2024-05-07T09:37:43-05:00 2023-06-30 420714325 RSM US LLP 30 South Wacker Dr Suite 3300 Chicago IL 606063392 990 2022-07-01 363097493 SwedishAmerican Health Foundation SWED 7796964009 1415 E State Street Rockford IL 61104 Patricia DeWane VP, CFO & Treasurer 7796964009 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 X Travis Andersen 1313 East State Street Rockford IL 61104 666062 0 X www.uwhealth.org X 1980 IL To provide financial and in-kind support for the stated missions of SwedishAmerican Hospital System Corporation, SwedishAmerican Hospital, and the affiliates operating in the State of Illinois. 12 9 0 13 0 0 1187090 469852 0 0 538539 190210 -40007 -44272 1685622 615790 400743 267970 0 0 359113 175656 34750 0 466800 357892 318259 1152498 761885 533124 -146095 18457440 19689408 195543 551127 18261897 19138281 X To provide financial and in-kind support for the stated missions of SwedishAmerican Hospital System Corporation, SwedishAmerican Hospital, and the affiliates operating in the State of Illinois. 0 1 210948 210948 0 SwedishAmerican Health Foundation (SAHF) supports UW Health SwedishAmerican Hospital, a 501(c)(3) organization in its mission to provide quality medical healthcare to communities in Northern Illinois and Southern Wisconsin regardless of race, creed, sex, national origin, handicap, age or ability to pay. During the current year, SAHF provided funding grants to specialized departments which helped enhance patient care and patient-visitor comfort.In 1918 UW Health SwedishAmerican Hospital opened its doors to patients in response to the city's need for healthcare services. UW Health SwedishAmerican Hospital recently completed a $126 million investment in our community. This major construction, modernization and expansion project will help us continue to provide the outstanding, top-quality healthcare which residents of Rockford and its surrounding communities expect and deserve. We recognize that improving the health of our community means investing in our community.During FY 2023, SwedishAmerican Health Foundation provided a grant of $210,948 toward UW Health SA Hospital departments for patient care and well-being. 57022 57022 0 During fiscal year 2023, SwedishAmerican Health Foundation provided $57,022 in grants to the chaplaincy program. UW Health SwedishAmerican Hospital's clinically trained staff chaplains compassionately and respectfully assist patients and their families during some of life's most difficult moments. Chaplains round daily, help with advance directives, take part in patient care consults and do much, much more. The Chaplaincy Endowment Fund helps insure there always will be Pastoral Care at UW Health SwedishAmerican by underwriting the cost of providing professional chaplain staff 24 hours a day, seven days a week. 267970 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 9 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 IL X Patricia DeWane 7796964009 1313 East State Street Rockford IL 61104 Travis Andersen President & CEO 2.00 46.00 X X 0 1014145 85450 Allen 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 Michael Broski 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 Marco T Lenis Director 2.00 6.00 X 0 0 0 Anqunette Parham Director 2.00 6.00 X 0 0 0 Steven C Sjogren Director 2.00 6.00 X 0 0 0 Frank Walter 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 Barbera Aaby Executive Director (as of 1/1/23) 40.00 0.00 X 0 0 0 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 6004819 669469 0 1 1 0 0 469852 469852 190210 190210 6000 50272 -44272 -44272 -44272 615790 0 0 145938 X 267970 267970 132816 132816 5571 5571 28544 28544 8725 8725 996 996 26119 26119 129177 129177 39319 39319 6332 6332 20965 20965 53286 53286 6271 6271 7140 7140 519 519 Special Function Fee 19387 19387 Misc Fees 8398 8398 Repairs & Maintenance 350 350 761885 267970 27115 466800 40649 4344 155960 171233 2025327 169185 1844916 1856142 11695040 13018856 4720875 4638833 18457440 19689408 195543 196453 0 354674 195543 551127 X 10722857 11188597 7539040 7949684 18261897 19138281 18457440 19689408 X -146095 825717 196762 X 0 1 X 1 0 X 1785626 566882 1019757 1187090 469852 5029207 1785626 566882 1019757 1187090 469852 5029207 763561 4265646 353730 642951 550257 544564 196210 2287712 7316919 0.58300 0.60930 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6669961 6250 380092 1521 7054782 7855142 10983 -1195892 272 6669961 6911513 8944 946640 11955 7855142 7189894 10679 -13961 275099 6911513 7072405 12701 320291 215503 7189894 0.61700 0.27420 0.10880 0 0 1785960 1785960 144439 86984 57455 10932 8361 2571 73272 64936 8336 10724 8904 1820 1856142 Beneficial Interest in Investment Pool 13018856 F 13018856 Beneficial interest in trust assets 4638833 4638833 Due to affiliates 354674 354674 X Part V, Line 4: 1) Medical and Non-medical health improvement initiatives 2) Rehabilitation or orthopedic programming and services within the greater Rockford community 3) Oncology patient services 4) Educational materials for the families of oncology patients 5) Chaplaincy program including grief services and counseling 6) Cardiology services 7) Medical programs and care for children 8) Cardiac education for women 9) Ongoing support of surgical service and education of surgical technicians Part X, Line 2: SwedishAmerican Foundation has received a determination letter from the Internal Revenue Service (IRS) stating it is tax-exempt under Section 501(c)(3) of the Code. The Foundation files a Form 990 (Return of Organization Exempt from Income Tax) annually. 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 hospitals and foundations 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 Form 990 filed by the Foundation is subject to examination for up to three years from the extended due date of the return. Form 990 filed by the Foundation is no longer subject to examination for tax years ended before June 30, 2020. 1 SwedishAmerican Hospital 1401 East State Street Rockford IL 61104 362222696 501(c)(3) 267970 0 Funding to hospital departments for patient care and well-being; reimburse chaplaincy wages 1 0 Part I, Line 2: The grant recipient is required to return a follow-up report within 12 months from the day the grant was received. Each recipient must provide 1) an itemized account of their organization's use of the grant funds including copies of receipts; 2) the number of people who benefitted from the grant and how the benefit was measured; 3) detail on how the funding allowed the recipient organization to meet its goals and/or accomplish its purpose through the event or program; and 4) identify anything from the program/project that they were unable to accomplish or would like to include in the future; 5) attach any photos, personal notes, or news clippings relative to the program or event. 1 1 0 0 0 0 0 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 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 Executive Director 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: Travis Andersen - $59,719; Patricia DeWane - $30,310; Timothy Flynn MD - $24,210; Sal Ababneh - $19,878; Rose Jeschke - $13,963. Payments from the 457(f) plan during 2022 include: 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 III, line 3 SwedishAmerican Health Foundation no longer provides grants to community organizations. That process in now handled by parent UW Health. Form 990, Part VI, Section A, line 4 On February 27, 2023 the organization's Bylaws were amended for the following items: - Name change to Swedish American Health Foundation; - To identify SwedishAmerican Health System Corporation as the sole member of the Foundation, and define their authority and powers therein; - To specify Board composition, term, removal, and meeting requirements; - To identify Officers of the organization; - To specify distribution of assets upon dissolution. Form 990, Part VI, Section A, line 6 SwedishAmerican Health System is a member, see 7a and 7b below. Form 990, Part VI, Section A, line 7a The members of the Board of Directors shall each be appointed by the Board of Directors of SwedishAmerican Health System. Form 990, Part VI, Section A, line 7b SwedishAmerican Health System retains reserve powers over SwedishAmerican Health Foundation. In the event of dissolution, any remaining assets will be transferred to SwedishAmerican Health System. Form 990, Part VI, Section B, line 11b A draft version of the Form 990 was reviewed by the Chief Financial Officer. The Board of Directors common to SwedishAmerican Health Foundation was provided with a copy of the Form 990 before it was filed. Form 990, Part VI, Section B, line 12c The Board of Directors common to SwedishAmerican Health Foundation 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 15a 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 Executive Director 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 Foundation, are available upon request. Form 990, Part IX, line 11g Other Purchased Services: Program service expenses 0. Management and general expenses 0. Fundraising expenses 58,830. Total expenses 58,830. Other Professional Fees: Program service expenses 0. Management and general expenses 0. Fundraising expenses 70,347. Total expenses 70,347. Form 990, Part XI, line 9: Changes in beneficial interest in trust assets 196,762. 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 System Corporation 1401 E State Street Rockford IL 61104 363241458 Parent Corporation to manage and direct activites of entities IL 501(c)(3) Line 12a, I Regional Division Inc 0 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 Chartwell Wisconsin Enterprises LLC 2241 Pinehurst Drive Middleton WI 53562 391796267 Parent Entity of CW and CMW-HR WI N/A 0 0 Madison Medical Center LLP 7974 UW Health Court Middleton WI 53562 391329429 Real Estate WI N/A 0 0 Northern Illinois Vein Clinic 2550 Charles St Rockford IL 61108 201642329 Outpatient Health Services IL N/A 0 0 Sixth Street Medical LLC 7974 UW Health Court Middleton WI 53562 472705724 Real Estate WI N/A 0 0 Three Rivers Partners LLC 1313 East State Street Rockford IL 61104 262231757 Information Technology Services IL N/A 0 0 Physician's Care Network Inc 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 N/A C 1 State & Charles Inc 1313 East State Street Rockford IL 61104 363321193 Holding Company IL N/A C 1 SwedishAmerican Health Management Corp 1401 East State Street Rockford IL 61104 363246511 Management Services IL N/A C 1 Wisconsin Dialysis Inc 3034 Fish Hatchery Road Fitchburg WI 53713 300072647 Dialysis services WI N/A C 0 Charitable Remainder Unitrust (5) Trust IL SwedishAmerican Health Foundation T 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 SwedishAmerican Hospital B 267970 Cash