2024-02-14T14:46:40-06:00 2023-06-30 420714325 RSM US LLP 30 S Wacker Drive Ste 3300 Chicago IL 60606 990 2022-07-01 391940656 Madison Surgery Center Inc MADI 6088214230 7974 UW Health Court Middleton WI 53562 Jodilynn Vitello VP of Finance 6088214230 2024-02-08 1 Jodilynn Vitello 999009999 0 Rebekuh Eley P01247672 3126343400 2024-02-08 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z Kelsie Doty 7974 UW Health Court Middleton WI 53562 37121798 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 2 0 2 0 0 412768 0 34806384 37121798 0 0 0 0 35219152 37121798 0 0 0 0 9101386 9698962 0 0 0 16286614 16753735 25388000 26452697 9831152 10669101 18211411 17584881 3955233 2848602 14256178 14736279 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 23842858 37121798 Madison Surgery Center is a nonstock, nonprofit corporation organized in 1996. The organization is staffed by a comprehensive team of general and vascular surgeons, ophthalmologists, gynecologists, otolaryngologists, urologists, plastic surgeons, orthopedic surgeons, anesthesiologists, and interventional pain proceduralists. Madison Surgery Center served a total of 15,869 cases from July 2022 - June 2023. 23842858 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 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 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 2 0 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X Aaron Prochaska 6088214272 7974 UW Health Court Middleton WI 53562 Kelsie Doty President 2.00 38.00 X X 0 331511 61125 Beth Erdman Vice President 2.00 2.00 X X 0 0 0 Mary Link Secretary 2.00 38.00 X X 0 406446 93661 Deborah Rusy Board Member 2.00 38.00 X 0 377187 62436 Roland Vega Board Member 2.00 38.00 X 0 477081 47164 James Arnett Board Member (Until 6/30/23) 2.00 2.00 X 0 0 0 Aaron Prochaska Treasurer 2.00 38.00 X 0 162363 45154 Dan Jordan Director of MSC 40.00 0.00 X 0 155315 44731 0 1909903 354271 0 0 1 0 0 Ambulatory Surgery Center 621910 37103579 37103579 18219 18219 37121798 37121798 37121798 0 0 200045 200045 6803011 6220213 582798 511658 470907 40751 1670848 1520242 150606 513400 458980 54420 1008497 1008497 4148 4148 1563690 1308260 255430 665 665 49281 20904 28377 21544 19260 2284 1859453 1662351 197102 16 16 4220 3773 447 920464 920464 67069 59960 7109 Drugs & Patient Care 10259563 10259563 Equip Repair/Maint 676927 605173 71754 Small Equip/Furnish 57124 51069 6055 Dues and Subscriptions 4068 4068 257006 257006 26452697 23842858 2609839 0 10054807 10012811 3547287 3673948 1321590 1131270 80386 80110 18567644 16155776 2881013 2411868 326328 274874 18211411 17584881 348547 187479 878967 0 2727719 2661123 3955233 2848602 X 14256178 14736279 14256178 14736279 18211411 17584881 X 10669101 -10189000 X 0 1 X 1 0 X 0 578350 270754 412768 0 1261872 15181927 25394760 29115215 34806384 37121798 141620084 15181927 25973110 29385969 35219152 37121798 142881956 0 0 0 142881956 15181927 25973110 29385969 35219152 37121798 142881956 1.00000 1.00000 0.00000 0.00000 X Part III, Short Year Explanation: Madison Surgery Center changed from a calendar year end to a June 30 fiscal year end during 2019. Therefore, the short year 1/1/2019 - 6/30/2019 has been presented in column (a) 2018. 6350272 6013152 337120 12217372 10142624 2074748 2411868 Due To Related Parties 2661123 2661123 X Part X, Line 2: The Organization is exempt from federal income tax as an organization described in Section 501(c)(3) of the Internal Revenue Code. The Organization is also exempt from state income tax. The Organization follows guidance relative to the uncertainty in income taxes, which addresses the determination of whether tax benefits claimed or expected to be claimed on a tax return should be recorded in the financial statements. Under this guidance, the Organization may recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by taxing authorities, based on the technical merits of the position. Examples of tax positions include the tax-exempt status of the Organization, and various positions related to the potential sources of unrelated business taxable income (UBTI). Any tax benefits recognized in the financial statements from such a position are measured based on the largest benefit that has a greater than 50 percent likelihood of being realized upon ultimate settlement. 0 1 0 0 0 0 0 0 0 Roland Vega Board Member 0 477081 0 0 0 0 0 45750 0 1414 0 524245 0 0 Mary Link Secretary 0 301218 0 90074 0 15154 0 53595 0 40066 0 500107 0 0 Deborah Rusy Board Member 0 377187 0 0 0 0 0 61000 0 1436 0 439623 0 0 Kelsie Doty President 0 254907 0 73083 0 3521 0 46444 0 14681 0 392636 0 0 Aaron Prochaska Treasurer 0 150622 0 10519 0 1222 0 14335 0 30819 0 207517 0 0 Dan Jordan Director of MSC 0 133189 0 20356 0 1770 0 15084 0 29647 0 200046 0 0 Part I, Line 3 Compensation is paid via a leasing agreement with members of the organization. Executive compensation is based on comparative data with like positions within the market. Part I, Line 4b Some members of the Board participate in supplemental, non-qualified retirement plans through their employers, which are related organizations to the filing entity. Those individuals participate in a 457(f) plan. In 2022, the following employer contributions were made: - Mary Link $31,330 - Kelsie Doty $6,938 In 2022, no distributions were made. Form 990, Part VI, Section A, line 3 Due to the management services agreement established between University of Wisconsin Medical Foundation, Inc. (UWMF) and Madison Surgery Center, Inc. (MSC), we have answered yes to Question #3 on Part VI, Section A. UWMF is the management company within this agreement. UWMF provides payroll services and reporting (through a paymaster agreement), human resources, patient billing and collections, accounts payable services, IT services, monthly financial statement preparation, tax return preparation support, financial audit support, compliance auditing, medical records storage/transcription, infection control/employee health, maintenance/mechanical support, nursing and nursing support, quality assurance and improvement, housekeeping, removal of hazardous waste, courier, mail and receiving, purchasing, security, and telecommunications. In addition, an administrative person is charged with carrying out the decision/direction of MSC's board of directors and any clinical duties performed for UWMF. Daniel Jordan (Director of Clinic Operations) spends 100% of his time carrying out the decision/direction of MSC's board of directors. Since UWMF is considered a related organization, all compensation paid from UWMF and related organizations for services provided to Madison Surgery Center, Inc., and related organizations is reported in Part VII. Form 990, Part VI, Section A, line 4 On June 30, 2023, University Of Wisconsin Hospitals and Clinic Authority acquired the one-third interest of Madison Surgery Center, Inc. held by University Of Wisconsin Medical Foundation Inc. to be effective on July 1, 2022 for audit purposes. Form 990, Part VI, Section A, line 6 The Corporation has two voting members consisting of University of Wisconsin Hospitals and Clinics Authority (UWHCA) with 66.7% membership interest and Unity Point Health-Meriter (Meriter) with 33.3% membership interest. UWHCA shall be entitled to two (2) Members votes and Meriter shall be entitled to one (1) Member vote. Members will be admitted, suspended, expelled, or terminated pursuant to Bylaws of Corporation. Form 990, Part VI, Section A, line 7a University of Wisconsin Hospitals and Clinics Authority shall appoint four (4) Directors and Unity Point Health-Meriter shall appoint two (2) 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 unanimous approval of the Members: (a) merger, consolidation, or dissolution of the Corporation, (b) amendment, restatement, alteration, or repeal of the Articles of Incorporation or 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, (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 11b Form 990 is completed by the organization's external accounting firm. Key finance employees review the Form 990 to determine complete and accurate. The return is provided to the members of the board of directors before filing. The return is submitted for filing with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c All annual conflict of interest forms were reviewed by the Office of Corporate Counsel and Business Integrity. In addition, a summary of all Key Employee and Board Members interests is created and provided to Corporate Governance for review during decision-making. If a member would have an actual or perceived conflict they would follow the respective conflict of interest policy. Form 990, Part VI, Section C, line 19 Madison Surgery Center, Inc. makes the governing documents, conflict of interest policy and financial statements available upon request for the same period of disclosure as set forth in IRC Section 6104(d). Form 990, Part XI, line 9: Distribution to Members -10,200,000. Gain on Trade-In 11,000. Generations Fertility Care 2365 Deming Way Middleton WI 53562 273496527 Reproductive Endocrinology and Infertility Services WI 501(c)(3) Line 10 N/A 1 Isthmus Project Inc 600 Highland Avenue Madison WI 53792 832278676 Research and Innovation WI 501(c)(3) Line 12a University of WI Hospital and Clinics Authority 1 Regional Division Inc 7974 UW Health Court No MC1020 Middleton WI 53562 391446049 Regional Parent Corp to manage and direct activities of entities WI 501(c)(3) Line 12a University of WI Hospitals and Clinics Authority 1 SwedishAmerican Foundation 1415 E State Street Rockford IL 61104 363097493 Supporting Fundraising for SwedishAmerican Hospital IL 501(c)(3) Line 7 SwedishAmerican Hospital 1 SwedishAmerican Health System Corporation 1401 E State Street Rockford IL 61104 363241458 Parent Corporation to Manage and Direct Activities of Entities IL 501(c)(3) Line 12a Regional Division Inc 1 SwedishAmerican Hospital 1401 E State Street Rockford IL 61104 362222696 Hospital IL 501(c)(3) Line 3 SwedishAmerican Health System Corporation 1 SwedishAmerican Hospital Self Insurance Trust 1401 E State Street Rockford IL 61104 366652702 Hospital Malpractice Trust VT 501(c)(3) Line 12a SwedishAmerican Hospital 1 SwedishAmerican Realty Corporation 1313 E State Street Rockford IL 61104 363248013 Title Holding Company IL 501(c)(2) SwedishAmerican Health System Corporation 1 University Health Care Inc 7974 UW Health Court Middleton WI 53562 472553196 Support Organization WI 501(c)(3) Line 12a University of WI Hospitals and Clinics Authority 1 University of Wisconsin Hospitals and Clinics Authority 7974 UW Health Court Middleton WI 53562 391835630 Hospital and Clinics WI 501(c)(3) Line 3 N/A 0 University of Wisconsin Medical Foundation 7974 UW Health Court Middleton WI 53562 391824445 Physician Services WI 501(c)(3) Line 10 University of WI Hospitals and Clinics Authority 0 UW Health ACO Inc 7974 UW Health Court Middleton WI 53562 455490584 Accountable Care Organization WI 501(c)(3) Line 10 University of WI Hospitals and Clinics Authority 1 Wisconsin Therapies Inc 7974 UW Health Court Middleton WI 53562 391807425 Infusion Therapy WI 501(c)(3) Line 12a University of WI Hospitals and Clinics Authority 1 Chartwell Wisconsin Enterprises LLC 2241 Pinehurst Drive Middleton WI 53562 391796267 Parent entity of CW and CMW-HR WI N/A 0 0 Madison Medical Center LLP 7974 UW Health Court Middleton WI 53562 391329429 Real Estate WI N/A 0 0 Northern Illinois Vein Clinic 2550 Charles Street Rockford IL 61108 201642329 Outpatient Health Services IL N/A 0 0 Sixth Street Medical LLC 7974 UW Health Court Middleton WI 53562 472705724 Real Estate WI N/A 0 0 Three Rivers Partners LLC 1313 E State Street Rockford IL 61104 262231757 Information Technology Services IL N/A 0 0 Physician's Care Network 1313 E State Street Rockford IL 61104 363455791 Health Services IL N/A C 1 Quartz Health Benefit Plans Corporation 840 Carolina Street Sauk City WI 53583 391450766 Health Maintenance Organization WI N/A C 1 Quartz Health Insurance Corporation 840 Carolina Street Sauk City WI 53583 391565691 Health Maintenance Organization WI N/A C 1 Quartz Health Solutions 840 Carolina Street Sauk City WI 53583 465710709 Insurance WI N/A C 1 Quartz Holding Company 840 Carolina Street Sauk City WI 53583 821728929 Holding Company WI N/A C 1 SARI Insurance Company 76 St Paul Street Suite 500 Burlington VT 054014477 030308753 Captive Insurance Company VT N/A C 1 State & Charles Inc 1313 E State Street Rockford IL 61104 363321193 Holding Company IL N/A C 1 SwedishAmerican Health Management Corp 1401 E State Street Rockford IL 61104 363246511 Management Services IL N/A C 1 Wisconsin Dialysis Inc 3034 Fish Hatchery Road Madison WI 53713 300072647 Dialysis Services WI N/A C 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0