2019-05-15T15:34:41-05:00 2018-06-30 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2017-07-01 391824445 UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION INC UNIV 6082657131 7974 UW HEALTH COURT MIDDLETON WI 53562 ROBERT W FLANNERY SVP/CFO 6088214220 2019-05-15 1 REBEKUH ELEY P01247672 3126343400 66.98.98.9 2019-05-15 09:26:16 CD P F6217F2D6ED5C2D75B43E0AF4E216B671259B073 2A28FA2E2A09A40AF4F0A751499BE74D16D20E85 2017 2019-02-21 02:37:17Z ALAN KAPLAN MD 7974 UW HEALTH COURT MIDDLETON WI 53562 976477217 0 X WWW.UWHEALTH.ORG X 1996 WI UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION (UWMF) SUPPORTS THE TEACHING, RESEARCH AND SERVICE MISSIONS OF THE UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE AND PUBLIC HEALTH BY PROMOTING THE DELIVERY OF EXCELLENT AND INNOVATIVE PATIENT CARE BY FACULTY AND STAFF WHO SERVE LOCAL, REGIONAL, NATIONAL AND INTERNATIONAL POPULATIONS. 14 3 5147 3 7305533 1666029 96330345 110594924 756188951 823831517 6709217 38476219 2927152 3562596 862155665 976465256 64756105 68154517 0 0 540735903 581220486 0 0 0 243417867 258759151 848909875 908134154 13245790 68331102 566190196 561949168 262903667 217958406 303286529 343990762 X UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION (UWMF) SUPPORTS THE TEACHING, RESEARCH AND SERVICE MISSIONS OF THE UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE AND PUBLIC HEALTH BY PROMOTING THE DELIVERY OF EXCELLENT AND INNOVATIVE PATIENT CARE BY FACULTY AND STAFF WHO SERVE LOCAL, REGIONAL, NATIONAL AND INTERNATIONAL POPULATIONS. 0 0 115751116 35439686 0 FUNDING ALLOCATED TO PROVIDE MEDICAL EDUCATION FOR THE BENEFIT OF, AND IN SUPPORT OF, THE PURPOSE OF THE UW MEDICAL SCHOOL AND PUBLIC HEALTH. 26205022 26205022 0 FUNDING ALLOCATED TO PROVIDE MEDICAL RESEARCH FOR THE BENEFIT OF, AND IN SUPPORT OF, THE PURPOSE OF THE UW MEDICAL SCHOOL AND PUBLIC HEALTH. 741619140 5537087 816525984 FUNDING ALLOCATED TO PROVIDE HEALTHCARE FOR THE BENEFIT OF, AND IN SUPPORT OF, THE PURPOSE OF THE UW MEDICAL SCHOOL AND PUBLIC HEALTH. 972722 972722 0 OTHER PROGRAM REVENUE AND EXPENSES ALLOCATED TO PROVIDE MEDICAL EDUCATION FOR THE BENEFIT OF AND IN SUPPORT OF THE PURPOSE OF THE UW MEDICAL SCHOOL AND PUBLIC HEALTH. 972722 972722 0 884548000 1 1 0 1 0 0 0 0 0 0 1 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 251 0 1 5147 1 1 1 0 0 0 0 0 0 0 0 0 X 14 3 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 IL WI X ROBERT W FLANNERY SVPCFO 6088214220 7974 UW HEALTH COURT MIDDLETON WI 53562 JENNIFER ALEXANDER DIRECTOR 1.00 X 0 0 0 RONALD ANDERSON DIRECTOR 1.00 X 0 0 0 PATRICIA BRADY DIRECTOR 1.00 X 0 0 0 SANDRA KAMNETZ MD DIRECTOR (AS OF 1/1/18) 1.00 39.00 X 231050 72048 54090 JON MATSUMURA MD DIRECTOR (UNTIL 12/31/17) 1.00 39.00 X 593911 150878 58013 STEPHEN NAKADA MD DIRECTOR 1.00 39.00 X 604039 229270 55463 RICHARD PAGE MD DIRECTOR 1.00 39.00 X 541365 220246 56463 J CARTER RALPHE MD DIRECTOR 1.00 39.00 X 228120 113168 45582 LAUREL RICE MD DIRECTOR 1.00 39.00 X 518077 171998 55463 DEBORAH RUSY MD MBA DIRECTOR 1.00 39.00 X 407552 74432 54090 ELIZABETH TROWBRIDGE MD DIRECTOR 1.00 39.00 X 209198 108685 53223 FREDERICK WENZEL DIRECTOR (UNTIL 5/23/18) 1.00 X 0 0 0 TERRY YOUNG MD MBA DIRECTOR 1.00 39.00 X 420085 180730 55463 ALAN KAPLAN MD UWH CEO 40.00 X X 0 1387139 161292 NIZAR JARJOUR MD PRESIDENT OF FOUNDATION 39.00 1.00 X X 372388 210851 109530 ROBERT FLANNERY SVP & CFO 40.00 X X 622795 0 103958 THERESA HOTTENROTH SECRETARY 40.00 X 196690 0 44112 KELSIE DOTY TREASURER 40.00 X 241058 0 49629 PETER NEWCOMER MEDICAL DIRECTOR 1.00 39.00 X 456027 108185 108443 JONATHAN JAFFERY MD MEDICAL DIRECTOR 1.00 39.00 X 238118 127367 91150 GEOFFREY S BAER MD PHD PHYSICIAN 39.00 1.00 X 1267142 61357 54090 MUSTAFA BASKAYA MD PHYSICIAN 39.00 1.00 X 1088470 69079 54090 ROBERT DEMPSEY MD PHYSICIAN 39.00 1.00 X 920966 166368 54059 DAVID NIEMANN MD PHYSICIAN 39.00 1.00 X 1226009 56926 54090 NILTO C DE OLIVEIRA MD PHYSICIAN 39.00 1.00 X 907454 32647 54090 PETER CHRISTMAN FORMER OFFICER 0.00 0.00 X 460233 0 708 11750747 3541374 1427091 1369 1 1 0 ENVIRONMENT CONTROL OF WISCONSIN INC 2902 AGRICULTURE DR MADISON WI 53718 CUSTODIAL SERVICES 1454694 EPIC SYSTEMS CORPORATION PO BOX 88314 MILWAUKEE WI 53288 HEALTH RECORD CONSULTING 1244885 ADVISORY BOARD COMPANY PO BOX 79461 BALTIMORE MD 21279 BEST PRACTICES CONSULTING 1014500 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 LOCUM PHYSICIANS 879162 COMPHEALTH INC PO BOX 972651 DALLAS TX 75397 LOCUM PHYSICIANS 653303 130 110594924 110594924 PATIENT SERVICES 621111 569566089 569566089 PREMIUM REVENUE 900099 218281284 218281284 35984144 28678611 7305533 823831517 4429933 4429933 3274688 11961 3262727 3262727 3262727 33924785 121501 0 0 33924785 121501 34046286 34046286 299869 299869 299869 976465256 816525984 7305533 42038815 68154517 68154517 5880472 4125785 1754687 504129931 483973596 20156335 13899406 13899406 34264214 34264214 23046463 23046463 43340475 42632439 708036 130772 130772 139928 139928 102267 102267 997575 997575 4172920 4172920 2749705 2749705 21333386 21333386 470561 470561 5375984 5375984 594129 594129 7792635 7792635 1253176 1253176 REIMB. OF MED SCHOOL EX 101205577 101205577 DRUGS AND PATIENT CARE 45528099 45528099 BAD DEBT EXPENSE 7639537 7639537 15932425 15932425 908134154 884548000 23586154 0 145270621 124669928 73020990 90400711 4629490 3955241 33993491 41926651 178561536 98632503 86969606 79929033 176387218 173310040 45821508 47665390 97272 92174 566190196 561949168 204694933 184568406 34175000 31390000 24033734 2000000 262903667 217958406 X 303286529 343990762 303286529 343990762 566190196 561949168 X 68331102 -26936869 -690000 X 0 1 X 1 0 X 54241924 57193313 78422871 96330345 110594924 396783377 658892013 700536394 713369590 750377423 817469698 3640645118 713133937 757729707 791792461 846707768 928064622 4037428495 0 0 0 4037428495 10221619 6735997 6358434 6320733 7826122 37462905 10221619 6735997 6358434 6320733 7826122 37462905 337265 337265 181069 138579 266645 283859 299869 1170021 723873890 764604283 798417540 853312360 936190613 4076398686 0.99040 0.98980 0.00920 0.00980 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER NON-PROGRAM REVENUE - 2013 AMOUNT: $ 181,069. 2014 AMOUNT: $ 138,579. 2015 AMOUNT: $ 266,645. 2016 AMOUNT: $ 283,859. 2017 AMOUNT: $ 299,869. 0 1 0 0 0 1 102267 0 0 0 102267 0 PART II-B, LINE 1: REPRESENTS THE PORTION OF THE DUES PAID TO STATE AND NATIONAL MEDICAL SOCIETIES FOR LOBBYING TOTALING $102,267. 9376347 9376347 92460540 39896522 52564018 13546989 7914741 5632248 62195111 50821240 11373871 982549 982549 79929033 WISCONSIN SLEEP, INC. 1750045 C GENERATIONS FERTILITY CARE, INC. 346383 C MADISON SURGERY CENTER 5940098 C MERITER PHYSICIAN CONTRACTING 24844 C WISCONSIN DIALYSIS, INC. 1367759 C TRANSFORMATION SURGERY CENTER, INC. 1366557 C UNIVERSITY HEALTH CARE, INC. 32370965 C CHARTWELL WISCONSIN ENTERPRISES, LLC 4365753 C UW HEALTH ACCOUNTABLE CARE ORG. 132986 C 47665390 DUE TO CARBONE CANCER CENTER 2000000 2000000 799029000 -26936868 -8329537 -35266405 834295405 142169851 142169851 976465256 758325000 0 758325000 149809154 149809154 908134154 PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -7,639,537. EQUITY IN EARNINGS OF JOINT VENTURES -690,000. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTED REVENUE PRESENTED NET OF EXPENSE 110,594,924. PROGRAM SERVICE REVENUE PRESENTED NET OF EXPENSE 30,904,455. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF BAD DEBT EXPENSES 7,639,537. FASB TO GASB CONVERSION 670,238. CONTRIBUTED REVENUE PRESENTED NET OF EXPENSE 110,594,924. PROGRAM SERVICE REVENUE PRESENTED NET OF EXPENSE 30,904,455. 1 ACCESS COMMUNITY HEALTH CENTER 2202 PARK STREET MADISON WI 53713 391391134 501(C)(3) 731497 SUPPORT FUNCTIONS OF THE ORGANIZATION AMERICAN FAMILY CHILDREN'S HOSPITAL 600 HIGHLAND AVENUE MADISON WI 53792 391835630 501(C)(3) 8425 SUPPORT FUNCTIONS OF THE ORGANIZATION AMERICAN HEART ASSOCIATION INC 2850 DAIRY DRIVE STE 300 MADISON WI 53718 135613797 501(C)(3) 9000 SUPPORT FUNCTIONS OF THE ORGANIZATION FRIENDS OF THE UW HOSPITALS AND CLINICS 301 S WESTFIELD ROAD STE 250 MADISON WI 53717 510137187 501(C)(3) 87800 SUPPORT FUNCTIONS OF THE ORGANIZATION HEALTHY CLASSROOMS FOUNDATION PO BOX 260199 MADISON WI 537265336 263490947 501(C)(3) 6000 SUPPORT FUNCTIONS OF THE ORGANIZATION JUVENILE DIABETES RESEARCH FOUNDATION 434 S YELLOWSTONE DRIVE STE 201 MADISON WI 53719 231907729 501(C)(3) 7500 SUPPORT FUNCTIONS OF THE ORGANIZATION MEDICAL STUDENTS FOR CHOICE PO BOX 40935 PHILADELPHIA PA 19107 205263777 501(C)(3) 5000 SUPPORT FUNCTIONS OF THE ORGANIZATION NATIONAL ALLIANCE ON MENTAL ILLNESS 3803 N FAIRFAX DRIVE STE 100 ARLINGTON VA 22203 431201653 501(C)(3) 10000 SUPPORT FUNCTIONS OF THE ORGANIZATION ORTHOPAEDIC RESEARCH AND EDUCATION FOUNDATION 6300 N RIVER ROAD STE 700 ROSEMONT IL 60019 366009467 501(C)(3) 30000 SUPPORT FUNCTIONS OF THE ORGANIZATION UNIVERSITY HEALTH CARE INC 301 S WESTFIELD ROAD STE 250 MADISON WI 53717 391446049 501(C)(3) 2067449 SUPPORT FOR CONTRACT MANAGEMENT UNIVERSITY OF WISCONSIN FOUNDATION 1848 UNIVERSITY AVENUE MADISON WI 53708 390743975 501(C)(3) 26218372 RESEARCH SUPPORT UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY 600 HIGHLAND AVENUE MADISON WI 53792 391835630 501(C)(3) 5000 SUPPORT FUNCTIONS OF THE ORGANIZATION UW HOUSE STAFF ASSOCIATION PO BOX 45373 MADISON WI 53744 540162532 501(C)(3) 11000 SUPPORT FUNCTIONS OF THE ORGANIZATION UW SCHOOL OF MEDICINE AND PUBLIC HEALTH 750 HIGHLAND AVENUE MADISON WI 53705 396006492 STATE OF WISCONSIN 35439686 SUPPORT FUNCTIONS OF THE MEDICAL SCHOOL WISCONSIN ALLIANCE FOR WOMEN'S HEALTH PO BOX 1726 MADISON WI 53701 800287566 501(C)(3) 5000 SUPPORT FUNCTIONS OF THE ORGANIZATION WISCONSIN TECHNOLOGY INNOVATION INNITIATIVE 301 S BEDFORD STREET SUITE 1 MADISON WI 53713 455205182 501(C)(3) 50000 SUPPORT FUNCTIONS OF THE ORGANIZATION WISCONSIN WOMEN'S HEALTH FOUNDATION 2503 TODD DRIVE MADISON WI 53713 391900678 501(C)(3) 6500 SUPPORT FUNCTIONS OF THE ORGANIZATION 17 0 PART I, LINE 2: THE GRANT SCHEDULE FOR UW SCHOOL OF MEDICINE IS BASED ON A 3 YEAR AGREEMENT AT A FIXED AMOUNT. UWMF MAKES A CONTRIBUTION TO UW FOUNDATION FOR R&D OF 2.5% OF PROFESSIONAL REVENUES WHICH IS PART OF ITS BYLAWS. A MONTHLY RECONCILIATION IS PERFORMED BY REVIEWING THE PROFESSIONAL REVENUES AND PERFORMING THE CALCULATION FOR R&D. THE DISCREPANCIES ARE GIVEN TO THE DEPARTMENTS FOR REVIEW AND FUNDS ARE ADJUSTED ON THE FOLLOWING MONTH'S TRANSFER. THE FIXED AMOUNTS ARE REVIEWED MONTHLY TO CONFIRM TRANSFERS TO CONTRACTS AND BUDGET. ANY DISCREPANCIES ARE ADJUSTED IN THE FOLLOWING MONTH. UNIVERSITY HEALTHCARE INC. SUPPORT IS BASED ON THEIR ANNUAL BUDGET. X 1 1 X X X 1 1 0 0 0 0 0 0 0 SANDRA KAMNETZ MD DIRECTOR (AS OF 1/1/18) 231050 72048 0 0 0 0 54000 0 90 0 285140 72048 0 0 JON MATSUMURA MD DIRECTOR (UNTIL 12/31/17) 593911 150878 0 0 0 0 54000 0 4013 0 651924 150878 0 0 STEPHEN NAKADA MD DIRECTOR 604039 229270 0 0 0 0 54000 0 1463 0 659502 229270 0 0 RICHARD PAGE MD DIRECTOR 541365 220246 0 0 0 0 54000 0 2463 0 597828 220246 0 0 J CARTER RALPHE MD DIRECTOR 228120 113168 0 0 0 0 45492 0 90 0 273702 113168 0 0 LAUREL RICE MD DIRECTOR 518077 171998 0 0 0 0 54000 0 1463 0 573540 171998 0 0 DEBORAH RUSY MD MBA DIRECTOR 407552 74432 0 0 0 0 54000 0 90 0 461642 74432 0 0 ELIZABETH TROWBRIDGE MD DIRECTOR 206876 108685 0 0 2322 0 51840 0 1383 0 262421 108685 0 0 TERRY YOUNG MD MBA DIRECTOR 420085 180730 0 0 0 0 54000 0 1463 0 475548 180730 0 0 ALAN KAPLAN MD UWH CEO 0 1066937 0 315000 0 5202 0 126870 0 34422 0 1548431 0 0 NIZAR JARJOUR MD PRESIDENT OF FOUNDATION 310018 210851 62370 0 0 0 109440 0 90 0 481918 210851 0 0 ROBERT FLANNERY SVP & CFO 555603 0 60775 0 6417 0 72672 0 31286 0 726753 0 0 0 THERESA HOTTENROTH SECRETARY 183968 0 9044 0 3678 0 23849 0 20263 0 240802 0 0 0 KELSIE DOTY TREASURER 189448 0 11429 0 40181 0 30851 0 18778 0 290687 0 0 0 PETER NEWCOMER MEDICAL DIRECTOR 396424 108185 59603 0 0 0 106980 0 1463 0 564470 108185 0 0 JONATHAN JAFFERY MD MEDICAL DIRECTOR 196425 127367 41693 0 0 0 91060 0 90 0 329268 127367 0 0 GEOFFREY S BAER MD PHD PHYSICIAN 1267142 61357 0 0 0 0 54000 0 90 0 1321232 61357 0 0 MUSTAFA BASKAYA MD PHYSICIAN 1088470 69079 0 0 0 0 54000 0 90 0 1142560 69079 0 0 ROBERT DEMPSEY MD PHYSICIAN 920966 166368 0 0 0 0 54000 0 59 0 975025 166368 0 0 DAVID NIEMANN MD PHYSICIAN 1226009 56926 0 0 0 0 54000 0 90 0 1280099 56926 0 0 NILTO C DE OLIVEIRA MD PHYSICIAN 907454 32647 0 0 0 0 54000 0 90 0 961544 32647 0 0 PETER CHRISTMAN FORMER OFFICER 0 0 0 0 460233 0 0 0 708 0 460941 0 0 0 PART I, LINE 1A UWMF REIMBURSES CHAIRS AND THE DEAN OF THE MEDICAL SCHOOL FOR THE BUSINESS USE OF THEIR SOCIAL CLUB DUES. AS A BUSINESS EXPENSE, AMOUNTS ARE NOT TAXABLE. PART I, LINES 4A-B PER THE TERMS OF SEVERANCE AGREEMENT BETWEEN THE ORGANIZATION AND PETER CHRISTMAN HE RECEIVED A SEVERANCE PAYMENT THAT WAS TREATED AS TAXABLE AND INCLUDED ON SCHEDULE J, PART II, COLUMN (B)(III). UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION PROVIDES CERTAIN EXECUTIVES DISCLOSED ON FORM 990, PART VII AND SCHEDULE J, PART III A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. AMOUNTS ARE CREDITED TO EACH PARTICIPANTS' ACCOUNTS EACH YEAR. PLAN AMOUNTS ARE SUBJECT TO FORFEITURE OR PAYMENT ONLY IF CERTAIN CONDITIONS ARE MET, AS OUTLINED IN THE PLAN AGREEMENT. NO AMOUNTS BECAME VESTED OR WERE PAID IN CALENDAR YEAR 2017. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS THE UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER OF THE ORGANIZATION HAS THE OVERALL RIGHTS TO GOVERN, DIRECT, AND OVERSEE THE PROPERTY, FUNDS, BUSINESS, AND AFFAIRS OF THE ORGANIZATION EXCEPT WHEN RESERVED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS COMPLETED BY THE ORGANIZATION'S EXTERNAL ACCOUNTING FIRM. UPON COMPLETION, THE PROGRAM DIRECTOR OF FINANCIAL REPORTING REVIEWS THE RETURN AND WORKPAPERS. ONCE THAT IS COMPLETE, THE RETURN IS THEN FORWARDED TO THE SR. VP/CFO AND VP OF FINANCE FOR REVIEW. WHEN ALL REVIEWERS HAVE DETERMINED THAT FORM 990 IS COMPLETE AND ACCURATE, THE RETURN IS PROVIDED TO THE MEMBERS OF THE BOARD OF DIRECTORS. AFTER THEY HAVE HAD TIME TO REVIEW, THE RETURN IS SUBMITTED FOR FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE COMPLIANCE AND LEGAL DEPARTMENT REVIEWS CONFLICT OF INTEREST FORMS. IF POTENTIAL CONFLICTS ARE FOUND, THERE IS A DISCUSSION BETWEEN LEGAL SERVICES, THE CAO, AND THE INDIVIDUAL. THE COMPLIANCE DEPARTMENT ISSUES QUESTIONNAIRES ANNUALLY AND THERE IS 100% COMPLIANCE IN RESPONDING. IF THERE IS A CONFLICT, THE FIX IS TO RECUSE ONESELF FROM ANY VOTE. IF IT IS A SENSITIVE MATTER, THE FIX IS TO RECUSE ONESELF FROM THE DISCUSSION AND THE VOTE. THE CONFLICT OF INTEREST POLICY PROVIDES A PROCESS FOR BOTH VOLUNTARY AND INVOLUNTARY RECUSAL. FORM 990, PART VI, SECTION B, LINE 15 A COMPENSATION REVIEW COMMITTEE (CRC) HAS BEEN ESTABLISHED. THE COMMITTEE SHALL CONSIST EXCLUSIVELY OF THE PUBLIC DIRECTORS. THE CRC SHALL ACT IN ACCORDANCE WITH THE FOUNDATION'S COMPENSATION PRINCIPLES AND POLICY. THE COMMITTEE SHALL MAKE FINAL DECISIONS ON SUCH MATTERS AFTER SATISFYING ITSELF THAT THE STANDARDS SET IN THE FOUNDATION'S COMPENSATION PRINCIPLES AND POLICY HAVE BEEN MET. THE COMMITTEE MAY REQUEST ADDITIONAL DATA OR INFORMATION PRIOR TO APPROVING MATTERS WITHIN ITS JURISDICTION. THE CRC SHALL TAKE FINAL ACTION TO APPROVE OR DISAPPROVE ALL FOUNDATION AND DEPARTMENTAL COMPENSATION FORMULAE AND POLICY. THE COMMITTEE ENGAGES AN INDEPENDENT COMPENSATION CONSULTANT TO REVIEW PHYSICIAN COMPENSATION. OUTLIERS IDENTIFIED ARE SUBSTANTIATED. A PRESENTATION IS MADE TO THE CRC FOR APPROVAL. EXECUTIVE COMPENSATION IS BASED ON COMPARATIVE DATA WITH LIKE POSITIONS WITHIN THE MARKET. THE COMPENSATION FOR PRESIDENT, CAO, AND ALL VICE PRESIDENTS IS PRESENTED TO THE COMPENSATION COMMITTEE ANNUALLY. THIS COMMITTEE IS COMPRISED OF THE UWMF'S PUBLIC BOARD MEMBERS. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS, BYLAWS, ARTICLES, CONFLICT OF INTEREST POLICIES, TAX RETURNS, AND FORM 1023 ARE AVAILABLE UPON REQUEST FROM THE CORPORATE OFFICE FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN IRC SECTION 6104(D). FORM 990, PART XI, LINE 9: REVENUE FROM UNCONSOLIDATED ENTITIES -690,000. UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY 600 HIGHLAND AVENUE MADISON WI 53792 391835630 HOSPITAL AND CLINICS WI 501(C)(3) LINE 3 N/A 0 REGIONAL DIVISION INC 301 SOUTH WESTFIELD ROAD SUITE 320 MADISON WI 53717 391446049 REGIONAL PARENT CORP. TO MANAGE AND DIRECT ACTIVITIES OF ENTITIES WI 501(C)(3) LINE 12A UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY 1 UNIVERSITY HEALTH CARE INC 301 SOUTH WESTFIELD ROAD SUITE 320 MADISON WI 53717 472553196 SUPPORT ORGANIZATION WI 501(C)(3) LINE 12A UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY 1 SWEDISHAMERICAN HEALTH SYSTEM CORPORATION 1401 EAST STATE STREET ROCKFORD IL 61104 363241458 PARENT CORPORATION TO MANAGE AND DIRECT ACTIVITES OF ENTITIES IL 501(C)(3) LINE 12A REGIONAL DIVISION INC 1 SWEDISHAMERICAN FOUNDATION 1415 EAST STATE STREET ROCKFORD IL 61104 363097493 SUPPORTS FUNDRAISING FOR SWEDISHAMERICAN HOSPITAL IL 501(C)(3) LINE 7 SWEDISHAMERICAN HOSPITAL 1 SWEDISHAMERICAN REALTY CORPORATION 1313 EAST STATE STREET ROCKFORD IL 61104 363248013 TITLE HOLDING COMPANY IL 501(C)(2) SWEDISHAMERICAN HEALTH SYSTEM CORPORATION 1 SWEDISHAMERICAN HOSPITAL SELF INSURANCE TRUST 1401 EAST STATE STREET ROCKFORD IL 61104 366652702 HOSPITAL MALPRACTICE TRUST VT 501(C)(3) LINE 12A SWEDISHAMERICAN HOSPITAL 1 WISCONSIN THERAPIES INC 600 HIGHLAND AVENUE MADISON WI 53792 391807425 INFUSION THERAPY WI 501(C)(3) LINE 12D UNIVERSITY OF WI HOSPITAL 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 WISCONSIN DIALYSIS 3034 FISH HATCHERY ROAD FITCHBURG WI 53713 300072647 DIALYSIS SERVICES WI 501(C)(3) LINE 12C N/A 1 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 UW HEALTH ACO INC 7974 UW HEALTH COURT MIDDLETON WI 53562 455490584 ACCOUNTABLE CARE ORGANIZATION WI 501(C)(3) LINE 10 UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY 1 SWEDISHAMERICAN HOSPITAL 1401 EAST STATE STREET ROCKFORD IL 61104 362222696 HOSPITAL IL 501(C)(3) LINE 3 SWEDISHAMERICAN HEALTH SYSTEM CORPORATION 1 GUNDERSEN HEALTH PLAN INC 3190 GUNDERSEN DRIVE ONALASKA WI 54650 391807071 HEALTH MAINTENANCE ORGANIZATION WI 501(C)(4) UNIVERSITY HEALTH CARE 1 GUNDERSEN HEALTH PLAN MINNESOTA INC 3190 GUNDERSEN DRIVE ONALASKA WI 54650 452633920 HEALTH INSURANCE WI 501(C)(4) UNIVERSITY HEALTH CARE 1 THREE RIVERS PARTNERS LLC 1313 EAST STATE STREET ROCKFORD IL 61104 262231757 INFORMATION TECHNOLOGY SERVICES IL N/A N/A 0 0 NORTHERN ILLINOIS VEIN CLINIC 2550 CHARLES STREET ROCKFORD IL 61108 201642329 OUTPATIENT HEALTH SERVICES IL N/A N/A 0 0 CHARTWELL WISCONSIN ENTERPRISES LLC 2241 PINEHURST DRIVE MIDDLETON WI 53562 391796267 PARENT ENTITY OF CMW AND CMW-HR WI N/A N/A 0 0 MADISON MEDICAL CENTER LLP 7974 UW HEALTH COURT MIDDLETON WI 53562 391329429 REAL ESTATE WI N/A N/A 0 0 SIXTH STREET MEDICAL LLC 7974 UW HEALTH COURT MIDDLETON WI 53562 472705724 REAL ESTATE WI N/A N/A 0 0 SARI INSURANCE COMPANY 76 ST PAUL STREET SUITE 500 BURLINGTON VT 054014477 030308753 CAPTIVE INSURANCE COMPANY VT SAHS CORPORATION C 1 STATE & CHARLES INC 1313 EAST STATE STREET ROCKFORD IL 61104 363321193 HOLDING COMPANY IL SAHS CORPORATION C 1 SWEDISHAMERICAN HEALTH MANAGEMENT CORP 1401 EAST STATE STREET ROCKFORD IL 61104 363246511 MANAGEMENT SERVICES IL STATE & CHARLES INC C 1 UNITY HEALTH PLANS INSURANCE CORPORATION 840 CAROLINA STREET SAUK CITY WI 53583 391450766 HEALTH MAINTENANCE ORGANIZATION WI UNIVERSITY HEALTH CARE INC C 1 HEALTH PROFESSIONALS OF WISCONSIN 301 SOUTH WESTFIELD ROAD MADISON WI 53717 391806711 REAL ESTATE WI UNIVERSITY HEALTH CARE INC C 1 PHYSICIAN'S CARE NETWORK 1313 EAST STATE STREET ROCKFORD IL 61104 363455791 HEALTH SERVICES IL STATE & CHARLES INC C 1 QUARTZ HEALTH SOLUTIONS 840 CAROLINA STREET SAUK CITY WI 53583 465710709 INSURANCE WI UNIVERSITY HEALTH CARE INC C 1 QUARTZ HOLDING COMPANY 840 CAROLINA STREET SAUK CITY WI 53583 821728929 HOLDING COMPANY WI UNIVERSITY HEALTH CARE INC C 1 PHYSICIANS PLUS INSURANCE CORPORATION 840 CAROLINA STREET SAUK CITY WI 53583 391565691 HEALTH MAINTENANCE ORGANIZATION WI C 1 ONE SOUTH PARK CONDOMINIUM ASSOCIATION 1 SOUTH PARK STREET MADISON WI 53701 CONDOMINIUM ASSOCIATION WI C 1 1 1 1 0 0 0 0 0 0 1 1 1 0 1 1 1 1 0 0 MADISON MEDICAL CENTER LLP K 1818132 FMV MADISON MEDICAL CENTER LLP L 114396 FMV MADISON SURGERY CENTER A 1616623 FMV MADISON SURGERY CENTER C 1400000 FMV MADISON SURGERY CENTER L 918316 FMV MADISON SURGERY CENTER L 877885 FMV MADISON SURGERY CENTER O 6742755 FMV MADISON SURGERY CENTER P 689796 FMV