2018-05-14T15:44:12-05:00 2017-06-30 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2016-07-01 455490584 UW HEALTH ACO INC UWHE 6082657131 7974 UW HEALTH COURT MIDDLETON WI 53562 DR JONATHAN JAFFERY PRESIDENT 6082657131 2018-05-14 1 WAYNE HARDER P00294296 3126343400 108.171.131.187 2018-05-14 15:01:37 CD P 4B8E1423B9F197D509CCF13AB357181C17C415CB 4EC0B96C62AE7F3F798FFAAE8A06701F68EED858 2016 2021-01-29 14:40:06Z DR MATTHEW ANDERSON 7974 UW HEALTH COURT MIDDLETON WI 53562 4960274 0 X WWW.UHEALTH.ORG X 2012 WI 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. 6 0 0 0 0 0 0 0 4399258 4960274 0 0 0 0 4399258 4960274 0 0 0 0 2894623 2576924 0 0 0 1504635 2383350 4399258 4960274 0 0 779346 838212 513374 572240 265972 265972 X 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. 0 0 4333790 4960274 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. 4333790 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 0 0 1 0 0 1 1 0 1 0 0 0 0 1 1 1 1 1 0 0 0 X ROBERT FLANNERY 6082657131 7974 UW HEALTH COURT MIDDLETON WI 53562 DR MATTHEW ANDERSON CHAIR (AS OF 02/16/17) 2.00 38.00 X 0 237774 90 SARAH DAVIS DIRECTOR 2.00 38.00 X 0 90133 0 DR JENNIFER EDGOOSE DIRECTOR (AS OF 02/16/17) 2.00 38.00 X 0 222401 34408 DR MICHAEL SLOAN DIRECTOR (AS OF 02/16/17) 2.00 38.00 X 0 397477 53090 DR ROY ALLAN JHAGROO DIRECTOR (AS OF 02/16/17) 2.00 38.00 X 0 192515 39486 RONALD SLIWINSKI DIRECTOR (UNTIL 02/16/17) 2.00 38.00 X 0 0 0 DR ROBERT GOLDEN DIRECTOR (UNTIL 02/16/17) 2.00 38.00 X 0 0 0 DR JEFFREY GROSSMAN DIRECTOR (UNTIL 10/24/16) 2.00 38.00 X 0 0 0 DR DAVID KINDIG DIRECTOR (UNTIL 02/16/17) 2.00 38.00 X 0 0 0 KENNETH MOUNT DIRECTOR (UNTIL 02/16/17) 2.00 38.00 X 0 0 0 PETER NEWCOMER DIRECTOR (UNTIL 02/16/17) 2.00 38.00 X 85985 394891 106326 JULIEANNE POFAHL PUBLIC MEMBER (AS OF 03/16/17) 2.00 38.00 X 0 0 0 DR JONATHAN JAFFERY PRESIDENT 2.00 38.00 X 0 345809 53090 STEPHANIE BERKSON VICE PRESIDENT & SECRETARY 2.00 38.00 X 0 189913 47134 ROBERT FLANNERY TREASURER 2.00 38.00 X 0 647067 88578 DAN BRZOZOWKI GEN. CNSL./SECRETARY(AS OF 02/16/17) 2.00 38.00 X 0 142483 20933 GRACE FLOOD MEDICAL DIRECTOR 2.00 38.00 X 0 201013 43143 85985 3061476 486278 0 0 1 0 EVOLENT HEALTH LLC 800 N GLEBE ROAD SUITE 500 ARLINGTON VA 22203 PROFESSIONAL SERVICES 151750 1 CASE MANAGEMENT SERVIC 621500 4960274 4960274 4960274 4960274 4960274 0 0 X 1903194 1671798 231396 152256 133744 18512 384444 337702 46742 137030 120369 16661 21219 21219 2141606 1881223 260383 98726 86723 12003 36712 32248 4464 5417 5417 17850 15680 2170 NONPHYSICIAN PROF. DEV. 15115 13277 1838 46705 41026 5679 4960274 4333790 626484 0 590748 626702 5930 13380 182668 198130 779346 838212 23898 27095 489476 545145 513374 572240 X 265972 265972 265972 265972 779346 838212 0 0 X 0 1 X 1 0 X 750000 2990304 3687384 4399258 4960274 16787220 750000 2990304 3687384 4399258 4960274 16787220 0 0 0 16787220 750000 2990304 3687384 4399258 4960274 16787220 X 0 DUE FROM MEMBERS 198130 198130 DUE TO MEMBERS 545145 545145 X 4960274 0 4960274 0 4960274 4960274 0 4960274 0 4960274 PART X, LINE 2: 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. 0 1 0 0 0 0 0 0 0 DR MATTHEW ANDERSON CHAIR (AS OF 02/16/17) 0 237774 0 0 0 0 0 0 0 90 0 237864 0 0 DR JENNIFER EDGOOSE DIRECTOR (AS OF 02/16/17) 0 222401 0 0 0 0 0 34408 0 0 0 256809 0 0 DR MICHAEL SLOAN DIRECTOR (AS OF 02/16/17) 0 397477 0 0 0 0 0 53000 0 90 0 450567 0 0 DR ROY ALLAN JHAGROO DIRECTOR (AS OF 02/16/17) 0 192515 0 0 0 0 0 39396 0 90 0 232001 0 0 PETER NEWCOMER DIRECTOR (UNTIL 02/16/17) 85985 394891 0 0 0 0 0 102314 0 4012 85985 501217 0 0 DR JONATHAN JAFFERY PRESIDENT 0 345809 0 0 0 0 0 53000 0 90 0 398899 0 0 STEPHANIE BERKSON VICE PRESIDENT & SECRETARY 0 171723 0 14690 0 3500 0 22900 0 24234 0 237047 0 0 ROBERT FLANNERY TREASURER 0 590225 0 50625 0 6217 0 63247 0 25331 0 735645 0 0 DAN BRZOZOWKI GEN. CNSL./SECRETARY(AS OF 02/16/17) 0 135564 0 6300 0 619 0 11684 0 9249 0 163416 0 0 GRACE FLOOD MEDICAL DIRECTOR 0 197528 0 0 0 3485 0 19230 0 23913 0 244156 0 0 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. 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. 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 UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY 0 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 UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY 0 UNIVERSITY HEALTH CARE INC 301 SOUTH WESTFIELD ROAD SUITE 320 MADISON WI 53717 472553196 SUPPORT ORGANIZATION WI 501(C)(3) LINE 12A UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY 0 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 REGIONAL DIVISION INC 0 SWEDISHAMERICAN FOUNDATION 1415 EAST STATE STREET ROCKFORD IL 61104 363097493 SUPPORTS FUNDRAISING FOR SWEDISHAMERICAN HOSPITAL IL 501(C)(3) LINE 7 SWEDISHAMERICAN HOSPITAL 0 SWEDISHAMERICAN REALTY CORPORATION 1313 EAST STATE STREET ROCKFORD IL 61104 363248013 TITLE HOLDING COMPANY IL 501(C)(2) SWEDISHAMERICAN HEALTH SYSTEM CORPORATION 0 SWEDISHAMERICAN HOSPITAL SELF INSURANCE TRUST 1401 EAST STATE STREET ROCKFORD IL 61104 366652702 HOSPITAL MALPRACTICE TRUST VT 501(C)(3) LINE 12A SWEDISHAMERICAN HOSPITAL 0 WISCONSIN THERAPIES INC 600 HIGHLAND AVENUE MADISON WI 53792 391807425 INFUSION THERAPY WI 501(C)(3) LINE 12D UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY 0 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 SWEDISHAMERICAN HEALTH SYSTEM CORPORATION 0 GUNDERSEN HEALTH PLAN INC 3190 GUNDERSEN DRIVE ONALASKA WI 54650 391807071 HEALTH MAINTENANCE ORGANIZATION WI 501(C)(4) UNIVERSITY HEALTH CARE INC 0 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 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 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0