARATION, TAX RETURN PREPARATION SUPPORT, FINANCIAL AUDIT SUPPORT, COMPLIANCE AUDITING, MEDICAL RECORDS STORAGE/TRANSCRIPTION, INFECTION CONTROL/EMPLOYEE HEALTH, MAINTENANCE/MECHANICAL SUPPORT, NURSING AND NURSING SUPPORT, QUALITY ASSURANCE AND IMPROVEMENT, HOUSEKEEPING, REMOVAL OF HAZARDOUS WASTE, COURIER, MAIL AND RECEIVING, PURCHASING, SECURITY AND TELECOMMUNICATIONS. IN ADDITION, VARIOUS ADMINISTRATIVE DUTIES ARE ASSIGNED TO AN INDIVIDUAL SO TO CARRY OUT THE DECISION/DIRECTION OF UW HEALTH ACO'S BOARD OF DIRECTORS AND ANY CLINICAL DUTIES PERFORMED FOR UWMF. FOR THE CURRENT FISCAL YEAR, DR. JONATHAN JAFFERY SPENDS A PORTION OF HIS TIME IMPLEMENTING THE DECISIONS AND DIRECTION OF UW HEALTH ACO'S BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS THREE EQUAL MEMBERS: UW SCHOOL OF MEDICINE AND PUBLIC HEALTH ("UWSMPH"), UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS ("UW HOSPITALS"), AND UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION ("UWMF"). |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD OF DIRECTORS INCLUDES REPRESENTATIVES OF THE MEMBER ORGANIZATIONS, THE PRESIDENT OF UW HEALTH ACO, THE DEAN OF UWSMPH, AND THE CFO OF UWSMPH. |
| FORM 990, PART VI, SECTION A, LINE 8B | UW HEALTH ACO, INC. HAS NO OTHER COMMITTEES BEYOND THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | KEY OFFICERS WITHIN THE ORGANIZATION REVIEW THE CONTENT OF THE FORM 990 PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | MEMBERS OF THE BOARD OF DIRECTORS MUST REVIEW AND SIGN THE CONFLICT OF INTEREST POLICY ON A YEARLY BASIS. SHOULD A CONFLICT ARISE, THE INTERESTED PARTY SHALL NOT PARTICIPATE IN ANY DISCUSSION OR VOTE RELATED TO THIS DETERMINATION, EXCEPT TO THE EXTENT NECESSARY TO FULLY EXPLAIN THE FINANCIAL INTEREST AND THE MANNER IN WHICH THE PROPOSED TRANSACTION OR ARRANGEMENT TO BE DISCUSSED OR ACTED UPON BY THE BOARD MAY OR WILL BEAR UPON OR RELATE TO THE FINANCIAL INTEREST. A MEMBER OF THE BOARD MAY DIRECT THAT THE INTERESTED PERSON LEAVE THE MEETING FOR ALL OR PART OF THE DISCUSSION OF WHETHER THE FINANCIAL INTEREST CREATES A CONFLICT OF INTEREST. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION IS PAID VIA A LEASING AGREEMENT WITH MEMBERS OF THE ORGANIZATION. EXECUTIVE COMPENSATION IS BASED ON COMPARATIVE DATA WITH LIKE POSITIONS WITHIN THE MARKET. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS REQUIRED PER IRC SECTION 6104(D). |
| FORM 990, PART IX, LINE 11G | PURCHASED MEDICAL AND NON-MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 1,881,223. MANAGEMENT AND GENERAL EXPENSES 260,383. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,141,606. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (14 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY | |||||||||||
| 600 HIGHLAND AVENUE | MADISON | WI | 53792 | 391835630 | HOSPITAL AND CLINICS | WI | 501(C)(3) | LINE 6 | N/A | 0 | |
| UNIVERSITY OF WI MEDICAL FOUNDATION | |||||||||||
| 600 HIGHLAND AVENUE | MADISON | WI | 53792 | 391824445 | PHYSICIAN SERVICES | WI | 501(C)(3) | LINE 10 | 0 | UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY | |
| REGIONAL DIVISION INC | |||||||||||
| 301 SOUTH WESTFIELD ROAD SUITE 320 | MADISON | WI | 53717 | 391446049 | REGIONAL PARENT CORP. TO MANAGE AND DIRECT ACTIVITIES OF ENTITIES | WI | 501(C)(3) | LINE 12A | 0 | UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY | |
| UNIVERSITY HEALTH CARE INC | |||||||||||
| 301 SOUTH WESTFIELD ROAD SUITE 320 | MADISON | WI | 53717 | 472553196 | SUPPORT ORGANIZATION | WI | 501(C)(3) | LINE 12A | 0 | UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY | |
| SWEDISHAMERICAN HEALTH SYSTEM CORPORATION | |||||||||||
| 1401 EAST STATE STREET | ROCKFORD | IL | 61104 | 363241458 | PARENT CORPORATION TO MANAGE AND DIRECT ACTIVITES OF ENTITIES | IL | 501(C)(3) | LINE 12A | 0 | REGIONAL DIVISION INC | |
| SWEDISHAMERICAN FOUNDATION | |||||||||||
| 1415 EAST STATE STREET | ROCKFORD | IL | 61104 | 363097493 | SUPPORTS FUNDRAISING FOR SWEDISHAMERICAN HOSPITAL | IL | 501(C)(3) | LINE 7 | 0 | SWEDISHAMERICAN HOSPITAL | |
| SWEDISHAMERICAN REALTY CORPORATION | |||||||||||
| 1313 EAST STATE STREET | ROCKFORD | IL | 61104 | 363248013 | TITLE HOLDING COMPANY | IL | 501(C)(2) | 0 | SWEDISHAMERICAN HEALTH SYSTEM CORPORATION | ||
| SWEDISHAMERICAN HOSPITAL SELF INSURANCE TRUST | |||||||||||
| 1401 EAST STATE STREET | ROCKFORD | IL | 61104 | 366652702 | HOSPITAL MALPRACTICE TRUST | VT | 501(C)(3) | LINE 12A | 0 | SWEDISHAMERICAN HOSPITAL | |
| WISCONSIN THERAPIES INC | |||||||||||
| 600 HIGHLAND AVENUE | MADISON | WI | 53792 | 391807425 | INFUSION THERAPY | WI | 501(C)(3) | LINE 12D | 0 | UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY | |
| GENERATIONS FERTILITY CARE | |||||||||||
| 2365 DEMING WAY | MIDDLETON | WI | 53562 | 273496527 | REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY SERVICES | WI | 501(C)(3) | LINE 10 | N/A | 0 | |
| WISCONSIN DIALYSIS | |||||||||||
| 3034 FISH HATCHERY ROAD | FITCHBURG | WI | 53713 | 300072647 | DIALYSIS SERVICES | WI | 501(C)(3) | LINE 12C | N/A | 0 | |
| MADISON SURGERY CENTER | |||||||||||
| 7974 UW HEALTH COURT | MIDDLETON | WI | 53562 | 391940656 | HEALTH CARE SERVICES AND TRAINING | WI | 501(C)(3) | LINE 10 | N/A | 0 | |
| SWEDISHAMERICAN HOSPITAL | |||||||||||
| 1401 EAST STATE STREET | ROCKFORD | IL | 61104 | 362222696 | HOSPITAL | IL | 501(C)(3) | LINE 3 | 0 | SWEDISHAMERICAN HEALTH SYSTEM CORPORATION | |
| GUNDERSEN HEALTH PLAN INC | |||||||||||
| 3190 GUNDERSEN DRIVE | ONALASKA | WI | 54650 | 391807071 | HEALTH MAINTENANCE ORGANIZATION | WI | 501(C)(4) | 0 | UNIVERSITY HEALTH CARE INC | ||
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Predominant Income TypePredominantIncomeTypeTxt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|---|
| THREE RIVERS PARTNERS LLC | ||||||||||
| 1313 EAST STATE STREET | ROCKFORD | IL | 61104 | 262231757 | INFORMATION TECHNOLOGY SERVICES | IL | N/A | N/A | 0 | 0 |
| NORTHERN ILLINOIS VEIN CLINIC | ||||||||||
| 2550 CHARLES STREET | ROCKFORD | IL | 61108 | 201642329 | OUTPATIENT HEALTH SERVICES | IL | N/A | N/A | 0 | 0 |
| CHARTWELL WISCONSIN ENTERPRISES LLC | ||||||||||
| 2241 PINEHURST DRIVE | MIDDLETON | WI | 53562 | 391796267 | PARENT ENTITY OF CMW AND CMW-HR | WI | N/A | N/A | 0 | 0 |
| MADISON MEDICAL CENTER LLP | ||||||||||
| 7974 UW HEALTH COURT | MIDDLETON | WI | 53562 | 391329429 | REAL ESTATE | WI | N/A | N/A | 0 | 0 |
| SIXTH STREET MEDICAL LLC | ||||||||||
| 7974 UW HEALTH COURT | MIDDLETON | WI | 53562 | 472705724 | REAL ESTATE | WI | N/A | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| SARI INSURANCE COMPANY | |||||||||
| 76 ST PAUL STREET SUITE 500 | BURLINGTON | VT | 054014477 | 030308753 | CAPTIVE INSURANCE COMPANY | VT | SAHS CORPORATION | C | 0 |
| LSG BUILDING CORPORATION | |||||||||
| 1313 EAST STATE STREET | ROCKFORD | IL | 61104 | 363033985 | REAL ESTATE | IL | SAHS CORPORATION | S | 0 |
| STATE & CHARLES INC | |||||||||
| 1313 EAST STATE STREET | ROCKFORD | IL | 61104 | 363321193 | HOLDING COMPANY | IL | SAHS CORPORATION | C | 0 |
| SWEDISHAMERICAN HEALTH MANAGEMENT CORP | |||||||||
| 1401 EAST STATE STREET | ROCKFORD | IL | 61104 | 363246511 | MANAGEMENT SERVICES | IL | STATE & CHARLES INC | C | 0 |
| UNITY HEALTH INSURANCE | |||||||||
| 840 CAROLINA STREET | SAUK CITY | WI | 53583 | 391450766 | HEALTH MAINTENANCE ORGANIZATION | WI | UNIVERSITY HEALTH CARE INC | C | 0 |
| HEALTH PROFESSIONALS OF WISCONSIN | |||||||||
| 301 SOUTH WESTFIELD ROAD | MADISON | WI | 53717 | 391806711 | REAL ESTATE | WI | UNIVERSITY HEALTH CARE INC | C | 0 |
| PHYSICIAN'S CARE NETWORK | |||||||||
| 1313 EAST STATE STREET | ROCKFORD | IL | 61104 | 363455791 | HEALTH SERVICES | IL | STATE & CHARLES INC | C | 0 |
| QUARTZ HEALTH SOLUTIONS | |||||||||
| 840 CAROLINA STREET | SAUK CITY | WI | 53583 | 465710709 | INSURANCE | WI | UNIVERSITY HEALTH CARE INC | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |