2011-11-14T17:12:55-06:00 2010-12-31 WIPFLI LLP 10000 INNOVATION DRIVE SUITE 250 MILWAUKEE WI 532264837 990 2010-01-01 391948840 TRANSFORMATIONS SURGERY CENTER INC TRAN 6088369990 2349 DEMING WAY MIDDLETON WI 53562 PETER CHRISTMAN 6088369990 2011-11-14 1 JAY ADKISSON 4144319300 2011-11-14 2010 2016-02-24 21:20:13Z PETER CHRISTMAN 7974 UW HEALTH COURT MIDDLETON WI 53562 3185582 0 X WWW.UWHEALTH.ORG X 2006 WI THE CORPORATION IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES. 6 2 12 0 0 0 0 0 2894798 3185561 22 21 0 0 2894820 3185582 0 0 0 0 1107961 1106117 0 0 0 2105437 2308320 3213398 3414437 -318578 -228855 1415147 1564278 257302 335288 1157845 1228990 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 3274651 3185561 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 3274651 1 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 1 0 0 0 0 1 4 0 0 12 1 0 0 0 0 0 0 0 0 0 0 X 6 2 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 WI X NICK COCHEMS 6082872200 ONE SOUTH PARK STREET MADISON WI 537151375 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 SERVICES AND SUPPLIES 1756780 BOARD OF REGENTS OF THE UW SYSTEM B6/319 CLINICAL SCIENCE CENTER MADISON WI 53792 ANESTHESIOLOGY SERVICES 382337 MERITER HOSPITAL 202 S PARK STREET MADISON WI 53715 MEDICAL SUPPLIES 224065 MENTOR WORLDWIDE 15600 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 BREAST PROSTHESES 158984 COVIDIEN DEPT 34179 PO BOX 39000 PALENTINE IL 60055 HEALTHCARE SERVICES 132871 5 INSURANCE 624100 2556723 2556723 COSMETIC - SELF PAY 624100 628838 628838 3185561 21 21 3185582 3185561 0 21 824971 773312 51659 66592 62422 4170 153658 144036 9622 60896 57083 3813 20120 20120 15628 15628 22177 15007 7170 5161 5161 580708 563287 17421 77 77 995 995 162079 158665 3414 25609 25314 295 MEDICAL SUPPLIES AND DR 727402 727402 PURCHASED SERVICES 472873 472873 STATE ASC ASSESSMENT 210238 210238 LAUNDRY SERVICES 33565 33565 OTHER EXPENSES 31688 30375 1313 3414437 3274651 139786 0 101543 364058 25568 25588 407972 407316 179353 197284 38958 52671 1164256 646895 661753 517361 1415147 1564278 257302 264941 0 70347 257302 335288 X 1157845 1228990 1157845 1228990 1415147 1564278 X -228855 300000 X 0 1 1 X 0 X 2018891 1239495 2894798 3185561 9338745 2018891 1239495 2894798 3185561 9338745 0 0 0 9338745 110 36 22 21 189 110 36 22 21 189 2019001 1239531 2894820 3185582 9338934 1.00000 1.00000 0.00000 X 33308 5385 27923 1130948 641510 489438 517361 STATE TAX ASSESSMENT PAYABLE 70347 70347 3185582 3414437 -228855 300000 300000 71145 3191846 6264 6264 3185582 0 3185582 3420701 6264 6264 3414437 0 3414437 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 XI, LINE 8 - OTHER ADJUSTMENTS: CAPITAL CONTRIBUTIONS 300,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 6,264. PART XIII, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 6,264. 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 7A EACH MEMBER SHALL HAVE A CONTINUING RIGHT TO APPOINT TWO (2) CLASS A DIRECTORS. INITIALLY, EACH MEMBER SHALL ALSO DESIGNATE AND APPOINT ONE (1) CLASS B DIRECTOR. THEREAFTER, EACH SUBSEQUENT CLASS B DIRECTOR SHALL BE NOMINATED BY THE MEMBER THAT DESIGNATED THE ORIGINAL CLASS B DIRECTOR THAT FILLED THAT SEAT, AND SUCH NOMINEE SHALL BE APPOINTED THERETO ONLY AFTER SUCH NOMINEE RECEIVES APPROVAL BY THE BOARD. A CLASS B DIRECTOR MAY NOT BE AN EMPLOYEE OF A MEMBER AND MAY NOT OTHERWISE BE UNDER THE CONTROL OF A MEMBER. CLASS B DIRECTORS SHALL REPRESENT THE INTEREST OF THE PUBLIC AT LARGE. 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 BUSINESS MANAGER AT TRANSFORMATIONS SURGERY CENTER 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CAPITAL CONTRIBUTIONS 300,000. TOTAL TO FORM 990, PART XI, LINE 5: 300,000. UW MEDICAL FOUNDATION 7974 UW HEALTH COURT MIDDLETON WI 53562 PATIENT CARE WI 501(C)(3) LINE 9 N/A 0 MERITER HOSPITAL 202 S PARK ST MADISON WI 53715 PATIENT CARE WI 501(C)(3) LINE 3 N/A 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 MERITER HOSPITAL G 222884 FAIR VALUE UW MEDICAL FOUNDATION N 1344328 FAIR VALUE