Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
AURORA HEALTH CARE METRO INC |
390806181 | 3 | No | 0 | 0 | |
| (B)
VERSITI WISCONSIN INC |
390807235 | 7 | No | 0 | 0 | |
| (C)
CHILDREN'S HOSPITAL OF WISCONSIN |
390812532 | 3 | No | 0 | 0 | |
| (D)
COLUMBIA ST MARY'S HOSPITAL |
390806315 | 3 | No | 0 | 0 | |
| (E)
FROEDTERT MEMORIAL LUTHERAN HOSPITAL |
396105970 | 3 | No | 0 | 0 | |
| (F)
THE MEDICAL COLLEGE OF WISCONSIN |
390806261 | 2 | No | 0 | 0 | |
| (G)
ASCENSION SE WISCONSIN HOSPITAL INC |
390816857 | 3 | No | 0 | 0 | |
| (H)
ZABLOCKI VA MEDICAL CENTER 5000 W NATIONAL AVE |
391326366 | 6 | No | 0 | 0 | |
| (I)
MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION |
396005720 | 6 | No | 0 | 0 | |
| (J)
MOSAIC FAMILY HEALTH INC |
473298660 | 3 | No | 0 | 0 | |
|
Total 10
|
0 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2018 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| FORM 990, SCHEDULE A, PART IV, SECTION A, LINE 1: | THE ORGANIZATION'S SUPPORTED ORGANIZATIONS, OTHER THAN THE MEDICAL COLLEGE OF WISCONSIN, ARE NOT LISTED BY NAME IN THE ORGANIZATION'S GOVERNING DOCUMENTS. AS INDICATED IN THE ORGANIZATION'S ARTICLES OF INCORPORATION AND BYLAWS, THE AFFILIATED INSTITUTIONS ARE PARTIES TO AFFILIATION AGREEMENTS |
| FORM 990, SCHEDULE A, PART IV, SECTION B, LINE 1: | THE MEDICAL COLLEGE OF WISCONSIN AND EACH AFFILIATED INSTITUTION HAS THE RIGHT TO ANNUALLY APPOINT DIRECTORS. IN ADDITION, THE EXECUTIVE DIRECTOR IS AN EX OFFICIO VOTING MEMBER OF THE BOARD. ANY DIRECTOR MAY BE REMOVED FROM OFFICE BY THE AFFIRMATIVE VOTE OF TWO-THIRDS OF THE DIRECTORS. |
| FORM 990, SCHEDULE A, PART 1, LINE 11G: | MEDICAL COLLEGE OF WISCONSIN AFFILIATED HOSPITALS, INC. PROVIDES SUPPORT TO FACILITATE THE ADMINISTRATION OF GRADUATE MEDICAL EDUCATION PROGRAMS CONDUCTED JOINTLY WITH THE MEDICAL COLLEGE OF WISCONSIN IN CONJUNCTION WITH HEALTH CARE INSTITUTIONS. NO FINANCIAL SUPPORT IS PROVIDED TO THESE ORGANIZATIONS. |
| FORM 990, SCHEDULE A, PART I LINE 12G(I): | BLOODCENTER OF WISCONSIN INC (EIN 39-0807235) CHANGED THEIR NAME TO VERSITI WISCONSIN INC AND THE NAME OF THE ORGANIZATION HAS BEEN UPDATED ACCORDINGLY. |
| FORM 990, SCHEDULE A, PART I LINE 12G(I): | WHEATON FRANSISCAN HEALTHCARE-ST. JOSEPH (EIN 39-0816857) CHANGED THEIR NAME TO ASCENSION SE WISCONSIN HOSPITAL INC AND THE NAME OF THE ORGANIZATION HAS BEEN UPDATED ACCORDINGLY. |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE CONSISTS OF THREE (3) OR MORE MEMBERS OF THE BOARD OF DIRECTORS INCLUDING THE PRESIDENT, VICE-PRESIDENT, AND EXECUTIVE DIRECTOR THAT ARE ELECTED BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE MAY EXERCISE, WHEN THE BOARD OF DIRECTORS IS NOT IN SESSION, ALL OF THE POWERS OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE BUSINESS AND AFFAIRS OF THE CORPORATION AND RECOMMENDS TO THE BOARD AN ANNUAL BUDGET FOR THE CORPORATION. AT JUNE 30, 2019, THE EXECUTIVE COMMITTEE WAS REPRESENTED WITH FOUR (4) BOARD MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE MEDICAL COLLEGE OF WISCONSIN AND EACH AFFILIATED INSTITUTION ARE MEMBERS OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEDICAL COLLEGE OF WISCONSIN AND EACH AFFILIATED INSTITUTION HAS THE RIGHT TO ANNUALLY APPOINT DIRECTORS. IN ADDITION, THE EXECUTIVE DIRECTOR IS AN EX OFFICIO VOTING MEMBER OF THE BOARD. ANY DIRECTOR MAY BE REMOVED FROM OFFICE BY THE AFFIRMATIVE VOTE OF TWO-THIRDS OF THE DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR AND THE SECRETARY/TREASURER OF THE CORPORATION. A COPY OF THE FORM 990 IS PROVIDED TO THE MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO SUBMITTAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | AN ANNUAL STATEMENT IS SIGNED BY EACH BOARD MEMBER AND BY THE SECRETARY/TREASURER. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE EXECUTIVE DIRECTOR IS NOMINATED BY THE MEDICAL COLLEGE OF WISCONSIN (MCW) AND IS ELECTED BY THE MEDICAL COLLEGE OF WISCONSIN AFFILIATED HOSPITALS' (MCWAH) BOARD. THE EXECUTIVE DIRECTOR MUST BE A MEMBER OF THE FACULTY OF MCW. MCW SETS THE SALARIES FOR ITS FACULTY. IT UTILIZES THE FACULTY SALARY INFORMATION PROVIDED BY THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES (AAMC) IN CONJUCTION WITH OTHER AVAILABLE SALARY COMPARISON TOOLS. THE MCWAH ADMINISTRATOR/SECRETARY/TREASURER'S COMPENSATION IS DETERMINED BY MCW USING SALARY POLICY GUIDELINES. THE MCWAH EXECUTIVE DIRECTOR AND THE ADMINISTRATOR ARE EMPLOYEES OF MCW. |
| FORM 990, PART VI, SECTION C, LINE 19 | UPON REQUEST |
| FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC | MONICA HILT - 229 SOUTH MORRISON STREET, APPLETON, WI 54911. JACOB BIDWELL, MD - 1020 NORTH 12TH STREET SUITE 5120, MILWAUKEE, WI 53233. JERRY GOTTSCHALL, MD - 638 NORTH 18TH STREET, MILWAUKEE, WI 53233. THOMAS ABSHIRE, MD - 638 NORTH 18TH STREET, MILWAUKEE, WI 53233. JEFFREY BAHR MD - 1020 NORTH 12TH STREET SUITE 5120, MILWAUKEE, WI 53233. MICHAEL GUTZEIT, MD - 9000 WEST WISCONSIN AVENUE, MILWAUKEE, WI 53201. RICHARD SHIMP, MD - 2301 LAKE DRIVE, MILWAUKEE, WI 53211. PAUL BURSTEIN, MD - 2301 LAKE DRIVE, MILWAUKEE, WI 53211. JEFF VAN DE KREEKE - 9200 WEST WISCONSIN AVENUE, MILWAUKEE, WI 53226. ANDREW RESNICK, MD MBA - 9200 WEST WISCONSIN AVENUE, MILWAUKEE, WI 53226. JOHN RAYMOND, MD - 8701 WATERTOWN PLANK ROAD, MILWAUKEE, WI 53226. JOSEPH E. KERSCHNER, MD - 8701 WATERTOWN PLANK ROAD, MILWAUKEE, WI 53226. JOHN SCHNEIDER, MD - 9455 WEST WATERTOWN PLANK ROAD, MILWAUKEE, WI 53226. MICHAEL LAPPEN - 9455 WEST WATERTOWN PLANK ROAD, MILWAUKEE, WI 53226. VICKY BARNTHOUSE - 229 SOUTH MORRISON STREET, APPLETON, WI 54911. SCOTT TURNER - 9000 WEST WISCONSIN AVENUE, MILWAUKEE, WI 53201. MICHAEL ERDMANN, MD - 5000 WEST NATIONAL AVENUE, MILWAUKEE, WI 53295. JEROME VAN RUISWYK MD - 5000 WEST NATIONAL AVENUE, MILWAUKEE, WI 53295. DANIEL ROSS, MD - 5000 WEST CHAMBERS, MILWAUKEE, WI 53210. ROBERT M. STERN, MD - 5000 WEST CHAMBERS, MILWAUKEE, WI 53210. LAWRENCE DONATELLE, MD - 229 SOUTH MORRISON STREET, APPLETON, WI 54911. |
| FORM 990, PART XII, LINE 2C: | PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| Software ID: | |
| Software Version: |