2021-11-11T17:17:25-06:00 2020-12-31 366055558 GRANT THORNTON LLP 100 E WISCONSIN AVE MILWAUKEE WI 53202 990 2020-01-01 390807235 VERSITI WISCONSIN INC VERS 4149335000 PO BOX 2178 638 NORTH 18TH ST MILWAUKEE WI 532012178 CHRIS MISKEL PRESIDENT & CEO 4149335000 2021-11-10 1 CHRIS MISKEL 999009999 MICHELLE L WEBER P00556798 4142898200 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z CHRIS MISKEL PO BOX 2178 638 NORTH 18TH ST MILWAUKEE WI 532012178 192345118 0 X WWW.VERSITI.ORG X 1947 WI (SEE SCHEDULE O) VERSITI WISCONSIN, INC. (VERSITI WISCONSIN) IS A BLOOD HEALTH INNOVATOR WHO ENHANCES LIVES THROUGH DISCOVERY, DIAGNOSIS AND TREATMENT. VERSITI EXPANDS THE FRONTIERS OF PATIENT HEALTH THROUGH THE INTEGRATION OF SCIENCE, MEDICINE AND SERVICE. 16 15 1189 321 116810 4416 24337374 26647932 145399666 157815223 2685170 2269212 100954 94793 172523164 186827160 4539001 9317174 0 0 76918040 80324208 0 0 0 94333476 96599389 175790517 186240771 -3267353 586389 123459642 135380410 24016344 29934011 99443298 105446399 X VERSITI WISCONSIN, INC. (VERSITI) IS A BLOOD HEALTH INNOVATOR WHO ENHANCES LIVES THROUGH DISCOVERY, DIAGNOSIS AND TREATMENT. VERSITI EXPANDS THE FRONTIERS OF PATIENT HEALTH THROUGH THE INTEGRATION OF SCIENCE, MEDICINE AND SERVICE. 0 0 40351654 25165 53245638 VERSITI RECRUITS VOLUNTEER BLOOD DONORS, COLLECTS, PROCESSES AND DISTRIBUTES BLOOD AND BLOOD COMPONENTS TO PROVIDE A SAFE AND RELIABLE SUPPLY OF BLOOD FOR HOSPITALS AND OTHER BLOOD CENTERS SERVED. DURING 2020, 177,996 BLOOD UNITS WERE COLLECTED. 34966126 102100 39436057 VERSITI OPERATES THE COMPREHENSIVE CENTER FOR BLEEDING DISORDERS (CCBD), UNDER A FEDERAL SUBAWARD AGREEMENT OF THE SOCIAL SECURITY ACT. CCBD PROVIDES CRITICAL SERVICES TO BLEEDING AND CLOTTING DISORDER PATIENTS AND THEIR FAMILIES. AS A COVERED ENTITY UNDER THE FEDERAL 340B DRUG DISCOUNT PROGRAM, VERSITI IS ELIGIBLE TO ACCESS CERTAIN SPECIALTY PHARMACEUTICALS AT DISCOUNTED PRICING. PHARMACEUTICAL NET INCOME IS PROGRAM INCOME AND FUNDS ARE RESTRICTED TO ACTIVITIES AND EXPENDITURES THAT FURTHER ELIGIBLE PROJECTS AND PROGRAM OBJECTIVES; INCLUDING PATIENT CARE, EDUCATION, SUPPORT SERVICES, APPROVED GRANT RESEARCH AND OTHER COSTS. VERSITI PROVIDES THESE SPECIALTY PHARMACY PRODUCTS TO HOME CARE PATIENTS AND HOSPITAL SYSTEMS. DURING 2020, 21,916,642 UNITS OF SPECIALTY PHARMACY PRODUCTS WERE PROVIDED. 33620300 9185000 VERSITI RESEARCH ADVANCES THE SCIENTIFIC AND MEDICAL UNDERSTANDING OF BLOOD BIOLOGY AND BLOOD DISEASE TO IMPROVE HEALTH. DURING 2020, VERSITI HAD 39 INVESTIGATORS. 51052865 4909 65134522 A. VERSITI WISCONSIN, INC. (VERSITI) PROVIDES CLINICAL DIAGNOSTIC TESTING SERVICES TO HOSPITALS, PHYSICIAN OFFICES AND OTHER REFERENCE LABORATORIES. DURING 2020, 125,329 TESTS WERE PERFORMED.B. VERSITI ORGAN AND TISSUE DONATION COMBINES PROCUREMENT SERVICES AND EDUCATION TO ENHANCE THE LIVES OF PATIENTS AND PROVIDES GUIDANCE TO THE FAMILIES OF POTENTIAL DONORS. DURING 2020, 353 ORGANS WERE TRANSPLANTED AND 615 MUSKULOSKELETAL DONORS WERE SEEN.C. VERSITI MEDICAL SERVICES PROVIDES MEDICAL AND THERAPEUTIC SERVICES IN PARTNERSHIP WITH LOCAL HOSPITALS. DURING 2020, 3,619 THERAPEUTIC PROCEDURES WERE PERFORMED.D. VERSITI DONOR TESTING LABORATORY PROVIDES INFECTIOUS DISEASE TESTING TO DETERMINE DONOR SUITABILITY AND PRODUCT SAFETY FOR VERSITI AFFILIATES AND OTHER BLOOD CENTER PARTNERS. 51052865 4909 65134522 159990945 1 1 0 1 0 0 0 0 0 1 1 1 0 0 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 1 1 1 1 0 0 1 2 0 1 1189 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 16 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X X PAUL MATSON 4149376349 638 N 18TH ST MILWAUKEE WI 532332121 X CHRIS MISKEL PRESIDENT & CEO 22.00 33.00 X X 458913 560893 43085 THOMAS ABSHIRE MD EVP MSI & CHIEF MED OFFICER 55.00 0.00 X 671220 0 25280 BRIAN BAUTISTA EVP & CHIEF OPERATING OFFICER 24.00 31.00 X 291374 356121 43085 BART REUTER EVP & GENERAL COUNSEL 22.00 33.00 X 264826 323675 43640 ANTHONY WATKINS EVP & CHIEF FINANCIAL OFFICER 18.00 26.00 X 232920 284679 36332 GITESH DUBAL EVP & CHIEF MARKETING OFFICER 24.00 31.00 X 217680 266052 41028 PETER NEWMAN PHD VP RESEARCH & ASSOC. DIR. BRI. 55.00 0.00 X 458594 0 31384 JAMES WEIDNER EVP & CHIEF HR OFFICER 23.00 32.00 X 188869 230837 38589 MATTHEW ANDERSON MD VP & DIAGNOSTIC LAB MED. DIR. 55.00 0.00 X 398471 0 43848 MEHRABOON IRANI MD MEDICAL DIRECTOR OF THERAPEUTIC SVS 55.00 0.00 X 391590 0 42251 KENNETH FRIEDMAN MD MEDICAL DIRECTOR 55.00 0.00 X 390698 0 39574 BRADLEY PIETZ EVP & CHIEF INNOVATION OFFICER 24.00 31.00 X 172699 211078 43406 LYNNE BRIGGS VP & CHIEF INFORMATION OFFICER 24.00 31.00 X 168193 205568 46219 JOSHUA J FIELD MD MEDICAL DIRECTOR 55.00 0.00 X 380150 0 38116 MARGARET MCELLIGOT VP & CHIEF QUALITY OFFICER 24.00 31.00 X 142849 174591 37051 GILBERT C WHITE MD PRINCIPAL INVESTIGATOR 19.00 9.00 X 215658 101486 29436 DALE KENT CHAIR 1.00 5.00 X X 0 0 0 THOMAS HAUSKE JR VICE CHAIR 1.00 4.00 X X 0 0 0 JAMES M RAUH SECRETARY 1.00 5.00 X X 0 0 0 JOHN PERRAS TREASURER 1.00 4.00 X X 0 0 0 CATHY BUCK BOARD MEMBER - THRU 5/2020 1.00 3.00 X 0 0 0 FRED GEILFUSS BOARD MEMBER; LEGAL ADVISOR 1.00 4.00 X 0 0 0 DAVID GINSBURG MD BOARD MEMBER 1.00 4.00 X 0 0 0 GAIL HANSON BOARD MEMBER 1.00 4.00 X 0 0 0 SHERRY HUSA BOARD MEMBER 1.00 4.00 X 0 0 0 ROBERT H MANEGOLD BOARD MEMBER 1.00 5.00 X 0 0 0 JEFFREY S MCDONALD BOARD MEMBER 1.00 4.00 X 0 0 0 RON MILLER BOARD MEMBER 1.00 4.00 X 0 0 0 MITCHELL G WATT BOARD MEMBER 1.00 4.00 X 0 0 0 GREG WESLEY BOARD MEMBER 1.00 4.00 X 0 0 0 L ALAN WHALEY BOARD MEMBER 1.00 4.00 X 0 0 0 PETER ZIEGLER BOARD MEMBER 1.00 5.00 X 0 0 0 5044704 2714980 622324 146 1 1 0 MEDSPEED LLC 655 W GRAND AVENUE STE 320 ELMHURST IL 60126 HEALTHCARE TRANSPORT 2568359 CERNER CORPORATION 2800 ROCKCREEK PARKWAY NORTH KANSAS CITY MO 64117 SOFTWARE SUPPORT 672403 MILWAUKEE REGIONAL MEDICAL CENTER 8700 WATERTOWN PLANK RD MILWAUKEE WI 53226 PHYSICIAN SERVICES 671587 INVITA HEALTHCARE TECHNOLOGIES 765 ELA RD LAKE ZURICH IL 60047 SOFTWARE TECHNOLOGY 464317 MEDICAL COLLEGE OF WISCONSIN INC 8701 WATERTOWN PLANK RD MILWAUKEE WI 53226 PHYSICIAN SERVICES 418469 33 7881629 16526642 2239661 26647932 BLOOD SERVICES 621500 53244644 53244644 PHARMACY 621500 39436057 39436057 DIAGNOSTIC LABORATORIES 621500 35611322 35495906 115416 ORGAN AND TISSUE DONATION 621500 19229841 19229841 MEDICAL SERVICES 621500 9962851 9962851 330508 330508 157815223 1834351 1394 1832957 30000 37053 -7053 -7053 -7053 5915766 5357560 123345 558206 -123345 434861 434861 ACQUIRED CASH RECEIPTS 900099 69250 69250 PATRONAGE DIVIDENDS 900099 31405 31405 INSURANCE INTEREST 900099 994 994 197 197 101846 186827160 157700801 116810 2361617 X 9317174 9317174 3002414 696500 2305914 235674 235674 60902129 53602786 7299343 2839160 2474588 364572 9081641 7767170 1314471 4263190 3607338 655852 107272 55558 51714 89976 31379 58597 1849 1849 20983012 20344075 638937 147979 96709 51270 375649 356853 18796 2930313 1739229 1191084 10785 10785 3616721 2027114 1589607 1397583 1158639 238944 222312 204914 17398 4622291 2806083 1816208 64731 29562 35169 COST OF IMPORTED PROD 39330083 39330083 0 MEDICAL LAB SUPPLIES 9845753 9845583 170 VERSITI SERVICES ALLOC 9842433 2278989 7563444 EQUIPMENT LEASE/MAINT 1632964 1195115 437849 1377683 1014719 362964 186240771 159990945 26249826 0 32688 513393 0 0 1947189 3593860 35425665 31310834 0 0 0 0 200000 0 7577166 6647927 813645 582634 111152572 77370899 34920858 33781673 28397340 42107947 13323614 16038879 0 0 0 0 821477 803263 123459642 135380410 18055464 20995523 0 0 0 133665 0 0 0 0 0 0 0 0 0 0 5960880 8804823 24016344 29934011 X 99443298 105446399 99443298 105446399 123459642 135380410 X 586389 2702749 2713963 X 0 1 X 1 1 1 X 22122317 22711570 24177316 24337374 26647932 119996509 22122317 22711570 24177316 24337374 26647932 119996509 37142636 82853873 1163577 1815274 1592014 904927 1862957 7338749 4713 4416 9129 995 2136 104382 100852 208365 127552752 713083493 0.64960 0.64980 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: PATRONAGE DIVIDENDS - 2016 AMOUNT: $ 0. 2017 AMOUNT: $ 0. 2018 AMOUNT: $ 0. 2019 AMOUNT: $ 55,250. 2020 AMOUNT: $ 31,405. COPY FEES - 2016 AMOUNT: $ 0. 2017 AMOUNT: $ 0. 2018 AMOUNT: $ 1,329. 2019 AMOUNT: $ 455. 2020 AMOUNT: $ 0. MISCELLANEOUS - 2016 AMOUNT: $ 0. 2017 AMOUNT: $ 995. 2018 AMOUNT: $ 807. 2019 AMOUNT: $ 17,233. 2020 AMOUNT: $ 197. ACQUIRED CASH RECEIPTS - 2016 AMOUNT: $ 0. 2017 AMOUNT: $ 0. 2018 AMOUNT: $ 0. 2019 AMOUNT: $ 22,974. 2020 AMOUNT: $ 69,250. ENTERPRISE FLEET SERVICES - 2016 AMOUNT: $ 0. 2017 AMOUNT: $ 0. 2018 AMOUNT: $ 0. 2019 AMOUNT: $ 8,470. 2020 AMOUNT: $ 0. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1196 1196 0 PART II-B, LINE 1: OTHER ACTIVITIES $1,196 OF THE DUES PAID TO THE ASSOCIATION OF ORGAN PROCUREMENT ORGANIZATIONS HAS BEEN ALLOCATED TO LOBBYING. 89992682 4494881 9457908 4333452 99612019 77632272 2512261 14163049 4314900 89992682 86045725 301738 -4472887 4242304 77632272 76439806 2294914 11411375 4100370 86045725 72401518 793676 7045041 3800429 76439806 0.97930 0.02070 0 1 1 4266958 4266958 65234388 43172695 22061693 846040 696845 149195 39199018 32652942 6546076 1606168 848417 757751 33781673 INVESTMENT IN CENETRON 16038879 F 16038879 LONG TERM RETIREMENT LIABILITIES 7294059 DEFERRED PAYROLL TAXES 1232700 ADDITIONAL INCENTIVES 278064 8804823 X 192403724 2702749 2702749 189700975 1849 -2875664 -2873815 186827160 186400622 161700 161700 186238922 1849 1849 186240771 PART V, LINE 4: ENDOWMENTS THE FILING ORGANIZATION IS A BENEFICIARY OF THE VERSITI BLOOD RESEARCH INSTITUTE FOUNDATION'S ("VBRIF") ENDOWMENT AS A SUPPORTED ORGANIZATION. THE BOARD DESIGNATED ENDOWMENT FUNDS ARE DESIGNATED BY THE BOARD AS ENDOWMENT FUNDS TO ENSURE THE CONTINUING AVAILABILITY OF FUNDS FOR RESEARCH PURPOSES. PART X, LINE 2: INCOME TAXES VERSITI, WISCONSIN, ILLINOIS, MICHIGAN, INDIANA AND THE FOUNDATION HAVE ALL RECEIVED TAX DETERMINATION LETTERS CONFIRMING THAT THE ORGANIZATIONS QUALIFY AS TAX-EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). THE ORGANIZATION FOLLOWS GUIDANCE THAT CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN, INCLUDING ISSUES RELATING TO FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT. THIS GUIDANCE PROVIDES THAT THE TAX EFFECTS FROM AN UNCERTAIN TAX POSITION CAN ONLY BE RECOGNIZED IN THE FINANCIAL STATEMENTS IF THE POSITION IS MORE LIKELY THAN NOT TO BE SUSTAINED IF THE POSITION WERE TO BE CHALLENGED BY A TAXING AUTHORITY. THE ASSESSMENT OF THE TAX POSITION IS BASED SOLELY ON THE TECHNICAL MERITS OF THE POSITION, WITHOUT REGARD TO THE LIKELIHOOD THAT THE TAX POSITION MAY BE CHALLENGED. VERSITI, WISCONSIN, ILLINOIS, MICHIGAN, INDIANA AND THE FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3), THOUGH THEY ARE SUBJECT TO TAX ON INCOME UNRELATED TO THEIR EXEMPT PURPOSES, UNLESS THAT INCOME IS OTHERWISE EXCLUDED BY THE IRC. THE ORGANIZATION HAS PROCESSES PRESENTLY IN PLACE TO ENSURE THE MAINTENANCE OF ITS TAX-EXEMPT STATUS; TO IDENTIFY AND REPORT UNRELATED INCOME; TO DETERMINE ITS FILING AND TAX OBLIGATIONS IN JURISDICTIONS FOR WHICH IT HAS NEXUS; AND TO IDENTIFY AND EVALUATE OTHER MATTERS THAT MAY BE CONSIDERED TAX POSITIONS. THE ORGANIZATION FILES FEDERAL AND STATE INCOME TAX RETURNS TO REPORT UNRELATED BUSINESS INCOME WHERE APPLICABLE, AND WITH FEW EXCEPTIONS, THOSE PERIODS GENERALLY REMAIN OPEN THREE YEARS FOR FEDERAL PURPOSES AND FOUR YEARS FOR STATE PURPOSES. THE STATUTE OF LIMITATIONS WILL REMAIN OPEN FOR ANY YEARS WHERE RETURNS WERE NOT FILED. THE ORGANIZATION HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. SALUS HAS BEEN ORGANIZED AS A LIMITED LIABILITY COMPANY AND, ACCORDINGLY, IS NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. ALL INCOME TAX ATTRIBUTES OF THE ENTITY ARE PASSED THROUGH TO ITS SOLE MEMBER, WISCONSIN. THE ENTITY IS INCLUDED IN THE CONSOLIDATED INFORMATION RETURN FILED BY VERSITI. CENETRON HAS BEEN ORGANIZED AS A WHOLLY OWNED LLC THAT HAS ELECTED TO BE TREATED AS A C-CORPORATION FOR TAX PURPOSES AND SO IS SUBJECT TO FEDERAL AND STATE INCOME TAXES. INCOME TAXES ARE PROVIDED FOR THE TAX EFFECTS OF TRANSACTIONS REPORTED BY CENETRON AND CONSIST OF TAXES CURRENTLY DUE AND DEFERRED TAXES. DEFERRED TAXES ARE RECOGNIZED FOR DIFFERENCES BETWEEN THE BASIS OF ASSETS AND LIABILITIES FOR FINANCIAL STATEMENT AND INCOME TAX PURPOSES. THE DIFFERENCES RELATE PRIMARILY TO INTANGIBLE ASSETS. THE DEFERRED TAX ASSETS AND LIABILITIES REPRESENT THE FUTURE TAX RETURN CONSEQUENCES OF THOSE DIFFERENCES, WHICH WILL EITHER BE TAXABLE OR DEDUCTIBLE WHEN THE ASSETS AND LIABILITIES ARE RECOVERED OR SETTLED. CENETRON IS SUBJECT TO TAXATION IN THE UNITED STATES AND THE STATE OF TEXAS. THE ORGANIZATION RECOGNIZES, IF NECESSARY, INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS IN THE PROVISION FOR INCOME TAXES. THERE WERE NO INTEREST OR PENALTIES RELATED TO INCOME TAXES THAT HAVE BEEN ACCRUED OR RECOGNIZED AS OF AND FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON ASSET SALE -123,345. RENTAL ACTIVITY EXPENSES -37,053. CHANGE IN EQUITY IN CENETRON -3,615,266. INVESTMENT IN AFFILIATE BALANCE SHEET AMOUNT 900,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON ASSET SALE 123,345. RENTAL ACTIVITY EXPENSES 37,053. BAD DEBT RESERVE ADJUSTMENT 1,302. 1 VERSITI BLOOD RESEARCH INSTITUTE FOUNDATION INC PO BOX 2178 638 N 18TH STREET MILWAUKEE WI 532012178 391372542 501(C)(3) 9185000 RESEARCH GREAT LAKES HEMOPHILIA FOUNDATION INC 638 NORTH 18TH STREET MILWAUKEE WI 53233 237367636 501(C)(3) 102100 PATIENT FINANCIAL ASSISTANCE 2 PART I, LINE 2: PROCEDURE FOR MONITORING USE OF GRANT FUNDS INSIDE U.S. VERSITI WISCONSIN CONTINUES TO PROVIDE GRANT FUNDING TO VERSITI BLOOD RESEARCH INSTITUTE FOUNDATION, INC. AND OTHER TAX-EXEMPT ORGANIZATIONS. THESE FUNDS WILL SUPPORT FUTURE BLOOD RESEARCH AND OTHER INITIATIVES TO SERVE MORE PATIENTS AND REDUCE OVERALL COSTS. MONITORING THE INVESTMENT OF THESE FUNDS, THE DISTRIBUTIONS AND WHAT THESE FUNDS ARE USED FOR IS COMPLETED BY LEADERSHIP OF VERSITI WISCONSIN. X 1 1 0 0 0 0 1 0 1 1 0 CHRIS MISKEL PRESIDENT & CEO 306743 374907 151509 185177 661 809 8775 10725 10613 12972 478301 584590 0 0 THOMAS ABSHIRE MD EVP MSI & CHIEF MED OFFICER 517993 0 146405 0 6822 0 22800 0 2480 0 696500 0 0 0 BRIAN BAUTISTA EVP & CHIEF OPERATING OFFICER 203872 249176 86570 105807 932 1138 8775 10725 10613 12972 310762 379818 0 0 BART REUTER EVP & GENERAL COUNSEL 174348 213092 89546 109445 932 1138 8664 10591 10974 13411 284464 347677 0 0 ANTHONY WATKINS EVP & CHIEF FINANCIAL OFFICER 167068 204195 59478 72695 6374 7789 8978 10972 7372 9010 249270 304661 0 0 GITESH DUBAL EVP & CHIEF MARKETING OFFICER 167109 204243 49910 61000 661 809 7849 9594 10613 12972 236142 288618 0 0 PETER NEWMAN PHD VP RESEARCH & ASSOC. DIR. BRI. 378830 0 72692 0 7072 0 22800 0 8584 0 489978 0 0 0 JAMES WEIDNER EVP & CHIEF HR OFFICER 141223 172605 46017 56242 1629 1990 8978 10972 8388 10251 206235 252060 0 0 MATTHEW ANDERSON MD VP & DIAGNOSTIC LAB MED. DIR. 343588 0 52842 0 2041 0 19500 0 24348 0 442319 0 0 0 MEHRABOON IRANI MD MEDICAL DIRECTOR OF THERAPEUTIC SVS 366241 0 19551 0 5798 0 18666 0 23585 0 433841 0 0 0 KENNETH FRIEDMAN MD MEDICAL DIRECTOR 359624 0 20149 0 10925 0 22800 0 16774 0 430272 0 0 0 BRADLEY PIETZ EVP & CHIEF INNOVATION OFFICER 129239 157959 42625 52098 835 1021 8644 10565 10888 13309 192231 234952 0 0 LYNNE BRIGGS VP & CHIEF INFORMATION OFFICER 132926 162465 32915 40229 2352 2874 10260 12540 10539 12880 188992 230988 0 0 JOSHUA J FIELD MD MEDICAL DIRECTOR 356439 0 21607 0 2104 0 14536 0 23580 0 418266 0 0 0 MARGARET MCELLIGOT VP & CHIEF QUALITY OFFICER 114808 140321 25713 31425 2328 2845 9376 11459 7298 8918 159523 194968 0 0 GILBERT C WHITE MD PRINCIPAL INVESTIGATOR 137717 64808 76225 35870 1716 808 9180 4320 10837 5099 235675 110905 0 0 PART I, LINE 1A BUSINESS CLUB DUES VERSITI WISCONSIN PROVIDES BUSINESS CLUB MEMBERSHIPS FOR THE FOLLOWING EMPLOYEE: GILBERT C. WHITE : $5,119 THE CLUB MEMBERSHIPS ARE NOT TREATED AS TAXABLE COMPENSATION. THE EMPLOYEES USE THESE MEMBERSHIPS FOR BUSINESS MEETINGS OFF SITE AND BUSINESS LUNCHES/DINNERS. ANY PERSONAL EXPENSES INCURRED AT THE CLUB ARE PAID FOR DIRECTLY BY THE EMPLOYEES OR THE EMPLOYEES REIMBURSE THE ENTITY FOR PERSONAL EXPENSES. PART I, LINE 3: TOP MANAGEMENT'S COMPENSATION THE COMPENSATION COMMITTEE OF THE VERSITI BOARD OF DIRECTORS, ACTING IN ITS CAPACITY AS THE COMPENSATION COMMITTEE, SETS AND MONITORS THE COMPENSATION PHILOSOPHY FOR VERSITI AND THE RELATED ENTITIES THAT IT SUPPORTS, INCLUDING VERSITI WISCONSIN. OTHER THAN THE VERSITI PRESIDENT AND CHIEF EXECUTIVE OFFICER, THE COMPENSATION COMMITTEE DOES NOT INCLUDE MEMBERS OF MANAGEMENT AND IS COMPRISED ENTIRELY OF INDIVIDUALS WHO DO NOT HAVE A CONFLICT OF INTEREST WITH RESPECT TO VERSITI COMPENSATION ARRANGEMENTS. THE VERSITI PRESIDENT AND CHIEF EXECUTIVE OFFICER RECUSES HER/HIMSELF FROM ALL DISCUSSIONS AND APPROVALS RELATED TO HER/HIS COMPENSATION. THE VERSITI COMPENSATION COMMITTEE REVIEWS EXECUTIVE COMPENSATION ARRANGEMENTS TO ENSURE SUCH ARRANGEMENTS ARE FAIR, REASONABLE, AND NOT EXCESSIVE WHEN COMPARED TO SIMILARLY-SITUATED EXECUTIVES. EXECUTIVE COMPENSATION ARRANGEMENTS ARE REVIEWED FOR REASONABLENESS AND APPROVED BY THE COMPENSATION COMMITTEE ANNUALLY IN ACCORDANCE WITH THE VERSITI REASONABLENESS REVIEW POLICY. IN ORDER TO ASSESS THE REASONABLENESS OF EXECUTIVE COMPENSATION ARRANGEMENTS, THE COMPENSATION COMMITTEE OBTAINS AND REVIEWS APPROPRIATE COMPARABILITY DATA COLLECTED BY THE HUMAN RESOURCE DEPARTMENT AND/OR A QUALIFIED INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE ENGAGES A QUALIFIED INDEPENDENT COMPENSATION CONSULTANT ANNUALLY. THE INDEPENDENT CONSULTANT PERFORMS AN ANALYSIS OF COMPENSATION LEVELS AT REGIONAL AND NATIONAL ORGANIZATIONS OF COMPARABLE SIZE, SCOPE AND STRUCTURE; AND PROVIDES THE COMMITTEE WITH COMPREHENSIVE DATA ON THE AVAILABILITY OF SIMILAR SERVICES WITHIN THE GEOGRAPHIC AREA, COMPENSATION SURVEYS, WRITTEN OFFERS FROM SIMILAR INSTITUTIONS, AND OTHER INFORMATION RELEVANT TO COMPARABILITY OF COMPENSATION. THE COMPENSATION COMMITTEE'S REVIEW, RECOMMENDATIONS AND APPROVALS ARE DOCUMENTED CONCURRENTLY IN THE COMMITTEE MINUTES, WHICH ARE SUBSEQUENTLY REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE AS REASONABLE, ACCURATE AND COMPLETE. A COPY OF THE COMPENSATION COMMITTEE'S MINUTES IS ALSO PROVIDED TO THE VERSITI BOARD OF DIRECTORS. VERSITI AND VERSITI WISCONSIN HAVE INCENTIVE PROGRAMS FOR EXECUTIVES, DIRECTORS, MANAGEMENT, INVESTIGATORS AND STAFF DESCRIBED IN DETAILED WRITTEN POLICIES APPROVED BY THE COMPENSATION COMMITTEE ANNUALLY. EVALUATION AND COMPENSATION REVIEW -CEO - EACH YEAR, THE EXECUTIVE/COMPENSATION COMMITTEE EVALUATES THE CEO'S PERFORMANCE AGAINST ESTABLISHED OBJECTIVES, DETERMINES INCENTIVE PAYMENT AND MERIT INCREASE BASED UPON PERFORMANCE AND MARKET DATA PROVIDED BY THE THIRD PARTY COMPENSATION CONSULTANT, AND WORKS WITH THE CEO TO ESTABLISH OBJECTIVES FOR THE NEXT YEAR. -EXECUTIVES - EACH YEAR, THE VERSITI/VERSITI WISCONSIN CEO REVIEWS THE PERFORMANCE OF EACH EXECUTIVE AND THE ACHIEVEMENT OF THEIR INDIVIDUAL GOALS AND OBJECTIVES. THE VERSITI/VERSITI WISCONSIN CEO PRESENTS HIS/HER RECOMMENDATIONS TO THE COMPENSATION COMMITTEE, WHICH REVIEWS AND APPROVES RECOMMENDED COMPENSATION RANGES, AND APPROVES FINAL SALARY AND INCENTIVE PAYMENTS. EXECUTIVES ARE POSITIONED WITHIN THE APPROPRIATE SALARY RANGE BASED UPON THE: -EXECUTIVE'S KNOWLEDGE, COMPETENCIES, AND EXPERIENCE, -PERFORMANCE OF THE EXECUTIVE'S AREAS OF RESPONSIBILITY, -THE EXECUTIVE'S CONTRIBUTION TO OVERALL PERFORMANCE, -THE IMPORTANCE OF RETAINING THE EXECUTIVE, -INTERNAL EQUITY CONSIDERATIONS, -THE FINANCIAL RESOURCES AVAILABLE, AND -EXECUTIVE BASE SALARY INCREASES PROVIDED IN THE COMPETITIVE MARKET. PART I, LINES 5B, 6B AND 7: NON-FIXED PAYMENTS INCENTIVE PAYOUT OPPORTUNITIES, BASED ON PERCENTAGE OF BASE PAY RATE, ARE AVAILABLE TO CERTAIN EMPLOYEES OF THE FILING ORGANIZATION. WHILE LEVELS OF THE INCENTIVE PAYOUT OPPORTUNITY ARE FIXED AND DETERMINED PERCENTAGES OF BASE COMPENSATION; THE INCENTIVE PAYOUT IS DETERMINED; IN PART, ON THE CONSOLIDATED REVENUE AND NET EARNINGS OF OPERATING DIVISIONS. THE INCENTIVE PAYOUT IS SUBJECT TO THE REVIEW OF ACCOMPLISHMENTS/OBJECTIVES AND THE ULTIMATE DETERMINATION OF INCENTIVE COMPENSATION IS SUBJECT TO PRESIDENT/CEO AND EXECUTIVE COMMITTEE OF THE BOARD APPROVAL. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS VERSITI, INC. IS THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A MEMBER OR STOCKHOLDER POWERS VERSITI, INC. HAS RESERVE POWERS; INCLUDING THE ABILITY TO ELECT A MAJORITY OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B REFER TO NARRATIVE LISTED IN LINE 7A. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW VERSITI WISCONSIN UTILIZES GRANT THORNTON LLP TO COMPLETE THE IRS FORM 990 AND RELATED SCHEDULES. FOLLOWING COMPLETION, THEY ARE REVIEWED BY THE CONTROLLER AND CEO. THE DRAFT FORMS ARE THEN REVIEWED BY THE COMPLIANCE AND AUDIT COMMITTEE PRIOR TO SUBMISSION TO THE IRS. THE FULL BOARD IS PROVIDED A COPY OF THE FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY VERSITI WISCONSIN MAINTAINS A WRITTEN CONFLICT OF INTEREST POLICY. ON AN ANNUAL BASIS, CURRENT DIRECTORS AND OFFICERS ARE ASKED TO COMPLETE A DISCLOSURE FORM BASED ON IRS REQUIREMENTS THAT INCLUDES THE FOLLOWING: WHETHER THEY HAVE ANY DIRECT OR INDIRECT RELATIONSHIP EITHER THROUGH BUSINESS OR FAMILY MEMBER WITH THE ORGANIZATION. WHETHER THEY RECEIVED COMPENSATION FROM ANY ORGANIZATION THAT SHARES COMMON OWNERSHIP OR CONTROL WITH THE ORGANIZATION. WHETHER THEY HAVE SERVED AS AN OFFICER, DIRECTOR, KEY EMPLOYEE, PARTNER OR MEMBER OF AN ENTITY (OR SHAREHOLDER OF A PROFESSIONAL CORPORATION) DOING BUSINESS WITH THE ORGANIZATION. THESE ANSWERS ARE ACCUMULATED, SUMMARIZED AND EVALUATED BY MANAGEMENT TO DETERMINE IF ANY CONFLICTS EXIST. IDENTIFIED CONFLICTS ARE ADDRESSED IN ACCORDANCE WITH THE WRITTEN POLICY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PROCESS VERSITI AND ITS AFFILIATED BLOOD CENTERS GREATLY VALUE THE GENEROUS CONTRIBUTIONS OF THE INDIVIDUALS AND ORGANIZATIONS THAT SUPPORT OUR MISSION WITHIN THE COMMUNITY WE SERVE. IN ORDER TO ENSURE PROPER STEWARDSHIP OF OUR CHARITABLE RESOURCES, VERSITI AND ITS AFFILIATES FOLLOW A FORMALIZED PROCESS TO CONFIRM THAT COMPENSATION PROVIDED TO OUR EXECUTIVE LEADERSHIP TEAM IS FAIR, REASONABLE, AND NOT EXCESSIVE WHEN COMPARED TO OTHER EXECUTIVES. THIS PROCESS ALSO HELPS US ENSURE THAT OUR COMPENSATION PROGRAM SUPPORTS THE RETENTION OF EXPERIENCED, HIGHLY-QUALIFIED EXECUTIVES WHO ARE COMMITTED TO OUR MISSION. THE COMPENSATION COMMITTEE OF THE VERSITI BOARD OF DIRECTORS, ACTING IN ITS CAPACITY AS THE COMPENSATION COMMITTEE, SETS AND MONITORS THE COMPENSATION PHILOSOPHY FOR VERSITI AND THE RELATED ENTITIES THAT IT SUPPORTS, INCLUDING VERSITI WISCONSIN. FORM 990, PART VI, SECTION C, LINE 19 ORGANIZATION'S DOCUMENTS OPEN TO THE PUBLIC THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST TO THE PUBLIC DURING NORMAL BUSINESS HOURS AND AT THE ORGANIZATION'S LOCATION. PART VII: AVERAGE HOURS THE HOURS LISTED ON FORM 990, PART VII ARE REPRESENTATIVE OF AN AVERAGE FOR THE OFFICERS AND EXECUTIVE TEAM. EACH INDIVIDUAL PERSON'S WEEKLY TALLY MAY BE GREATER OR LESSER PER WEEK BASED ON THEIR INDIVIDUAL ROLES AND RESPONSIBILITIES WITHIN THE FILING ORGANIZATION AND RELATED PARTIES. THE SALARY PRESENTED FOR THE PRESIDENT AND CEO IS REFLECTIVE OF TOTAL SALARY COMPENSATION FOR SERVICES TO THE FILING ORGANIZATION AND RELATED AFFILIATES. FORM 990, PART IX, LINE 11G DONOR TESTING: PROGRAM SERVICE EXPENSES 7,444,905. TOTAL EXPENSES 7,444,905. SUBAWARDS: PROGRAM SERVICE EXPENSES 2,124,326. TOTAL EXPENSES 2,124,326. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,535,635. MANAGEMENT AND GENERAL EXPENSES 146,187. TOTAL EXPENSES 1,681,822. ANIMAL CARE COSTS: PROGRAM SERVICE EXPENSES 1,252,547. TOTAL EXPENSES 1,252,547. OPERATING ROOM: PROGRAM SERVICE EXPENSES 1,048,403. TOTAL EXPENSES 1,048,403. SHIPPING & TRANSPORTATION: PROGRAM SERVICE EXPENSES 769,645. MANAGEMENT AND GENERAL EXPENSES 97,428. TOTAL EXPENSES 867,073. GRADUATE STUDENT STIPENDS: PROGRAM SERVICE EXPENSES 651,140. TOTAL EXPENSES 651,140. OUTSIDE LAB SERVICE: PROGRAM SERVICE EXPENSES 502,264. TOTAL EXPENSES 502,264. ICU: PROGRAM SERVICE EXPENSES 472,468. TOTAL EXPENSES 472,468. PHARMACY: PROGRAM SERVICE EXPENSES 404,006. TOTAL EXPENSES 404,006. LAB: PROGRAM SERVICE EXPENSES 376,659. TOTAL EXPENSES 376,659. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 98,763. MANAGEMENT AND GENERAL EXPENSES 207,870. TOTAL EXPENSES 306,633. OTHER HOSPITAL CHARGES: PROGRAM SERVICE EXPENSES 302,575. TOTAL EXPENSES 302,575. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 302,057. TOTAL EXPENSES 302,057. MEDICAL TRANSPORT: PROGRAM SERVICE EXPENSES 302,011. TOTAL EXPENSES 302,011. ANESTHESIA: PROGRAM SERVICE EXPENSES 297,410. TOTAL EXPENSES 297,410. CLAIM/BILLING REVIEW: PROGRAM SERVICE EXPENSES 271,103. TOTAL EXPENSES 271,103. TEMPORARY HELP: PROGRAM SERVICE EXPENSES 250,003. MANAGEMENT AND GENERAL EXPENSES 9,746. TOTAL EXPENSES 259,749. CARDIOLOGY: PROGRAM SERVICE EXPENSES 246,117. TOTAL EXPENSES 246,117. FACILITY CHARGES: PROGRAM SERVICE EXPENSES 234,607. TOTAL EXPENSES 234,607. RADIOLOGY: PROGRAM SERVICE EXPENSES 213,275. TOTAL EXPENSES 213,275. BOARD MEMBER FEES: PROGRAM SERVICE EXPENSES 205,679. TOTAL EXPENSES 205,679. RESPIRATORY THERAPY: PROGRAM SERVICE EXPENSES 178,093. TOTAL EXPENSES 178,093. PS SUPPLIES: PROGRAM SERVICE EXPENSES 137,421. TOTAL EXPENSES 137,421. OTHER PURCHASE SERV AFFILIATES: PROGRAM SERVICE EXPENSES 122,331. TOTAL EXPENSES 122,331. TISSUE DONOR TRANSPORT: PROGRAM SERVICE EXPENSES 108,713. TOTAL EXPENSES 108,713. OUTSIDE CORE LAB CHARGES: PROGRAM SERVICE EXPENSES 102,237. TOTAL EXPENSES 102,237. RECORD STORAGE: PROGRAM SERVICE EXPENSES 6,825. MANAGEMENT AND GENERAL EXPENSES 87,959. TOTAL EXPENSES 94,784. FUNERAL HOME CHARGES: PROGRAM SERVICE EXPENSES 90,388. TOTAL EXPENSES 90,388. CUSTOMER TESTING: PROGRAM SERVICE EXPENSES 82,745. TOTAL EXPENSES 82,745. US POSTAL SERVICE: PROGRAM SERVICE EXPENSES 2,134. MANAGEMENT AND GENERAL EXPENSES 70,474. TOTAL EXPENSES 72,608. OUTSIDE SALARY & FRINGES: PROGRAM SERVICE EXPENSES 59,435. TOTAL EXPENSES 59,435. NON-MARKETING PRINTING COSTS: PROGRAM SERVICE EXPENSES 52,924. MANAGEMENT AND GENERAL EXPENSES 5,384. TOTAL EXPENSES 58,308. PUBLICATION SERVICES: PROGRAM SERVICE EXPENSES 56,339. TOTAL EXPENSES 56,339. LICENSES, PERMITS, & HOSP FEES: PROGRAM SERVICE EXPENSES 46,020. MANAGEMENT AND GENERAL EXPENSES 8,163. TOTAL EXPENSES 54,183. DNA SEQUENCING: PROGRAM SERVICE EXPENSES 48,711. TOTAL EXPENSES 48,711. PHARMACY DISPENSING FEE: PROGRAM SERVICE EXPENSES 33,200. TOTAL EXPENSES 33,200. TRANSLATION SERVICE: PROGRAM SERVICE EXPENSES 24,505. TOTAL EXPENSES 24,505. CREDIT CARD FEES: PROGRAM SERVICE EXPENSES 23,309. TOTAL EXPENSES 23,309. EDUCATION: PROGRAM SERVICE EXPENSES 11,444. MANAGEMENT AND GENERAL EXPENSES 1,011. TOTAL EXPENSES 12,455. BANK ACCOUNT FEES: PROGRAM SERVICE EXPENSES 11,221. MANAGEMENT AND GENERAL EXPENSES 3,938. TOTAL EXPENSES 15,159. LAUNDRY COSTS: PROGRAM SERVICE EXPENSES 6,221. TOTAL EXPENSES 6,221. SHIPPING SUPPLIES: PROGRAM SERVICE EXPENSES 3,279. MANAGEMENT AND GENERAL EXPENSES 777. TOTAL EXPENSES 4,056. INTER-DEPT CROSS CHARGE (OM): PROGRAM SERVICE EXPENSES 4,053. TOTAL EXPENSES 4,053. NON-HOSPITAL BUSINESS DEVELOPMENT: PROGRAM SERVICE EXPENSES 4,484. TOTAL EXPENSES 4,484. EMPLOYMENT RECRUITMENT FEES: PROGRAM SERVICE EXPENSES 1,890. TOTAL EXPENSES 1,890. MISCELLANEOUS: PROGRAM SERVICE EXPENSES -1,302. TOTAL EXPENSES -1,302. OUTSIDE MEDICAL DIRECTOR (OPO): PROGRAM SERVICE EXPENSES -41,542. TOTAL EXPENSES -41,542. INTER-DEPT CORE LAB CHARGES: PROGRAM SERVICE EXPENSES -136,601. TOTAL EXPENSES -136,601. FORM 990, PART XI, LINE 9: CHANGE IN EQUITY IN CENETRON 3,615,266. INVESTMENT IN AFFILIATE BALANCE SHEET AMOUNT -900,000. BAD DEBT RESERVE ADJUSTMENT -1,303. 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