2020-02-19T11:02:17-06:00 2019-06-30 420714325 RSM US LLP 1 S Wacker Drive Ste 800 Chicago IL 60606 990 2018-07-01 300072647 Wisconsin Dialysis Inc WISC 6082705600 3034 Fish Hatchery Road Fitchburg WI 53713 Mary Link President 6082705600 2020-02-18 1 Rebekuh Eley P01247672 3126343400 66.98.98.134 2020-02-18 18:29:01 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 64E34636FEC2DFD844E3D394C3B342543AC68841 2018 2020-09-23 17:36:50Z Mary Link 3034 Fish Hatchery Road Fitchburg WI 53713 21901708 0 X www.wisconsindialysis.org X 2002 WI 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. 5 0 0 0 0 0 50 200 18030130 17639637 140659 147336 27585 33730 18198424 17820903 4000000 0 0 0 6790810 6239292 0 0 0 7984255 10068985 18775065 16308277 -576641 1512626 16081597 18230807 807824 1195829 15273773 17034978 Wisconsin Dialysis, Inc. exists to provide In-Center, Home, and Inpatient Dialysis to patients in Central Wisconsin with End Stage Renal Disease. 0 0 13311323 17639637 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. During the June 30, 2019 period, 39,600 treatments were provided to 258 patients, with 129 in the Fitchburg clinic, 70 in the Madison East clinic, and 59 receiving home dialysis treatment. Wisconsin Dialysis also focuses 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. 13311323 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 0 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X Megan Isaacson 6082650166 3034 Fish Hatchery Road Fitchburg WI 53713 Mary Link President 0.30 40.00 X X 0 336286 89580 Ronald Schroeder Treasurer 0.50 45.00 X X 0 238105 35095 Kristine Holmes RN Director 1.00 45.00 X 0 165218 26924 Dr Jeff Pothof Director (As of 7/18) 0.30 40.00 X 0 338218 41334 Jodi Vitellio Director 0.30 40.00 X 0 317013 48565 Karil Walther VP Primary Care 0.30 40.00 X 0 233006 6841 Tami Morin Secretary 36.00 8.00 X 163727 0 44927 Diane Marie Haag Care Team Leader 32.00 8.00 X 0 156592 34817 Karen Schlageter RN Clinic Manager 32.00 8.00 X 0 144713 36733 Cheryl Bass Care Team Leader 32.00 8.00 X 0 127523 18859 Sarah Clark In Patient RN 32.00 8.00 X 0 110043 32784 Casie Adkins RN Clinic Manager 32.00 8.00 X 0 128972 36509 163727 2295689 452968 14 0 1 0 Foundation Medical Staffing 416 W 15th Street 600 Edmond OK 73013 Agency Staffing 1039727 University of Wisconsin Medical Foundati 7974 UW Health Court Middleton WI 53562 Management Fees 296472 Medefis Inc PO Box 5068 New York NY 10087 Agency Staffing 233137 Dialysis Solutions LLC 1961 Hillcrest Drive Delafield WI 53018 Repairs and Maintenance 156907 4 200 200 Outpatient Revenue 621400 16514020 16514020 Inpatient Revenue 621990 1125617 1125617 17639637 171834 171834 33730 0 33730 33730 33730 4056307 4080805 -24498 -24498 -24498 17820903 17639637 0 181066 X 4692420 3831055 861365 361227 300629 60598 844391 678189 166202 341254 283929 57325 11346 11346 4282525 2597098 1685427 54190 40608 13582 41960 16775 25185 719413 641969 77444 19300 18485 815 1603 304 1299 399510 399510 18717 18717 Pharmaceutical Supplies 2597749 2597749 Medical Supplies 1841893 1841440 453 Equipment Purchases 10843 10210 633 69936 53373 16563 16308277 13311323 2996954 0 2825819 6686440 3512774 2736772 1042590 48836 4005367 2656237 1738631 1349130 6961783 7409629 16081597 18230807 314748 251127 49809 65226 443267 879476 807824 1195829 X 15273773 17034978 15273773 17034978 16081597 18230807 1512626 248579 0 X 0 1 X 1 0 X X 3 UnityPoint Health-Meriter 390806367 3 1 0 0 Univ of WI Hospitals and Clinics Authority 391835630 6 1 0 0 Univ of WI Medical Foundation Inc 391824445 10 1 0 0 3 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 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. 2568869 1553244 1015625 1436498 1102993 333505 1349130 Due to UWHCA 879476 879476 X 18069482 248579 248579 17820903 0 17820903 16308277 0 16308277 0 16308277 Part X, Line 2: The Organization is exempt from federal income tax as an organization described in Section 501(c)(3) of the Internal Revenue Code. The Organization is also exempt from state income tax. The Organization follows guidance relative to the uncertainty in income taxes, which addresses the determination of whether tax benefits claimed or expected to be claimed on a tax return should be recorded in the financial statements. Under this guidance, the Organization may recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by taxing authorities, based on the technical merits of the position. Examples of tax positions include the tax-exempt status of the Organization, and various positions related to the potential sources of unrelated business taxable income (UBTI). Any tax benefits recognized in the financial statements from such a position are measured based on the largest benefit that has a greater than 50 percent likelihood of being realized upon ultimate settlement. 0 0 0 0 0 0 0 0 0 Mary Link President 0 273814 0 55506 0 6966 0 21725 0 67855 0 425866 0 0 Ronald Schroeder Treasurer 0 179555 0 29136 0 29414 0 9742 0 25353 0 273200 0 0 Kristine Holmes RN Director 0 150522 0 8021 0 6675 0 6785 0 20139 0 192142 0 0 Dr Jeff Pothof Director (As of 7/18) 0 338218 0 0 0 0 0 41250 0 84 0 379552 0 0 Jodi Vitellio Director 0 265010 0 50632 0 1371 0 21725 0 26840 0 365578 0 0 Karil Walther VP Primary Care 0 217984 0 15022 0 0 0 0 0 6841 0 239847 0 0 Tami Morin Secretary 145544 0 18183 0 0 0 13142 0 31785 0 208654 0 0 0 Diane Marie Haag Care Team Leader 0 154636 0 0 0 1956 0 12469 0 22348 0 191409 0 0 Karen Schlageter RN Clinic Manager 0 136101 0 7068 0 1544 0 11829 0 24904 0 181446 0 0 Casie Adkins RN Clinic Manager 0 121931 0 6206 0 835 0 10456 0 26053 0 165481 0 0 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. 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. Tami Morin spends 90% of her time carrying out the decision/director of WDI's Board of Directors. WDI incurred and paid $163,727 for her services. The remaining 10% of her time is spent working at UWHCA. WDI's highest compensated individuals with $100,000 or more reportable compensation for services provided to WDI includes Diane Marie Haag (R.N.), Karen Schlageter (R.N.), Casey Adkins (R.N.), Sarah Clark (R.N.) and Cheryl Bass (R.N.). 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 A copy of the Form 990 is emailed as an attachment to each Board Member during a brief comment period before it is filed with the IRS. 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 IX, line 11g CONSULTANT: Program service expenses 0. Management and general expenses 3,000. Fundraising expenses 0. Total expenses 3,000. UW MEDICAL FEES: Program service expenses 0. Management and general expenses 200,135. Fundraising expenses 0. Total expenses 200,135. PROFESSIONAL SERVICES-OTHER: Program service expenses 2,942. Management and general expenses 13,336. Fundraising expenses 0. Total expenses 16,278. COMMERCIAL LAB: Program service expenses 160,471. Management and general expenses 0. Fundraising expenses 0. Total expenses 160,471. MISCELLANEOUS MEDICAL: Program service expenses 115,558. Management and general expenses 0. Fundraising expenses 0. Total expenses 115,558. PURCHASE SERVICES: Program service expenses 2,318,127. Management and general expenses 1,468,956. Fundraising expenses 0. Total expenses 3,787,083. Regional Division Inc 301 S Westfield Road Suite 320 Madison WI 53717 391446049 Regional Parent Corporation to manage and direct activities of entities WI 501(c)(3) Line 12a University of WI Hospitals and Clinics Authority 1 University Health Care Inc 301 S Westfield Road Suite 320 Madison WI 53717 472553196 Support Organization WI 501(c)(3) Line 12a University of WI Hospitals and Clinics Authority 1 Generations Fertility Care 2365 Deming Way Middleton WI 53562 273496527 Reproductive Endocrinology and Infertility Services WI 501(c)(3) Line 10 N/A 1 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 N/A 1 UnityPoint Health-Meriter 202 S Park Street Madison WI 53715 390806367 Hospital WI 501(c)(3) Line 3 N/A 0 University of Wisconsin Hospitals and Clinics Authority 301 S Westfield Road Suite 320 Madison WI 53717 391835630 Hospital WI 115 N/A 0 Transformations Surgery Center 7974 UW Health Court Middleton WI 53562 391948840 Health Care Services and Training WI 501(c)(3) Line 10 N/A 1 Wisconsin Therapies Inc 600 Highland Avenue Madison WI 53792 391807425 Infusion Therapy WI 501(c)(3) Line 12a University of WI Hospitals and Clinics Authority 1 Wisconsin Sleep Inc 6001 Research Park Blvd Madison WI 53719 260902344 Health Care Services and Training WI 501(c)(3) Line 10 N/A 1 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 1 SwedishAmerican Hospital 1401 E State Street Rockford IL 61104 362222696 Hospital IL 501(c)(3) Line 3 SwedishAmerican Health System Corporation 1 SwedishAmerican Foundation 1415 E State Street Rockford IL 61104 363097493 Supporting Fundraising for SwedishAmerican Hospital IL 501(c)(3) Line 7 SwedishAmerican Hospital 1 SwedishAmerican Realty Corporation 1313 E State Street Rockford IL 61104 363248013 Title Holding Company IL 501(c)(2) SwedishAmerican Health System Corporation 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 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 1 Quartz Health Plan Corporation 840 Carolina Street Sauk City WI 53583 391807071 Health Insurance WI 501(c)(4) University Health Care Inc 1 Quartz Health Plan MN Corporation 840 Carolina Street Sauk City WI 53583 452633920 Health Insurance WI 501(c)(4) Quartz Health Plan Corporation 1 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 SARI Insurance Company 76 St Paul Street Suite 500 Burlington VT 054014477 030308753 Captive Insurance Company VT N/A C 1 State & Charles Inc 1313 E State Street Rockford IL 61104 363321193 Holding Company IL N/A C 1 SwedishAmerican Health Management Corp 1401 E State Street Rockford IL 61104 363246511 Management Services IL N/A C 1 Physician's Care Network 1313 E State Street Rockford IL 61104 363455791 Health Services IL N/A C 1 Unity Health Insurance 840 Carolina Street Sauk City WI 53583 391450766 Health Maintenance Organization WI N/A C 1 Health Professionals of Wisconsin 301 S Westfield Road Madison WI 53717 391806711 Real Estate WI N/A C 1 Quartz Holding Company 840 Carolina Street Sauk City WI 53583 821728929 Holding Company WI N/A C 1 Quartz Health Solutions Inc 840 Carolina Street Sauk City WI 53583 465710709 Insurance WI N/A C 1 Physicians Plus Insurance Corporation 840 Carolina Street Sauk City WI 53583 391565691 Health Maintenance Organization WI N/A C 1 One South Park Condominium Association 1 South Park Street Madison WI 53701 Condominium Association WI N/A C 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0