Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and 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 | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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 on 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) |
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| 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) |
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| 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): |
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| 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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2024 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2024 |
(iii) Distributable Amount for 2024 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2024 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2024: | ||||
| a From 2019....... | ||||
| b From 2020....... | ||||
| c From 2021....... | ||||
| d From 2022....... | ||||
| e From 2023....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2024 distributable amount | ||||
|
i
Carryover from 2019 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2024 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2024 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2024, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2024. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2025. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2020..... | ||||
| b Excess from 2021..... | ||||
| c Excess from 2022..... | ||||
| d Excess from 2023..... | ||||
| e Excess from 2024..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
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| FORM 990, PART V, LINE 2A: | THE ORGANIZATION HAD A CO-EMPLOYMENT AGREEMENT WITH INSPERITY PEO SERVICES, L.P. THE ORGANIZATION'S EMPLOYEES TOTALLING 141 FOR 2024 WERE REPORTED AS EMPLOYEES OF INSPERITY PEO SERVICES, L.P. THE COMPENSATION PAID TO INSPERITY PEO SERVICES, L.P. FOR THESE EMPLOYEES IS INCLUDED IN THE FORM 990, PART VII, SECTION B. |
| FORM 990, PART VI, SECTION A, LINE 1A | THE BOARD IS COMPRISED OF SIX CLASS A DIRECTORS AND THREE CLASS B DIRECTORS. CLASS B DIRECTORS MAY NOT BE AN EMPLOYEE OF A MEMBER AND MAY NOT OTHERWISE BE UNDER THE CONTROL OF A MEMBER. A SIMPLE MAJORITY OF ALL DIRECTORS SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF BUSINESS AT ANY MEETING OF THE BOARD, PROVIDED, THAT AT LEAST ONE CLASS A DIRECTOR APPOINTED BY EACH MEMBER IS IN ATTENDANCE. |
| FORM 990, PART VI, SECTION A, LINE 2 | HEATHER HOEFFLER, TRICIA SCHUTZ, AND SARA CLARK HAVE A BUSINESS RELATIONSHIP. GAIL OSTRANDER, AMY HERBST, AND ALY CAPP HAVE A BUSINESS RELATIONSHIP. WENDY BARTON, JULIE MEYER, AND QUENTIN MAYER HAVE A BUSINESS RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE CORPORATION HAS TWO CLASSES OF MEMBERS WITH MEMBERSHIP INTEREST IN THE CORPORATION. EACH CLASS HAS THE DESIGNATIONS, QUALIFICATIONS, REQUIREMENTS, VOTING RIGHTS AND OTHER RIGHTS OF MEMBERSHIP AS SET FORTH IN THE CORPORATION'S ARTICLES OF INCORPORATION AND ITS BYLAWS. AFFINITY HEALTH SYSTEM IS THE SOLE MEMBER IN THE MAJORITY MEMBERSHIP CLASS AND HOLDS A 70% MEMBERSHIP INTEREST. CHILDREN'S HOSPITAL OF WISCONSIN, INC. AND THEDACARE, INC. COMBINE TO MAKE UP THE MINORITY MEMBERSHIP CLASS AND EACH HOLDS A 15% MEMBERSHIP INTEREST. EACH MEMBER SHALL CONTRIBUTE FUNDS IN PROPORTION TO THEIR MEMBERSHIP INTEREST TO THE EXTENT THE CORPORATION SHOULD HAVE AN OPERATING LOSS IN ANY GIVEN YEAR. THE MAXIMUM CONTRIBUTION MEMBERS ARE OBLIGATED TO COLLECTIVELY CONTRIBUTE IS MUTALLY AGREED UPON BY THE MEMBERS. SEE FORM 990, PART VI, LINE 7A AND 7B FOR MEMBERS' RIGHTS TO ELECT BOARD MEMBERS AND MATTERS REQUIRING MEMBERS' APPROVAL. |
| FORM 990, PART VI, SECTION A, LINE 7A | EACH MEMBER SHALL HAVE A CONTINUING RIGHT TO APPOINT TWO CLASS A DIRECTORS. EACH MEMBER MAY NOMINATE A CLASS B DIRECTOR SUBJECT TO APPROVAL BY THE BOARD. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING ACTIONS SHALL REQUIRE UNANIMOUS APPROVAL OF THE MEMBERS: 1) MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION, 2) PARTICIPATION IN ANY JOINT VENTURE OR AFFILIATION BY THE CORPORATION, 3) AMENDMENT, RESTATEMENT, ALTERATION OR REPEAL OF THE ARTICLES OF INCORPORATION, 4) AMENDMENT, RESTATEMENT, ALTERATION OR REPEAL OF THE BYLAWS, 5) A SALE, LEASE, EXCHANGE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY OR ASSETS OF THE CORPORATION, 6) THE CALL FOR CONTRIBUTIONS FROM MEMBERS TO THE CORPORATION OR ASSESSMENTS AGAINST THE MEMBERS, OTHER THAN ANNUAL CONTRIBUTIONS DESCRIBED IN FORM 990, PART VI, LINE 6 EXPLANATION, 7) THE INCURRING BY THE CORPORATION OF INDEBTEDNESS FOR BORROWED FUNDS AND THE AMOUNT OF ANY SUCH INDEBTEDNESS, 8) ANY DISTRIBUTION OF ASSETS OF THE CORPORATION TO ONE OR MORE MEMBERS, 9) EXECUTION, AMENDMENT, OR TERMINATION OF ANY AGREEMENT BETWEEN THE CORPORATION AND ANY MEMBER, EXCEPT ANY AGREEMENT FOR ACCOUNTING SERVICES AS DESCRIBED IN #3 BELOW , 10) AN INCREASE OR DECREASE IN THE NUMBER OF DIRECTORS ON THE BOARD, 11) THE ADDITION OF NEW MEMBERS. ADDITIONALLY, THE FOLLOWING MATTERS REQUIRE APPROVAL BY THE MAJORITY MEMBER: 1) THE ESTABLISHMENT, FORMATION, ACQUISITION, MERGER, CONSOLIDATION OR DISSOLUTION OF ANY SUBSIDIARY OF THE CORPORATION; 2) THE SELECTION, APPOINTMENT AND REMOVAL OF PERSONS TO SERVE AS THE CORPORATION'S PRESIDENT, AND APPROVAL OF THE PRESIDENT'S EVALUATION; 3) THE SELECTION, APPOINTMENT AND REMOVAL OF THE CORPORATION'S AUDITORS, EXCEPT TO THE EXTENT THAT THE CORPORATION IS CONSIDERING APPOINTING OR HAS APPOINTED THE MAJORITY MEMBER AND/OR ONE OF THE MAJORITY MEMBER'S PARENTS, SUBSIDIARIES, AFFILIATES, OR RELATED COMPANIES TO PROVIDE ACCOUNTING SERVICES, IN WHICH CASE, THE APPROVAL OF THE MINORITY MEMBERS SHALL BE REQUIRED TO SELECT AND APPOINT SUCH ENTITY AS AUDITOR, AND THE MINORITY MEMBERS SHALL HAVE THE AUTHORITY TO, WITHOUT MAJORITY MEMBER APPROVAL: (I) REMOVE SUCH ENTITY AS AUDITOR; (II) INSPECT THE BOOKS AND RECORDS OF THE CORPORATION UPON REQUEST; (III) APPROVE THE CORPORATION'S AUDIT REPORT; AND/OR (IV) REQUIRE ANY BOARD MEMBER DEEMED BY THE MINORITY MEMBERS TO BE ASSOCIATED WITH THE MAJORITY MEMBER TO RECUSE HERSELF OR HIMSELF DURING DISCUSSIONS RELATED TO ACCOUNTING SERVICES; 4) THE ADOPTION OF THE OPERATING AND CAPITAL BUDGETS AND STRATEGIC PLANS FOR THE CORPORATION; 5) CAPITAL EXPENDITURES IN EXCESS OF FIFTY THOUSAND DOLLARS NOT ACCOUNTED FOR IN THE CAPITAL AND OPERATING BUDGETS OF THE CORPORATION; 6) THE SALE, LEASE, TRANSFER OR OTHER DISPOSITION OR ENCUMBERANCE OF ANY ASSET WITH A FAIR MARKET VALUE THAT EXCEEDS FIFTY THOUSAND DOLLARS THAT IS NOT PROVIDED FOR IN THE CAPITAL OR OPERATING BUDGETS OF THE CORPORATION; 7) THE ADDITION OF ANY NEW PROGRAM OR SERVICE IF THE NEW PROGRAM OR SERVICE MAY CONFLICT WITH THE DIRECTIVES; 8) THE MAJORITY MEMBER MAY REQUIRE THE CORPORATION TO DISCONTINUE ANY PROGRAM OR SERVICE THAT VIOLATES THE DIRECTIVES. |
| FORM 990, PART VI, SECTION A, LINE 8B | THE ORGANIZATION DOES NOT HAVE A COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | A COPY OF THE FORM 990 IS FIRST PROVIDED TO THE CFO AND CEO FOR REVIEW AND THEN IS PROVIDED TO THE BOARD FOR APPROVAL PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | EMPLOYED OFFICERS ARE REQUIRED TO FILL OUT A CONFLICT OF INTEREST FORM THAT IS REVIEWED BY MANAGEMENT. BOARD MEMBERS ARE REQUIRED TO DISCLOSE THE EXISTENCE OF POSSIBLE CONFLICTS OF INTEREST. ANY POSSIBLE CONFLICTS ARE DISCUSSED AT THE BOARD LEVEL. BOARD MEMBERS WITH POSSIBLE CONFLICTS OF INTEREST DO NOT PARTICIPATE IN DISCUSSION NOR VOTE ON TRANSACTIONS THAT INVOLVE POSSIBLE CONFLICTS OF INTEREST. |
| FORM 990, PART VI, SECTION B, LINE 15 | L15A.) THE COMPENSATION COMMITTEE REVIEWED THE CEO'S PERFORMANCE AND SALARY COMPARABILITY DATA. THE COMMITTEE'S CONCLUSIONS WERE THEN REVIEWED WITH THE BOARD. THE BOARD AGREED ON A SALARY ADJUSTMENT BASED ON THAT DIALOGUE, WHICH WAS CONTEMPORANEOUSLY SUBSTANTIATED. L15B.) INSPERITY COMPENSATION SERVICES WERE USED TO DETERMINE APPROPRIATE PAY GRADES WITHIN THE SURROUNDING COMPETITIVE MARKET. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2024. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES COPIES OF ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
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