2012-06-25T15:56:45-05:00 2011-09-30 WIPFLI LLP 3703 OAKWOOD HILLS PARKWAY/PO BOX 6 EAU CLAIRE WI 547020690 990 2010-10-01 260596045 UPLAND HILLS HEALTH FOUNDATION INC UPLA 6089307169 800 COMPASSION WAY DODGEVILLE WI 53533 ARTHUR K PUSTINA 6089308000 2012-06-15 1 HOLLY POKRANDT 7158323407 2012-05-22 2010 2016-02-24 21:20:13Z PHYLLIS FRITSCH 800 COMPASSION WAY DODGEVILLE WI 53533 179869 0 X WWW.UPLANDHILLSHEALTH.ORG/FOUNDATION X 2007 WI TO SOLICIT, RECEIVE, AND ACCEPT GIFTS AND BEQUESTS ON BEHALF OF UPLAND HILLS HEALTH, INC. 14 13 0 54 0 0 453088 168067 0 0 7782 7074 4631 3364 465501 178505 38215 105322 0 0 0 0 0 0 0 60 66 38275 105388 427226 73117 756417 931290 91141 192897 665276 738393 X THE PRIMARY PURPOSE OF THE UPLAND HILLS HEALTH FOUNDATION, INC. IS TO RECORD AND FACILITATE PHILANTHROPIC GIVING FOR UPLAND HILLS HEALTH, INC. BY SERVING AS THE GATEWAY FOR ALL PHILANTHROPY, THE FOUNDATION OFFICE WILL MAINTAIN A COMPLETE GIVING HISTORY FOR DONORS TO UPLAND HILLS HEALTH, ENSURING THAT CONTRIBUTORS ARE APPROPRIATELY ACKNOWLEDGED, AND THAT THE PHILANTHROPY FIGURES PRESENTED TO EXTERNAL SOURCES ARE AS COMPLETE AS POSSIBLE. 0 0 105322 105322 THE UPLAND HILLS HEALTH FOUNDATION IS OPERATED TO PROVIDE SUPPORT AND PERFORM FUNCTIONS FOR UPLAND HILLS HEALTH, INC., WHICH PROVIDES HEALTH CARE SERVICES TO THE RESIDENTS OF IOWA COUNTY, WISCONSIN, AND THE SURROUNDING AREAS. 105322 1 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 0 0 0 0 0 WI X ARTHUR K PUSTINA 6089308000 800 COMPASSION WAY DODGEVILLE WI 53533 PHIL CRAWFORD 1.00 X 0 0 0 CONNIE HALLADA 1.00 X 0 0 0 LORRAINE HENNESSEY 1.00 X 0 0 0 GEORGE STAUFFER 1.00 X 0 0 0 MARY JO CENITI 1.00 X 0 0 0 STEVE DEAL 1.00 X 0 0 0 DICK JOSH 1.00 X 0 0 0 BRAD LAUFENBERG 1.00 X 0 0 0 MARK MASTERS 1.00 X 0 0 0 DEBRA MORGAN 1.00 X 0 0 0 LYNN MUNZ 1.00 X 0 0 0 DEBRA TERRILL 1.00 X 0 0 0 DAVE WILKE 1.00 X 0 0 0 PHYLLIS FRITSCH 1.00 X X 0 188359 19395 ARTHUR K PUSTINA 1.00 X 0 125480 19847 0 313839 39242 0 0 1 0 0 168067 4930 168067 7074 7074 4728 1364 3364 3364 178505 0 0 10438 105322 105322 INVESTMENT FEES 66 66 105388 105322 66 0 400226 623066 356191 308224 756417 931290 91141 192897 91141 192897 X 181721 171611 277189 359400 206366 207382 665276 738393 756417 931290 73117 0 X X 0 1 1 X 0 X 146073 89061 453088 168067 856289 146073 89061 453088 168067 856289 27870 828419 2557 8451 7782 7074 25864 -1770 4631 3364 6225 888378 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 208412 1016 792 210220 75366 131000 2046 208412 0.00000 0.98650 0.01350 0 0 0 DUE FROM UPLAND HILLS HEALTH, INC. 148356 NET PLEDGES RECEIVABLE 159868 308224 DUE TO UPLAND HILLS HEALTH, INC. 192897 192897 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: UPLAND HILLS HEALTH FOUNDATION, INC.'S ENDOWMENT FUNDS CONSISTS OF TWO FUNDS HELD IN THE NAMES OF THE INDIVIDUAL DONORS. THESE FUNDS WERE ESTABLISHED TO PROVIDE INCOME FOR THE FOUNDATION TO HELP SUPPORT SPECIFIC PROGRAMS OF UPLAND HILLS HEALTH, INC. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: UPLAND HILLS HEALTH, INC. AND UPLAND HILLS HEALTH FOUNDATION, INC. ARE TAX-EXEMPT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THEY ARE ALSO EXEMPT FROM STATE INCOME TAXES PURSUANT TO SIMILAR STATE OF WISCONSIN TAX LAWS. UPLAND HILLS HEALTH HOLDINGS, LLC IS A TAXABLE ENTITY, WHICH IS CONSIDERED A DISREGARDED ENTITY FOR TAX PURPOSES. THE PRIMARY ACTIVITY OF THE HOLDING COMPANY IS TO INVEST IN A PARTNERSHIP, WHICH IS A LIMITED LIABILITY COMPANY THAT IS ENGAGED IN THE BUSINESS OF SUPPLYING MEDICAL EQUIPMENT AND SUPPLIES TO PATIENTS IN THEIR HOMES OR FACILITIES. INCOME OR LOSS ATTRIBUTABLE TO THIS PARTNERSHIP INTEREST IS PASSED THROUGH TO THE HOSPITAL FOR TAX PURPOSES. EACH YEAR THE HOSPITAL EVALUATES WHETHER THIS INCOME OR A PORTION OF THE INCOME SHOULD BE CONSIDERED AS UNRELATED BUSINESS INCOME AND, AS SUCH, WOULD BE SUBJECT TO FEDERAL AND STATE INCOME TAXES. IF ANY TAX PROVISIONS OR CREDITS ARE DETERMINED TO BE NECESSARY, THE HOSPITAL RECORDS THESE AMOUNTS IN THE CONSOLIDATED FINANCIAL STATEMENTS. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, UPLAND HILLS ASSESSES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. UPLAND HILLS' POLICY IS TO RECOGNIZE INTEREST AND ANY PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. AS OF SEPTEMBER 30, 2011 AND 2010, THERE WERE NO TAX PENALTIES, OR INTEREST RELATED TO TAX PENALTIES, RECORDED BY UPLAND HILLS IN THE CONSOLIDATED FINANCIAL STATEMENTS. IN ADDITION, UPLAND HILLS RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS IN 2011 OR 2010. FEDERAL TAX RETURNS FOR TAX YEARS ENDED SEPTEMBER 30, 2008, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. 1 UPLAND HILLS HEALTH INC 800 COMPASSION WAY DODGEVILLE WI 53533 421017512 501(C)3 105322 0 CASH DONATED N/A TO ASSIST IN THE DELIVERY OF HEALTHCARE SERVICES TO INDIVIDUALS IN THE DODGEVILLE AREA. 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: UPLAND HILLS FOUNDATION, INC'S BOARD OF DIRECTORS REVIEWS REQUESTS FOR DONATIONS FROM OR OFFERS TO PROVIDE ASSISTANCE TO UPLAND HILLS HEALTH, INC. TO FURTHER THE MISSION OF UPLAND HILLS HEALTH, INC. THESE GRANTS ARE APPROVED BY THE FOUNDATION'S BOARD OF DIRECTORS DURING IT REGULARLY SCHEDULED BOARD OF DIRECTOR'S MEETINGS THROUGHOUT THE YEAR. 0 0 0 0 0 0 0 0 0 PHYLLIS FRITSCH 0 188359 0 0 0 0 0 7005 0 12390 0 207754 0 0 SUPPLEMENTAL INFORMATION PART III COMPENSATION PLANS AND POLICIES FOR THE OFFICER NOTED IS DETERMINED AND REVIEWED BY THE FOUNDATION'S PARENT ORGANIZATION, UPLAND HILLS HEALTH, INC. PROCEDURES OF UPLAND HILLS HEALTH, INC. INCLUDE COMPENSATION SURVEYS, WRITTEN EMPLOYMENT AGREEMENTS, AND APPROVAL BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 4 SINCE THE PRIOR FORM 990 WAS FORMED, UPLAND HILLS HEALTH FOUNDATION, INC. HAS MADE A SIGNIFICANT CHANGE TO ITS GOVERNING DOCUMENTS. THE SOLE CORPORATE MEMBER, UPLAND HILLS HEALTH, INC., APPROVED THE INCLUSION OF THE STANDING PRESIDENT OF THE UPLAND HILLS HEALTH, INC. BOARD OF DIRECTORS AS A VOTING MEMBER OF UPLAND HILLS HEALTH FOUNDATION, INC.'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 UPLAND HILLS HEALTH, INC. IS THE SOLE CORPORATE MEMBER OF UPLAND HILLS HEALTH FOUNDATION, INC. FORM 990, PART VI, SECTION A, LINE 7A UPLAND HILLS HEALTH, INC., THE SOLE CORPORATE MEMBER OF UPLAND HILLS HEALTH FOUNDATION, INC., CAN APPOINT OR REMOVE MEMBERS OF THE GOVERNING BODY AND CAN ALSO DETERMINE THE NUMBER OF GOVERNING MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B CHANGES TO THE GOVERNING DOCUMENTS OF UPLAND HILLS HEALTH FOUNDATION, INC. REQUIRE APPROVAL OF ITS SOLE CORPORATE MEMBER UPLAND HILLS HEALTH, INC. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF FORM 990 WAS PROVIDED TO THE ORGANIZATION'S BOARD OF DIRECTORS AT THE MAY 2012 BOARD MEETING PRIOR TO FINAL SUBMISSION. RESPONSES ON THE 990 ARE ALSO REVIEWED BY THE ASSISTANT ADMINISTRATOR OF FINANCE OF UPLAND HILLS HEALTH, INC. PRIOR TO ITS SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C UPLAND HILLS HEALTH FOUNDATION, INC. REQUIRES OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, AND HIGHEST-COMPENSATED EMPLOYEES TO COMPLETE AN ANNUAL DISCLOSURE STATEMENT. THESE STATEMENTS ARE THEN REVIEWED BY THE BOARD OF DIRECTORS, NOTING ANY RELATIONSHIPS THAT COULD POTENTIALLY CREATE A CONFLICT OF INTEREST. IF BOARD MEMBERS HAVE CONFLICTS OF INTEREST THAT ARE NOTED, THESE MEMBERS ARE ASKED TO ABSTAIN FROM VOTING ON THOSE MATTERS. THE TWO OFFICERS OF UPLAND HILLS HEALTH FOUNDATION, INC. ARE EMPLOYED BY UPLAND HILLS HEALTH, INC. THE COMPENSATION LISTED IN FORM 990, PART VII RELATES TO ALL THE SERVICES THEY PERFORM AS AN EMPLOYEE OF UPLAND HILLS HEALTH, INC. THE BOARD OF DIRECTORS OF UPLAND HILLS HEALTH, INC. HAS ESTABLISHED A PROCESS TO REVIEW THE COMPENSATION OF THE OFFICERS. COMPARATIVE DATA FROM WAGE SURVEYS, AREA LABOR ADJUSTMENTS, AND MARKET RATES IN OTHER AREA FACILITIES ARE USED IN DETERMINING COMPENSATION. THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS OF UPLAND HILLS HEALTH, INC. REVIEWS AND APPROVES ANY EXCEPTIONS TO ACROSS-THE-BOARD RAISES AND STANDARD NEW HIRE WAGES. DURING THE REVIEW PROCESS, DECISIONS AFFECTING COMPENSATION AND CONTRACTS ARE ONLY REVIEWED AND APPROVED BY INDIVIDUALS WHO DO NOT HAVE NOTED CONFLICTS. THE DECISIONS AND DELIBERATION ARE ALSO DOCUMENTED IN THE MINUTES OF THE BOARD OF DIRECTORS UPON APPROVAL BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 UPLAND HILLS HEALTH FOUNDATION, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINACIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT ITS BUSINESS LOCATION DURING NORMAL BUSINESS HOURS. OVERSIGHT OF AUDIT FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS OF UPLAND HILLS HEALTH, INC. ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE CONSOLIDATED FINANCIAL STATEMENTS BY AN INDEPENDENT ACCOUNTANT. THE BOARD OF DIRECTORS OF UPLAND HILLS HEALTH, INC. ALSO APPROVES THE SELECTION OF THE INDEPENDENT AUDITORS AND HISTORICALLY HAS USED A PROCESS OF SOLICITATION OF SEALED BIDS FROM INDEPENDENT AUDIT FIRMS WITH HEALTHCARE AUDIT EXPERIENCE EVERY FIVE YEARS SO THAT THE AUDIT FIRM REVIEW IS DONE ON A REGULAR BASIS. THIS PROCESS AND PROCEDURES HAVE NOT CHANGED IN THE CURRENT YEAR. WRITTEN WHISTLEBLOWER POLICY FORM 990, PART VI, LINE 13 UPLAND HILLS HEALTH FOUNDATION, INC. ANSWERED "NO" TO THE QUESTION REGARDING A WRITTEN WHISTLEBLOWER POLICY, BECAUSE THIS SPECIFIC ORGANIZATION DOES NOT HAVE SUCH A POLICY IN PLACE. HOWEVER, UPLAND HILLS HEALTH FOUNDATION, INC. FOLLOWS THE WRITTEN WHISTLEBLOWER POLICY OF UPLAND HILLS HEALTH, INC. DOCUMENT RETENTION AND DESTRUCTION POLICY FORM 990, PART VI, LINE 14 UPLAND HILLS HEALTH FOUNDATION, INC. ANSWERED "NO" TO THE QUESTION REGARDING A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY, BECAUSE THIS SPECIFIC ORGANIZTION DOES NOT HAVE SUCH A POLICY IN PLACE. HOWEVER, UPLAND HILLS HEALTH FOUNDATION, INC. FOLLOWS THE WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY OF UPLAND HILLS HEALTH, INC. FORM 990, PART VII, SECTION A, RELATED PARTY OFFICERS: THE TWO OFFICERS OF UPLAND HILLS HEALTH FOUNDATION, INC. ARE EMPLOYED BY UPLAND HILLS HEALTH, INC. IN ADDITION TO THE HOURS WORKED AS AN OFFICER OF UPLAND HILLS FOUNDATION, INC., THEY ALSO WORK A MINIMUM OF AN AVERAGE OF 40 HOURS PER WEEK PERFORMING OTHER SERVICES FOR UPLAND HILLS HEALTH, INC. THE HOURS LISTED ON THE FORM 990 RELATE TO THEIR ROLE AS AN OFFICER, WHILE THE COMPENSATION LISTED RELATES TO ALL THE SERVICES THEY PERFORM AS AN EMPLOYEE OF UPLAND HILLS HEALTH, INC. UPLAND HILLS HEALTH HOLDINGS LLC 800 COMPASSION WAY DODGEVILLE WI 53533 800809494 PARTNERSHIP FOR DURABLE MEDICAL EQUIPMENT PROVIDED TO PATIENTS WI 0 0 UPLAND HILLS HEALTH INC UPLAND HILLS HEALTH INC 800 COMPASSION WAY DODGEVILLE WI 53533 411017512 HOSPITAL WI 501(C)3 LINE 3 N/A 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 UPLAND HILLS HEALTH INC B 105322 FAIR MARKET VALUE