Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| PROGRAM SERVICE STATEMENT | FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS: | DELLS MEDICAL BUILDING, INC'S (DMBI) LEASING ACTIVITIES ARE A VITAL COMPONENT OF THE HOSPITAL'S MEDICAL STAFF DEVELOPMENT EFFORTS. BY PROVIDING QUALITY OFFICE SPACE IN THE HOSPITAL'S SERVICE AREA CONVENIENT TO MEMBERS OF THE PUBLIC, DMBI IS SUPPORTING ITS EFFORTS IN RECRUITING AND RETAINING QUALIFIED PHYSICIANS TO THESE LOCALITIES. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE CORPORATION IS SSM HEALTH CARE OF WISCONSIN. SSM HEALTH CARE OF WISCONSIN IS A NONPROFIT 501(C)(3) ORGANIZATION THAT CURRENTLY OPERATES TWO HOSPITALS AND TWO NURSING HOMES IN WISCONSIN. BOTH DELLS MEDICAL BUILDING, INC. AND SSM HEALTH CARE OF WISCONSIN ARE PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH CARE, WHICH OPERATES IN FOUR STATES AND OWNS, MANAGES AND IS AFFILIATED WITH 16 ACUTE-CARE HOSPITALS AND TWO NURSING HOMES. | |
| FORM 990, PART VI, SECTION A, LINE 7A | DIRECTORS ARE ELECTED BY A MAJORITY VOTE OF ALL OUTSTANDING SHARES | |
| FORM 990, PART VI, SECTION B, LINE 11 | ACCOUNTING/FINANCE PERSONNEL AT EACH SSMHC (SSM HEALTH CARE SYSTEM) ENTITY, IN CONJUNCTION WITH CORPORATE FINANCE PERSONNEL, PREPARE A CHECKLIST CONTAINING INFORMATION AND SUPPORTING SCHEDULES THAT ARE USED TO PREPARE THE FORM 990. THIS CHECKLIST IS THEN REVIEWED BY A SUPERVISOR/MANAGER AND SENT TO THE CORPORATE OFFICE FOR FINAL REVIEW AND COORDINATION OF THE SYSTEM LEVEL FORM 990 INFORMATION. THE INFORMATION IS SUBMITTED TO AN OUTSIDE TAX CONSULTING FIRM WHO PREPARES AND SIGNS THE FORM 990 FROM THE SSMHC INFORMATION. PRIOR TO FINALIZING THE RETURN, A DRAFT IS SENT TO PERSONNEL AT SSMHC FOR REVIEW AND APPROVAL. UPON SSMHC APPROVAL, THE OUTSIDE PREPARER FORWARDS THE COMPLETED FORM 990 FOR THE APPROPRIATE SIGNATURES AND FILING ACTION. A COMPLETE COPY OF THE RETURN IS PROVIDED TO THE BOARD PRIOR TO FILING WITH THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. THE PRESIDENT AND SECRETARY TO THE BOARD OVERSEE COMPLIANCE WITH THIS REQUIREMENT. ALL BOARD MEMBERS WITH AN IDENTIFIED CONFLICT OF INTEREST ABSTAIN FROM BOARD DISCUSSIONS AND VOTES WHEN APPLICABLE. EMPLOYEES WITH PURCHASING AUTHORITY AND/OR ABILITY TO INFLUENCE PURCHASING DECISIONS ARE ASSIGNED THE CONFLICT OF INTEREST DISCLOSURE COURSE (COI) WHICH MUST BE COMPLETED ON LINE. PERIODICALLY THROUGH THE YEAR, THE ENTITY'S CORPORATE RESPONSIBILITY CONTACT PERSON (WITH THE HELP OF THE ENTITY'S LEARNING MANAGEMENT SYSTEM COORDINATOR) SENDS DEPARTMENT MANAGERS A LIST OF EMPLOYEES WHO HAVE NOT YET COMPLETED THEIR COI SO THEY CAN REMIND THE EMPLOYEES AND ENSURE THE EMPLOYEES HAVE TIME IN THEIR SCHEDULE TO COMPLETE THE REQUIRED COURSE. RESOLUTION OF ANY CONFLICTS THAT ARE DISCLOSED MUST BE DOCUMENTED AND KEPT ON FILE AT THE ENTITY. SUPERVISORS VERIFY REQUIRED COURSE COMPLETION PRIOR TO YEAR END. | |
| FORM 990, PART VI, SECTION B, LINE 15 | ALL SSMHC EXECUTIVE SALARY/COMPENSATION INFORMATION IS BASED ON COMPARATIVE DATA WITH LIKE POSITIONS IN THE MARKET. THE COMPENSATION REVIEW PROCESS IS PERFORMED BY EXTERNAL INDEPENDENT COMPENSATION CONSULTANTS. THE SAME COMPARATIVE PROCESS IS PERFORMED INTERNALLY FOR EMPLOYEES. THE SALARY DATA AND POTENTIAL ADJUSTMENTS, FOR THE CEO OF THE SYSTEM, THE PRESIDENT/COO AND THE SENIOR VICE PRESIDENTS ARE PRESENTED TO THE SSMHC BOARD OF DIRECTORS BY THE SAME INDEPENDENT COMPENSATION CONSULTANTS TO APPROVE, DISAPPROVE, MODIFY. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE YEAR-END AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND UNAUDITED QUARTERLY CONSOLIDATED FINANCIAL STATEMENT FOR THE SSM HEALTH CARE SYSTEM ARE MADE AVAILABLE TO THE PUBLIC ON SSM HEALTH CARE'S WEBSITE. THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE UPON REQUEST TO THE WISCONSIN DEPARTMENT OF FINANCIAL INSTITUTION'S OFFICE. COPIES OF THE FORM 990 AND THE ORGANIATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. | |
| AVG HOURS DEVOTED TO RELATED ORG(S) WHEN RELATED COMP IS REPORTED: | FORM 990, PART VII: | ALL INDIVIDUALS WHO RECEIVE COMPENSATION FOR SERVICES RENDERED TO THE FILING ORGANIZATION ARE EMPLOYED AND COMPENSATED BY A RELATED ORGANIZATION. IN ADDITION, ALL COMPENSATED REPORTABLE INDIVIDUALS LISTED ON FORM 990, PART VII WORK A MINIMUM OF 40 HOURS PER WEEK FOR SSMHC RELATED ORGANIZATIONS. |
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