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Nonprofiteer
← SWEDISH AMERICAN HOSPITAL SELF INSURANCE TRUST

Form 990 for tax year 2023

Filed by SWEDISH AMERICAN HOSPITAL SELF INSURANCE TRUST.

Totals

Total revenue
$57,070
Total expenses
$3,081,580
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$0
Investment income
$57,070
Other revenue
$0
Total assets, end of year
$8,485,703
Total liabilities, end of year
$0
Net assets or fund balances, end of year
$8,485,703
Program services expenses (Part IX)
$3,031,947
Management and general expenses
$49,633
Fundraising expenses
$0
Program service expenses (Part III)
$3,031,947

Program services were 98.4% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 3 · Investment income

    total $461,341 · excluded $461,341

  • 7a · Gross sales of assets other than inventory

    securities $3,710,307

  • 7b · Less cost or other basis and sales expenses

    securities $4,114,578

  • 7c · Gain or loss

    securities -$404,271

  • 7d · Net gain or loss

    total -$404,271 · excluded -$404,271

Functional expenses

Part IX, the statement of functional expenses.

  • 11g · Fees: other

    total $49,633 · management and general $49,633

  • 24a · Other expenses: Malpractice/Gen Claims

    total $2,950,000 · program services $2,950,000

  • 24b · Other expenses: Shared Services

    total $81,947 · program services $81,947

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $3,522,836 · end of year $1,803,657

  • 11 · Investments: publicly traded securities

    beginning of year $7,214,087 · end of year $6,682,046

  • 29 · Capital stock, trust principal or current funds

    beginning of year $0 · end of year $0

  • 30 · Paid-in or capital surplus, or land, building or equipment fund

    beginning of year $0 · end of year $0

  • 31 · Retained earnings, endowment or other funds

    beginning of year $0 · end of year $0

Mission and programs · 2023

Mission

Through excellence in healthcare and compassionate service, we care for our community.

Activities or mission (Part I)

Management and payment of Malpractice and General Liability claims of UW Health SwedishAmerican Hospital.

  • Management and payment of Malpractice and General Liability claims of UW Health SwedishAmerican Hospital.

    Expenses $3,031,947

As filed on the 2023 return.

Listed in Part VII

  • Peter D Newcomer MD MMM

    Trustee

    Total calculated
    $1,387,607
    From this org
    $0
    From related orgs
    $1,121,369
    Other
    $266,238
    Hours/week
    2 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $773,250 related
    Bonus
    $0 + $348,119 related
    Other
    $0
    Deferred
    $0 + $264,810 related
    Nontaxable benefits
    $0 + $1,428 related
    Filer's total
    $0 + $1,387,607 related
  • Carey Gehl

    Trustee

    Total calculated
    $1,343,722
    From this org
    $0
    From related orgs
    $1,169,859
    Other
    $173,863
    Hours/week
    2 + 55 related

    Schedule J breakdown matched by us

    Base
    $0 + $642,233 related
    Bonus
    $0 + $241,202 related
    Other
    $0 + $286,424 related
    Deferred
    $0 + $137,568 related
    Nontaxable benefits
    $0 + $36,295 related
    Filer's total
    $0 + $1,343,722 related
  • Travis Andersen

    President/CEO

    Total calculated
    $1,155,921
    From this org
    $0
    From related orgs
    $948,984
    Other
    $206,937
    Hours/week
    2 + 46 related

    Schedule J breakdown matched by us

    Base
    $0 + $797,792 related
    Bonus
    $0 + $123,125 related
    Other
    $0 + $28,067 related
    Deferred
    $0 + $159,713 related
    Nontaxable benefits
    $0 + $47,224 related
    Filer's total
    $0 + $1,155,921 related
  • Timothy Flynn MD

    President, SA Medical Group

    Total calculated
    $682,720
    From this org
    $0
    From related orgs
    $550,572
    Other
    $132,148
    Hours/week
    2 + 44 related

    Schedule J breakdown matched by us

    Base
    $0 + $471,882 related
    Bonus
    $0 + $53,431 related
    Other
    $0 + $25,259 related
    Deferred
    $0 + $82,440 related
    Nontaxable benefits
    $0 + $49,708 related
    Filer's total
    $0 + $682,720 related
  • Sal Ababneh

    COO & President of UWNI Hospitals

    Total calculated
    $678,610
    From this org
    $0
    From related orgs
    $571,410
    Other
    $107,200
    Hours/week
    2 + 44 related

    Schedule J breakdown matched by us

    Base
    $0 + $474,686 related
    Bonus
    $0 + $54,163 related
    Other
    $0 + $42,561 related
    Deferred
    $0 + $60,914 related
    Nontaxable benefits
    $0 + $46,286 related
    Filer's total
    $0 + $678,610 related
  • Thomas O'Connor

    Former President & CEO

    Total calculated
    $585,228
    From this org
    $0
    From related orgs
    $585,228
    Other
    $0
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $11,766 related
    Bonus
    $0
    Other
    $0 + $573,462 related
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $0 + $585,228 related
  • Patricia DeWane

    VP, CFO, & Treasurer

    Total calculated
    $578,277
    From this org
    $0
    From related orgs
    $497,721
    Other
    $80,556
    Hours/week
    2 + 46 related

    Schedule J breakdown matched by us

    Base
    $0 + $426,805 related
    Bonus
    $0 + $67,788 related
    Other
    $0 + $3,128 related
    Deferred
    $0 + $72,684 related
    Nontaxable benefits
    $0 + $7,872 related
    Filer's total
    $0 + $578,277 related
  • Michael Polizzotto

    Former CMO/CIO

    Total calculated
    $466,857
    From this org
    $0
    From related orgs
    $409,575
    Other
    $57,282
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $382,884 related
    Bonus
    $0 + $26,691 related
    Other
    $0
    Deferred
    $0 + $19,965 related
    Nontaxable benefits
    $0 + $37,317 related
    Filer's total
    $0 + $466,857 related
  • James Cole DO

    VP Medical Affairs/CMO

    Total calculated
    $461,963
    From this org
    $0
    From related orgs
    $363,596
    Other
    $98,367
    Hours/week
    2 + 44 related

    Schedule J breakdown matched by us

    Base
    $0 + $289,076 related
    Bonus
    $0 + $74,520 related
    Other
    $0
    Deferred
    $0 + $98,312 related
    Nontaxable benefits
    $0 + $55 related
    Filer's total
    $0 + $461,963 related
  • Julia Zimmerman

    VP Strategic Growth

    Total calculated
    $434,201
    From this org
    $0
    From related orgs
    $314,180
    Other
    $120,021
    Hours/week
    2 + 44 related

    Schedule J breakdown matched by us

    Base
    $0 + $277,273 related
    Bonus
    $0 + $33,991 related
    Other
    $0 + $2,916 related
    Deferred
    $0 + $48,957 related
    Nontaxable benefits
    $0 + $71,064 related
    Filer's total
    $0 + $434,201 related
  • William Mewes

    Former Interim VP Patient Svcs/CNO

    Total calculated
    $433,782
    From this org
    $0
    From related orgs
    $393,941
    Other
    $39,841
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $248,557 related
    Bonus
    $0 + $12,145 related
    Other
    $0 + $133,239 related
    Deferred
    $0 + $4,326 related
    Nontaxable benefits
    $0 + $35,515 related
    Filer's total
    $0 + $433,782 related
  • Allen Williams MD

    Trustee

    Total calculated
    $420,967
    From this org
    $0
    From related orgs
    $347,963
    Other
    $73,004
    Hours/week
    2 + 44 related

    Schedule J breakdown matched by us

    Base
    $0 + $338,640 related
    Bonus
    $0 + $6,900 related
    Other
    $0 + $2,423 related
    Deferred
    $0 + $26,400 related
    Nontaxable benefits
    $0 + $46,604 related
    Filer's total
    $0 + $420,967 related
  • Rosa Jeschke

    VP Human Resources

    Total calculated
    $337,589
    From this org
    $0
    From related orgs
    $297,585
    Other
    $40,004
    Hours/week
    2 + 44 related

    Schedule J breakdown matched by us

    Base
    $0 + $268,720 related
    Bonus
    $0 + $26,193 related
    Other
    $0 + $2,672 related
    Deferred
    $0 + $34,668 related
    Nontaxable benefits
    $0 + $5,336 related
    Filer's total
    $0 + $337,589 related
  • Anna Taylor

    VP Patient Services/CNO (until 2/24)

    Total calculated
    $201,908
    From this org
    $0
    From related orgs
    $196,225
    Other
    $5,683
    Hours/week
    2 + 44 related

    Schedule J breakdown matched by us

    Base
    $0 + $187,369 related
    Bonus
    $0 + $8,856 related
    Other
    $0
    Deferred
    $0 + $5,538 related
    Nontaxable benefits
    $0 + $145 related
    Filer's total
    $0 + $201,908 related
  • Daniel T Ross

    Chmn of the Board

    Total calculated
    $0
    Hours/week
    2 + 8 related
  • Jeffrey J Kaney Sr

    Immediate Past Chairman (until 6/24)

    Total calculated
    $0
    Hours/week
    2 + 6 related
  • Jeffrey S Hultman

    1st Vice Chmn/Secy

    Total calculated
    $0
    Hours/week
    2 + 8 related
  • Thomas R Walsh

    Audit/Compliance Chairman

    Total calculated
    $0
    Hours/week
    2 + 6 related
  • Michael Broski

    Director

    Total calculated
    $0
    Hours/week
    2 + 6 related
  • Helen Chung Hill

    Director

    Total calculated
    $0
    Hours/week
    2 + 6 related
  • Kathleen Kelly MD

    Director

    Total calculated
    $0
    Hours/week
    2 + 6 related
  • Marco T Lenis

    Director

    Total calculated
    $0
    Hours/week
    2 + 6 related
  • Pamela Maher

    Director

    Total calculated
    $0
    Hours/week
    2 + 4 related
  • Anqunette Parham

    Director

    Total calculated
    $0
    Hours/week
    2 + 6 related
  • Steven C Sjogren

    Director

    Total calculated
    $0
    Hours/week
    2 + 6 related
  • Frank Walter

    Director

    Total calculated
    $0
    Hours/week
    2 + 6 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

Part I, Line 3
All compensation is determined by the Executive Compensation Committee of SwedishAmerican Health System Corporation and is paid by UW Health 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 2023 include: Tom O'Connor - $573,462; William Mewes - $87,850. These payments are reported as taxable compensation on Part II, column (B)(iii). Contributions to the 457(f) plan during 2023 include: Travis Andersen - $151,133; Faisal Ababneh - $55,164; Timothy Flynn MD - $56,040; Patricia DeWane - $46,284; Julia Zimmerman - $29,700; Rose Jeschke - $30,972; James Cole - $32,312; Carey Gehl - $112,158; Peter Newcomer - $198,810. Payments from the 457(f) plan during 2023 include: Julia Zimmerman - $18,973; Carey Gehl - $285,741. 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).

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

  • Chartwell Wisconsin Enterprises LLC

    Parent Entity of CW and CMW-HR · WI

  • Sixth Street Medical LLC

    Real Estate · WI

  • Three Rivers Partners LLC

    Information Technology Services · IL

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • Physician's Care Network

    C · Health Services · IL

  • Quartz Health Benefit Plans Corporation

    C · Health Maintenance Organization · WI

  • Quartz Health Insurance Corporation

    C · Health Maintenance Organization · WI

  • Quartz Health Solutions Inc

    C · Insurance · WI

  • Quartz Holding Company

    C · Holding Company · WI

  • State & Charles Inc

    C · Holding Company · IL

  • SwedishAmerican Health Managment Corp

    C · Management Services · IL

  • Wisconsin Dialysis Inc

    C · Dialysis Services · WI

  • Charitable Remainder Unitrusts (5)

    T · Trust · IL

Provenance

Return type
form_990
Tax year
2023
Filed
6 May 2025
IRS schema version
2023v6.0
Source object
202521279349302947

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