Wisconsin Dialysis Inc: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- Wisconsin Dialysis Inc (EIN 30-0072647)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2017-12-08
- IRS object ID
- 201723429349300602
- Schema version
- 2016v3.0
- 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 | 2017-12-08T08:35:52-06:00 | ReturnTs |
| Tax Period End | 2017-06-30 | 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 | 1 S WACKER DRIVE STE 800 | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60606 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | 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 | Madison | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 537133125 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Mark A Hamilton | PersonNm |
| Person Title | Executive Director and Secretary | PersonTitleTxt |
| Phone | 6082705600 | PhoneNum |
| Signature | 2017-12-05 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Wayne Harder | PreparerPersonNm |
| PTIN | P00294296 | PTIN |
| Phone | 3126343400 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 108.171.131.186 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-12-05 | IPDt |
| IP Tm | 08:59:50 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 273CC9BE664104F25245DA4E4D67715D8D253944 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 4B8E1423B9F197D509CCF13AB357181C17C415CB | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Mark A Hamilton | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3034 Fish Hatchery Road | AddressLine1Txt |
| City | Madison | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 537133125 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $20,725,077 | 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 |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 5 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,998 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,700 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,857,899 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $18,718,811 | CYProgramServiceRevenueAmt |
| PY Investment Income | $24,603 | PYInvestmentIncomeAmt |
| CY Investment Income | $118,339 | CYInvestmentIncomeAmt |
| PY Other Revenue | $28,092 | PYOtherRevenueAmt |
| CY Other Revenue | $30,677 | CYOtherRevenueAmt |
| PY Total Revenue | $17,912,592 | PYTotalRevenueAmt |
| CY Total Revenue | $18,870,527 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $2,000,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,360,840 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,984,538 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,278,615 | PYOtherExpensesAmt |
| CY Other Expenses | $6,995,292 | CYOtherExpensesAmt |
| PY Total Expenses | $13,639,455 | PYTotalExpensesAmt |
| CY Total Expenses | $15,979,830 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,273,137 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,890,697 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $14,085,740 | TotalAssetsBOYAmt |
| Total Assets EOY | $16,844,007 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $868,594 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $841,218 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $13,217,146 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,002,789 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Wisconsin Dialysis, Inc. exists to provide In-Center, Home, and Inpatient Dialysis to patients in Central Wisconsin with End Stage Renal Disease. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $14,087,904 | ExpenseAmt |
| Grant | $2,000,000 | GrantAmt |
| Revenue | $18,718,811 | 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. During the June 30, 2017 period, 41,378 treatments were provided to 275 patients, with 142 in the Fitchburg clinic, 78 in the Madison East clinic, and 55 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. | Desc |
| Total Program Service Expenses | $14,087,904 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| 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 | 0 | UnrelatedBusIncmOverLimitInd |
| 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 |
| 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 | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Megan Isaacson | PersonNm |
| Phone | 6082650166 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3034 Fish Hatchery Road | AddressLine1Txt |
| City | Madison | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 537133125 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Kristine Holmes RN | ||||||||
| President | 1.00 | 45.00 | Yes (X) | Yes (X) | $0 | $175,255 | $28,885 | |
| Ronald Schroeder | ||||||||
| Treasurer (As of 9/4/16) | 0.50 | 45.00 | Yes (X) | Yes (X) | $0 | $195,073 | $29,836 | |
| Robert O'Keefe | ||||||||
| Treasurer (Until 9/3/16) | 0.50 | 40.00 | Yes (X) | Yes (X) | $0 | $585,258 | $90,235 | |
| Chris Green MD | ||||||||
| Director | 0.30 | 40.00 | Yes (X) | $0 | $361,211 | $53,090 | ||
| Jodi Vitellio | ||||||||
| Director | 0.30 | 40.00 | Yes (X) | $0 | $191,479 | $40,818 | ||
| Mary Link | ||||||||
| Director (As of March 2017) | 0.30 | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| Steven Means | ||||||||
| Director (Until 9/12/16) | 0.30 | 40.00 | Yes (X) | $0 | $321,728 | $66,033 | ||
| Mark A Hamilton | ||||||||
| Executive Director and Secretary | 44.00 | 11.00 | Yes (X) | $0 | $281,750 | $50,915 | ||
| Michelle Walker RN | ||||||||
| Clinical Nurse Manager | 32.00 | 8.00 | $0 | $122,379 | $29,837 | Yes (X) | ||
| Karen Schlageter RN | ||||||||
| Clinic Manager | 32.00 | 8.00 | $0 | $114,902 | $33,884 | Yes (X) | ||
| Xinliu Meyer RN | ||||||||
| Clinical Nurse Specialist | 32.00 | 8.00 | $0 | $102,779 | $30,274 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,451,814 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $453,807 | 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 (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Foundation Medical Staffing | |||||
| 416 West 15th Street 600 | Edmond | OK | 73013 | Agency Staffing | $692,879 |
| JH Findorff & Son Inc | |||||
| 300 South Bedford Street | Madison | WI | 53703 | Construction Contractor | $478,812 |
| Medefis Inc | |||||
| 2121 North 117th Avenue Ste 200 | Omaha | NE | 68164 | Agency Staffing | $198,223 |
| Ascend Clinical LLC | |||||
| 1400 Industrial Way | Redwood City | CA | 94063 | Medical Lab Testing | $184,440 |
| Dialysis Solutions LLC | |||||
| 1961 Hillcrest Drive | Delafield | WI | 53018 | Repairs and Maintenance | $150,998 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $2,700 | AllOtherContributionsAmt |
| Total Contributions | $2,700 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Outpatient Revenue | 621400 | $18,091,577 | $18,091,577 |
| Inpatient Revenue | 621990 | $627,234 | $627,234 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $18,718,811 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $126,114 | TotalRevenueColumnAmt |
| Exclusion | $126,114 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $30,677 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $30,677 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,677 | TotalRevenueColumnAmt |
| Exclusion | $30,677 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,846,775 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,854,550 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$7,775 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$7,775 | TotalRevenueColumnAmt |
| Exclusion | -$7,775 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,870,527 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,718,811 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $149,016 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,000,000 | TotalAmt |
| Program Services | $2,000,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $253,295 | TotalAmt |
| Program Services | $209,449 | ProgramServicesAmt |
| Management And General | $43,846 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,977,172 | TotalAmt |
| Program Services | $4,111,303 | ProgramServicesAmt |
| Management And General | $865,869 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $391,184 | TotalAmt |
| Program Services | $322,416 | ProgramServicesAmt |
| Management And General | $68,768 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $987,040 | TotalAmt |
| Program Services | $830,223 | ProgramServicesAmt |
| Management And General | $156,817 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $375,847 | TotalAmt |
| Program Services | $315,192 | ProgramServicesAmt |
| Management And General | $60,655 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $284,431 | TotalAmt |
| Management And General | $284,431 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,735 | TotalAmt |
| Management And General | $10,735 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,478,318 | TotalAmt |
| Program Services | $1,268,580 | ProgramServicesAmt |
| Management And General | $209,738 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,883 | TotalAmt |
| Program Services | $80,512 | ProgramServicesAmt |
| Management And General | $13,371 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,652 | TotalAmt |
| Program Services | $15,706 | ProgramServicesAmt |
| Management And General | $42,946 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $636,568 | TotalAmt |
| Program Services | $587,351 | ProgramServicesAmt |
| Management And General | $49,217 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,570 | TotalAmt |
| Program Services | $16,566 | ProgramServicesAmt |
| Management And General | $9,004 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,922 | TotalAmt |
| Program Services | $358 | ProgramServicesAmt |
| Management And General | $6,564 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $367,324 | TotalAmt |
| Program Services | $367,324 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,844 | TotalAmt |
| Management And General | $39,844 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Pharmaceutical Supplies | $2,216,515 | $2,216,515 | |
| Medical Supplies | $1,637,859 | $1,637,328 | $531 |
| Equipment Purchases | $81,266 | $71,301 | $9,965 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,405 | TotalAmt |
| Program Services | $37,780 | ProgramServicesAmt |
| Management And General | $19,625 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,979,830 | TotalAmt |
| Program Services | $14,087,904 | ProgramServicesAmt |
| Management And General | $1,891,926 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,862,769 | BOYAmt |
| EOY | $5,569,621 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,286,551 | BOYAmt |
| EOY | $2,152,563 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,427 | BOYAmt |
| EOY | $61,676 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,279,342 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,258,239 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,887,045 | BOYAmt |
| EOY | $2,021,103 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,000,018 | BOYAmt |
| EOY | $7,039,044 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,930 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,085,740 | BOYAmt |
| EOY | $16,844,007 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $223,119 | BOYAmt |
| EOY | $184,464 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,316 | BOYAmt |
| EOY | $19,745 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $626,159 | BOYAmt |
| EOY | $637,009 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $868,594 | BOYAmt |
| EOY | $841,218 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,217,146 | BOYAmt |
| EOY | $16,002,789 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,217,146 | BOYAmt |
| EOY | $16,002,789 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,085,740 | BOYAmt |
| EOY | $16,844,007 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,890,697 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$105,054 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| 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) | $900,000 | $0 |
| Univ of WI Hospitals and Clinics Authority | ||||
| 391835630 | 6 | Yes (1) | $900,000 | $0 |
| Univ of WI Medical Foundation Inc | ||||
| 391824445 | 10 | Yes (1) | $200,000 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 3 | SupportedOrganizationsTotalCnt |
| Support Sum | $2,000,000 | 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
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,601,315 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,189,368 | DepreciationAmt |
| Book Value | $1,411,947 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,678,027 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,068,871 | DepreciationAmt |
| Book Value | $609,156 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,021,103 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due to UWHCA | Desc |
| Amt | $637,009 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $637,009 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $18,765,473 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$105,054 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$105,054 | RevenueNotReportedAmt |
| Revenue Subtotal | $18,870,527 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $18,870,527 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,979,830 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $15,979,830 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $15,979,830 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | 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 (UBIT). 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. | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| UnityPoint Health-Meriter | |||||||
| 202 S Park Street | Madison | WI | 537151596 | 390806367 | 501(c)(3) | $900,000 | Dialysis Services |
| University of Wisconsin Hospitals and Clinics Authority | |||||||
| 301 S Westfield Road | Madison | WI | 53717 | 391835630 | 115 | $900,000 | Dialysis Services |
| University of Wisconsin Medical Foundation | |||||||
| 7974 UW Health Court | Middleton | WI | 53562 | 391824445 | 501(c)(3) | $200,000 | Dialysis Services |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 3 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | The Organization is a supporting organization and provides support in direct furtherance of the dialysis services provided by the member supported organizations. The Board of Directors of the Organization is composed of individuals from the three supported organizations and grant funds are monitored and applied through this oversight structure. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | 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 (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Kristine Holmes RN | ||||||||||||||
| President | $0 | $149,427 | $0 | $18,707 | $0 | $7,121 | $0 | $7,187 | $0 | $21,698 | $0 | $204,140 | $0 | $0 |
| Ronald Schroeder | ||||||||||||||
| Treasurer (As of 9/4/16) | $0 | $157,068 | $0 | $31,065 | $0 | $6,940 | $0 | $8,024 | $0 | $21,812 | $0 | $224,909 | $0 | $0 |
| Robert O'Keefe | ||||||||||||||
| Treasurer (Until 9/3/16) | $0 | $330,345 | $0 | $51,638 | $0 | $203,275 | $0 | $66,570 | $0 | $23,665 | $0 | $675,493 | $0 | $95,888 |
| Chris Green MD | ||||||||||||||
| Director | $0 | $305,168 | $0 | $56,043 | $0 | $0 | $0 | $53,000 | $0 | $90 | $0 | $414,301 | $0 | $0 |
| Jodi Vitellio | ||||||||||||||
| Director | $0 | $182,380 | $0 | $8,216 | $0 | $883 | $0 | $15,162 | $0 | $25,656 | $0 | $232,297 | $0 | $0 |
| Steven Means | ||||||||||||||
| Director (Until 9/12/16) | $0 | $280,236 | $0 | $34,299 | $0 | $7,193 | $0 | $34,851 | $0 | $31,182 | $0 | $387,761 | $0 | $0 |
| Mark A Hamilton | ||||||||||||||
| Executive Director and Secretary | $0 | $246,160 | $0 | $22,097 | $0 | $13,493 | $0 | $20,670 | $0 | $30,245 | $0 | $332,665 | $0 | $0 |
| Michelle Walker RN | ||||||||||||||
| Clinical Nurse Manager | $0 | $118,987 | $0 | $2,720 | $0 | $672 | $0 | $9,785 | $0 | $20,052 | $0 | $152,216 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Lines 4a-b | FormAndLineReferenceDesc |
| Explanation | Robert O'Keefe received a severance payment in the amount of $83,578 during 2016, following the System-wide merger and reorganization. Robert O'Keefe participated in a 457(f) deferred compensation plan through a related organization. During 2016, $45,900 UWHCA contributed to the 457(f) plan. Also during 2016, $95,888 distributions were paid from the 457(f) plan. The distribution is reported within taxable compensation on Schedule J, Part II, column B(iii). | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. Mark A. Hamilton spends 80% of his time carrying out the decision/director of WDI's Board of Directors. WDI incurred and paid $253,295 for his services. The remaining 20% of his time is spent working at UWHCA. WDI's highest compensated individuals with $100,000 or more reportable compensation for services provided to WDI includes Michelle Walker (R.N.), Karen Schlageter (R.N.), and Xinliu Meyer (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). |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (11 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 | |||||||||||
| 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 | 0 | |
| 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 | 0 | |
| Generations Fertility Care | |||||||||||
| 2365 Deming Way | Middleton | WI | 53562 | 273496527 | Reproductive Endocrinology and Infertility Services | WI | 501(c)(3) | Line 10 | 0 | 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 | 0 | 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 | 0 | N/A | |
| Wisconsin Therapies Inc | |||||||||||
| 600 Highland Avenue | Madison | WI | 53792 | 391807425 | Infusion Therapy | WI | 501(c)(3) | Line 12d | University of WI Hospitals and Clinics Authority | 0 | |
| Wisconsin Sleep Inc | |||||||||||
| 6001 Research Park Blvd | Madison | WI | 53719 | 260902344 | Health Care Services and Training | WI | 501(c)(3) | Line 10 | 0 | 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 | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Predominant Income TypePredominantIncomeTypeTxt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Madison Medical Center LLP | |||||||||||
| 7974 UW Health Court | Middleton | WI | 53562 | 391329429 | Specialized Medical Center | WI | N/A | N/A | 0 | 0 | |
| Chartwell Wisconsin Enterprises LLC | |||||||||||
| 2241 Pinehurst Drive | Middleton | WI | 53562 | 391796267 | Infusion Therapy | WI | N/A | N/A | 0 | 0 | |
| Sixth Street Medical LLC | |||||||||||
| 7974 UW Health Court | Middleton | WI | 53562 | 472705724 | Lease and Rental Services | WI | N/A | 0 | 0 | University of Wisconsin Medical Foundation | |
| Meriter UW Physician Contracting Company LLC | |||||||||||
| 202 S Park Street | Madison | WI | 53715 | 391998819 | Health Services | WI | N/A | N/A | 0 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | 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 |