efile Public Visual Render
ObjectId: 201911359349308376 - Submission: 2019-05-15
TIN: 39-1824445
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to
www.irs.gov/Form990
for the latest information.
OMB No. 1545-0047
20
17
Open to Public Inspection
Name of the organization
UNIVERSITY OF WISCONSIN MEDICAL
FOUNDATION INC
Employer identification number
39-1824445
Part I
Identification of Disregarded Entities
Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
Part II
Identification of Related Tax-Exempt Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13) controlled entity?
Yes
No
(1)
UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY
600 HIGHLAND AVENUE
MADISON
,
WI
53792
39-1835630
HOSPITAL AND CLINICS
WI
501(C)(3)
LINE 3
N/A
No
(2)
REGIONAL DIVISION INC
301 SOUTH WESTFIELD ROAD SUITE 320
MADISON
,
WI
53717
39-1446049
REGIONAL PARENT CORP. TO MANAGE AND DIRECT ACTIVITIES OF ENTITIES
WI
501(C)(3)
LINE 12A
UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY
Yes
(3)
UNIVERSITY HEALTH CARE INC
301 SOUTH WESTFIELD ROAD SUITE 320
MADISON
,
WI
53717
47-2553196
SUPPORT ORGANIZATION
WI
501(C)(3)
LINE 12A
UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY
Yes
(4)
SWEDISHAMERICAN HEALTH SYSTEM CORPORATION
1401 EAST STATE STREET
ROCKFORD
,
IL
61104
36-3241458
PARENT CORPORATION TO MANAGE AND DIRECT ACTIVITES OF ENTITIES
IL
501(C)(3)
LINE 12A
REGIONAL DIVISION INC
Yes
(5)
SWEDISHAMERICAN FOUNDATION
1415 EAST STATE STREET
ROCKFORD
,
IL
61104
36-3097493
SUPPORTS FUNDRAISING FOR SWEDISHAMERICAN HOSPITAL
IL
501(C)(3)
LINE 7
SWEDISHAMERICAN HOSPITAL
Yes
(6)
SWEDISHAMERICAN REALTY CORPORATION
1313 EAST STATE STREET
ROCKFORD
,
IL
61104
36-3248013
TITLE HOLDING COMPANY
IL
501(C)(2)
SWEDISHAMERICAN HEALTH SYSTEM CORPORATION
Yes
(7)
SWEDISHAMERICAN HOSPITAL SELF INSURANCE TRUST
1401 EAST STATE STREET
ROCKFORD
,
IL
61104
36-6652702
HOSPITAL MALPRACTICE TRUST
VT
501(C)(3)
LINE 12A
SWEDISHAMERICAN HOSPITAL
Yes
(8)
WISCONSIN THERAPIES INC
600 HIGHLAND AVENUE
MADISON
,
WI
53792
39-1807425
INFUSION THERAPY
WI
501(C)(3)
LINE 12D
UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY
Yes
(9)
GENERATIONS FERTILITY CARE
2365 DEMING WAY
MIDDLETON
,
WI
53562
27-3496527
REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY SERVICES
WI
501(C)(3)
LINE 10
N/A
Yes
(10)
WISCONSIN DIALYSIS
3034 FISH HATCHERY ROAD
FITCHBURG
,
WI
53713
30-0072647
DIALYSIS SERVICES
WI
501(C)(3)
LINE 12C
N/A
Yes
(11)
MADISON SURGERY CENTER
7974 UW HEALTH COURT
MIDDLETON
,
WI
53562
39-1940656
HEALTH CARE SERVICES AND TRAINING
WI
501(C)(3)
LINE 10
N/A
Yes
(12)
UW HEALTH ACO INC
7974 UW HEALTH COURT
MIDDLETON
,
WI
53562
45-5490584
ACCOUNTABLE CARE ORGANIZATION
WI
501(C)(3)
LINE 10
UNIVERSITY OF WI HOSPITAL AND CLINICS AUTHORITY
Yes
(13)
SWEDISHAMERICAN HOSPITAL
1401 EAST STATE STREET
ROCKFORD
,
IL
61104
36-2222696
HOSPITAL
IL
501(C)(3)
LINE 3
SWEDISHAMERICAN HEALTH SYSTEM CORPORATION
Yes
(14)
GUNDERSEN HEALTH PLAN INC
3190 GUNDERSEN DRIVE
ONALASKA
,
WI
54650
39-1807071
HEALTH MAINTENANCE ORGANIZATION
WI
501(C)(4)
UNIVERSITY HEALTH CARE
Yes
(15)
GUNDERSEN HEALTH PLAN MINNESOTA INC
3190 GUNDERSEN DRIVE
ONALASKA
,
WI
54650
45-2633920
HEALTH INSURANCE
WI
501(C)(4)
UNIVERSITY HEALTH CARE
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2017
Page 2
Schedule R (Form 990) 2017
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
(1)
THREE RIVERS PARTNERS LLC
1313 EAST STATE STREET
ROCKFORD
,
IL
61104
26-2231757
INFORMATION TECHNOLOGY SERVICES
IL
N/A
N/A
No
No
(2)
NORTHERN ILLINOIS VEIN CLINIC
2550 CHARLES STREET
ROCKFORD
,
IL
61108
20-1642329
OUTPATIENT HEALTH SERVICES
IL
N/A
N/A
No
No
(3)
CHARTWELL WISCONSIN ENTERPRISES LLC
2241 PINEHURST DRIVE
MIDDLETON
,
WI
53562
39-1796267
PARENT ENTITY OF CMW AND CMW-HR
WI
N/A
N/A
No
No
(4)
MADISON MEDICAL CENTER LLP
7974 UW HEALTH COURT
MIDDLETON
,
WI
53562
39-1329429
REAL ESTATE
WI
N/A
N/A
No
No
(5)
SIXTH STREET MEDICAL LLC
7974 UW HEALTH COURT
MIDDLETON
,
WI
53562
47-2705724
REAL ESTATE
WI
N/A
N/A
No
No
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
SARI INSURANCE COMPANY
76 ST PAUL STREET SUITE 500
BURLINGTON
,
VT
054014477
03-0308753
CAPTIVE INSURANCE COMPANY
VT
SAHS CORPORATION
C
Yes
(2)
STATE & CHARLES INC
1313 EAST STATE STREET
ROCKFORD
,
IL
61104
36-3321193
HOLDING COMPANY
IL
SAHS CORPORATION
C
Yes
(3)
SWEDISHAMERICAN HEALTH MANAGEMENT CORP
1401 EAST STATE STREET
ROCKFORD
,
IL
61104
36-3246511
MANAGEMENT SERVICES
IL
STATE & CHARLES INC
C
Yes
(4)
UNITY HEALTH PLANS INSURANCE CORPORATION
840 CAROLINA STREET
SAUK CITY
,
WI
53583
39-1450766
HEALTH MAINTENANCE ORGANIZATION
WI
UNIVERSITY HEALTH CARE INC
C
Yes
(5)
HEALTH PROFESSIONALS OF WISCONSIN
301 SOUTH WESTFIELD ROAD
MADISON
,
WI
53717
39-1806711
REAL ESTATE
WI
UNIVERSITY HEALTH CARE INC
C
Yes
(6)
PHYSICIAN'S CARE NETWORK
1313 EAST STATE STREET
ROCKFORD
,
IL
61104
36-3455791
HEALTH SERVICES
IL
STATE & CHARLES INC
C
Yes
(7)
QUARTZ HEALTH SOLUTIONS
840 CAROLINA STREET
SAUK CITY
,
WI
53583
46-5710709
INSURANCE
WI
UNIVERSITY HEALTH CARE INC
C
Yes
(8)
QUARTZ HOLDING COMPANY
840 CAROLINA STREET
SAUK CITY
,
WI
53583
82-1728929
HOLDING COMPANY
WI
UNIVERSITY HEALTH CARE INC
C
Yes
(9)
PHYSICIANS PLUS INSURANCE CORPORATION
840 CAROLINA STREET
SAUK CITY
,
WI
53583
39-1565691
HEALTH MAINTENANCE ORGANIZATION
WI
C
Yes
(10)
ONE SOUTH PARK CONDOMINIUM ASSOCIATION
1 SOUTH PARK STREET
MADISON
,
WI
53701
CONDOMINIUM ASSOCIATION
WI
C
Yes
Schedule R (Form 990) 2017
Page 3
Schedule R (Form 990) 2017
Page
3
Part V
Transactions With Related Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1
During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a
Receipt of
(i)
interest,
(ii)
annuities,
(iii)
royalties, or
(iv)
rent from a controlled entity
.....................
1a
Yes
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
Yes
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
Yes
d
Loans or loan guarantees to or for related organization(s)
............................
1d
No
e
Loans or loan guarantees by related organization(s)
............................
1e
No
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
Yes
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
Yes
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
Yes
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
Yes
o
Sharing of paid employees with related organization(s)
............................
1o
Yes
p
Reimbursement paid to related organization(s) for expenses
............................
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
Yes
r
Other transfer of cash or property to related organization(s)
............................
1r
No
s
Other transfer of cash or property from related organization(s)
............................
1s
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
MADISON MEDICAL CENTER LLP
K
1,818,132
FMV
(2)
MADISON MEDICAL CENTER LLP
L
114,396
FMV
(3)
MADISON SURGERY CENTER
A
1,616,623
FMV
(4)
MADISON SURGERY CENTER
C
1,400,000
FMV
(5)
MADISON SURGERY CENTER
L
918,316
FMV
(6)
MADISON SURGERY CENTER
L
877,885
FMV
(7)
MADISON SURGERY CENTER
O
6,742,755
FMV
(8)
MADISON SURGERY CENTER
P
689,796
FMV
Schedule R (Form 990) 2017
Page 4
Schedule R (Form 990) 2017
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income
(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2017
Page 5
Schedule R (Form 990) 2017
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference
Explanation
Schedule R (Form 990) 2017
Additional Data
Software ID:
Software Version: