2024-05-07T09:35:16-05:00 2023-06-30 420714325 RSM US LLP 30 South Wacker Dr Suite 3300 Chicago IL 60606 990 2022-07-01 363241458 SwedishAmerican Health System Corp SWED 7796964009 1401 E State Street Rockford IL 61104 Patricia DeWane VP, CFO & Treasurer 7796964727 2024-05-02 1 Patricia DeWane 999009999 1 Rebekuh Eley P01247672 3126343400 2024-05-02 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Travis Andersen 1313 E State Street Rockford IL 61104 85163 0 X www.uwhealth.org X 1982 IL Through excellence in healthcare and compassionate service, we care for our community. 14 9 0 13 0 0 0 0 0 0 0 0 116722 85163 116722 85163 0 0 0 0 0 0 0 0 0 1145353 1228453 1145353 1228453 -1028631 -1143290 40131758 39669975 7681911 8448581 32449847 31221394 Through excellence in healthcare and compassionate service, we care for our community. 0 0 1198861 0 85163 Regional Division, Inc. is the parent corporation of SwedishAmerican Health System Corporation. SwedishAmerican Health System Corporation is the parent corporation of SwedishAmerican Hospital, SwedishAmerican Foundation, SwedishAmerican Self Insurance Trust and SwedishAmerican Realty Corporation, which are exempt organizations. SwedishAmerican Health System Corporation is also the parent of State & Charles, Inc. and SARI Insurance Company (disclosed on Schedule R) which are for profit entities. The purpose of SwedishAmerican Health System Corporation is to manage and direct the activities of these entities. 1198861 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 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 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL X Patricia DeWane 7796964009 1313 East State Street Rockford IL 61104 Elizabeth Bolt Director 2.00 55.00 X 0 1822826 203857 Peter D Newcomer MD MMM Director 2.00 55.00 X 0 940501 181791 Travis Andersen President & CEO 2.00 46.00 X X 0 1014145 85450 Allen D Williams MD Director 2.00 44.00 X 0 333058 64753 Tiffanie Ferry MD Director (until 12/31/22) 2.00 44.00 X 0 229949 54345 Jeffrey J Kaney Sr Chmn of the Board (until 8/31/22) 2.00 6.00 X X 0 0 0 Daniel T Ross Chmn of the Board (as of 9/1/22) 2.00 8.00 X X 0 0 0 Eric Fulcomer PhD 1st Vice Chmn/Secy (until 12/31/22) 2.00 8.00 X X 0 0 0 Jeffrey S Hultman 1st Vice Chmn/Secy (as of 1/1/23) 2.00 8.00 X X 0 0 0 Thomas R Walsh Audit/Compliance Chairman 2.00 6.00 X 0 0 0 Patrick T Derry Quality/Safety Chmn (until 12/31/22) 2.00 6.00 X 0 0 0 Anqunette Parham Director 2.00 6.00 X 0 0 0 Frank E Walter Director 2.00 6.00 X 0 0 0 Helen Chung Hill Director 2.00 6.00 X 0 0 0 Kathleen Kelly MD Director 2.00 6.00 X 0 0 0 Michael Broski Director 2.00 6.00 X 0 0 0 Marco T Lenis Director 2.00 6.00 X 0 0 0 Steven C Sjogren Director 2.00 6.00 X 0 0 0 Patricia DeWane VP, CFO, & Treasurer 2.00 46.00 X 0 566671 62593 Timothy Flynn MD President, SA Medical Group 2.00 44.00 X 0 515532 56805 Ann Gantzer VP Patient Svcs/CNO (until 9/23/22) 2.00 44.00 X 0 487186 37870 Julia Zimmerman VP Strategic Growth 2.00 44.00 X 0 343935 63293 Sal Ababneh COO & President of UWNI Hospitals 2.00 44.00 X 0 314281 46068 William Mewes Interim VP Patient Services & CNO 2.00 44.00 X 0 210358 51968 Rosa Jeschke VP Human Resources 2.00 44.00 X 0 176285 20093 James Cole DO VP Medical Affairs/CMO 2.00 44.00 X 0 304466 60956 Thomas O'Connor Former President & CEO 0.00 0.00 X 0 761147 0 Michael Polizzotto Former CMO/CIO 0.00 0.00 X 0 491231 55683 Jedediah Cantrell Former VP Operations 0.00 0.00 X 0 150775 9592 Celia Shaughnessy Former VP Human Resources 0.00 0.00 X 0 105800 0 0 8768146 1055117 0 1 1 0 0 Three Rivers Partners, 518210 85163 85163 85163 85163 85163 0 0 29592 29592 37165 37165 26 26 Organizational Costs 1161670 1161670 1228453 1198861 29592 0 461983 200 37996757 37996757 1673018 1673018 40131758 39669975 7681911 8448581 7681911 8448581 X 32449847 31221394 32449847 31221394 40131758 39669975 X -1143290 -85163 X 0 1 X 1 0 X X 3 SwedishAmerican Hospital 362222696 3 1 0 0 SwedishAmerican Health Foundation 363097493 7 1 0 0 Regional Division Inc 391446049 3 1 0 0 3 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 Investment in State & Charles, Inc. 37996757 C 37996757 Due to Affiliates 8448581 8448581 X Part X, Line 2: SwedishAmerican Health System Corporation has received a determination letter from the Internal Revenue Service (IRS) stating it is tax-exempt under Section 501(c)(3) of the Code. SwedishAmerican Health System Corporation files a Form 990 (Return of Organization Exempt from Income Tax). When this return is filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to health systems include such matters as the following: tax-exempt status of each entity, the nature, characterization and taxability of joint venture income and various positions relative to potential sources of unrelated business taxable income (UBTI). UBTI is reported on Internal Revenue Service Form 990-T, as appropriate. The benefit of a tax position is recognized in the consolidated financial statements in the period during which, based on all available evidence, management believes that it is more likely than not that the tax position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. Tax positions are not offset or aggregated with other positions. Tax positions that meet the "more likely than not" recognition threshold are measured as the largest amount of tax benefit that is more than 50% likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with the tax positions taken that exceeds the amount measured as described above is reflected as a liability for unrecognized tax benefits in the accompanying consolidated balance sheets along with any associated interest and penalties that would be payable to the taxing authorities upon examination. At June 30, 2023 and 2022, there were no unrecognized tax benefits identified or recorded as liabilities. The Forms 990 filed by the Corporation are subject to examination for up to three years from the extended due date of each return. These returns are no longer subject to examination for tax years ended before June 30, 2020. X X X X 1 1 0 0 0 0 0 0 0 Elizabeth Bolt Director 0 962880 0 406895 0 453051 0 165875 0 37982 0 2026683 0 432157 Peter D Newcomer MD MMM Director 0 602328 0 338173 0 0 0 180355 0 1436 0 1122292 0 0 Travis Andersen President & CEO 0 685014 0 210627 0 118504 0 60071 0 25379 0 1099595 0 0 Thomas O'Connor Former President & CEO 0 50986 0 0 0 710161 0 0 0 0 0 761147 0 0 Patricia DeWane VP, CFO, & Treasurer 0 384070 0 177799 0 4802 0 54710 0 7883 0 629264 0 0 Timothy Flynn MD President, SA Medical Group 0 375489 0 109771 0 30272 0 48610 0 8195 0 572337 0 0 Michael Polizzotto Former CMO/CIO 0 371875 0 29711 0 89645 0 18453 0 37230 0 546914 0 88726 Ann Gantzer VP Patient Svcs/CNO (until 9/23/22) 0 262925 0 136116 0 88145 0 5902 0 31968 0 525056 0 86178 Julia Zimmerman VP Strategic Growth 0 244658 0 82585 0 16692 0 19896 0 43397 0 407228 0 14725 Allen D Williams MD Director 0 325237 0 5600 0 2221 0 24400 0 40353 0 397811 0 0 James Cole DO VP Medical Affairs/CMO 0 304466 0 0 0 0 0 60893 0 63 0 365422 0 0 Sal Ababneh COO & President of UWNI Hospitals 0 208532 0 40000 0 65749 0 19878 0 26190 0 360349 0 0 Tiffanie Ferry MD Director (until 12/31/22) 0 209627 0 10000 0 10322 0 15062 0 39283 0 284294 0 0 William Mewes Interim VP Patient Services & CNO 0 194886 0 15472 0 0 0 13766 0 38202 0 262326 0 0 Rosa Jeschke VP Human Resources 0 171122 0 0 0 5163 0 13963 0 6130 0 196378 0 0 Jedediah Cantrell Former VP Operations 0 59096 0 0 0 91679 0 438 0 9154 0 160367 0 91176 Celia Shaughnessy Former VP Human Resources 0 105800 0 0 0 0 0 0 0 0 0 105800 0 0 Part I, Line 3 All compensation is determined by the Executive Compensation Committee of SwedishAmerican Health System Corporation and is paid by SwedishAmerican Hospital. All compensation decisions are made by independent persons. With respect to the President & CEO and other Officers, SwedishAmerican Health System Corporation follows a compensation approval procedure annually that involves approval of proposed and final compensation arrangements by SwedishAmerican Health System Corporation's Executive Compensation Committee using comparability data, as well as contemporaneous documentation of compensation decisions in the minutes. Part I, Lines 4a-b Severance payments during 2022 include: Tom O'Connor - $710,161. These payments are reported as taxable compensation on Part II, column (B)(iii). Contributions to the 457(f) plan during 2022 include: Peter Newcomer - $119,355; Elizabeth Bolt - $143,610; Travis Andersen - $59,719; Patricia DeWane - $30,310; Timothy Flynn MD -$24,210; Sal Ababneh - $19,878; Rosa Jeschke - $13,963. Payments from the 457(f) plan during 2022 include: Elizabeth Bolt - $432,157; Michael Polizzotto - $88,726; Ann Gantzer - $86,178; Julia Zimmerman - $14,725; Jedediah Cantrell - $91,176. These payments are reported as taxable income on Part II, column (B) (iii). Part II, Column F: The amounts shown in column F were reported as deferred compensation in prior years but paid out in the current year. The amounts are also included in column (B) (iii). Form 990, Part VI, Section A, line 6 The sole corporate member of the organization is Regional Division, Inc. Form 990, Part VI, Section A, line 7a Regional Division, Inc. as the sole corporate member shall have powers and voting rights to approve and remove Directors on the Board. Form 990, Part VI, Section A, line 7b Regional Division, Inc. as the sole corporate member shall have powers and voting rights to do the following: - Approval and removal of the President/CEO of the organization; - Approval of the Corporation's strategic plans, annual budgets and quality and safety measures; - Approval of annual unbudgeted capital expenditures above $100,000 for new lines of business, above $250,000 for existing lines of business and any such cumulative expenditures exceeding $1,000,000 per year; - Approval of changes to the organizational documents and changes that would affect the organization's not-for-profit and/or tax-exempt status; - Approval of all plans of mergers or consolidations of the organization; or the sale, lease, exchange, mortgage, pledge or other disposition of all or substantially all of the assets of the organization; or a voluntary dissolution of the organization; - Approve all of the Contracts of Indebtedness that exceed $1,000,000 in principal amount or that are effective for longer than 60 months; all accounting policies and financial auditors; contracts with competitors of UHC, the University of Wisconsin Hospitals and Clinics Authority, or the organization that could result in a Material Adverse Effect; and compliance policies. - Creation and dissolution of any operating units, or Subsidiaries of the organization, and approval of clinical service acquisition, addition, or elimination. Form 990, Part VI, Section B, line 11b A draft version of the Form 990 was reviewed by the Chief Financial Officer. The entire Board of Directors was provided with a copy of the Form 990 before it was filed. Form 990, Part VI, Section B, line 12c SAHS regularly and consistently monitors and enforces compliance with its conflict of interest policies, which apply to all members of the Board of Directors and to all employees. Procedures are in place to identify conflicts of both directors and employees. Director conflicts are handled by Board deliberation and Board vote from which the interested director is excluded. Employee conflicts are handled by the Compliance Department and in certain instances may require separate Board action. The Board is provided with periodic compliance reports regarding conflicts of interest. Form 990, Part VI, Section B, line 15 All compensation is determined by the Executive Compensation Committee of SwedishAmerican Health System Corporation and is paid by SwedishAmerican Hospital. All compensation decisions are made by independent persons. With respect to the President & CEO and other Officers, SwedishAmerican Health System Corporation follows a compensation approval procedure annually that involves approval of proposed and final compensation arrangements by SwedishAmerican Health System Corporation's Executive Compensation Committee using comparability data, as well as contemporaneous documentation of compensation decisions in the minutes. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements have not been made available to the public. The consolidated audited financial statements of SwedishAmerican Health System, which includes SwedishAmerican Health System Corporation, are available upon request. Form 990, Part XI, line 9: Book/Tax Difference Joint Venture -85,163. Generations Fertility Care 2365 Deming Way Middleton WI 53562 273496527 Reproductive endocrinology and infertility services WI 501(c)(3) Line 10 N/A 0 Isthmus Project Inc 600 Highland Avenue Madison WI 53792 832278676 Research and innovation WI 501(c)(3) Line 12a, I University of WI Hospital and Clinics Authority 0 Madison Surgery Center 7974 UW Health Court Middleton WI 53562 391940656 Health care services and training WI 501(c)(3) Line 10 N/A 0 Regional Division Inc 7974 UW Health Court No MC1020 Middleton WI 53562 391446049 Regional Parent Corp. to manage and direct activities of entities WI 501(c)(3) Line 12a, I University of WI Hospital and Clinics Authority 0 SwedishAmerican Health Foundation 1415 E State Street Rockford IL 61104 363097493 Supports fundraising for SwedishAmerican Hospital IL 501(c)(3) Line 7 SwedishAmerican Health System Corporation 1 SwedishAmerican Hospital 1401 E State Street Rockford IL 61104 362222696 Hospital IL 501(c)(3) Line 3 SwedishAmerican Health System Corporation 1 SwedishAmerican Hospital Self Insurance Trust 1401 E State Street Rockford IL 61104 366652702 Hospital Malpractice Trust VT 501(c)(3) Line 12a, I SwedishAmerican Hospital 1 SwedishAmerican Realty Corporation 1313 E State Street Rockford IL 61104 363248013 Title Holding Company IL 501(c)(2) SwedishAmerican Health System Corporation 1 University Health Care Inc 7974 UW Health Court Middleton WI 53562 472553196 Support Organization WI 501(c)(3) Line 12a, I University of WI Hospital and Clinics Authority 0 University of Wisconsin Hospital and Clinics Authority 7974 UW Health Court Middleton WI 53562 391835630 Hospital and Clinics WI 501(c)(3) Line 3 N/A 0 University of Wisconsin Medical Foundation 7974 UW Health Court Middleton WI 53562 391824445 Physician Services WI 501(c)(3) Line 10 University of WI Hospital and Clinics Authority 0 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 0 Wisconsin Therapies Inc 7974 UW Health Court Middleton WI 53562 391807425 Infusion Therapy WI 501(c)(3) Line 12a, I University of WI Hospital and Clinics Authority 0 Three Rivers Partners LLC 1313 East State Street Rockford IL 61104 262231757 Information Technology Services IL SAHS Corporation Related 85163 3137999 0 1 0.50000 Chartwell Wisconsin Enterprises LLC 2241 Pinehurst Drive Middleton WI 53562 391796267 Parent Entity of CW 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 Northern Illinois Vein Clinic 2550 Charles St Rockford IL 61108 201642329 Outpatient Health Services IL 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 Physician's Care Network 1313 East State Street Rockford IL 61104 363455791 Health Services IL N/A C 1 Quartz Health Benefit Plans Corporation 840 Carolina Street Sauk City WI 53583 391450766 Health Maintenance Organization WI N/A C 0 Quartz Health Insurance Corporation 840 Carolina Street Sauk City WI 53583 391565691 Health Maintenance Organization WI N/A C 0 Quartz Health Solutions Inc 840 Carolina Street Sauk City WI 53583 465710709 Insurance WI N/A C 0 Quartz Holding Company 840 Carolina Street Sauk City WI 53583 821728929 Holding Company WI N/A C 0 SARI Insurance Company 76 St Paul Street Suite 500 Burlington VT 054014477 030308753 Captive Insurance Company VT SAHS Corporation C 1.00000 1 State & Charles Inc 1313 East State Street Rockford IL 61104 363321193 Holding Company IL SAHS Corporation C 18352241 13767714 1.00000 1 SwedishAmerican Health Management Corp 1401 East State Street Rockford IL 61104 363246511 Management Services IL N/A C 1 Wisconsin Dialysis 3034 Fish Hatchery Road Fitchburg WI 53713 300072647 Dialysis Services WI N/A C 0 Charitable Remainder Unitrusts (5) Trust IL N/A T 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0