2016-08-11T11:57:50-05:00 2015-12-31 390857178 SMITH & GESTELAND LLP PO BOX 1764 MADISON WI 53701 990 2015-01-01 391534744 SHARED MAGNETIC RESONANCE IMAGING FACILITY INC SHAR 6082594376 1104 JOHN NOLEN DRIVE MADISON WI 53713 SETH TEIGEN PRESIDENT 6082594376 2016-08-10 1 KEITH BAUMGARTNER P00187845 6088367500 2015 2016-12-15 16:53:06Z TURVILLE BAY MRI AND RADIATION ONCOLOGY CENTER BARBARA THEIRMANN 1104 JOHN NOLEN DRIVE MADISON WI 53713 21467930 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 85 0 7269 2536 0 112370 22202096 21270438 33209 -858814 11246 25828 22246551 20549822 3000000 3000000 0 0 8108163 8399394 0 0 0 7624502 7660347 18732665 19059741 3513886 1490081 33466253 34828210 1158391 1030267 32307862 33797943 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 7938747 1500000 12408457 RADIATION ONCOLOGY SERVICES: TURVILLY BAY RADIATION ONCOLOGY CENTER PROVIDES RADIATION THERAPY TREATMENT SERVICES. THE CENTER PERFORMED 10,970 TREATMENTS IN 2015. 5817377 1500000 8869250 MRI SERVICES: TURVILLY BAY MRI CENTER PROVIDES DIAGNOSTIC EXAMINATIONS USING MAGNETIC RESONANCE IMAGING. THE CENTER PERFORMED 9,264 SCANS IN 2015. 13756124 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 40 0 1 85 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 181485 61121 DAVID CHILDERS VICE PRESIDENT 0.50 45.00 X X 0 188852 14184 KERRY SWANSON SECRETARY/TREASURER 0.50 45.00 X X 0 346288 102292 SANDRA ANDERSON DIRECTOR 0.50 45.00 X 0 281974 13438 SUE ERICKSON DIRECTOR 0.50 45.00 X 0 442330 52567 ERIC GREGOR DIRECTOR 0.50 45.00 X 0 84070 2161 RICHARD BAKER DIRECTOR/MRI MEDICAL DIRECTOR 0.50 45.00 X 0 0 0 BARBARA THIERMANN EXECUTIVE DIRECTOR 40.00 0.00 X 162952 0 52631 SARAH FAUST CONTROLLER 40.00 0.00 X 112168 0 47981 MICHELLE MACKAY RADIATION ONCOLOGY MEDICAL DIRECTOR 40.00 0.00 X 718892 0 38425 FRANK GOODIN CHIEF PHYSICIST 40.00 0.00 X 211878 0 60669 JUNE KIM RADIATION ONCOLOGIST 40.00 0.00 X 491676 0 19012 JESSICA KLAERS PHYSICIST 40.00 0.00 X 171787 0 20471 JAMES RICHARDSON RADIATION ONCOLOGIST 40.00 0.00 X 534912 0 64472 JESSICA SAWYER RADIATION ONCOLOGIST 40.00 0.00 X 479055 0 17877 2883320 1524999 567301 14 0 1 0 SIEMENS MEDICAL SOLUTIONS USA INC DEPT CH 14195 PALATINE IL 600554195 EQUIPMENT MAINTENANCE 657674 VARIAN MEDICAL SYSTEMS 70140 NETWORK PL CHICAGO IL 606731701 EQUIPMENT MAINTENANCE 467403 PHILIPS MEDICAL SYSTEMS NA COMPANY PO BOX 100355 ATLANTA GA 303840355 EQUIPMENT MAINTENANCE 296837 CDW COMPUTER CENTERS INC 75 REMITTANCE DRIVE SUITE 1515 CHICAGO IL 606755723 COMPUTER CONSULTING 285671 ELEKTA INC PO BOX 404199 ATLANTA GA 303844199 EQUIPMENT MAINTENANCE 202723 5 112370 112370 112370 RADIATION ONCOLOGY REVENUE 621500 12401188 12401188 MRI REVENUE 621500 8869250 8869250 21270438 49586 49586 9708 918108 -908400 -908400 -908400 MISCELLANEOUS REVENUE 900099 18559 18559 STANDARD IMAGING, SCANDIDOS 621500 7269 7269 25828 20549822 21270438 7269 -840255 3000000 3000000 1133049 757317 375732 5702808 4387353 1315455 239782 175362 64420 916268 576894 339374 407487 284422 123065 15064 15064 76257 76257 291122 180959 110163 510254 510254 307980 35560 272420 462949 462949 991339 362823 628516 41343 16608 24735 52482 12567 39915 2277476 1695304 582172 104554 28229 76325 MAINTENANCE CONTRACTS 1309233 1309233 BAD DEBT EXPENSE 601465 601465 PHARMACEUTICALS 177066 177066 UBI TAXES 314 314 441449 154962 286487 19059741 13756124 5303617 0 11236035 15745033 502670 2676 2811251 2372354 657648 776195 36823793 21224543 14517442 15599250 3741207 332702 33466253 34828210 1158391 1030267 1158391 1030267 X 32307862 33797943 32307862 33797943 33466253 34828210 1490081 0 X X 0 1 X 1 0 X X 2 MERITER HOSPITAL INC 390806367 3 0 1500000 0 SSM HEALTHCARE OF WISCONSIN 430688874 3 0 1500000 0 2 3000000 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). RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 822982 822982 8003388 4349844 3653544 27938647 16841326 11097321 58776 33373 25403 15599250 X 19948357 0 19948357 601465 601465 20549822 18458276 0 18458276 601465 601465 19059741 PART X, LINE 2: THE COMPANY HAS RECEIVED A DETERMINATION LETTER DATED FEBRUARY 14, 1986, FROM THE INTERNAL REVENUE SERVICE STATING THAT IT IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). THE COMPANY IS ALSO EXEMPT FROM WISCONSIN INCOME TAXES. HOWEVER, THE COMPANY IS SUBJECT TO FEDERAL AND STATE INCOME TAX ON UNRELATED BUSINESS INCOME. THE COMPANY DOES NOT HAVE ANY MATERIAL INCOME TAX LIABILITIES AS A RESULT OF UNRELATED BUSINESS INCOME FOR THE YEARS ENDING DECEMBER 31, 2015 AND 2014. THE COMPANY RECOGNIZES THE FINANCIAL STATEMENT BENEFIT OF A TAX POSITION ONLY AFTER DETERMINING THAT THE RELEVANT TAX AUTHORITY WOULD MORE LIKELY THAN NOT SUSTAIN THE POSITION FOLLOWING AN AUDIT. THE ASSESSMENT OF THE POSITION IS BASED SOLELY ON THE TECHNICAL MERITS OF THE POSITION, WITHOUT REGARD TO THE LIKELIHOOD THAT THE TAX POSITION MAY BE CHALLENGED. THE COMPANY IS EXEMPT FROM INCOME TAX, THOUGH IT IS SUBJECT TO TAX ON INCOME UNRELATED TO ITS EXEMPT PURPOSES, UNLESS THAT INCOME IS OTHERWISE EXCLUDED BY THE IRC. IF APPLICABLE, THE COMPANY RECOGNIZES INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS IN THE PROVISION FOR INCOME TAXES. THERE WERE NO INTEREST OR PENALTIES RELATED TO INCOME TAXES THAT HAVE BEEN ACCRUED OR RECOGNIZED AS OF AND FOR THE YEARS ENDED DECEMBER 31, 2015 AND 2014. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE (SHOWN NET FOR AUDIT) 601,465. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE (SHOWN NET FOR AUDIT) 601,465. 1 MERITER HOSPITAL INC 202 S PARK ST MADISON WI 53715 390806367 501(C)3 1500000 GENERAL OPERATIONAL SUPPORT SSM HEALTHCARE OF WISCONSIN 707 S MILLS ST MADISON WI 53715 430688874 501(C)3 1500000 GENERAL OPERATIONAL SUPPORT 2 PART I, LINE 2: DISTRIBUTIONS ARE MADE IN EQUAL INSTALLMENTS TO MERITER HOSPITAL AND SSM HEALTHCARE OF WISCONSIN AT THE DISCRETION AND BY VOTE OF THE BOARD OF DIRECTORS. THE ORGANIZATION DOES NOT MONITOR THE USE OF FUNDS GRANTED TO THE GRANT RECIPIENTS LISTED IN PART II. X X X 0 0 0 1 0 0 0 0 0 SETH TEIGEN PRESIDENT 0 179214 0 0 0 2271 0 31163 0 29958 0 242606 0 0 DAVID CHILDERS VICE PRESIDENT 0 154502 0 34118 0 232 0 7547 0 6637 0 203036 0 0 KERRY SWANSON SECRETARY/TREASURER 0 289419 0 20698 0 36171 0 69823 0 32469 0 448580 0 40788 SANDRA ANDERSON DIRECTOR 0 178037 0 40521 0 63416 0 1984 0 11454 0 295412 0 64461 SUE ERICKSON DIRECTOR 0 285014 0 121144 0 36172 0 39752 0 12815 0 494897 0 0 BARBARA THIERMANN EXECUTIVE DIRECTOR 162597 0 217 0 138 0 24870 0 27761 0 215583 0 0 0 SARAH FAUST CONTROLLER 111624 0 0 0 544 0 18571 0 29410 0 160149 0 0 0 MICHELLE MACKAY RADIATION ONCOLOGY MEDICAL DIRECTOR 433000 0 172034 0 113858 0 15900 0 22525 0 757317 0 172034 0 FRANK GOODIN CHIEF PHYSICIST 211116 0 0 0 762 0 31833 0 28836 0 272547 0 0 0 JUNE KIM RADIATION ONCOLOGIST 490914 0 0 0 762 0 7385 0 11627 0 510688 0 0 0 JESSICA KLAERS PHYSICIST 168916 0 2750 0 121 0 10387 0 10084 0 192258 0 0 0 JAMES RICHARDSON RADIATION ONCOLOGIST 508415 0 26359 0 138 0 47830 0 16642 0 599384 0 26359 0 JESSICA SAWYER RADIATION ONCOLOGIST 479007 0 0 0 48 0 5560 0 12317 0 496932 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. X SOFTWARE 1 112000 FMV 0 0 0 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 11 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 1 0 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 0 MERITER HOSPITAL B 1500000 ST MARY'S HOSPITAL B 1500000 MERITER HOSPITAL K 105140 ST MARY'S HOSPITAL K 144373