RONALD MCDONALD HOUSE MADISON INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: RONALD MCDONALD HOUSE MADISON INC (EIN 39-1655790)
Tax period: 2011-01-01 to 2011-12-31
Filed: 2012-06-27
IRS object ID: 201221799349300217
Schema version: 2011v1.2
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
Form 990
Schedule A
Schedule B
Schedule D
Schedule I
Schedule M
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-06-27T11:26:02-05:00	Timestamp
Tax Period End Date	2011-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	390974031	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	WEGNER CPAS LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	2110 LUANN LN	AddressLine1
City	MADISON	City
State	WI	State
ZIP Code	537133074	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2011-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	391655790	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	RONALD MCDONALD HOUSE CHARITIES OF MADISON INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	RONA	NameControl
Phone	6082324660	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2716 MARSHALL CT	AddressLine1
City	MADISON	City
State	WI	State
ZIP Code	537052256	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	KEVIN HUDDLESTON	Name
Title	EXECUTIVE DIRECTOR	Title
Phone	6082324660	Phone
Date Signed	2012-06-26	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	GLENN MILLER CPA	Name
PTIN	P00086726	PTIN
Phone	6082744020	Phone

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	KEVIN HUDDLESTON	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	2716 MARSHALL CT	AddressLine1
City	MADISON	City
State	WI	State
ZIP Code	537052256	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	3109466	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.RMHCMADISON.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1996	YearFormation
State Legal Domicile	WI	StateLegalDomicile
Activity Or Mission Description	WE PROVIDE A "HOME AWAY FROM HOME" FOR FAMILIES WHOSE CHILDREN (18 AND UNDER) ARE UNDERGOING TREATMENT AT MADISON AREA HEALTH CARE FACILITIES. THE HOUSE ALLOWS FAMILIES TO STAY TOGETHER DURING AN OFTEN VERY DIFFICULT TIME.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	14	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	14	NbrIndependentVotingMembers
Total Nbr Employees	14	TotalNbrEmployees
Total Nbr Volunteers	150	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	1112312	ContributionsGrantsPriorYear
Contributions Grants Current Year	1395568	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	46973	ProgramServiceRevenuePriorYear
Program Service Revenue CY	54948	ProgramServiceRevenueCY
Investment Income Prior Year	44842	InvestmentIncomePriorYear
Investment Income Current Year	116621	InvestmentIncomeCurrentYear
Other Revenue Prior Year	3776	OtherRevenuePriorYear
Other Revenue Current Year	5060	OtherRevenueCurrentYear
Total Revenue Prior Year	1207903	TotalRevenuePriorYear
Total Revenue Current Year	1572197	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	176000	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	487464	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	367315	SalariesEtcPriorYear
Salaries Etc Current Year	392052	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	123600	TotalFundrsngExpCurrentYear
Other Expense Prior Year	522416	OtherExpensePriorYear
Other Expenses Current Year	600784	OtherExpensesCurrentYear
Total Expenses Prior Year	1065731	TotalExpensesPriorYear
Total Expenses Current Year	1480300	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	142172	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	91897	RevenuesLessExpensesCY
Total Assets BOY	6108540	TotalAssetsBOY
Total Assets EOY	6251907	TotalAssetsEOY
Total Liabilities BOY	47622	TotalLiabilitiesBOY
Total Liabilities EOY	353821	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	6060918	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	5898086	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	RONALD MCDONALD HOUSE CHARITIES OF MADISON (RMHC-MADISON) IS A NON-PROFIT, 501(C)(3) ORGANIZATION DEDICATED TO ADVANCING THE WELL-BEING AND HEALTH OF CHILDREN.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	719690	Expense
Grants	296464	Grants
Revenue	38645	Revenue
Description	THE ORGANIZATION OWNS AND OPERATES THE 18-BEDROOM, 17,000 SQUARE FOOT RONALD MCDONALD HOUSE IN MADISON, WISCONSIN. THE HOUSE IS LOCATED WITHIN WALKING DISTANCE OF THE UNIVERSITY OF WISCONSIN CHILDREN'S HOSPITAL AND A FREE SHUTTLE SERVICE, OPERATED WITH VOLUNTEER DRIVERS, IS PROVIDED TO AND FROM ALL MADISON AREA HOSPITALS AND AFFILIATED CLINICS. THE FAMILIES OF SERIOUSLY ILL CHILDREN MAY STAY IN THE HOUSE FOR A NOMINAL $10 PER NIGHT SUGGESTED DONATION. THE SUGGESTED DONATION IS WAIVED IF THE FAMILY CANNOT AFFORD IT. IN ADDITION TO A ROOM, THE FAMILIES ARE PROVIDED FOOD, LAUNDRY FACILITIES, AND ALL THE COMFORTS OF HOME. THE HOUSE IS STAFFED 24 HOURS PER DAY AND OPERATES 365 DAYS A YEAR UNDER THE MANAGEMENT OF A SMALL FULL-TIME STAFF, A PART-TIME STAFF OF TEN, AND 150 VOLUNTEERS. IN 2011, 1,289 FAMILIES WERE GUESTS OF THE HOUSE.	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	573204	Expense
Grants	191000	Grants
Revenue	16303	Revenue
Description	THE ORGANIZATION PROVIDES FREE DENTAL AND MEDICAL SERVICES TO CHILDREN THROUGH THE RONALD MCDONALD CARE MOBILE. THE CARE MOBILE OPERATES AT PUBLIC SCHOOLS IN DANE COUNTY, WISCONSIN (BASED ON THE PERCENTAGE OF CHILDREN WHO QUALIFY FOR FREE OR REDUCED LUNCHES) AS WELL AS IN FIVE COUNTIES IN NORTHERN ILLINOIS. SINCE ITS INCEPTION, THE CARE MOBILE HAS HELPED MORE THAN 19,000 CHILDREN PROVIDING SERVICES WORTH IN EXCESS OF $3.8 MILLION BY PROVIDING RESTORATIVE CARE FOR UNINSURED OR UNDERINSURED CHILDREN, AND OFFERS SEALANTS TO ANY CHILDREN IN THOSE SCHOOLS WHO NEED THEM. IN THE 2011, OVER 5,000 CHILDREN WERE SCREENED AND TREATED IN NINE DANE COUNTY SCHOOLS AND LOCATIONS THROUGHOUT NORTHERN ILLINOIS.	Description

Field	Value	IRS element (for citing)
Total Program Service Expense	1292894	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	1	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	0	ReportOtherLiabilities
Report Fin48 Footnote	0	ReportFin48Footnote
Independent Audit Financial Stmt	1	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	0	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	0	Hospital
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	0	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	1	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	0	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transaction Related Entity	0	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	2	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	14	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	0	UnrelatedBusinessIncome
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	14	NbrVotingGoverningBodyMembers
Number Independent Voting Members	14	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	0	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	0	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	0	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	WI	StatesWhereCopyOfReturnIsFiled
Own Website	X	OwnWebsite
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	DEBRA GRIMM	NamePerson
Telephone Number	6082324660	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	2716 MARSHALL CT	AddressLine1
City	MADISON	City
State	WI	State
ZIP Code	537052256	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation
KEITH BAUMGARTNER
PRESIDENT	2.00	X	X	0	0	0
RANDY BANKS
VICE PRESIDENT	2.00	X	X	0	0	0
SHEILA BOOTHBY STEVENS
SECRETARY	2.00	X	X	0	0	0
KIRT SOUKUP
TREASURER	2.00	X	X	0	0	0
CARRIE BENNETT-BARNDT
VICE PRESIDENT	1.00	X	X	0	0	0
GUY BUCCIFERRO III
DIRECTOR	1.00	X		0	0	0
JAMES CONWAY MD
DIRECTOR	1.00	X		0	0	0
DICK FEMRITE
DIRECTOR	1.00	X		0	0	0
JILL FOLEY
DIRECTOR	1.00	X		0	0	0
STEVE HOFF
DIRECTOR	1.00	X		0	0	0
JEFF JURGELLA
DIRECTOR	1.00	X		0	0	0
STEVE LANDRY
DIRECTOR	1.00	X		0	0	0
JEFF POLTAWSKY
DIRECTOR	1.00	X		0	0	0
JOAN BEGLINGER
DIRECTOR	1.00	X		0	0	0
KEVIN HUDDLESTON
EXECUTIVE DIRECTOR	40.00		X	82349	0	16072

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	82349	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	16072	TotalOtherCompensation
Number Individuals GT100 K	0	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	0	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources
Number Of Contractors GT100 K	0	NumberOfContractorsGT100K
All Other Contributions	1395568	AllOtherContributions
Noncash Contributions	216226	NoncashContributions
Total Contributions	1395568	TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
ROOM DONATIONS	624221	38645	38645
OTHER PROGRAM SERVICES	624190	16303	16303

Field	Value	IRS element (for citing)
Total Program Service Revenue	54948	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	79128	TotalRevenueColumn
Exclusion	$79,128	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	1574762	Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	1537269	Securities

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	37493	Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	37493	TotalRevenueColumn
Exclusion	$37,493	ExclusionAmount

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	5060	GrossSalesOfInventory

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	5060	TotalRevenueColumn
Exclusion	$5,060	ExclusionAmount

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	1572197	TotalRevenueColumn
Related Or Exempt Function Income	54948	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$121,681	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	487464	Total
Program Services	487464	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	98421	Total
Program Services	68895	ProgramServices
Management And General	9842	ManagementAndGeneral
Fundraising	19684	Fundraising

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	236452	Total
Program Services	193904	ProgramServices
Management And General	22529	ManagementAndGeneral
Fundraising	20019	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	13419	Total
Program Services	10723	ProgramServices
Management And General	1110	ManagementAndGeneral
Fundraising	1586	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	19406	Total
Program Services	17099	ProgramServices
Management And General	1328	ManagementAndGeneral
Fundraising	979	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	24354	Total
Program Services	19460	ProgramServices
Management And General	2015	ManagementAndGeneral
Fundraising	2879	Fundraising

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	10250	Total
Management And General	10250	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	2809	Total
Program Services	2107	ProgramServices
Management And General	702	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	45950	Total
Program Services	34462	ProgramServices
Fundraising	11488	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	187883	Total
Program Services	127213	ProgramServices
Management And General	4073	ManagementAndGeneral
Fundraising	56597	Fundraising

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	6386	Total
Program Services	4767	ProgramServices
Management And General	1456	ManagementAndGeneral
Fundraising	163	Fundraising

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	110844	Total
Program Services	110844	ProgramServices

Travel Travel

Field	Value	IRS element (for citing)
Total	293	Total
Program Services	156	ProgramServices
Management And General	137	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	9075	Total
Program Services	6312	ProgramServices
Management And General	1483	ManagementAndGeneral
Fundraising	1280	Fundraising

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	40130	Total
Program Services	40130	ProgramServices

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	164111	Total
Program Services	148954	ProgramServices
Management And General	7174	ManagementAndGeneral
Fundraising	7983	Fundraising

Insurance Insurance

Field	Value	IRS element (for citing)
Total	20122	Total
Program Services	18018	ProgramServices
Management And General	1707	ManagementAndGeneral
Fundraising	397	Fundraising

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	2931	Total
Program Services	2386	ProgramServices
Fundraising	545	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	1480300	Total
Program Services	1292894	ProgramServices
Management And General	63806	ManagementAndGeneral
Fundraising	123600	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	9004	BOY
EOY	23684	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	499855	BOY
EOY	699354	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	221030	BOY
EOY	296059	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	14009	BOY
EOY	14880	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	3913	BOY
EOY	3716	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	2902055	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	961315	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	2001774	BOY
EOY	1940740	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	3335957	BOY
EOY	3251473	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	22998	BOY
EOY	22001	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	6108540	BOY
EOY	6251907	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	17041	BOY
EOY	21775	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	30581	BOY
EOY	332046	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	47622	BOY
EOY	353821	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	5890163	BOY
EOY	5652453	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	170370	BOY
EOY	245633	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	385	BOY
EOY	0	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	6060918	BOY
EOY	5898086	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	6108540	BOY
EOY	6251907	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	91897	ReconcilationRevenueExpenses
Reconcilation Other Changes	-254729	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Separate	X	FinancialStatementSeparate
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org170b1 Avi	X	PubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1398131	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	800081	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1078485	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1112312	CurrentTaxYearMinus1Year
Current Tax Year	1395568	CurrentTaxYear
Total	5784577	Total

Total170 Total170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1398131	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	800081	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1078485	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1112312	CurrentTaxYearMinus1Year
Current Tax Year	1395568	CurrentTaxYear
Total	5784577	Total

Field	Value	IRS element (for citing)
Public Support Total170	5784577	PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	153775	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	153961	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	76521	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	94739	CurrentTaxYearMinus1Year
Current Tax Year	79128	CurrentTaxYear
Total	558124	Total

Field	Value	IRS element (for citing)
Total Support	6342701	TotalSupport
Gross Receipts From Admissions Etc	295897	GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage170	0.91200	PublicSupportPertcentage170
Public Support Pertcent Prior Year	0.90310	PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170	X	ThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	22998	BeginningOfYearBalance
Investment Earnings Or Losses	-997	InvestmentEarningsOrLosses
End Of Year Balance	22001	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	21150	BeginningOfYearBalance
Investment Earnings Or Losses	1848	InvestmentEarningsOrLosses
End Of Year Balance	22998	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Contributions	20000	Contributions
Investment Earnings Or Losses	1150	InvestmentEarningsOrLosses
End Of Year Balance	21150	EndOfYearBalance

Field	Value	IRS element (for citing)
Board Designated EOY Balance	1.00000	BoardDesignatedEOYBalance
Endowments Held By Unrelated Orgs	0	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	0	EndowmentsHeldByRelatedOrgs

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	222406	OtherCostOrOtherBasis
Book Value	222406	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	2047824	OtherCostOrOtherBasis
Depreciation	697382	Depreciation
Book Value	1350442	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	631825	OtherCostOrOtherBasis
Depreciation	263933	Depreciation
Book Value	367892	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	1940740	TotalOfBookValueLandBuildings
Total Revenue	1572197	TotalRevenue
Total Expenses	1480300	TotalExpenses
Excess Or Deficit For Year	91897	ExcessOrDeficitForYear
Net Unrealized GL On Investments	-201759	NetUnrealizedGLOnInvestments
Donated Services And Facilities	-52970	DonatedServicesAndFacilities
Total Adjustments	-254729	TotalAdjustments
Excess Or Deficit Per FS	-162832	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	1380241	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	-201759	NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities	9803	DonatedSrvcAndUseOfFacilities
Revenue Not Rptd F990	-191956	RevenueNotRptdF990
Revenue Subtotal	1572197	RevenueSubtotal
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	1572197	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	1543073	TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities	62773	DonatedServicesUseOfFacilities
Expenses Not Rptd F990	62773	ExpensesNotRptdF990
Expenses Subtotal	1480300	ExpensesSubtotal
Expenses Not Rptd On Fin Stmt	0	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	1480300	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:	Identifier
Return Reference	PART V, LINE 4:	ReturnReference
Explanation	THE INCOME FROM THE ENDOWMENT FUNDS CAN BE USED TO SUPPORT THE HOUSE'S GENERAL OPERATIONS.	Explanation

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Purpose Of GrantPurposeOfGrant
UNIVERSITY OF WISCONSIN FOUNDATION
1848 UNIVERSITY AVE	MADISON	WI	537264090	390743975	501(C)(3)	117500	DENTAL CARE SERVICES FOR UNDERPRIVILEGED CHILDREN
ROCKFORD MEMORIAL DEVELOPMENT FOUNDATION
2400 N ROCKTON AVE	ROCKFORD	IL	611033655	363197918	501(C)(3)	73500	DENTAL CARE SERVICES FOR UNDERPRIVILEGED CHILDREN
ST MARY'S HOSPITAL
700 S PARK ST	MADISON	WI	537151830	390806393	501(C)(3)	296464	ST. MARY'S FAMILY ROOM

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	3	TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	PROCEDURE FOR MONITORING GRANTS IN THE U.S.:	Identifier
Return Reference	PART I, LINE 2:	ReturnReference
Explanation	SCHEDULE I, PART I, LINE 2: THE ORGANIZATION PARTNERS WITH THE AMERICAN FAMILY CHILDREN'S HOSPITAL AND ROCKFORD HEALTH SYSTEMS TO PROVIDE MEDICAL AND DENTAL SERVICES ABOARD THE ORGANIZATION'S CARE MOBILE. THE EXECUTIVE DIRECTOR REVIEWS AND APPROVES CHECKS FOR PAYMENT, A BOARD OFFICER SIGNS THEM, AND THEY ARE RETURNED TO THE BUSINESS MANAGER WHO MAILS THEM TO THE RESPECTIVE HOSPITALS. THE AMERICAN FAMILY CHILDREN'S HOSPITAL AND ROCKFORD HEALTH SYSTEMS SUBMIT QUARTERLY INVOICES TO THE ORGANIZATION. THESE INVOICES DETAIL THEIR EXPENSES FOR OPERATING THE CARE MOBILE, AND THE ORGANIZATION PAYS EXACTLY ONE-HALF OF THOSE EXPENSES UP TO AN ANNUAL CAP OF $136,500 FOR THE AMERICAN FAMILY CHILDREN'S HOSPITAL AND $73,500 FOR ROCKFORD HEALTH SYSTEMS. THE ORGANIZATION'S EXECUTIVE DIRECTOR REVIEWS THE QUARTERLY INVOICES AND THEN FORWARDS THEM TO THE ORGANIZATION'S BUSINESS MANAGER WHO ENTERS THE EXPENSE DATA INTO THE ACCOUNTING SYSTEM AND PREPARES CHECKS FOR PAYMENT. THE EXECUTIVE DIRECTOR REVIEWS AND APPROVES CHECKS FOR PAYMENT, SIGNS THEM, AND RETURNS THEM TO THE BUSINESS MANAGER WHO MAILS THEM TO THE RESPECTIVE HOSPITALS.	Explanation

Schedule M IRS990ScheduleM

Food Inventory FoodInventory

Field	Value	IRS element (for citing)
Non Cash Checkbox	X	NonCashCheckbox
Number Of Contributions	242	NumberOfContributions
Noncash Contribs Rptd F990	25303	NoncashContribsRptdF990
Method Of Determining Revenues	COST/SELLING PRICE	MethodOfDeterminingRevenues

Other Non Cash Contributions Table OtherNonCashContributionsTable (3 entries)

Non Cash CheckboxNonCashCheckbox	DescriptionDescription	Number Of ContributionsNumberOfContributions	Noncash Contribs Rptd F990NoncashContribsRptdF990	Method Of Determining RevenuesMethodOfDeterminingRevenues
X	OFFICE EQUIPMENT	43	92626	COST/SELLING PRICE
X	HOUSE MAINTENANCE	381	96822	COST/SELLING PRICE
X	CAPITAL EQUIPMENT	2	1475	COST/SELLING PRICE

Field	Value	IRS element (for citing)
Any Property That Must Be Held	0	AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts	0	ReviewProcessUnusualNCGifts
Third Parties Used	0	ThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII

Field	Value	IRS element (for citing)
Identifier	METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS:	Identifier
Return Reference	PART I, COLUMN (B):	ReturnReference
Explanation	THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS IN COLUMN (B).	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11	THE PREPARED FORM 990 IS REVIEWED BY THE PRESIDENT AND THE TREASURER OF THE GOVERNING BODY AND APPROVED BY THE MEMBERS OF THE ORGANIZATION'S EXECUTIVE COMMITTEE BEFORE THE RETURN IS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	ANNUALLY, ALL DIRECTORS COMPLETE AND SIGN A STATEMENT THAT DISCLOSES INTERESTS THAT COULD GIVE RISE TO CONFLICTS. THE DIRECTORS COLLECTIVELY REVIEW THE COMPLETED FORMS, WHICH ARE KEPT AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. ANY DIRECTOR WITH A CONFLICT OF INTEREST IS PROHIBITED FROM PARTICIPATING IN THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS REGARDING THE TRANSACTION.
FORM 990, PART VI, SECTION B, LINE 15A	THE EXECUTIVE COMMITTEE OF THE GOVERNING BODY ANNUALLY CONDUCTS A REVIEW OF THE EXECUTIVE DIRECTOR, REVIEWS COMPENSATION DATA FOR COMPARABLE POSITIONS AT SIMILAR AGENCIES, AND RECOMMENDS A COMPENSATION LEVEL THAT IS THEN APPROVED BY THE ENTIRE GOVERNING BODY DURING THE ANNUAL BUDGETING PROCESS.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS (EXCEPT FOR THE CONTINGENCY PLAN AND THE HOUSE OPERATIONS MANUAL) AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. ANNUAL FINANCIAL STATEMENTS ARE INCLUDED IN THE ORGANIZATION'S ANNUAL REPORT THAT IS AVAILABLE TO THE PUBLIC ON THE ORGANIZATION'S WEBSITE.
FORM 990, PART XI, LINE 5:	NET UNREALIZED LOSSES ON INVESTMENTS: -201,759. DONATED SERVICES AND USE OF FACILITIES: -52,970. TOTAL TO FORM 990, PART XI, LINE 5: -254,729.	CHANGES IN NET ASSETS OR FUND BALANCES: