SHARED MAGNETIC RESONANCE IMAGING FACILITY INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- SHARED MAGNETIC RESONANCE IMAGING FACILITY INC (EIN 39-1534744)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-10-08
- IRS object ID
- 201332819349300418
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-10-08T10:26:53-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grant Thornton LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E Wisconsin Ave | AddressLine1 |
| City | Milwaukee | City |
| State | WI | State |
| ZIP Code | 53202 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391534744 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Shared Magnetic Resonance Imaging | BusinessNameLine1 |
| Business Name Line2 | Facility Inc | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % SARAH FAUST | InCareOfName |
| Name Control | SHAR | NameControl |
| Phone | 6082594376 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1104 John Nolen Drive | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | Madison | City |
| State | WI | State |
| ZIP Code | 53713 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kevin Boren | Name |
| Title | Secretary / Treasurer | Title |
| Phone | 6082594376 | Phone |
| Date Signed | 2013-09-30 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Michelle L Weber | Name |
| Phone | 4142898200 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Turville Bay MRI | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Barbara Theirmann | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1104 John Nolen Drive | AddressLine1 |
| City | Madison | City |
| State | WI | State |
| ZIP Code | 53713 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 17891838 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.turvillebay.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1986 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | To operate and maintain a facility for the performance of magnetic resonance imaging and radiation therapy procedures, and to provide advanced medical technology for its patients. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 5 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 1 | NbrIndependentVotingMembers |
| Total Nbr Employees | 75 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 9320 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 4021 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 16911292 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 17521636 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 31490 | InvestmentIncomePriorYear |
| Investment Income Current Year | -87799 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 14467 | OtherRevenuePriorYear |
| Other Revenue Current Year | 15968 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 16957249 | TotalRevenuePriorYear |
| Total Revenue Current Year | 17449805 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 2000000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 3000000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 6531161 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 6499556 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 5240754 | OtherExpensePriorYear |
| Other Expenses Current Year | 5706346 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 13771915 | TotalExpensesPriorYear |
| Total Expenses Current Year | 15205902 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3185334 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2243903 | RevenuesLessExpensesCY |
| Total Assets BOY | 22890835 | TotalAssetsBOY |
| Total Assets EOY | 25066671 | TotalAssetsEOY |
| Total Liabilities BOY | 1121536 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1053469 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 21769299 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 24013202 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE CORE MISSION OF TURVILLE BAY MRI AND RADIATION ONCOLOGY CENTER IS TO PRESERVE AND IMPROVE HUMAN LIFE. THIS MISSION WILL BE ACHIEVED THROUGH PROVIDING PATIENT CARE WITH UNRELENTING ATTENTION TO CLINICAL EXCELLENCE, PATIENT SAFETY AND AN UNPARALLELED PASSION AND COMMITMENT TO ENSURE THE VERY BEST HEALTHCARE FOR THOSE WE SERVE. TURVILLE BAY MRI AND RADIATION ONCOLOGY CENTER IS A NOT FOR PROFIT CENTER PRINCIPALLY FORMED TO PROVIDE QUALITY HEALTHCARE SERVICES. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 7135726 | Expense |
| Grants | 1500000 | Grants |
| Revenue | 9159755 | Revenue |
| Description | Radiation Oncology Services: Turville Bay Radiation Oncology Center provides radiation therapy treatment services. The center performed 9,768 treatments in 2012 | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 5578763 | Expense |
| Grants | 1500000 | Grants |
| Revenue | 8361881 | Revenue |
| Description | MRI Services: Turville Bay MRI Center provides diagnostic examinations using magnetic resonance imaging. The center performed 8,613 scans in 2012. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 12714489 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 37 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 75 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 5 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 1 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | SARAH FAUST | NamePerson |
| Telephone Number | 6082594376 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1104 JOHN NOLEN DRIVE | AddressLine1 |
| City | Madison | City |
| State | WI | State |
| ZIP Code | 53713 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| Marilyn Biros | |||||||||
| President | 2.0 | 45.0 | X | X | 0 | 296704 | 64441 | ||
| David Childers | |||||||||
| Vice President | 2.0 | 45.0 | X | X | 0 | 180533 | 17223 | ||
| Charlie Johnson III | |||||||||
| Board Member | 2.0 | 45.0 | X | 0 | 444473 | 62245 | |||
| Kevin Boren | |||||||||
| Secretary/Treasurer | 2.0 | 45.0 | X | X | 0 | 292584 | 31273 | ||
| Richard Baker MD | |||||||||
| Board Member/MRI Medical Dir | 2.0 | X | 0 | 0 | 0 | ||||
| Barbara Thiermann | |||||||||
| Executive Director | 40.0 | X | 151140 | 0 | 37655 | ||||
| Sarah Faust | |||||||||
| Controller | 40.0 | X | 109662 | 0 | 31992 | ||||
| Michael Zinda MD | |||||||||
| Radiation Oncologist | 36.0 | 334966 | 0 | 48260 | X | ||||
| Ming Teng MD | |||||||||
| Radiation Oncologist | 36.0 | 381482 | 0 | 24779 | X | ||||
| Glenn Applegate MD | |||||||||
| Radiation Oncologist | 36.0 | 553882 | 0 | 26858 | X | ||||
| Frank Goodin | |||||||||
| Physicist | 40.0 | 168760 | 0 | 38786 | X | ||||
| Renee Olson | |||||||||
| IT Manager | 40.0 | 107406 | 0 | 32165 | X | ||||
| Mike Graffin | |||||||||
| MRI Manager | 40.0 | 104380 | 0 | 16985 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1911678 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1214294 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 432662 | TotalOtherCompensation |
| Number Individuals GT100 K | 8 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Adams Outdoor Advertising | |||||
| PO BOX 809140 | CHICAGO | IL | 60680 | Advertising | 181968 |
| Midwest Family Broadcasting | |||||
| 730 Rayovac Drive | MADISON | WI | 53711 | Advertising | 103463 |
| CompHealth | |||||
| PO Box 972651 | DALLAS | TX | 75397 | Locum | 111135 |
| JH Findorff Son | |||||
| 300 S Bedford St | MADISON | WI | 53713 | Construction | 637768 |
| Maximum Mechanical | |||||
| 6273 Ahwahnee Ct | OREGON | WI | 53575 | HVAC | 186477 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Info In Schedule O Part VIII | X | InfoInScheduleOPartVIII |
| Total Contributions | 0 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| RADIATION ONCOLOGY REVENUE | 621500 | 9159755 | 9159755 |
| MRI REVENUE | 621500 | 8361881 | 8361881 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 17521636 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 19234 | TotalRevenueColumn |
| Exclusion | $19,234 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 335000 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 442033 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -107033 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -107033 | TotalRevenueColumn |
| Exclusion | -$107,033 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|
| STANDARD IMAGING, ITECH, SCANDIDOS | 621500 | 9320 | 9320 | |
| MISCELLANEOUS REVENUE | 900099 | 6648 | $6,648 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 15968 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17449805 | TotalRevenueColumn |
| Related Or Exempt Function Income | 17521636 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 9320 | UnrelatedBusinessRevenue |
| Exclusion | -$81,151 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3000000 | Total |
| Program Services | 3000000 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 713675 | Total |
| Program Services | 383226 | ProgramServices |
| Management And General | 330449 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4413313 | Total |
| Program Services | 3731894 | ProgramServices |
| Management And General | 681419 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 177664 | Total |
| Program Services | 148910 | ProgramServices |
| Management And General | 28754 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 866874 | Total |
| Program Services | 670492 | ProgramServices |
| Management And General | 196382 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 328030 | Total |
| Program Services | 260388 | ProgramServices |
| Management And General | 67642 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20612 | Total |
| Program Services | 15985 | ProgramServices |
| Management And General | 4627 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50822 | Total |
| Management And General | 50822 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 503342 | Total |
| Program Services | 479304 | ProgramServices |
| Management And General | 24038 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 470219 | Total |
| Program Services | 470219 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 190097 | Total |
| Program Services | 128509 | ProgramServices |
| Management And General | 61588 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 310127 | Total |
| Program Services | 185453 | ProgramServices |
| Management And General | 124674 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 208768 | Total |
| Program Services | 208768 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35264 | Total |
| Program Services | 25134 | ProgramServices |
| Management And General | 10130 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38407 | Total |
| Program Services | 19337 | ProgramServices |
| Management And General | 19070 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1259241 | Total |
| Program Services | 927412 | ProgramServices |
| Management And General | 331829 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 92819 | Total |
| Program Services | 42996 | ProgramServices |
| Management And General | 49823 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MAINTENANCE CONTRACTS | 858764 | 858764 | |
| BAD DEBT EXPENSE | 530845 | 530845 | |
| REPAIRS & MAINTENANCE | 203477 | 75646 | 127831 |
| PHARMACEUTICALS | 176921 | 176921 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 756621 | Total |
| Program Services | 374286 | ProgramServices |
| Management And General | 382335 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15205902 | Total |
| Program Services | 12714489 | ProgramServices |
| Management And General | 2491413 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7554782 | BOY |
| EOY | 3808612 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5001520 | BOY |
| EOY | 4002656 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3033675 | BOY |
| EOY | 2058349 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 501787 | BOY |
| EOY | 426578 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 26740706 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 16219203 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6350378 | BOY |
| EOY | 10521503 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 448693 | BOY |
| EOY | 4248973 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22890835 | BOY |
| EOY | 25066671 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1121536 | BOY |
| EOY | 1053469 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1121536 | BOY |
| EOY | 1053469 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21769299 | BOY |
| EOY | 24013202 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21769299 | BOY |
| EOY | 24013202 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22890835 | BOY |
| EOY | 25066671 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 2243903 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | false | ContribByControllingIndividual |
| Contribution By Related Party | false | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | false | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (2 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | AmountAmount |
|---|---|---|---|
| MERITER HOSPITAL INC | |||
| 390806367 | 03 | true | $1,500,000 |
| SSM HEALTHCARE OF WISCONSIN | |||
| 430688874 | 03 | true | $1,500,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 2 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 3000000 | SumOfAmounts |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 475509 | OtherCostOrOtherBasis |
| Book Value | 475509 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7689698 | OtherCostOrOtherBasis |
| Depreciation | 3538489 | Depreciation |
| Book Value | 4151209 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 18550499 | OtherCostOrOtherBasis |
| Depreciation | 12656964 | Depreciation |
| Book Value | 5893535 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 25000 | OtherCostOrOtherBasis |
| Depreciation | 23750 | Depreciation |
| Book Value | 1250 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 10521503 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| GOODWILL | 300000 |
| EQUIPMENT DEPOSITS | 3948973 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 4248973 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
| Total Of Amounts | 0 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 16918960 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 16918960 | RevenueSubtotal |
| Other Revenues Not Included | 530845 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 530845 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 17449805 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 14675057 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 14675057 | ExpensesSubtotal |
| Other Expenses Not Included | 530845 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 530845 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 15205902 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER ASC 740-10 | SCHEDULE D, PART X, QUESTION 2 | THE COMPANY RECOGNIZES THE FINANCIAL STATEMENT BENEFIT OF A TAX POSITION ONLY AFTER DETERMINING THAT THE RELEVANT TAX AUTHORITY WOULD MORE LIKELY THAN NOT SUSTAIN THE POSITION FOLLOWING AN AUDIT. THE ASSESSMENT OF THE POSITION IS BASED SOLELY ON THE TECHNICAL MERITS OF THE POSITION, WITHOUT REGARD TO THE LIKELIHOOD THAT THE TAX POSITION MAY BE CHALLENGED. THE COMPANY IS EXEMPT FROM INCOME TAX (SEE NOTE J), THOUGH IT IS SUBJECT TO TAX ON INCOME UNRELATED TO ITS EXEMPT PURPOSES, UNLESS THAT INCOME IS OTHERWISE EXCLUDED BY THE INTERNAL REVENUE CODE. THE COMPANY HAS NOT HISTORICALLY FILED A FEDERAL OR STATE INCOME TAX RETURN; THUS, ALL TAX YEARS ARE STILL OPEN TO AUDIT FOR BOTH FEDERAL AND STATE PURPOSE. IF APPLICABLE, THE COMPANY RECOGNIZES INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS IN THE PROVISION FOR INCOME TAXES. THERE WERE NO INTEREST OR PENALTIES RELATED TO INCOME TAXES THAT HAVE BEEN ACCRUED OR RECOGNIZED AS OF AND FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011. |
| Reconciliation of Revenue and Expense | Schedule D, Part XI and XII | Part XI, Line 4b and Part XII, Line 4b Bad Debt Expense (shown net for audit) $530,845 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| Meriter Hospital Inc | |||||||
| 202 S Park St | Madison | WI | 53715 | 390806367 | 501(c)(3) | 1500000 | General Operational SupporT |
| SSM HEALTHCARE OF WISCONSIN | |||||||
| 707 S MILLS ST | MADISON | WI | 53715 | 430688874 | 501(C)(3) | 1500000 | GENERAL OPERATIONAL SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCESS FOR MONITORING USE OF GRANT FUNDS | Identifier |
| Return Reference | SCHEDULE I, PART I, QUESTION 2 | ReturnReference |
| Explanation | DISTRIBUTIONS ARE MADE IN EQUAL INSTALLMENTS TO MERITER HOSPITAL AND SSM HEALTHCARE OF WISCONSIN AT THE DISCRETION AND BY VOTE OF THE BOARD OF DIRECTORS. THE ORGANIZATION DOES NOT MONITOR THE USE OF FUNDS GRANTED TO THE GRANT RECIPIENTS LISTED IN PART II. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | true | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Marilyn Biros | ||||||||||||||
| President | 0 | 284786 | 0 | 1000 | 0 | 10918 | 0 | 43250 | 0 | 21191 | 0 | 361145 | 0 | 0 |
| David Childers | ||||||||||||||
| Vice President | 0 | 153935 | 0 | 26483 | 0 | 115 | 0 | 11504 | 0 | 5719 | 0 | 197756 | 0 | 0 |
| Charlie Johnson III | ||||||||||||||
| Board Member | 0 | 426236 | 0 | 3290 | 0 | 14947 | 0 | 43250 | 0 | 18995 | 0 | 506718 | 0 | 0 |
| Kevin Boren | ||||||||||||||
| Secretary/Treasurer | 0 | 207887 | 0 | 67478 | 0 | 17219 | 0 | 14173 | 0 | 17100 | 0 | 323857 | 0 | 0 |
| Barbara Thiermann | ||||||||||||||
| Executive Director | 123002 | 0 | 28000 | 0 | 138 | 0 | 8319 | 0 | 29336 | 0 | 188795 | 0 | 0 | 0 |
| Michael Zinda MD | ||||||||||||||
| Radiation Oncologist | 279270 | 0 | 35504 | 0 | 20192 | 0 | 20461 | 0 | 27799 | 0 | 383226 | 0 | 21389 | 0 |
| Ming Teng MD | ||||||||||||||
| Radiation Oncologist | 254474 | 0 | 126857 | 0 | 151 | 0 | 9632 | 0 | 15147 | 0 | 406261 | 0 | 21389 | 0 |
| Glenn Applegate MD | ||||||||||||||
| Radiation Oncologist | 388933 | 0 | 164866 | 0 | 83 | 0 | 15000 | 0 | 11858 | 0 | 580740 | 0 | 21389 | 0 |
| Frank Goodin | ||||||||||||||
| Physicist | 165508 | 0 | 2856 | 0 | 396 | 0 | 11708 | 0 | 27078 | 0 | 207546 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | COMPENSATION CONTINGENT ON THE REVENUES OF THE ORGANIZATION | Identifier |
| Return Reference | SCHEDULE J, PART I, QUESTION 5A | ReturnReference |
| Explanation | NO COMPENSATION IS PAID OR ACCRUED BASED ON ACTUAL REVENUE AMOUNTS. THE PHYSICIANS RECEIVE A BONUS WHICH IS BASED ON VOLUME (wrvus) WHICH IS INDIRECTLY RELATED TO REVENUE IN THAT THE MORE PATIENTS, TREATMENTS, ETC. THERE ARE, THE MORE WRVUS THERE ARE AND THEREFORE, THE MORE REVENUE THERE IS. THERE IS NO CALCULATION TO DETERMINE THE BoNUS WHICH USES THE REVENUE MONEY AMOUNT. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ELECTING OR APPOINTING MEMBERS OF THE GOVERNING BODY | PART VI, SECTION A, QUESTION 7A | BOTH MERITER HOSPITAL AND SSM HEALTHCARE OF WISCONSIN HAVE THE RIGHT TO APPOINT TWO MEMBERS OF THE ORGANIZATION'S GOVERNING BODY, PERIODICALLY, OR AS VACANCIES ARISE. |
| PROCESS USED TO REVIEW FORM 990 | PART VI, SECTION B, QUESTION 11 | AFTER THE FORM 990 WAS PREPARED BY THE ORGANIZATION'S ACCOUNTING FIRM, AND PRIOR TO FILING THE FORM 990, THE CONTROLLER PERFORMED AN IN-DEPTH REVIEW; AND THEN THE EXECUTIVE DIRECTOR AND MEDICAL DIRECTOR PERFORMED A CURSORY REVIEW, FOLLOWED BY A HIGH-LEVEL REVIEW PERFORMED BY ALL MEMBERS OF THE BOARD OF DIRECTORS. BOARD MEMBERS, THE EXECUTIVE DIRECTOR, AND MEDICAL DIRECTOR BROUGHT QUESTIONS OR CHANGES TO THE ATTENTION OF THE CONTROLLER, AS APPLICABLE. THE CONTROLLER COMMUNICATED THESE CHANGES TO THE PREPARING ACCOUNTING FIRM, GRANT THORNTON LLP. THE ORGANIZATION'S CONTROLLER WAS PROVIDED A COPY OF THE RETURN BY EMAIL BY THE ORGANIZATION'S TAX PREPARER. THE CONTROLLER REVIEWED THE FINAL COPY OF FORM 990 TO ENSURE THAT ALL CHANGES HAD BEEN MADE. FINALLY, THE ORGANIZATION E-FILED THE RETURN PROVIDED BY THE ORGANIZATION'S TAX PREPARER WITH THE INTERNAL REVENUE SERVICE. |
| ORGANIZATION'S PRACTICES FOR MONITORING CONFLICTS OF INTEREST | PART VI, SECTION B, QUESTION 12C | THE ORGANIZATION REQUIRES COMPLIANCE TRAINING AND EDUCATION INITIALLY ON HIRE AND ANNUALLY THEREAFTER. ALL EMPLOYEES, OFFICERS, AND DIRECTORS OF THE ORGANIZATION ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY. DETERMINATIONS ABOUT WHETHER A CONFLICT OF INTEREST EXIST ARE MADE BY THE ORGANIZATION'S BOARD OF DIRECTORS UPON REVIEW BY MANAGEMENT. PERSONS FOUND TO HAVE A CONFLICT OF INTEREST ARE PROHIBITED FROM PARTICIPATING IN THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS IN THE TRANSACTION OR MATTER UNDER CONSIDERATION. |
| PROCESS FOR DETERMINING/REVIEWING/APPROVING COMPENSATION | PART VI, SECTION B, QUESTIONS 15A & B | THE BOARD OF DIRECTORS DETERMINES COMPENSATION FOR THE EXECUTIVE DIRECTOR, MEDICAL DIRECTOR, AND OTHER PHYSICIANS WITH INPUT FROM THE HUMAN RESOURCES MANAGER AND AN OUTSIDE CONSULTANT. THE PROCESS FOR DETERMINING, REVIEWING, AND APPROVING COMPENSATION OF THE EXECUTIVE DIRECTOR IS CONDUCTED ANNUALLY. WITH RESPECT TO PHYSICIANS, THE PROCESS DESCRIBED ABOVE IS CONDUCTED EVERY THREE YEARS DURING THE PHYSICIAN CONTRACT RENEWAL PROCESS. |
| PROCESS FOR MAKING GOVERNING DOCUMENTS, ETC. AVAILABLE FOR PUBLIC INSPECT. | PART VI, SECTION C, QUESTION 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| SSM Healthcare of Wisconsin | ||||||||||
| 700 S Park Street | Madison | WI | 53715 | 430688874 | Hospital | MO | 501(c)(3) | 03 | NA | false |
| MERITER HOSPITAL INC | ||||||||||
| 202 S PARK STREET | MADISON | WI | 53715 | 390806367 | HOSPITAL | WI | 501(c)(3) | 03 | NA | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NOT REQUIRED | BusinessNameLine1 |
Comments