2017-11-15T16:01:37-06:00 2016-12-31 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2016-01-01 472553196 University Health Care Inc UNIV 6082637923 301 S Westfield Road No 320 Madison WI 53717 Michael E Dallman President 6082637923 2017-11-15 1 Wayne Harder P00294296 3126343400 108.171.131.187 2017-11-15 16:01:32 CS P 4B8E1423B9F197D509CCF13AB357181C17C415CB 37AB53F3E1FE5B259FEACB8EAA64376B229EE5AE 2016 2021-01-29 14:40:06Z Michael E Dallman 301 S Westfield Road No 320 Madison WI 53717 298068419 0 X N/A X 2014 WI Furthering the service, instruction, and research mission of the University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospitals and Clinics, and the University of Wisconsin Medical Foundation. 6 0 0 0 970680 301594 74781457 21075000 259544439 275903384 1078 5068 1472065 1084967 335799039 298068419 5475 0 0 0 0 0 0 0 0 262024784 275278901 262030259 275278901 73768780 22789518 89625995 112259887 20162916 30326902 69463079 81932985 Furthering the service, instruction, and research mission of the University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, and the University of Wisconsin Medical Foundation. 0 0 252825561 252826486 Payments to providers for care of patients under managed care contracting arrangements. These arrangements assist the University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, and University of Wisconsin Medical Foundation in obtaining access to sufficient patient populations essential to fulfilling their instruction and research missions. 6936216 19899327 Furthering the service, instruction, and research mission of the University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, and University of Wisconsin Medical Foundation (collectively, UW Health) by developing and enhancing relationships with regional physicians, hospitals, and other health care providers, bringing programs and clinical centers for the specialty health care services of UW Health to regional communities, and facilitating communication between the regional health care resources and UW Health. 4893173 4262538 e-Care of Wisconsin, LLC, a single member limited liability company, provides remote monitoring services of patients in intensive care units of customer hospitals to further the instruction, research, and service mission of the University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, and University of Wisconsin Medical Foundation. 264654950 1 1 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X 6 0 1 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Heather Apfelbeck 6082628061 301 S Westfield Road Suite 350 Madison WI 53717 Michael Dallman President/Director 55.00 0.00 X X 438524 0 77493 Robert O'Keefe Past Director 2.00 55.00 X 0 786305 81387 Stephanie Orzechoweski Vice President 55.00 0.00 X 246591 0 36485 Kenneth Mount Secretary 2.00 55.00 X X 0 221249 36840 Robert N Golden MD Director 2.00 55.00 X 0 706247 98722 Bob Flannery Director 2.00 55.00 X 0 647067 60182 Ronald Sliwinski Director 2.00 55.00 X 0 1070999 126701 Alan Kaplan Director 2.00 55.00 X 0 860741 137165 685115 4292608 654975 13 0 1 0 Hogan Lovells 105 E Jefferson Boulevard South Bend IN 46601 Legal 1185159 Wyntec Consulting LLC 4207 Chrismac Way Colleyville TX 76034 Data Consulting 1067388 AE Business Solutions 2310 Crossroads Drive Madison WI 53718 I.T. Soultions 970935 Mile Bluff Medical Center 1050 Division Street Madison WI 53948 Healthcare 306750 Healtheos by Multiplan PO Box 29940 New York NY 10087 Data Management 304800 16 21075000 21075000 Capitation Fees 524292 252826486 252826486 Program and Support Revenues 621300 16950268 16950268 Monitoring Fees 621300 4262538 4262538 Cancer Center Affiliate 621500 1864092 1864092 275903384 5068 5068 Administrative Revenue 621300 64625 11825 52800 1020342 102462 917880 1084967 298068419 276017671 970680 5068 1809012 1809012 666018 666018 4447004 1070869 3376135 17727 17431 296 97725 77418 20307 146813 83243 63570 708829 400843 307986 139666 85364 54302 41507 27486 14021 306 306 1220941 271781 949160 5411 2399 3012 Capitation Costs 252825561 252825561 Contracted Svcs-Affil. 10506430 7681910 2824520 Equip. Rental & Maint. 664986 377047 287939 1980965 1733598 247367 275278901 264654950 10623951 0 2036790 4390228 20465592 31747703 379988 425756 8625372 6979238 4041814 1646134 60012724 71360979 2689087 2689087 89625995 112259887 19757285 30326902 354103 0 51528 0 20162916 30326902 X 69463079 81932985 69463079 81932985 89625995 112259887 X 22789518 -1162942 -9156670 X 0 1 X 1 0 X X 3 University of Wisconsin School of Medicine and Public Health 391805963 6 0 0 0 University of Wisconsin Hospitals and Clinics 391835630 3 0 112572120 0 University of Wisconsin Medical Foundation 391824445 9 0 154488085 0 3 267060205 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 FORM 990, SCHEDULE A, PART I Payments to our supported organizations include payments to providers for care of patients under managed care contracting arrangements, and reimbursement for expense items paid by them on behalf of University Health Care, Inc. These items include, but are not limited to, salaries, wages and benefits of UHC staff; professional service expenses; facility rent and fees, and equipment rental and maintenance costs. FORM 990, SCHEDULE A, PART IV, SECTION A, LINE 2 Per IRC Section 509(a)(1) and under section 170(b)(1)(a)(v) as defined in section 170(c)(1), governmental entities like the University of Wisconsin School of Medicine and Public Health are deemed to be public charities. FORM 990, SCHEDULE A, PART IV, SECTION B, LINE 1 The business and affairs of the corporation shall be managed by the board of directors. The number of the directors shall be seven. All of who serve ex-officio (based on their role with the following organizations), include from the supported organizations UWMF (1), UWHCA (2), UWSMPH (2), and UW Health (1). The president of the filing organization serves as the seventh director. If vacancy exists in any such position, the person acting in such a position shall serve as a director until such time as the position is filled. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1339 1339 0 8491635 6881035 1610600 132398 96864 35534 1646134 Investment in Health Professionals of Wisconsin 3438244 C Investment in Unity Health Plans Insurance Corporation 67800750 C Investment in e-Care of Wisconsin, LLC 121985 C 71360979 X 276086201 -1162942 255724 -907218 276993419 21075000 21075000 298068419 275278901 0 275278901 0 275278901 Part X, Line 2: University Health Care, Inc. (UHC) is exempt from income tax, though it is subject to tax on income unrelated to its exempt purposes, unless that income is otherwise excluded by the internal revenue code (the code). UHC files a federal informational return each year. UHC files a federal and state income tax return due to unrelated business income. Calendar years 2013, 2014, and 2015 are open to examination under federal and state statute of limitations. e-Care is a wholly-owned disregarded entity of UHC. As such, e-Care does not have a federal or a state income tax filing requirement. The company recognizes the financial statement benefit of a tax position only after determining that the relevant tax authority would more likely than not sustain the position following an audit. For tax positions meeting the more-likely-than-not threshold, the amount recognized in the financial statements is the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement with the relevant tax authority. The company has applied the uncertain tax position guidance to all tax positions for which the statute of limitations remained open. There are no material unrecognized tax benefits taken or expected to be taken in a tax return that have been recorded on the company's financial statements for the year ended December 31, 2016. As it was determined that all tax positions taken meet the more likely than not threshold. The company 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 year ended December 31, 2016. Part XI, Line 2d - Other Adjustments: Investment Income - HPW, Inc. 129,153. Investment Income - Unity 597,452. Investment Income - e-Care -630,635. Other Investment Income 159,754. Part XI, Line 4b - Other Adjustments: Net Asset Contribution 21,075,000. 1 1 0 0 0 0 0 0 0 Michael Dallman President/Director 362132 0 39174 0 37218 0 58970 0 18523 0 516017 0 0 0 Robert O'Keefe Past Director 0 531392 0 51638 0 203275 0 66570 0 14817 0 867692 0 0 Stephanie Orzechoweski Vice President 210019 0 18678 0 17894 0 18196 0 18289 0 283076 0 0 0 Kenneth Mount Secretary 0 217925 0 0 0 3324 0 17872 0 18968 0 258089 0 0 Robert N Golden MD Director 0 697496 0 0 0 8751 0 75295 0 23427 0 804969 0 0 Bob Flannery Director 0 590225 0 50625 0 6217 0 34851 0 25331 0 707249 0 0 Ronald Sliwinski Director 0 849734 0 114750 0 106515 0 105670 0 21031 0 1197700 0 0 Alan Kaplan Director 0 779011 0 65625 0 16105 0 125670 0 11495 0 997906 0 0 Part I, Lines 4a-b Line 4a: In 2016, the following individual received severance conmpensation: - Robert O'Keefe $83,578 Line 4b: Several members of the Board participate in supplemental, non-qualified retirement plans through their employers, who are "related organizations to the filing entity. Those individuals particpate in a 457(f) plan. In 2016, the following employer contributions were made: - Ronald Sliwinski $85,000 - Alan Kaplan $105,000 - Michael Dallman $38,300 - Robert O'Keefe $45,900 In 2016, the following distributions from the 457(f) plan were made and reported in Part II, (B)(iii): - Ronald Sliwinski $50,315 - Robert O'Keefe $95,888 Form 990, Part VI, Section A, line 2 Ronald Sliwinski and Michael Dallman have a business relationship. Form 990, Part VI, Section A, line 6 The organization has two members: University of Wisconsin Medical Foundation, Inc. and University of Wisconsin Hospitals and Clinics Authority. Form 990, Part VI, Section A, line 7b Each member shall be entitled to one vote on any matter submitted to a vote of the members. Two members shall constitute a quorum at a meeting of members. Certain actions, including amendments to the bylaws and entity dissolution, require affirmative vote of the members. Form 990, Part VI, Section B, line 11b Form 990 is prepared by the independent accounting firm RSM US LLP and then reviewed by the member's financial officer and Directors of finance. The full board is provided a copy of the form 990 prior to filing. Form 990, Part VI, Section B, line 12c All board members and management staff complete a disclosure questionnaire annually. Any disclosure noted are reviewed by the board. Form 990, Part VI, Section B, line 15 All wages are paid by the supported organizations which are: University of Wisconsin Hospital and Clinics and University of Wisconsin Medical Foundation. The CEO and VP's compensation is discussed and reviewed with the Board in an executive session by the Director of compensation and benefits for UW Hospitals and Clinics (the employer of record). Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy and financial statements are made available to the public upon request for the same period of disclosure as set forth in IRC section 6104(d). Requests can be made by mailing University Health Care, Inc., c/o Heather Apfelbeck, 301 S. Westfield Road, Suite 350, Madison, WI 53717. Form 990, Part XI, line 9: Investment Income from HPW, Inc., Unity, e-Care, and other 255,724. Equity Interest in Income of Joint Ventures -9,412,394. e-Care of Wisconsin LLC 301 S Westfield Road Suite 3 Madison WI 53717 262921480 Hospital Care WI 630635 207148 UHC UW School of Medicine and Public Health 600 Highland Avenue Madison WI 53792 391805963 School WI 501(c)(3) 06 N/A 0 University of WI Hospital and Clinics 600 Highland Avenue Madison WI 53792 391835630 Hospital WI 501(c)(3) 03 N/A 0 University of WI Medical Foundation 600 Highland Avenue Madison WI 53792 391824445 Supported Organization WI 501(c)(3) 09 N/A 0 Regional Division Inc 301 S Westfield Road Madison WI 53717 391446049 Supported Organization WI 501(c)(3) 11-I N/A 0 Health Professionals of Wisconsin Inc 301 S Westfield Road Suite 1320 Madison WI 53717 391806711 REAL ESTATE WI UHC C 515017 3572756 1.00000 1 Unity Health Plans Insurance Corporation 840 Carolina Street Sauk City WI 53583 391450766 HMO WI UHC C 9727017 69856809 0.75000 1 0 0 1 0 0 0 0 0 0 0 1 1 0 1 1 1 1 0 0 Health Profesionals of Wisconsin Inc L 52800 Intercompany Account Unity Health Plans Insurance Corporation L 252826486 Intercompany Account Unity Health Plans Insurance Corporation L 917880 Intercompany Account