SHARED MAGNETIC RESONANCE IMAGING FACILITY INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- SHARED MAGNETIC RESONANCE IMAGING FACILITY INC (EIN 39-1534744)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-10-02
- IRS object ID
- 201712759349300206
- Schema version
- 2016v3.0
- 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) |
|---|---|---|
| Return | 2017-10-02T08:59:53-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390857178 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SMITH & GESTELAND LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1764 | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391534744 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHARED MAGNETIC RESONANCE IMAGING | BusinessNameLine1Txt |
| Business Name Line2 | FACILITY INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SHAR | BusinessNameControlTxt |
| Phone | 6082594376 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1104 JOHN NOLEN DRIVE | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53713 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVE CHILDERS | PersonNm |
| Person Title | VICE PRESIDENT | PersonTitleTxt |
| Phone | 6082594376 | PhoneNum |
| Signature | 2017-09-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KEITH BAUMGARTNER | PreparerPersonNm |
| PTIN | P00187845 | PTIN |
| Phone | 6088367500 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 71.13.118.18 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-09-08 | IPDt |
| IP Tm | 07:27:53 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 7C145FA1F12AB633E8FA88E1883CB6E89FD91A07 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | BC9C8F3DA8534C15B8167071CC0A49CD3C15A948 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TURVILLE BAY MRI AND RADIATION | BusinessNameLine1Txt |
| Business Name Line2 | ONCOLOGY CENTER | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | BARBARA THEIRMANN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1104 JOHN NOLEN DRIVE | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53713 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $22,016,345 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.TURVILLEBAY.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1986 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 1 | VotingMembersIndependentCnt |
| Total Employee | 88 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $4,469 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $1,287 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $112,370 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $21,270,438 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $21,541,979 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$858,814 | PYInvestmentIncomeAmt |
| CY Investment Income | $420,934 | CYInvestmentIncomeAmt |
| PY Other Revenue | $25,828 | PYOtherRevenueAmt |
| CY Other Revenue | $17,055 | CYOtherRevenueAmt |
| PY Total Revenue | $20,549,822 | PYTotalRevenueAmt |
| CY Total Revenue | $21,979,968 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $3,000,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,399,394 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,094,293 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,660,347 | PYOtherExpensesAmt |
| CY Other Expenses | $8,446,289 | CYOtherExpensesAmt |
| PY Total Expenses | $19,059,741 | PYTotalExpensesAmt |
| CY Total Expenses | $17,540,582 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,490,081 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,439,386 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $34,828,210 | TotalAssetsBOYAmt |
| Total Assets EOY | $40,190,471 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,030,267 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,953,142 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $33,797,943 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $38,237,329 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE CORE MISSION OF TURVILLE BAY MRI AND RADIATION ONCOLOGY CENTER IS TO PRESERVE AND IMPROVE HUMAN LIFE. THE 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $7,248,260 | ExpenseAmt |
| Revenue | $12,485,139 | RevenueAmt |
| Desc | RADIATION ONCOLOGY SERVICES: TURVILLE BAY RADIATION ONCOLOGY CENTER PROVIDES RADIATION THERAPY TREATMENT SERVICES. THE CENTER PERFORMED 11,653 TREATMENTS IN 2016. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,452,847 | ExpenseAmt |
| Revenue | $9,056,840 | RevenueAmt |
| Desc | MRI SERVICES: TURVILLY BAY MRI CENTER PROVIDES DIAGNOSTIC EXAMINATIONS USING MAGNETIC RESONANCE IMAGING. THE CENTER PERFORMED 9,644 SCANS IN 2016. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $11,701,107 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 41 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 88 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 1 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SARAH FAUST | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6082594376 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1104 JOHN NOLEN DRIVE | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53713 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| SETH TEIGEN | |||||||||
| PRESIDENT | 1.00 | 45.00 | Yes (X) | Yes (X) | $0 | $193,891 | $51,926 | ||
| DAVID CHILDERS | |||||||||
| VICE PRESIDENT | 0.50 | 45.00 | Yes (X) | Yes (X) | $0 | $194,011 | $39,644 | ||
| KERRY SWANSON | |||||||||
| SECRETARY/TREASURER | 0.50 | 45.00 | Yes (X) | Yes (X) | $0 | $342,077 | $90,393 | ||
| SUE ERICKSON | |||||||||
| DIRECTOR | 0.50 | 45.00 | Yes (X) | $0 | $420,388 | $70,307 | |||
| RICHARD BAKER | |||||||||
| DIRECTOR/MRI MEDICAL DIRECTOR | 0.50 | 45.00 | Yes (X) | $0 | $0 | $0 | |||
| BARBARA THIERMANN | |||||||||
| EXECUTIVE DIRECTOR | 40.00 | Yes (X) | $162,459 | $0 | $51,266 | ||||
| SARAH FAUST | |||||||||
| CONTROLLER | 40.00 | Yes (X) | $116,201 | $0 | $48,140 | ||||
| MICHELLE MACKAY | |||||||||
| RADIATION ONCOLOGY MEDICAL DIRECTOR | 40.00 | $558,086 | $0 | $68,852 | Yes (X) | ||||
| RICHARD AUCHTER | |||||||||
| RADIATION ONCOLOGIST | 40.00 | $222,090 | $0 | $11,966 | Yes (X) | ||||
| FRANK GOODIN | |||||||||
| CHIEF PHYSICIST | 40.00 | $232,254 | $0 | $53,785 | Yes (X) | ||||
| JUNE KIM | |||||||||
| RADIATION ONCOLOGIST | 40.00 | $475,137 | $0 | $27,264 | Yes (X) | ||||
| JESSICA KLAERS | |||||||||
| PHYSICIST | 40.00 | $172,541 | $0 | $20,254 | Yes (X) | ||||
| JAMES RICHARDSON | |||||||||
| RADIATION ONCOLOGIST | 40.00 | $481,319 | $0 | $28,693 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,420,087 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,150,367 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $562,490 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| VARIAN MEDICAL SYSTEMS | |||||
| 70140 NETWORK PL | CHICAGO | IL | 606731701 | EQUIPMENT MAINTENANCE | $1,646,541 |
| JH FINDORFF & SON INC | |||||
| 300 SOUTH BEDFORD STREET | MADISON | WI | 53703 | CONSTRUCTION | $879,820 |
| SIEMENS MEDICAL SOLUTIONS USA INC | |||||
| DEPT CH 14195 | PALATINE | IL | 600554195 | EQUIPMENT MAINTENANCE | $814,524 |
| PHILIPS MEDICAL SYSTEMS NA COMPANY | |||||
| PO BOX 100355 | ATLANTA | GA | 303840355 | EQUIPMENT MAINTENANCE | $353,953 |
| TOMOTHERAPY INCORPORATED | |||||
| PO BOX 204793 | DALLAS | TX | 753204793 | SERVICE CONTRACT | $275,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| RADIATION ONCOLOGY REVENUE | 621500 | $12,485,139 | $12,485,139 |
| MRI REVENUE | 621500 | $9,056,840 | $9,056,840 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $21,541,979 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $75,815 | TotalRevenueColumnAmt |
| Exclusion | $75,815 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $381,496 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $36,377 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $345,119 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $345,119 | TotalRevenueColumnAmt |
| Exclusion | $345,119 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| MISCELLANEOUS REVENUE | 900099 | $12,586 | $12,586 | |
| STANDARD IMAGING, SCANDIDOS | 621500 | $4,469 | $4,469 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $17,055 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,979,968 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $21,541,979 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $4,469 | UnrelatedBusinessRevenueAmt |
| Exclusion | $433,520 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,005,004 | TotalAmt |
| Program Services | $626,939 | ProgramServicesAmt |
| Management And General | $378,065 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,448,351 | TotalAmt |
| Program Services | $4,990,231 | ProgramServicesAmt |
| Management And General | $1,458,120 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $277,722 | TotalAmt |
| Program Services | $203,795 | ProgramServicesAmt |
| Management And General | $73,927 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $913,939 | TotalAmt |
| Program Services | $594,488 | ProgramServicesAmt |
| Management And General | $319,451 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $449,277 | TotalAmt |
| Program Services | $322,277 | ProgramServicesAmt |
| Management And General | $127,000 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,193 | TotalAmt |
| Management And General | $31,193 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,722 | TotalAmt |
| Management And General | $71,722 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $258,866 | TotalAmt |
| Program Services | $127,734 | ProgramServicesAmt |
| Management And General | $131,132 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $581,732 | TotalAmt |
| Management And General | $581,732 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $398,172 | TotalAmt |
| Program Services | $36,222 | ProgramServicesAmt |
| Management And General | $361,950 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $548,561 | TotalAmt |
| Management And General | $548,561 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,135,708 | TotalAmt |
| Program Services | $488,974 | ProgramServicesAmt |
| Management And General | $646,734 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,757 | TotalAmt |
| Program Services | $19,942 | ProgramServicesAmt |
| Management And General | $28,815 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,637 | TotalAmt |
| Program Services | $18,849 | ProgramServicesAmt |
| Management And General | $30,788 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,704,864 | TotalAmt |
| Program Services | $1,955,303 | ProgramServicesAmt |
| Management And General | $749,561 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $114,757 | TotalAmt |
| Program Services | $34,072 | ProgramServicesAmt |
| Management And General | $80,685 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MAINTENANCE CONTRACTS | $1,332,500 | $1,332,500 | |
| BAD DEBT EXPENSE | $528,371 | $528,371 | |
| PHARMACEUTICALS | $202,115 | $202,115 | |
| UBI TAXES | $211 | $211 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $439,123 | TotalAmt |
| Program Services | $219,295 | ProgramServicesAmt |
| Management And General | $219,828 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,540,582 | TotalAmt |
| Program Services | $11,701,107 | ProgramServicesAmt |
| Management And General | $5,839,475 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,745,033 | BOYAmt |
| EOY | $19,573,817 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,676 | BOYAmt |
| EOY | $2,681 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,372,354 | BOYAmt |
| EOY | $2,486,578 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $776,195 | BOYAmt |
| EOY | $890,817 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $38,891,552 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $21,974,575 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,599,250 | BOYAmt |
| EOY | $16,916,977 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $332,702 | BOYAmt |
| EOY | $319,601 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,828,210 | BOYAmt |
| EOY | $40,190,471 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,030,267 | BOYAmt |
| EOY | $1,953,142 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,030,267 | BOYAmt |
| EOY | $1,953,142 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,797,943 | BOYAmt |
| EOY | $38,237,329 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,797,943 | BOYAmt |
| EOY | $38,237,329 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,828,210 | BOYAmt |
| EOY | $40,190,471 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $4,439,386 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 2 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (2 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| MERITER HOSPITAL INC | ||||
| 390806367 | 3 | 0 | $0 | $0 |
| SSM HEALTHCARE OF WISCONSIN | ||||
| 430688874 | 3 | 0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 2 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | 0 | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, SECTION A, LINE 1: | SHARED MAGNETIC RESONANCE IMAGING FACILITY, INC. HAS HISTORICALLY SUPPORTED THE LISTED ORGANIZATIONS WHICH ARE ITS MEMBERS. THESE ORGANIZATIONS, OR THEIR SUCCESSORS, WERE LISTED AS SUPPORTED ORGANIZATIONS ON THE FORM 1023 APPLICATION. |
| PART IV, SECTION B, LINE 1: | THE SUPPORTED ORGANIZATIONS EACH HAVE THE POWER TO APPOINT TWO OF THE FIVE MEMBERS OF THE GOVERNING BODY, PERIODICALLY OR AS VACANCIES ARISE. THE MEMBERS (SUPPORTED ORGANIZATIONS) SHALL ELECT THE REMAINING DIRECTOR(S). |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $822,982 | OtherCostOrOtherBasisAmt |
| Book Value | $822,982 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,060,394 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,620,673 | DepreciationAmt |
| Book Value | $3,439,721 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $29,949,400 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,317,151 | DepreciationAmt |
| Book Value | $12,632,249 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $58,776 | OtherCostOrOtherBasisAmt |
| Depreciation | $36,751 | DepreciationAmt |
| Book Value | $22,025 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $16,916,977 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $21,451,597 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $21,451,597 | RevenueSubtotalAmt |
| Other Revenues Not Included | $528,371 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $528,371 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $21,979,968 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $17,012,211 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $17,012,211 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $528,371 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $528,371 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $17,540,582 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE (SHOWN NET FOR AUDIT) 528,371. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE (SHOWN NET FOR AUDIT) 528,371. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SETH TEIGEN | ||||||||||||||
| PRESIDENT | $0 | $180,872 | $0 | $11,004 | $0 | $2,015 | $0 | $21,236 | $0 | $30,690 | $0 | $245,817 | $0 | $11,004 |
| DAVID CHILDERS | ||||||||||||||
| VICE PRESIDENT | $0 | $168,381 | $0 | $25,536 | $0 | $94 | $0 | $24,511 | $0 | $15,133 | $0 | $233,655 | $0 | $0 |
| KERRY SWANSON | ||||||||||||||
| SECRETARY/TREASURER | $0 | $289,024 | $0 | $36,582 | $0 | $16,471 | $0 | $57,653 | $0 | $32,740 | $0 | $432,470 | $0 | $36,582 |
| SUE ERICKSON | ||||||||||||||
| DIRECTOR | $0 | $305,802 | $0 | $88,705 | $0 | $25,881 | $0 | $57,880 | $0 | $12,427 | $0 | $490,695 | $0 | $0 |
| BARBARA THIERMANN | ||||||||||||||
| EXECUTIVE DIRECTOR | $147,579 | $0 | $14,742 | $0 | $138 | $0 | $22,717 | $0 | $28,549 | $0 | $213,725 | $0 | $14,742 | $0 |
| SARAH FAUST | ||||||||||||||
| CONTROLLER | $104,450 | $0 | $11,207 | $0 | $544 | $0 | $18,883 | $0 | $29,257 | $0 | $164,341 | $0 | $11,207 | $0 |
| MICHELLE MACKAY | ||||||||||||||
| RADIATION ONCOLOGY MEDICAL DIRECTOR | $527,102 | $0 | $30,930 | $0 | $54 | $0 | $45,023 | $0 | $23,829 | $0 | $626,938 | $0 | $30,930 | $0 |
| RICHARD AUCHTER | ||||||||||||||
| RADIATION ONCOLOGIST | $222,032 | $0 | $0 | $0 | $58 | $0 | $0 | $0 | $11,966 | $0 | $234,056 | $0 | $0 | $0 |
| FRANK GOODIN | ||||||||||||||
| CHIEF PHYSICIST | $212,902 | $0 | $19,123 | $0 | $229 | $0 | $24,831 | $0 | $28,954 | $0 | $286,039 | $0 | $19,123 | $0 |
| JUNE KIM | ||||||||||||||
| RADIATION ONCOLOGIST | $474,908 | $0 | $0 | $0 | $229 | $0 | $15,900 | $0 | $11,364 | $0 | $502,401 | $0 | $0 | $0 |
| JESSICA KLAERS | ||||||||||||||
| PHYSICIST | $172,487 | $0 | $0 | $0 | $54 | $0 | $10,393 | $0 | $9,861 | $0 | $192,795 | $0 | $0 | $0 |
| JAMES RICHARDSON | ||||||||||||||
| RADIATION ONCOLOGIST | $481,181 | $0 | $0 | $0 | $138 | $0 | $15,900 | $0 | $12,793 | $0 | $510,012 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 5 | FormAndLineReferenceDesc |
| 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 DOLLAR AMOUNT. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 7A | BOTH MERITER HOSPITAL AND SSM HEALTHCARE EACH HAVE THE RIGHT TO APPOINT TWO MEMBERS OF THE ORGANIZATION'S GOVERNING BODY, PERIODICALLY, OR AS VACANCIES ARISE. |
| FORM 990, PART VI, SECTION B, LINE 11B | 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, SMITH & GESTELAND 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. |
| FORM 990, PART VI, SECTION B, LINE 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 EXISTS 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 BOARD'S DELIBERATIONS AND DECISIONS IN THE TRANSACTION OR MATTER UNDER CONSIDERATION. |
| FORM 990, PART VI, SECTION B, LINE 15 | 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. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| SSM HEALTHCARE OF WISCONSIN | ||||||||||
| 700 S PARK ST | MADISON | WI | 53715 | 430688874 | HOSPITAL | MO | 501(C)(3) | LINE 3 | N/A | 0 |
| MERITER HOSPITAL INC | ||||||||||
| 202 S PARK ST | MADISON | WI | 53715 | 390806367 | HOSPITAL | WI | 501(C)(3) | LINE 3 | N/A | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt |
|---|---|
| MERITER HOSPITAL | |
| K | $181,752 |
| ST MARY'S HOSPITAL | |
| K | $147,983 |