Wisconsin Dialysis Inc: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- Wisconsin Dialysis Inc (EIN 30-0072647)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2022-01-18
- IRS object ID
- 202200189349301310
- Schema version
- 2019v5.2
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-01-18T13:06:47-06:00 | ReturnTs |
| Tax Period End | 2020-06-30 | 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 | 30 S Wacker Drive Ste 3300 | AddressLine1Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60606 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 300072647 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wisconsin Dialysis Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WISC | BusinessNameControlTxt |
| Phone | 6082705600 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3034 Fish Hatchery Road | AddressLine1Txt |
| City | Fitchburg | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53713 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jodilynn Vitello | PersonNm |
| Person Title | VP of Finance | PersonTitleTxt |
| Phone | 6082705600 | PhoneNum |
| Signature | 2022-01-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Rebekuh Eley | PreparerPersonNm |
| PTIN | P01247672 | PTIN |
| Phone | 3126343400 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amended Return | Yes (X) | AmendedReturnInd |
| Principal Officer | Mary Link | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3034 Fish Hatchery Road | AddressLine1Txt |
| City | Fitchburg | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53713 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $61,789,372 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.wisconsindialysis.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2002 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | To provide outpatient kidney dialysis treatments for patients in a clinic or home based setting according to the regulations established by the Centers for Medicare & Medicaid. | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $288,478 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$669,818 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $200 | PYContributionsGrantsAmt |
| CY Contributions Grants | $500 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,639,637 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $4,729,802 | CYProgramServiceRevenueAmt |
| PY Investment Income | $147,336 | PYInvestmentIncomeAmt |
| CY Investment Income | $55,720,962 | CYInvestmentIncomeAmt |
| PY Other Revenue | $33,730 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $17,820,903 | PYTotalRevenueAmt |
| CY Total Revenue | $60,451,264 | 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 | $6,239,292 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,594,836 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,068,985 | PYOtherExpensesAmt |
| CY Other Expenses | $1,518,387 | CYOtherExpensesAmt |
| PY Total Expenses | $16,308,277 | PYTotalExpensesAmt |
| CY Total Expenses | $6,113,223 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,512,626 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $54,338,041 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $18,230,807 | TotalAssetsBOYAmt |
| Total Assets EOY | $35,354,594 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,195,829 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $574,312 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $17,034,978 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $34,780,282 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Through October 7, 2019, Wisconsin Dialysis, Inc. exists to provide In-Center, Home, and Inpatient Dialysis to patients in Central Wisconsin with End State Renal Disease. As a result of the contribution on 10/7/19, Wisconsin Dialysis, Inc. no longer provides services and holds a 30% membership interest in Fresenius Kidney Care of Madison, LLC. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $5,308,546 | ExpenseAmt |
| Revenue | $4,729,802 | RevenueAmt |
| Desc | Wisconsin Dialysis, Inc. provides dialysis care to End Stage Renal Disease patients throughout Central Wisconsin, with clinics in Fitchburg and Madison, home services, and inpatient care. From July 1, 2019 through October 7, 2019, Wisconsin Dialysis provided 9,963 treatments. Wisconsin Dialysis also focused on home patient training with an eye to encourage fewer hospitalizations in the future. Wisconsin Dialysis services are governed by CMS (Medicare) and must meet a set of Clinical Standards established through the Quality Improvement Program (QIP). Patient Data is reported on a regular basis to CMS. On 10/7/2019, WDI contributed substantially all of the assets used in its business to Fresenius Kidney Care Madison, LLC. WDI retains a 30% membership interest in Fresenius Kidney of Madison. UWHCA retained a 45% membership interest, Unity Point-Meriter retained a 45% membership interest, and UWMF retained a 10% membership interest in WDI. | Desc |
| Total Program Service Expenses | $5,308,546 | 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 |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (1) | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | 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 With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | Yes (1) | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| 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 | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | 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 | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | 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 | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Aaron Prochaska | PersonNm |
| Phone | 6088214272 | 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 (10 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 Jeff Pothof | ||||||||
| Director | 0.30 | 39.70 | Yes (X) | $0 | $487,671 | $83,283 | ||
| Mary Link | ||||||||
| President | 0.30 | 39.70 | Yes (X) | $0 | $364,685 | $105,336 | Yes (X) | |
| Jodi Vitello | ||||||||
| Director | 0.30 | 39.70 | Yes (X) | $0 | $384,044 | $80,883 | ||
| Karil Walther | ||||||||
| VP Primary Care | 0.30 | 39.70 | $0 | $291,921 | $56,305 | Yes (X) | ||
| Ronald Schroeder | ||||||||
| Treasurer | 0.50 | 39.50 | Yes (X) | $0 | $225,679 | $29,879 | Yes (X) | |
| Karen Schlageter RN | ||||||||
| Clinic Manager | 32.00 | 8.00 | $0 | $180,912 | $37,527 | Yes (X) | ||
| Tami Morin | ||||||||
| Secretary | 36.00 | 4.00 | $0 | $174,604 | $33,542 | Yes (X) | ||
| Kristine Holmes RN | ||||||||
| Director | 1.00 | 39.00 | Yes (X) | $0 | $174,858 | $22,218 | ||
| Diane Marie Haag | ||||||||
| Care Team Leader | 32.00 | 8.00 | $0 | $157,026 | $32,592 | Yes (X) | ||
| Sarah Clark | ||||||||
| In Patient RN | 32.00 | 8.00 | $0 | $119,806 | $33,147 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,561,206 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $514,712 | 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 (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Medefis Inc | |||||
| PO Box 5068 | New York | NY | 10087 | Agency Staffing | $1,399,253 |
| Foundation Medical Staffing | |||||
| 416 W 15th Street 600 | Edmond | OK | 73013 | Agency Staffing | $1,132,935 |
| University of Wisconsin Medical Foundati | |||||
| 7974 UW Health Court | Middleton | WI | 53562 | Medical Director Fees | $128,257 |
| Dialysis Solutions LLC | |||||
| 1961 Hillcrest Drive | Delafield | WI | 53018 | Repairs and Maintenance | $116,834 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $500 | AllOtherContributionsAmt |
| Total Contributions | $500 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Outpatient Revenue | 621400 | $4,351,168 | $4,351,168 | |
| Inpatient Revenue | 621990 | $223,976 | $223,976 | |
| Equity Interest in JV | 621400 | $154,658 | $154,658 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $4,729,802 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $188,771 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $142,924 | UnrelatedBusinessRevenueAmt |
| Exclusion | $45,847 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $56,870,299 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $10,428 | SecuritiesAmt |
| Other | $1,327,680 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$10,428 | SecuritiesAmt |
| Other | $55,542,619 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $55,532,191 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | -$9,104 | UnrelatedBusinessRevenueAmt |
| Exclusion | $55,541,295 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $60,451,264 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,575,144 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $288,478 | UnrelatedBusinessRevenueAmt |
| Exclusion | $55,587,142 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,328,003 | TotalAmt |
| Program Services | $2,776,477 | ProgramServicesAmt |
| Management And General | $551,526 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $974,526 | TotalAmt |
| Program Services | $828,863 | ProgramServicesAmt |
| Management And General | $145,663 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $292,307 | TotalAmt |
| Program Services | $241,038 | ProgramServicesAmt |
| Management And General | $51,269 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,443 | TotalAmt |
| Management And General | $4,443 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $139,976 | TotalAmt |
| Program Services | $138,027 | ProgramServicesAmt |
| Management And General | $1,949 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,436 | TotalAmt |
| Program Services | $110,828 | ProgramServicesAmt |
| Management And General | $56,608 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $845 | TotalAmt |
| Program Services | $596 | ProgramServicesAmt |
| Management And General | $249 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,772 | TotalAmt |
| Management And General | $76,772 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Pharmaceutical Supplies | $602,879 | $602,879 |
| Medical Supplies | $336,206 | $336,206 |
| Cleaning Supplies | $24,802 | $24,802 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $165,028 | TotalAmt |
| Program Services | $248,830 | ProgramServicesAmt |
| Management And General | -$83,802 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,113,223 | TotalAmt |
| Program Services | $5,308,546 | ProgramServicesAmt |
| Management And General | $804,677 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,686,440 | BOYAmt |
| EOY | $6,788,358 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,736,772 | BOYAmt |
| EOY | $1,208,373 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,836 | BOYAmt |
| EOY | $2,238 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $0 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $0 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,349,130 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,409,629 | BOYAmt |
| EOY | $7,766,769 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $19,516,931 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $71,925 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,230,807 | BOYAmt |
| EOY | $35,354,594 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $251,127 | BOYAmt |
| EOY | $31,803 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,226 | BOYAmt |
| EOY | $4,680 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $879,476 | BOYAmt |
| EOY | $537,829 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,195,829 | BOYAmt |
| EOY | $574,312 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,034,978 | BOYAmt |
| EOY | $34,780,282 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,034,978 | BOYAmt |
| EOY | $34,780,282 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,230,807 | BOYAmt |
| EOY | $35,354,594 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $54,338,041 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $148,359 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$36,741,096 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type3 Func Int | Yes (X) | SupportingOrgType3FuncIntInd |
| Supported Organizations | 3 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (3 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| UnityPoint Health-Meriter | ||||
| 390806367 | 3 | Yes (1) | $0 | $0 |
| Univ of WI Hospitals and Clinics Authority | ||||
| 391835630 | 6 | Yes (1) | $0 | $0 |
| Univ of WI Medical Foundation Inc | ||||
| 391824445 | 10 | Yes (1) | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 3 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | Yes (1) | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timely Provided Documents | Yes (1) | TimelyProvidedDocumentsInd |
| Officers Close Relationship | Yes (1) | OfficersCloseRelationshipInd |
| Supported Org Voice Investment | Yes (1) | SupportedOrgVoiceInvestmentInd |
Form990 Sch A Type3 Func Int Form990SchAType3FuncIntGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Test | Yes (X) | ActivitiesTestInd |
| Activities Further Exempt Prps | Yes (1) | ActivitiesFurtherExemptPrpsInd |
| Activities Engaged Org Invlmnt | Yes (1) | ActivitiesEngagedOrgInvlmntInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Section A, Line 2 | University of Wisconsin Hospitals and Clinics Authority is one of the supported organizations and does not have an IRS determination of status under Section 509(a)(1) or (2). It is not required to obtain recognition of its public charity status because it is considered a governmental unit (public authority, a public body corporate and politic created by Wisconsin statutes). UnityPoint Health-Meriter is one of the supported organizations and does not have an IRS determination of status under Section 509(a)(1) or (2). It is not required to obtain recognition of its public charity status because it is a hospital under Section 170(b)(1)(A)(iii). |
| Part IV, Section D, Line 3 | According to the Bylaws of the Organization, there shall be at least 5 Board Members. Two of the Board Members will be appointed by Meriter Hospital, Inc. (one of the three members of the Organization and is a supported organization), two of the Board Members will be appointed by University of Wisconsin Hospitals and Clinics Authority (one of the three members of the Organization and is a supported organization) and one of the Board Members will be appointed by UW Medical Foundation (one of the three members of the Organization and is a supported organization). Each Board Member has a vote. All Board Members must be from one of the three supported organizations. Based on the composition of the Board, all three supported organizations have a significant voice in directing the use of the Organization's income and assets during the year. |
| Part IV, Section E, Line 2A | How these activities directly furthered the supported organizations exempt purposes: The Organization is a collaborative project among the three tax-exempt healthcare providers in Madison, Wisconsin (and are the three supported organizations). The three supported organizations formed the Organization to provide comprehensive dialysis services to their patients. The sole activity of the Organization is providing dialysis services. By doing this, the Organization is directly furthering the exempt purposes of the three supported organizations. How the Organization was responsive to those supported organizations: The Organization's Board of Directors is composed of individuals from the three supported organizations. The Board of Directors meet throughout the year to discuss the activities of the Organization to make sure the activities further the exempt purposes of the three supported organizations. How the Organization determined that these activities constituted substantially all of its activities: The Organization was formed to provide comprehensive dialysis services. This is the sole activity of the Organization. |
| Part IV, Section E, Line 2B | The three supported organizations are healthcare providers in Madison, Wisconsin. One of the goals of the Organization was to develop and implement a collaborative model for the provision of dialysis services that enable the three supported organizations to work together to provide patient care at a higher level of quality and satisfaction than is achievable through individual efforts. The three supported organizations as healthcare providers would have engaged in this activity (i.e. providing dialysis services) but for the Organization's involvement. |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Investment in Fresenius Kidney Care Madison LLC | Desc |
| Book Value | $19,516,931 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $19,516,931 | TotalBookValueProgramRltdAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due to UWHCA | Desc |
| Amt | $537,829 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $537,829 | TotalLiabilityAmt |
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 Jeff Pothof | ||||||||||||||
| Director | $0 | $415,536 | $0 | $72,135 | $0 | $0 | $0 | $83,220 | $0 | $63 | $0 | $570,954 | $0 | $0 |
| Mary Link | ||||||||||||||
| President | $0 | $293,641 | $0 | $61,950 | $0 | $9,094 | $0 | $46,903 | $0 | $58,433 | $0 | $470,021 | $0 | $0 |
| Jodi Vitello | ||||||||||||||
| Director | $0 | $318,284 | $0 | $63,840 | $0 | $1,920 | $0 | $48,289 | $0 | $32,594 | $0 | $464,927 | $0 | $0 |
| Karil Walther | ||||||||||||||
| VP Primary Care | $0 | $242,435 | $0 | $45,378 | $0 | $4,108 | $0 | $43,008 | $0 | $13,297 | $0 | $348,226 | $0 | $0 |
| Ronald Schroeder | ||||||||||||||
| Treasurer | $0 | $194,584 | $0 | $30,249 | $0 | $846 | $0 | $9,390 | $0 | $20,489 | $0 | $255,558 | $0 | $0 |
| Karen Schlageter RN | ||||||||||||||
| Clinic Manager | $0 | $144,318 | $0 | $26,666 | $0 | $9,928 | $0 | $12,587 | $0 | $24,940 | $0 | $218,439 | $0 | $0 |
| Tami Morin | ||||||||||||||
| Secretary | $0 | $150,349 | $0 | $15,000 | $0 | $9,255 | $0 | $12,869 | $0 | $20,673 | $0 | $208,146 | $0 | $0 |
| Kristine Holmes RN | ||||||||||||||
| Director | $0 | $156,395 | $0 | $15,933 | $0 | $2,530 | $0 | $7,161 | $0 | $15,057 | $0 | $197,076 | $0 | $0 |
| Diane Marie Haag | ||||||||||||||
| Care Team Leader | $0 | $145,264 | $0 | $300 | $0 | $11,462 | $0 | $12,069 | $0 | $20,523 | $0 | $189,618 | $0 | $0 |
| Sarah Clark | ||||||||||||||
| In Patient RN | $0 | $109,642 | $0 | $9,000 | $0 | $1,164 | $0 | $9,483 | $0 | $23,664 | $0 | $152,953 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | Wisconsin Dialysis, Inc.'s Board Secretary functions as the Organization's Executive Director and compensation is paid by a related organization, University of Wisconsin Hospitals and Clinics Authority (UWHCA). Every 1-2 years, executive compensation is reviewed by UW Health's HR department as part of a compensation study by an independent contractor. |
| Part I, Line 4b | Some members of the Board participate in supplemental, non-qualified retirement plans through their employers, which are related organizations to the filing entity. Those individuals participate in a 457(f) plan. In 2019, the following employer contributions were made: - Dr. Jeff Pothof $41,220 - Mary Link $29,500 - Jodi Vitello $30,400 - Karil Walther $6,624 In 2019, no distributions were made. |
Schedule N IRS990ScheduleN
Disposition Of Assets Detail DispositionOfAssetsDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Assets Distri Or Expnss Paid | Property, plant, equipment and other intangible assets | AssetsDistriOrExpnssPaidDesc |
| Distribution | 2019-10-07 | DistributionDt |
| Fair Market Value Of Asset | $56,655,647 | FairMarketValueOfAssetAmt |
| Method Of FMV Determination | Arms length transaction | MethodOfFMVDeterminationTxt |
| EIN | 842525990 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fresenius Kidney Care Madison LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 920 Winter Street | AddressLine1Txt |
| City | Waltham | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 024511457 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | N/A | IRCSectionTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | 0 | DirectorOfSuccessor2Ind |
| Employee Of Successor2 | 0 | EmployeeOfSuccessor2Ind |
| Owner Of Successor2 | 0 | OwnerOfSuccessor2Ind |
| Receive Compensation2 | 0 | ReceiveCompensation2Ind |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Explanation of Changes: | On 10/7/19, WDI contributed substantially all of the assets used in its business to Fresenius Kidney Care Madison, LLC. WDI retained a 30% membership interest in the joint venture. Due to the contribution of assets, WDI is no longer primarily operated for charitable purposes and ceased to be a tax exempt entity under IRC 501(c)(3) as of 10/7/19. The Form 990 is amended to reflect the income from the joint venture arrangement as unrelated business income. Part VIII reflects the changes to income. Part XI, line 9 reflects the book/tax differences between the Form K-1 revenue from the joint venture and the amounts recorded on the books under the equity method of accounting. The changes to the Form 990 resulting from the unrelated business activities are as follows: i. Page 1, box G ii. Part I, line 9 & 10 iii. Part III, line 3 narrative iv. Part III line, 4a revenue v. Part IV line 32 vi. Part V, lines 3a & 3b vii. Part VIII, lines 2a-c, line 3, and line 7 viii. Part XI, Line 9 ix. addition of Schedule N. All unrelated business income for the year ended June 30, 2020 will be reported on Form 990-T for that year. Beginning with the tax year ending June 30, 2021 and all subsequent tax years, WDI will file Form 1120 in lieu of Form 990. |
| Form 990, Part III, line 3 | Due to the contribution of assets and business operations to the joint venture on 10/7/2019, WDI is no longer primarily operated for charitable purposes and ceased to be a tax exempt entity under IRC 501(c)(3). WDI has filed Form 990-T to report income from the joint venture arrangement as unrelated business income, for the tax period October 8, 2019 through June 30, 2020. For the tax year ending June 30, 2021 and for all subsequent tax years, WDI will file Form 1120 in lieu of Form 990. |
| Form 990, Part VI, Section A, line 3 | DELEGATION OF CONTROL OVER MANAGEMENT DUTIES Wisconsin Dialysis, Inc.'s Board Secretary functions as the Organization's Executive Director and compensation is paid by a related organization, University of Wisconsin Hospitals and Clinics Authority (UWHCA). All management duties are provided for under a Management Services Agreement between WDI and UWHCA. |
| Form 990, Part VI, Section A, line 6 | MEMBERS OF THE ORGANIZATION Members are all of one class with a 45% ownership by UnityPoint Health-Meriter, 45% owned by University of Wisconsin Hospitals and Clinics Authority, and 10% owned by University of Wisconsin Medical Foundation. |
| Form 990, Part VI, Section A, line 7a | POWER TO ELECT OR APPOINT GOVERNING BODY The Board of Directors will be appointed solely by the Members of Wisconsin Dialysis, Inc. |
| Form 990, Part VI, Section A, line 7b | GOVERNANCE DECISIONS RESERVED TO PERSONS OTHER THAN GOVERNING BODY The Members of Wisconsin Dialysis shall have the rights to approve, - Merger, consolidation or dissolution of the Company; - Amendment or restatement of the Articles of Incorporation or the Bylaws of the Company; and - Amendment of Management Services Agreement between the Company and University of Wisconsin Hospitals and Clinics Authority. |
| Form 990, Part VI, Section B, line 11b | REVIEW OF FORM 990 BY THE ORGANZATION'S GOVERNING BODY Form 990 is completed by the organization's external accounting firm. Key finance employees reviewed the Form 990 to determine if complete and accurate. The original and amended return were provided to the members of the board of directors with a memorandum related to the amended Form 990 before filing. The original and amended return was submitted for filing with the Internal Revenue Service. |
| Form 990, Part VI, Section B, line 12c | MONITORING AND ENFORCING COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY To ensure that the Organization operates in a manner consistent with charitable purposes and that it does not engage in activities that could jeopardize its status as an organization exempt from federal income tax, periodic reviews shall be conducted. The periodic reviews shall, at a minimum, include the following subjects, to the extent such subjects are applicable: 1) Whether compensation arrangements and benefits are reasonable and are the result of arm's length bargaining; 2) Whether acquisitions of physician practices and other provider services result in inurement or impermissible private benefit; 3) Whether partnership and joint venture arrangements and arrangements with management service organizations and physician hospital organizations conform to written policies, are properly recorded, reflect reason able payments for goods and services, further the Organization's charitable purposes and do not result in inurement or impermissible private benefit; 4) Whether agreements to provide health care and agreements with other health care providers, employees, and third party payers further the Corporation's charitable purposes and do not result in inurement or impermissible private benefit; 5) The policy covers all voting and ex-officer Board Members. Anyone found to be in violation of this policy would be recused from voting on and discussion about the transaction or topic. All review activity of actual or potential conflicts takes place at the full board level. |
| Form 990, Part VI, Section C, line 19 | AVAILABILIIY OF ORGANZATION DOCUMENTS All referenced documents are available to the public upon request pursuant to the guidelines of Section 6104(d). |
| Form 990, Part XI, line 9: | Capital Transferred Out -37,000,000. Book/Tax Difference for Equity Interest in Joint Venture 258,904. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (19 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Regional Division Inc | |||||||||||
| 7974 UW Health Court No MC1020 | Middleton | WI | 53562 | 391446049 | Regional Parent Corporation to manage and direct activities of entities | WI | 501(c)(3) | Line 12a | University of WI Hospitals and Clinics Authority | Yes (1) | |
| University Health Care Inc | |||||||||||
| 7974 UW Health Court | Middleton | WI | 53562 | 472553196 | Support Organization | WI | 501(c)(3) | Line 12a | University of WI Hospitals and Clinics Authority | Yes (1) | |
| Generations Fertility Care | |||||||||||
| 2365 Deming Way | Middleton | WI | 53562 | 273496527 | Reproductive Endocrinology and Infertility Services | WI | 501(c)(3) | Line 10 | Yes (1) | N/A | |
| University of Wisconsin Medical Foundation | |||||||||||
| 7974 UW Health Court | Middleton | WI | 53562 | 391824445 | Physician Services | WI | 501(c)(3) | Line 10 | University of WI Hospitals and Clinics Authority | 0 | |
| Madison Surgery Center | |||||||||||
| 7974 UW Health Court | Middleton | WI | 53562 | 391940656 | Health Care Services and Training | WI | 501(c)(3) | Line 10 | Yes (1) | N/A | |
| UnityPoint Health-Meriter | |||||||||||
| 202 S Park Street | Madison | WI | 53715 | 390806367 | Hospital | WI | 501(c)(3) | Line 3 | 0 | N/A | |
| University of Wisconsin Hospitals and Clinics Authority | |||||||||||
| 301 S Westfield Road Suite 320 | Madison | WI | 53717 | 391835630 | Hospital | WI | 115 | 0 | N/A | ||
| Transformations Surgery Center | |||||||||||
| 7974 UW Health Court | Middleton | WI | 53562 | 391948840 | Health Care Services and Training | WI | 501(c)(3) | Line 10 | Yes (1) | N/A | |
| Wisconsin Therapies Inc | |||||||||||
| 7974 UW Health Court | Middleton | WI | 53562 | 391807425 | Infusion Therapy | WI | 501(c)(3) | Line 12a | University of WI Hospitals and Clinics Authority | Yes (1) | |
| Wisconsin Sleep Inc | |||||||||||
| 6001 Research Park Blvd | Madison | WI | 53719 | 260902344 | Health Care Services and Training | WI | 501(c)(3) | Line 10 | Yes (1) | N/A | |
| UW Health ACO Inc | |||||||||||
| 7974 UW Health Court | Middleton | WI | 53562 | 455490584 | Accountable Care Organization | WI | 501(c)(3) | Line 10 | University of WI Hospitals and Clinics Authority | Yes (1) | |
| SwedishAmerican Hospital | |||||||||||
| 1401 E State Street | Rockford | IL | 61104 | 362222696 | Hospital | IL | 501(c)(3) | Line 3 | SwedishAmerican Health System Corporation | Yes (1) | |
| SwedishAmerican Foundation | |||||||||||
| 1415 E State Street | Rockford | IL | 61104 | 363097493 | Supporting Fundraising for SwedishAmerican Hospital | IL | 501(c)(3) | Line 7 | SwedishAmerican Hospital | Yes (1) | |
| SwedishAmerican Realty Corporation | |||||||||||
| 1313 E State Street | Rockford | IL | 61104 | 363248013 | Title Holding Company | IL | 501(c)(2) | SwedishAmerican Health System Corporation | Yes (1) | ||
| SwedishAmerican Hospital Self Insurance Trust | |||||||||||
| 1401 E State Street | Rockford | IL | 61104 | 366652702 | Hospital Malpractice Trust | VT | 501(c)(3) | Line 12a | SwedishAmerican Hospital | Yes (1) | |
| SwedishAmerican Health System Corporation | |||||||||||
| 1401 E State Street | Rockford | IL | 61104 | 363241458 | Parent Corporation to Manage and Direct Activities of Entities | IL | 501(c)(3) | Line 12a | Regional Division Inc | Yes (1) | |
| Quartz Health Plan Corporation | |||||||||||
| 840 Carolina Street | Sauk City | WI | 53583 | 391807071 | Health Insurance | WI | 501(c)(4) | University Health Care Inc | Yes (1) | ||
| Quartz Health Plan MN Corporation | |||||||||||
| 840 Carolina Street | Sauk City | WI | 53583 | 452633920 | Health Insurance | WI | 501(c)(4) | Quartz Health Plan Corporation | Yes (1) | ||
| Isthmus Project Inc | |||||||||||
| 600 Highland Avenue | Madison | WI | 53792 | 832278676 | Research and Innovation | WI | 501(c)(3) | Line 12a | University of WI Hospitals and Clinics Authority | Yes (1) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| Madison Medical Center LLP | |||||||
| 7974 UW Health Court | Middleton | WI | 53562 | 391329429 | Specialized Medical Center | WI | N/A |
| Chartwell Wisconsin Enterprises LLC | |||||||
| 2241 Pinehurst Drive | Middleton | WI | 53562 | 391796267 | Infusion Therapy | WI | N/A |
| Sixth Street Medical LLC | |||||||
| 7974 UW Health Court | Middleton | WI | 53562 | 472705724 | Lease and Rental Services | WI | N/A |
| Meriter UW Physician Contracting Company LLC | |||||||
| 202 S Park Street | Madison | WI | 53715 | 391998819 | Health Services | WI | N/A |
| Three Rivers Partners LLC | |||||||
| 1313 E State Street | Rockford | IL | 61104 | 262231757 | Information Technology Services | IL | N/A |
| Northern Illinois Vein Clinic | |||||||
| 2550 Charles Street | Rockford | IL | 61108 | 201642329 | Outpatient Health Services | IL | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| SARI Insurance Company | |||||||||
| 76 St Paul Street Suite 500 | Burlington | VT | 054014477 | 030308753 | Captive Insurance Company | VT | N/A | C | Yes (1) |
| State & Charles Inc | |||||||||
| 1313 E State Street | Rockford | IL | 61104 | 363321193 | Holding Company | IL | N/A | C | Yes (1) |
| SwedishAmerican Health Management Corp | |||||||||
| 1401 E State Street | Rockford | IL | 61104 | 363246511 | Management Services | IL | N/A | C | Yes (1) |
| Physician's Care Network | |||||||||
| 1313 E State Street | Rockford | IL | 61104 | 363455791 | Health Services | IL | N/A | C | Yes (1) |
| Quartz Health Benefit Plans Corporation | |||||||||
| 840 Carolina Street | Sauk City | WI | 53583 | 391450766 | Health Maintenance Organization | WI | N/A | C | Yes (1) |
| Health Professionals of Wisconsin | |||||||||
| 301 S Westfield Road | Madison | WI | 53717 | 391806711 | Real Estate | WI | N/A | C | Yes (1) |
| Quartz Holding Company | |||||||||
| 840 Carolina Street | Sauk City | WI | 53583 | 821728929 | Holding Company | WI | N/A | C | Yes (1) |
| Quartz Health Solutions Inc | |||||||||
| 840 Carolina Street | Sauk City | WI | 53583 | 465710709 | Insurance | WI | N/A | C | Yes (1) |
| Quartz Health Insurance Corporation | |||||||||
| 840 Carolina Street | Sauk City | WI | 53583 | 391565691 | Health Maintenance Organization | WI | N/A | C | Yes (1) |
| 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 | 0 | 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 | Yes (1) | 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 | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |