2012-11-13T10:02:55-06:00 2011-12-31 390758449 WIPFLI LLP 10000 INNOVATION DRIVE SUITE 250 MILWAUKEE WI 532264837 990 2011-01-01 391948840 TRANSFORMATIONS SURGERY CENTER INC TRAN 6088214883 7974 UW HEALTH COURT MIDDLETON WI 53562 PETER CHRISTMAN 6088214883 2012-11-09 1 JAY ADKISSON CPA P01360892 4144319300 2012-11-09 2011 2016-02-24 21:20:13Z X PETER CHRISTMAN 7974 UW HEALTH COURT MIDDLETON WI 53562 3575317 0 X WWW.UWHEALTH.ORG X 2006 WI THE CORPORATION IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES. 6 6 29 0 0 0 0 0 3185561 3575303 21 14 0 0 3185582 3575317 0 0 0 0 1106117 1086691 0 0 0 2308320 2346554 3414437 3433245 -228855 142072 1564278 1770145 335288 399083 1228990 1371062 X THE CORPORATION'S PURPOSES ARE TO: (A) PROMOTE AND ADVANCE THE HEALTH AND WELFARE OF PERSONS IN THE COMMUNITY THROUGH PROVISION OF RECONSTRUCTIVE AND PLASTIC SURGERY SERVICES; (B) CARRY ON EDUCATIONAL ACTIVITIES RELATED TO RENDERING HEALTH CARE SERVICES TO PATIENTS; AND (C) PARTICIPATE IN OTHER ACTIVITIES AS AGREED TO BY THE CORPORATION'S MEMBERS THAT ARE DESIGNED AND CARRIED ON TO PROMOTE AND ADVANCE THE GENERAL HEALTH AND WELFARE OF PERSONS IN THE COMMUNITY. 0 0 3251997 3575303 OFFERED A FULL COMPLEMENT OF COSMETIC, PLASTIC AND RECONSTRUCTIVE SURGERY AND AESTHETIC AND LASER TREATMENT OPTIONS IN A CARING, DISCRETE ENVIRONMENT, APPROXIMATELY 1000 SURGERIES WERE PERFORMED 3251997 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 6 0 1 29 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 1 0 1 1 1 0 0 0 1 1 1 1 1 0 0 0 WI X NICK COCHEMS 6088214883 7974 UW HEALTH COURT MIDDLETON WI 56562 X PETER CHRISTMAN 2.00 X X 0 0 0 PAT GRUNWALD 2.00 X X 0 0 0 JERRY HISGEN 2.00 X X 0 0 0 KEVIN BOREN 2.00 X X 0 0 0 MICHAEL BENTZ MD 2.00 X 0 0 0 MARIE STATTON 2.00 X 0 0 0 0 0 0 0 0 0 0 UNIVERSITY OF WISCONSIN MEDICAL FOUNDATO 7474 UW HEALTH COURT MIDDLETON WI 53562 ADMINISTRATIVE SERVICES AND SUPPLIES 1726930 BOARD OF REGENTS OF THE UW SYSTEM B6/319 CLINICAL SCIENCE CENTER MADISON WI 53792 ANESTHESIOLOGY SERVICES 325254 MERITER HOSPITAL 202 S PARK STREET MADISON WI 53715 MEDICAL SUPPLIES 265061 MENTOR WORLDWIDE 15600 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 MEDICAL SUPPLIES 126206 4 INSURANCE 624100 2914363 2914363 COSMETIC - SELF PAY 624100 660940 660940 3575303 14 14 3575317 3575303 0 14 804056 735637 68419 66560 60896 5664 158440 144958 13482 57635 52731 4904 22655 22655 13699 13699 14710 14710 20280 14724 5556 8011 8011 599940 581942 17998 534 534 875 875 191279 187532 3747 25740 25441 299 MEDICAL SUPPLIES AND DR 780603 780603 PURCHASED SERVICES 457488 457488 STATE ASC ASSESSMENT 141748 141748 OTHER EXPENSES 39864 37760 2104 29128 29128 3433245 3251997 181248 0 364058 464185 25588 25601 407316 625390 197284 143932 52671 54832 1296438 840233 517361 456205 1564278 1770145 264941 327681 70347 71402 335288 399083 X 1228990 1371062 1228990 1371062 1564278 1770145 142072 0 X 0 1 1 X 0 X 2018891 1239495 2894798 3185561 3575303 12914048 2018891 1239495 2894798 3185561 3575303 12914048 0 0 0 12914048 110 36 22 21 14 203 110 36 22 21 14 203 2019001 1239531 2894820 3185582 3575317 12914251 1.00000 1.00000 0.00000 X 78632 9213 69419 1217806 831020 386786 456205 STATE TAX ASSESSMENT PAYABLE 71402 71402 3575317 3433245 142072 142072 3587512 12195 12195 3575317 0 3575317 3445440 12195 12195 3433245 0 3433245 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE SURGERY CENTER IS A TAX-EXEMPT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE"CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SURGERY CENTER IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. FEDERAL TAX RETURNS FOR TAX YEARS 2007 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XII, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 12,195. PART XIII, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 12,195. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION HAS TWO MEMBERS CONSISTING OF THE UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION, INC., A WISCONSIN NONSTOCK, NONPROFIT CORPORATION AND MERITER HOSPITAL, INC., A WISCONSIN NONSTOCK, NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS REQUIRE UNANIMOUS APPROVAL BY THE MEMBERS: (A) MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION; (B) AMENDMENT, RESTATEMENT, ALTERATION OR REPEAL OF THE ARTICLES OF INCORPORATION OR THE BYLAWS OF THE CORPORATION; (C) A SALE, LEASE, EXCHANGE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY OR ASSETS OF THE CORPORATION; (D) THE CALL FOR ADDITIONAL CONTRIBUTIONS FROM MEMBERS TO THE CORPORATION OR ASSESSMENTS AGAINST THE MEMBER; (E) ANY DISTRIBUTION OF ASSETS OF THE CORPORATION TO ONE OR MORE MEMBERS; AND (F) EXECUTION, AMENDMENT, OR TERMINATION OF ANY AGREEMENT BETWEEN THE CORPORATION AND ANY MEMBER. FORM 990, PART VI, SECTION B, LINE 11 THE SENIOR FINANCIAL ANALYST AT UWMF REVIEWS THE FORM 990 BEFORE IT IS SIGNED BY THE VP OF FINANCE FOR THE MANAGING PARTNER. FORM 990, PART VI, SECTION B, LINE 12C AT THE FIRST MEETINGS OF THE BOARD OF DIRECTORS AND THE OPERATIONS BOARD SUBSEQUENT TO THE ANNUAL MEETING OF THE SURGERY CENTER MEMBERS, EACH MEMBER OF THE BOARD OF DIRECTORS AND THE OPERATIONS BOARD SHALL SIGN A WRITTEN STATEMENT CERTIFYING TO ALL OF THE FOLLOWING: (I) HE OR SHE HAS RECEIVED A COPY OF THIS CONFLICT OF INTEREST POLICY; (II) HE OR SHE HAS READ AND UNDERSTANDS THIS CONFLICT OF INTEREST POLICY; (III) HE OR SHE AGREES TO COMPLY WITH THIS CONFLICT OF INTEREST POLICY; (IV) HE OR SHE UNDERSTANDS THAT THIS CONFLICT OF INTEREST POLICY APPLIES TO ALL COMMITTEES AND SUBCOMMITTEES HAVING BOARD-DELEGATED POWERS; AND (V) HE OR SHE UNDERSTANDS THAT THE SURGERY CENTER IS A CHARITABLE ORGANIZATION, AND THAT, IN ORDER TO OBTAIN AND MAINTAIN THE TAX-EXEMPT STATUS OF THE SURGERY CENTER UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986 AS AMENDED, THE SURGERY CENTER MUST CONTINUALLY ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. ANY MEMBER OF THE BOARD OF DIRECTORS WHO REFUSES OR FAILS TO SIGN SUCH A STATEMENT SHALL BE PROHIBITED FROM PARTICIPATING IN DISCUSSION OR ACTION BY THE BOARD OF DIRECTORS OR THE OPERATIONS BOARD UNTIL SUCH STATEMENT IS SIGNED. IF IT IS DETERMINED AT ANY TIME THAT AN INTERESTED PERSON HAS NEGLIGENTLY OR INTENTIONALLY FAILED TO DISCLOSE A FINANCIAL INTEREST, THE PRESIDENT SHALL CONSIDER THE IMPOSITION OF SUCH SANCTIONS AS THE PRESIDENT, IN HIS OR HER EXCLUSIVE DISCRETION, MAY DEEM APPROPRIATE. FORM 990, PART VI, SECTION C, LINE 19 TRANSFORMATIONS SURGERY CENTER MAKES THESE DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.