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 391940656 MADISON SURGERY CENTER INC MADI 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 25634784 0 X WWW.MADISONSURGCENTER.ORG X 1996 WI THE CORPORATION'S GOAL IS TO PROVIDE QUALITY HEALTH CARE SERVICES, FACILITATE TRAINING OF MEDICAL STUDENTS, AND BE COMMITTED TO THE COMMUNITY IT SERVES. 6 0 122 0 0 0 0 0 23135830 25634734 74 50 0 0 23135904 25634784 0 0 0 0 6825763 6836174 0 0 0 10787079 11189281 17612842 18025455 5523062 7609329 12238773 12847751 1357769 1332418 10881004 11515333 X THE CORPORATION'S PURPOSES ARE TO: (A) PROVIDE SURGICAL SERVICES TO PATIENTS NOT REQUIRING HOSPITALIZATION IN FURTHERANCE OF THE NEEDS OF THE COMMUNITY; (B) CARRY ON EDUCATIONAL ACTIVITIES RELATED TO RENDERING HEALTH CARE SERVICES TO PATIENTS; (C) PARTICIPATE IN ANY ACTIVITY DESIGNED AND CARRIED ON TO PROMOTE AND ADVANCE THE GENERAL HEALTH AND WELFARE OF PERSONS IN THE COMMUNITY; AND (D) TO DO ALL OTHER THINGS NECESSARY OR CONVENIENT TO ACCOMPLISH ITS PURPOSES. 0 0 17002510 25634734 HEALTH CARE SERVICES 17002510 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 14 0 1 122 1 0 0 0 0 0 0 0 0 0 0 X 6 0 0 0 0 0 1 1 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 53562 X PETER CHRISTMAN 2.00 X X 0 0 0 KEVIN BOREDN 2.00 X X 0 0 0 PAT GRUNWALD 2.00 X X 0 0 0 JAMES DECHENE 2.00 X X 0 0 0 RENEE RIZZO 2.00 X X 0 0 0 ROBERT PEARCE MD 2.00 X 0 0 0 0 0 0 0 0 0 0 UNIVERSITY OF WISCONSIN MEDICAL FOUNDATI 7974 UW HEALTH COURT MIDDLETON WI 53562 MEDICAL SERVICES 9451074 MERITER HOSPITAL INC 202 S PARK STREET MADISON WI 53715 MEDICAL SERVICES 1625834 VANTAGE TECHNOLOGY PO BOX 428 EFFINGHAM IL 62401 MEDICAL SERVICES 1422065 BOARD OF REGENTS UW SYSTEM B6/319 CLINICAL SCIENCE CENTER 600 MADISON WI 53792 ANESTHESIOLOGY SERVICES 438535 TRI-NORTH BUILDERS 2625 RESEARCH PARK DR FITCHBURG WI 53711 BUILDING CONTRACTOR 386240 18 AMBULATORY SURGERY CEN 621910 25589265 25589265 OTHER REVENUE 621910 45469 45469 25634734 50 50 25634784 25634734 0 50 5019966 4560575 459391 423512 384755 38757 1019896 926562 93334 372800 338684 34116 111685 111685 16235 16235 32389 32389 202693 159455 43238 69891 69891 2184541 2119005 65536 4427 4427 8926 8926 1117430 1092546 24884 77130 76141 989 MEDICAL SUPPLIES AND DR 5202891 5202891 STATE ASC ASSESSMENT 1015871 1015871 PURCHASED SERVICES 828318 797738 30580 LAUNDRY SERVICES 229034 229034 87820 85900 1920 18025455 17002510 1022945 0 978285 1143569 99816 99866 4761207 5040686 950876 1169824 110757 125967 13619132 8351293 5337832 5267839 12238773 12847751 857340 816976 500429 515442 1357769 1332418 X 10881004 11515333 10881004 11515333 12238773 12847751 X 7609329 -6975000 X 0 1 1 X 0 X 15838359 20178914 21279185 23135830 25634734 106067022 15838359 20178914 21279185 23135830 25634734 106067022 0 0 0 106067022 111626 49474 393 74 50 161617 111626 49474 393 74 50 161617 13606 188 1836 15630 15963591 20228576 21281414 23135904 25634784 106244269 0.99830 0.99770 0.00150 0.00210 X 3190159 2849506 340653 10428973 5501787 4927186 5267839 STATE TAX ASSESSMENT PAYABLE 515442 515442 25634784 18025455 7609329 -6975000 -6975000 634329 25906327 271543 271543 25634784 0 25634784 18296998 271543 271543 18025455 0 18025455 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. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE SURGERY CENTER DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINIATION ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE SURGERY CENTER RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS IN 2011 OR 2010 AS MANAGEMENT BELIEVES THE SURGERY CENTER HAS NO MATERIAL UNRECOGNIZED INCOME TAX POSITIONS. FEDERAL TAX RETURNS FOR TAX YEARS 2008 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE PART XI, LINE 8 - OTHER ADJUSTMENTS: DISTRIBUTIONS TO MEMBERS -6,975,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 271,543. PART XIII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 271,543. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION HAS ONE CLASS OF THREE VOTING MEMBERS WHICH HAVE IDENTIAL RIGHTS AND OBLIGATIONS WITH RESPECT TO VOTING, DISSOLUTION, REDEMPTION, TRANSFER AND OTHERWISE. MEMBERS WILL BE ADMITTED, SUSPENDED, EXPELLED OR TERMINATED PURSUANT TO BYLAWS OF THE CORPORATION. THE MEMBERS ARE UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION, INC., MERITER HOSPITAL, INC. AND UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY. FORM 990, PART VI, SECTION A, LINE 7A EACH MEMBER APPOINTS TWO DIRECTORS. DIRECTORS WILL SERVE UNTIL HIS OR HER DEATH, RESIGNATION OR REMOVAL, OR UNTIL A SUCCESSOR HAS BEEN APPOINTED. UPON THE EXPIRATION OF A DIRECTOR'S TERM, THE MEMBER THAT APPOINTED SUCH DIRECTOR WILL APPOINT HIS OR HER SUCCESSOR. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS REQUIRE THE APPROVAL OF 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, OR THE ADOPTION OF NEW ARTICLES OF INCORPORATION OR BYLAWS; (C) A SALE, LEASE, EXCHANGE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE CORPORATION; (D) THE CALL FOR ADDITIONAL CONTRIBUTIONS FROM MEMBERS TO THE CORPORATION OR ASSESSMENTS AGAINST THE MEMBERS; AND (3) ANY DISTRIBUTION OF ASSETS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 THE SENIOR FINANCIAL ANALYST FOR 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 MADISON SURGERY CENTER MAKES THESE DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: DISTRIBUTIONS TO MEMBERS -6,975,000. TOTAL TO FORM 990, PART XI, LINE 5: -6,975,000.