2017-10-02T08:59:53-05:00 2016-12-31 390857178 SMITH & GESTELAND LLP PO BOX 1764 MADISON WI 53701 990 2016-01-01 391534744 SHARED MAGNETIC RESONANCE IMAGING FACILITY INC SHAR 6082594376 1104 JOHN NOLEN DRIVE MADISON WI 53713 DAVE CHILDERS VICE PRESIDENT 6082594376 2017-09-08 1 KEITH BAUMGARTNER P00187845 6088367500 71.13.118.18 2017-09-08 07:27:53 CD P 7C145FA1F12AB633E8FA88E1883CB6E89FD91A07 BC9C8F3DA8534C15B8167071CC0A49CD3C15A948 2016 2021-01-29 14:40:06Z TURVILLE BAY MRI AND RADIATION ONCOLOGY CENTER BARBARA THEIRMANN 1104 JOHN NOLEN DRIVE MADISON WI 53713 22016345 0 X WWW.TURVILLEBAY.COM X 1986 WI 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. 5 1 88 0 4469 1287 112370 0 21270438 21541979 -858814 420934 25828 17055 20549822 21979968 3000000 0 0 0 8399394 9094293 0 0 0 7660347 8446289 19059741 17540582 1490081 4439386 34828210 40190471 1030267 1953142 33797943 38237329 X 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. 0 0 7248260 12485139 RADIATION ONCOLOGY SERVICES: TURVILLE BAY RADIATION ONCOLOGY CENTER PROVIDES RADIATION THERAPY TREATMENT SERVICES. THE CENTER PERFORMED 11,653 TREATMENTS IN 2016. 4452847 9056840 MRI SERVICES: TURVILLY BAY MRI CENTER PROVIDES DIAGNOSTIC EXAMINATIONS USING MAGNETIC RESONANCE IMAGING. THE CENTER PERFORMED 9,644 SCANS IN 2016. 11701107 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 41 0 1 88 1 1 1 0 0 0 0 0 0 0 0 0 X 5 1 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X SARAH FAUST 6082594376 1104 JOHN NOLEN DRIVE MADISON WI 53713 SETH TEIGEN PRESIDENT 1.00 45.00 X X 0 193891 51926 DAVID CHILDERS VICE PRESIDENT 0.50 45.00 X X 0 194011 39644 KERRY SWANSON SECRETARY/TREASURER 0.50 45.00 X X 0 342077 90393 SUE ERICKSON DIRECTOR 0.50 45.00 X 0 420388 70307 RICHARD BAKER DIRECTOR/MRI MEDICAL DIRECTOR 0.50 45.00 X 0 0 0 BARBARA THIERMANN EXECUTIVE DIRECTOR 40.00 X 162459 0 51266 SARAH FAUST CONTROLLER 40.00 X 116201 0 48140 MICHELLE MACKAY RADIATION ONCOLOGY MEDICAL DIRECTOR 40.00 X 558086 0 68852 RICHARD AUCHTER RADIATION ONCOLOGIST 40.00 X 222090 0 11966 FRANK GOODIN CHIEF PHYSICIST 40.00 X 232254 0 53785 JUNE KIM RADIATION ONCOLOGIST 40.00 X 475137 0 27264 JESSICA KLAERS PHYSICIST 40.00 X 172541 0 20254 JAMES RICHARDSON RADIATION ONCOLOGIST 40.00 X 481319 0 28693 2420087 1150367 562490 15 0 1 0 VARIAN MEDICAL SYSTEMS 70140 NETWORK PL CHICAGO IL 606731701 EQUIPMENT MAINTENANCE 1646541 JH FINDORFF & SON INC 300 SOUTH BEDFORD STREET MADISON WI 53703 CONSTRUCTION 879820 SIEMENS MEDICAL SOLUTIONS USA INC DEPT CH 14195 PALATINE IL 600554195 EQUIPMENT MAINTENANCE 814524 PHILIPS MEDICAL SYSTEMS NA COMPANY PO BOX 100355 ATLANTA GA 303840355 EQUIPMENT MAINTENANCE 353953 TOMOTHERAPY INCORPORATED PO BOX 204793 DALLAS TX 753204793 SERVICE CONTRACT 275000 10 RADIATION ONCOLOGY REVENUE 621500 12485139 12485139 MRI REVENUE 621500 9056840 9056840 21541979 75815 75815 381496 36377 345119 345119 345119 MISCELLANEOUS REVENUE 900099 12586 12586 STANDARD IMAGING, SCANDIDOS 621500 4469 4469 17055 21979968 21541979 4469 433520 1005004 626939 378065 6448351 4990231 1458120 277722 203795 73927 913939 594488 319451 449277 322277 127000 31193 31193 71722 71722 258866 127734 131132 581732 581732 398172 36222 361950 548561 548561 1135708 488974 646734 48757 19942 28815 49637 18849 30788 2704864 1955303 749561 114757 34072 80685 MAINTENANCE CONTRACTS 1332500 1332500 BAD DEBT EXPENSE 528371 528371 PHARMACEUTICALS 202115 202115 UBI TAXES 211 211 439123 219295 219828 17540582 11701107 5839475 0 15745033 19573817 2676 2681 2372354 2486578 776195 890817 38891552 21974575 15599250 16916977 332702 319601 34828210 40190471 1030267 1953142 1030267 1953142 X 33797943 38237329 33797943 38237329 34828210 40190471 4439386 0 X X 0 1 X 1 0 X X 2 MERITER HOSPITAL INC 390806367 3 0 0 0 SSM HEALTHCARE OF WISCONSIN 430688874 3 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 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). 822982 822982 8060394 4620673 3439721 29949400 17317151 12632249 58776 36751 22025 16916977 21451597 0 21451597 528371 528371 21979968 17012211 0 17012211 528371 528371 17540582 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. X X X 0 0 0 1 0 0 0 0 0 SETH TEIGEN PRESIDENT 0 180872 0 11004 0 2015 0 21236 0 30690 0 245817 0 11004 DAVID CHILDERS VICE PRESIDENT 0 168381 0 25536 0 94 0 24511 0 15133 0 233655 0 0 KERRY SWANSON SECRETARY/TREASURER 0 289024 0 36582 0 16471 0 57653 0 32740 0 432470 0 36582 SUE ERICKSON DIRECTOR 0 305802 0 88705 0 25881 0 57880 0 12427 0 490695 0 0 BARBARA THIERMANN EXECUTIVE DIRECTOR 147579 0 14742 0 138 0 22717 0 28549 0 213725 0 14742 0 SARAH FAUST CONTROLLER 104450 0 11207 0 544 0 18883 0 29257 0 164341 0 11207 0 MICHELLE MACKAY RADIATION ONCOLOGY MEDICAL DIRECTOR 527102 0 30930 0 54 0 45023 0 23829 0 626938 0 30930 0 RICHARD AUCHTER RADIATION ONCOLOGIST 222032 0 0 0 58 0 0 0 11966 0 234056 0 0 0 FRANK GOODIN CHIEF PHYSICIST 212902 0 19123 0 229 0 24831 0 28954 0 286039 0 19123 0 JUNE KIM RADIATION ONCOLOGIST 474908 0 0 0 229 0 15900 0 11364 0 502401 0 0 0 JESSICA KLAERS PHYSICIST 172487 0 0 0 54 0 10393 0 9861 0 192795 0 0 0 JAMES RICHARDSON RADIATION ONCOLOGIST 481181 0 0 0 138 0 15900 0 12793 0 510012 0 0 0 PART I, LINE 5 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. 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. 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 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 0 MERITER HOSPITAL K 181752 ST MARY'S HOSPITAL K 147983