ST CROIX REGIONAL MEDICAL CENTER: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- ST CROIX REGIONAL MEDICAL CENTER (EIN 39-0890676)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-15
- IRS object ID
- 202331359349310098
- Schema version
- 2021v4.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-15T13:24:26-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390890676 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CROIX REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STCR | BusinessNameControlTxt |
| Phone | 7154830556 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL YOUSO | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7154830556 | PhoneNum |
| Signature | 2023-05-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MICHAEL | PersonFirstNm |
| Person Last | YOUSO | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2023-05-09 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVE DOBOSENSKI | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $143,084,452 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SCRMC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1954 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | WE HELP PEOPLE TO LIVE HEALTHIER, HAPPIER, AND LONGER LIVES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 903 | TotalEmployeeCnt |
| Total Volunteers | 6 | TotalVolunteersCnt |
| Total Gross UBI | $7,128,359 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,637,189 | PYContributionsGrantsAmt |
| CY Contributions Grants | $469,277 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $133,730,865 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $141,994,360 | CYProgramServiceRevenueAmt |
| PY Investment Income | $462 | PYInvestmentIncomeAmt |
| CY Investment Income | $219,785 | CYInvestmentIncomeAmt |
| PY Other Revenue | $201,389 | PYOtherRevenueAmt |
| CY Other Revenue | $385,737 | CYOtherRevenueAmt |
| PY Total Revenue | $138,569,905 | PYTotalRevenueAmt |
| CY Total Revenue | $143,069,159 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $3,300 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $2,885 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $62,128,880 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $66,055,703 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $67,645,396 | PYOtherExpensesAmt |
| CY Other Expenses | $72,882,054 | CYOtherExpensesAmt |
| PY Total Expenses | $129,777,576 | PYTotalExpensesAmt |
| CY Total Expenses | $138,940,642 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,792,329 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,128,517 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $114,134,286 | TotalAssetsBOYAmt |
| Total Assets EOY | $108,254,193 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $30,844,503 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $20,835,893 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $83,289,783 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $87,418,300 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WE HELP PEOPLE TO LIVE HEALTHIER, HAPPIER, AND LONGER LIVES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $92,981,318 | ExpenseAmt |
| Grant | $2,885 | GrantAmt |
| Revenue | $103,581,552 | RevenueAmt |
| Desc | OUTPATIENT SERVICES - SURGICAL, LABORATORY, BASIC, AND ADVANCED RADIOLOGY PROCEDURES. DURING FISCAL YEAR 2022, THERE WERE 12,160 EMERGENCY ROOM VISITS RECORDED, 1,318 OUTPATIENT SURGERIES, AND 116,929 CLINICAL VISITS.INPATIENT SERVICES - OBSTETRIC, MEDICAL-SURGICAL, INTENSIVE CARE, AND SHORT STAY INPATIENT CARE. DURING FISCAL YEAR 2022, THERE WERE 249 BIRTHS, 1,495 INPATIENT ADMISSIONS, AND A TOTAL OF 5,242 INPATIENT DAYS FOR AN AVERAGE LENGTH OF 3.51 DAYS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $14,399,098 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $16,023,879 | RevenueAmt |
| Desc | ST. CROIX REGIONAL MEDICAL CENTER OPERATES FOUR PROVIDER-BASED CLINICS AND ONE FREE STANDING CLINIC. TOGETHER, THE CLINICS STRIVE TO MEET THE HEALTHCARE NEEDS OF PATIENTS AND FAMILIES WHO LIVE AND WORK IN THE COMMUNITIES THEY SERVE. A TOTAL OF 116,929 CLINIC VISITS OCCURRED IN FISCAL YEAR 2022. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $8,026,366 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $8,932,054 | RevenueAmt |
| Desc | CONTRACT PHARMACY - ST. CROIX REGIONAL MEDICAL CENTER BECAME ELIGIBLE TO PARTICIPATE IN THE 340B DRUG PRICING PROGRAM, WHICH IS MANAGED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OFFICE OF PHARMACY AFFAIRS (OPA), RESULTING IN THE REALIZATION OF A CONTRACT PHARMACY SERVICE. PARTICIPATION IN THE 340B DRUG PRICING PROGRAM RESULTS IN SIGNIFICANT SAVINGS, ESTIMATED TO BE 20-50%, ON THE COST OF PHARMACEUTICALS FOR USE BY OUTPATIENTS OF THE FACILITY. THROUGH THIS PROGRAM, ST. CROIX REGIONAL MEDICAL CENTER IS ABLE TO REACH MORE ELIGIBLE PATIENTS AND PROVIDE MORE COMPREHENSIVE SERVICES. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,361,033 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $5,965,966 | RevenueAmt |
| Desc | ST. CROIX VALLEY PHARMACIES PROVIDE LOCAL PHARMACY CARE TO THE SERVICE AREA OF ST. CROIX REGIONAL MEDICAL CENTER. ST. CROIX VALLEY PHARMACIES IS THE SOLE MEMBER OF THE FOLLOWING COMMUNITY PHARMACIES: UNITY PHARMACY LOCATED IN THE UNITY CLINIC BUILDING NEAR BALSAM, WI, FREDERIC PHARMACY LOCATED IN THE FREDERIC CLINIC BUILDING IN FREDERIC, WI, AND, ST. CROIX FALLS PHARMACY LOCATED IN THE ST. CROIX FALLS CLINIC BUILDING IN ST. CROIX FALLS, WI. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $5,361,033 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $5,965,966 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $120,767,815 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| 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 | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 76 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 903 | 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 |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | 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 | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | 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 |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL YOUSO | PersonNm |
| Phone | 7154830556 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| JOHN DRISCOLL | ||||||||
| CHAIR | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JOSEPH THIMM | ||||||||
| CHAIR (THRU OCT 2021) | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| TRUDY CANINE | ||||||||
| VICE CHAIR | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JOSEPH WHITE | ||||||||
| TREASURER | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| GURDESH BEDI | ||||||||
| TRUSTEE/PHYSICIAN OF SCRMC | 40.00 | Yes (X) | Yes (X) | $1,175,209 | $0 | $7,829 | ||
| KAREN HAUER | ||||||||
| SECRETARY | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JOHN CUMMING | ||||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| LISA EDSTROM | ||||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| CONNIE ERICKSON | ||||||||
| TRUSTEE (THRU OCT 2021) | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| REBECCA LYMAN MD | ||||||||
| TRUSTEE/PHYSICIAN OF SCRMC | 40.00 | Yes (X) | $233,738 | $0 | $41,037 | |||
| WILLIAM TIES | ||||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| DAVE DOBOSENSKI | ||||||||
| CEO | 40.00 | Yes (X) | $564,041 | $0 | $46,097 | |||
| SALLY BAJAK | ||||||||
| CFO | 40.00 | Yes (X) | $266,931 | $0 | $42,834 | |||
| JOHN KAMPA | ||||||||
| SCRMC PHYSICIAN | 40.00 | $761,279 | $0 | $26,900 | Yes (X) | |||
| MUHAMMAD KHAN | ||||||||
| SCRMC PHYSICIAN | 40.00 | $543,770 | $0 | $49,594 | Yes (X) | |||
| VITTAL NAGAR | ||||||||
| SCRMC PHYSICIAN | 40.00 | $473,893 | $0 | $49,337 | Yes (X) | |||
| CLAUDIO NUNES | ||||||||
| SCRMC PHYSICIAN | 40.00 | $469,218 | $0 | $45,074 | Yes (X) | |||
| MARISA SPENCER | ||||||||
| SCRMC PHYSICIAN | 40.00 | $544,508 | $0 | $18,429 | Yes (X) | |||
| PATRICK MCDONOUGH | ||||||||
| FORMER VC/SPORTS MED MD | 40.00 | $279,507 | $0 | $45,857 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $5,312,094 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $372,988 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 100 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | 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 |
|---|---|---|---|---|---|
| REGIONS HOSPITAL | |||||
| MAIL STOP 21109A PO BOX 1309 | MINNEAPOLIS | MN | 55440 | EMERGENCY DEPT SERVICES | $2,938,109 |
| MIDWEST RADIOLOGY PA | |||||
| 2355 HIGHWAY 36 WEST | ROSEVILLE | MN | 55113 | RADIOLOGY SERVICES | $1,983,043 |
| ST CROIX VALLEY ANESTHESIA LLC | |||||
| BOX 45 | OSCEOLA | WI | 54020 | CRNA SERVICES | $1,702,001 |
| ALLINA HEALTH LABORATORY | |||||
| PO BOX 342 MAIL ROUTE 20201 | MINNEAPOLIS | MN | 55440 | LABORATORY SERVICES | $1,262,207 |
| GROUP HEALTH INC | |||||
| MAIL STOP 21109A PO BOX 1309 | MINNEAPOLIS | MN | 55440 | CARDIOLOGY, NEPHROLOGY, ONCOLOGY SERVICE | $1,123,306 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 18 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $419,001 | GovernmentGrantsAmt |
| All Other Contributions | $50,276 | AllOtherContributionsAmt |
| Total Contributions | $469,277 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT SERVICES | 624100 | $117,897,757 | $117,897,757 | |
| CONTRACT PHARMACY | 624100 | $8,932,054 | $8,932,054 | |
| FREDERIC PHARMACY | 624100 | $5,149,139 | $1,331,478 | $3,817,661 |
| SCF PHARMACY | 624100 | $4,919,257 | $3,141,866 | $1,777,391 |
| UNITY PHARMACY | 624100 | $3,025,929 | $1,492,622 | $1,533,307 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,070,224 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,599,367 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $470,857 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $141,994,360 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $184,058 | TotalRevenueColumnAmt |
| Exclusion | $184,058 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $123,600 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $15,293 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $108,307 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $108,307 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $108,307 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $35,727 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $35,727 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,727 | TotalRevenueColumnAmt |
| Exclusion | $35,727 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | JOINT VENTURE REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $277,430 | TotalRevenueColumnAmt |
| Exclusion | $277,430 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $277,430 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $143,069,159 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $134,503,451 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $7,128,359 | UnrelatedBusinessRevenueAmt |
| Exclusion | $968,072 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,885 | TotalAmt |
| Program Services | $2,885 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,174,506 | TotalAmt |
| Program Services | $1,462,800 | ProgramServicesAmt |
| Management And General | $711,706 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,818,699 | TotalAmt |
| Program Services | $41,488,138 | ProgramServicesAmt |
| Management And General | $8,330,561 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,229,913 | TotalAmt |
| Program Services | $1,831,362 | ProgramServicesAmt |
| Management And General | $398,551 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,244,804 | TotalAmt |
| Program Services | $6,746,020 | ProgramServicesAmt |
| Management And General | $1,498,784 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,587,781 | TotalAmt |
| Program Services | $2,921,948 | ProgramServicesAmt |
| Management And General | $665,833 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,464 | TotalAmt |
| Program Services | $6,659 | ProgramServicesAmt |
| Management And General | $166,805 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,500 | TotalAmt |
| Management And General | $29,500 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,613 | TotalAmt |
| Management And General | $10,613 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,320,599 | TotalAmt |
| Program Services | $18,373,373 | ProgramServicesAmt |
| Management And General | $1,947,226 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $308,196 | TotalAmt |
| Program Services | $14,189 | ProgramServicesAmt |
| Management And General | $294,007 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,006,913 | TotalAmt |
| Program Services | $433,571 | ProgramServicesAmt |
| Management And General | $573,342 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,130,257 | TotalAmt |
| Program Services | $1,079,544 | ProgramServicesAmt |
| Management And General | $2,050,713 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,688,503 | TotalAmt |
| Program Services | $1,441,152 | ProgramServicesAmt |
| Management And General | $247,351 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,424 | TotalAmt |
| Program Services | $61,380 | ProgramServicesAmt |
| Management And General | $9,044 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $254,655 | TotalAmt |
| Program Services | $166,272 | ProgramServicesAmt |
| Management And General | $88,383 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,490 | TotalAmt |
| Program Services | $40,895 | ProgramServicesAmt |
| Management And General | $3,595 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,308,619 | TotalAmt |
| Program Services | $3,949,824 | ProgramServicesAmt |
| Management And General | $358,795 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $384,827 | TotalAmt |
| Program Services | $245,848 | ProgramServicesAmt |
| Management And General | $138,979 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $19,153,699 | $18,775,513 | $378,186 |
| DRUGS AND MEDS | $17,711,737 | $17,711,737 | |
| DUES AND PUBLICATIONS | $1,080,333 | $976,503 | $103,830 |
| REPAIRS AND MAINTENANCE | $1,028,048 | $970,236 | $57,812 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,177,177 | TotalAmt |
| Program Services | $2,067,966 | ProgramServicesAmt |
| Management And General | $109,211 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,940,642 | TotalAmt |
| Program Services | $120,767,815 | ProgramServicesAmt |
| Management And General | $18,172,827 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,289,317 | BOYAmt |
| EOY | $1,117,787 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,268,291 | BOYAmt |
| EOY | $38,583,106 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,610,050 | BOYAmt |
| EOY | $18,039,876 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $338,310 | BOYAmt |
| EOY | $380,583 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,422,003 | BOYAmt |
| EOY | $3,748,483 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $949,190 | BOYAmt |
| EOY | $1,191,392 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $77,631,134 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $47,283,975 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,783,496 | BOYAmt |
| EOY | $30,347,159 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,531,576 | BOYAmt |
| EOY | $1,624,910 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $460,000 | BOYAmt |
| EOY | $402,500 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,482,053 | BOYAmt |
| EOY | $12,818,397 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $114,134,286 | BOYAmt |
| EOY | $108,254,193 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,961,220 | BOYAmt |
| EOY | $12,782,173 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $473,434 | BOYAmt |
| EOY | $560,969 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,410,752 | BOYAmt |
| EOY | $1,095,930 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,999,097 | BOYAmt |
| EOY | $6,396,821 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,844,503 | BOYAmt |
| EOY | $20,835,893 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,289,783 | BOYAmt |
| EOY | $87,418,300 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,289,783 | BOYAmt |
| EOY | $87,418,300 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $114,134,286 | BOYAmt |
| EOY | $108,254,193 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $4,128,517 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $10,613 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $10,613 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | ST CROIX REGIONAL MEDICAL CENTER (THE ORGANIZATION") PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. A PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. THE ORGANIZATION IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE ORGANIZATION PAYS MEMBERSHIP FEES TO THE RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO DOES PROVIDE ANALYSIS ON CURRENT HEALTH CARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTH CARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. THE ORGANIZATION IS ALSO A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION. THESE DUES PAID ARE PRIMARILY USED TO ENSURE THEIR MEMBERS' PERSPECTIVES AND NEEDS ARE HEARD AND ADDRESSED IN NATIONAL HEALTH POLICY DEVELOPMENT, LEGISLATIVE AND REGULATORY DEBATES AND JUDICIAL MATTERS. THE ORGANIZATION IS ALSO A MEMBER OF THE NATIONAL RURAL HEALTH ASSOCIATION. THESE DUES PAID ARE PRIMARILY USED TO SUPPORT RURAL HEALTH ISSUES THROUGH ADVOCACY, COMMUNICATIONS, EDUCATION AND RESEARCH. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,437,437 | OtherCostOrOtherBasisAmt |
| Book Value | $1,437,437 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $44,934,897 | OtherCostOrOtherBasisAmt |
| Depreciation | $28,059,664 | DepreciationAmt |
| Book Value | $16,875,233 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $50,236 | OtherCostOrOtherBasisAmt |
| Depreciation | $48,293 | DepreciationAmt |
| Book Value | $1,943 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $27,549,512 | OtherCostOrOtherBasisAmt |
| Depreciation | $19,176,018 | DepreciationAmt |
| Book Value | $8,373,494 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,659,052 | OtherCostOrOtherBasisAmt |
| Book Value | $3,659,052 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $30,347,159 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| UNEMPLOYMENT RESERVE FUND | $415,156 |
| DEFERRED COMPENSATION PLAN | $5,743,241 |
| AMOUNTS RECEIVABLE FROM THIRD-PARTY REIMBURSEMENT PROGRAMS | $6,660,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $12,818,397 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ASSET RETIREMENT OBLIGATION | $189,865 |
| DEFERRED COMPENSATION PLAN | $6,206,956 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,396,821 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $371,137 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $371,137 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00270 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,240,420 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,828,140 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,412,280 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05370 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,611,557 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,828,140 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,783,417 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05640 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,983,192 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,839,312 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,143,880 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08080 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,983,192 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,839,312 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,143,880 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08080 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $43,594,749 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $24,667,452 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $18,927,297 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13720 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $550,049 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $275,025 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $30,474,160 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $30,221,920 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $252,240 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CROIX REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SCRMC.ORG | WebsiteAddressTxt |
| State License | 1041 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CROIX REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C, LINE 7D | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | SEE PART V, SECTION C, LINE 7D | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C, LINE 7D | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, SECTION C, LINE 16J | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, SECTION C, LINE 16J | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 5: USING A MULTI-SECTOR APPROACH (SUBSTANCE ABUSE ORGANIZATIONS, STATE/LOCAL/TRIBAL GOVERNMENT,HEALTHCARE PROFESSIONALS, RELIGIOUS/FRATERNAL ORGANIZATIONS, CIVIC/VOLUNTEER ORGANIZATIONS, LAWENFORCEMENT, YOUTH SERVING ORGANIZATIONS, SCHOOLS, MEDIA, BUSINESS, PARENTS, YOUTH), OVER 100ORGANIZATIONS WERE IDENTIFIED AND INVITED TO PARTICIPATE IN COMMUNITY CONVERSATIONS/KEY INFORMANTINTERVIEWS. OF THE TWELVE SECTORS, IN THE SEVENTEEN LISTENING SESSIONS, THE ONLY SECTORS NOT REPRESENTEDARE THE MEDIA AND YOUTH SECTORS.DURING THE COMMUNITY CONVERSATIONS/KEY INFORMANT INTERVIEWS, FOUR OPEN-ENDED QUESTIONS WEREASKED: 1. FOR YOU, WHAT DOES IT MEAN TO BE HEALTHY AND HAPPY? 2. WHAT DOES IT MEAN FOR OUR COMMUNITY TO BE HEALTHY AND HAPPY? 3. WHAT WOULD MAKE IT EASIER TO LIVE A HEALTHIER AND HAPPIER LIFE? 4. WHAT SHOULD OUR COMMUNITY DO TOGETHER TO IMPROVE HEALTH AND WELL-BEING?THERE WAS A MINIMUM OF TWO COALITION LEADERS AT EACH COMMUNITY CONVERSATION/KEY INFORMANTINTERVIEW, ONE TO FACILITATE AND ONE TO TAKE NOTES. THE FACILITATOR WAS INTENTIONAL NOT TO "LEAD" THECONVERSATION WHEN A QUESTION WAS ASKED AS TO NOT SKEW DATA OR DRIVE ANSWERS IN A CERTAIN DIRECTION.WHEN THE FACILITATOR(S) ASKED QUESTIONS, IT WAS FOR CLARIFICATION PURPOSES TO ENSURE UNDERSTANDING.IN ADDITION TO THE FOUR OPEN-ENDED QUESTIONS, PARTICIPANTS WERE ASKED TO RANK WHAT THEY VIEWED AS THEIRTOP THREE COMMUNITY STRENGTHS AND TOP THREE COMMUNITY CHALLENGES. IF PARTICIPANTS WERE NOTCOMFORTABLE, OR READY, TO GIVE THIS INFORMATION DURING THE CONVERSATION, THEY WERE SENT A FOLLOW-UPSURVEY (CREATED THROUGH QUALTRICS XM ) THAT ASKED THEM TO RANK THEIR TOP THREE COMMUNITY STRENGTHSAND CHALLENGES.ONCE THE COMMUNITY CONVERSATIONS/KEY INFORMANT INTERVIEWS WERE COMPLETE, A SURVEY (CREATEDTHROUGH QUALTRICS XM) ASKING THE SAME FOUR OPEN-ENDED QUESTIONS AND TWO RANKING QUESTIONS, WASSENT TO THE OVER 100 ORGANIZATIONS INVITED ASKING THEM TO DISTRIBUTE THE SURVEY TO OTHER KEY INFORMANTSAND TO THE COMMUNITY MEMBERS THEY SERVED.SECONDARY DATA WAS COLLECTED FROM A MULTITUDE OF RELIABLE AND VALID SOURCES. THIS INCLUDES, BUT IS NOTLIMITED TO, THE U.S. CENSUS BUREAU, THE U.S. BUREAU OF LABOR STATISTICS, THE CENTERS FOR DISEASE CONTROLAND PREVENTION, AND SO FORTH, TO NAME A FEW. YOU CAN FIND SPECIFIC SOURCES ASSOCIATED WITH DATA POINTSIDENTIFIED ON THE CORRESPONDING PAGE OF THIS REPORT.THE FRAMEWORK USED AS A GUIDE TO THE MULTIPLE FACTORS THAT INFLUENCE HOW LONG AND HOW WELL PEOPLE LIVEIS THE COUNTY HEALTH RANKINGS MODEL DEVELOPED BY THE UNIVERSITY OF WISCONSIN'S POPULATION HEALTHINSTITUTE AND SUPPORTED BY THE ROBERT WOOD JOHNSON FOUNDATION.DATA WAS SEPARATED INTO FOUR AREAS: 1. COMMUNITY CONVERSATIONS/KEY INFORMANT INTERVIEW DATA 2. RANKING DATA 3. SURVEY DATA 4. SECONDARY DATAONCE THE COMMUNITY CONVERSATIONS/KEY INFORMANT INTERVIEWS DATA AND THE SURVEY DATA WAS REVIEWEDAND COMPILED, COMMON THEMES WERE IDENTIFIED, AND THE DATA WAS SEPARATED INTO RESPECTIVE CATEGORIES.WHEN THE RESPECTIVE CATEGORIES WERE DEVELOPED AND ESTABLISHED, COMPARISON EVALUATIONS TOOK PLACE TODETERMINE IF THE QUALITATIVE DATA COINCIDED WITH THE QUANTITATIVE RANKING DATA. ONCE PRIMARY DATASYNTHESIS WAS COMPLETE, ROBUST SECONDARY DATA WAS GATHERED TO VALIDATE OR REJECT THE TRENDS BEINGREVEALED, IN ADDITION TO ENSURING THAT THE MULTIPLE FACTORS THAT ENCOMPASS HEALTH WERE NOT BEINGOVERLOOKED. |
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 6A: THE MEDICAL CENTER WORKED IN COLLABORATION WITH AMERY HOSPITAL AND CLINIC AND OSCEOLA MEDICAL CENTER WITH THE ULTIMATE GOAL TO IDENTIFY PRIORITY HEALTH ISSUES AND TO DEVELOP STRATEGIES TO ADDRESS THE COMMUNITY'S HEALTH NEEDS. |
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 6B: IN ADDITION TO THE HOSPITAL FACILITIES MENTIONED ABOVE, THE MEDICAL CENTER WORKED IN COLLABORATION WITH THE POLK COUNTY HEALTH DEPARTMENT, MENTAL HEALTH TASK FORCE OF POLK COUNTY, UNITED WAY OF ST. CROIX VALLEY, AND UNIVERSITY OF WISCONSIN. |
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 7D: SECTION B, LINE 7A:HTTPS://WWW.SCRMC.ORG/DOCUMENTS/CHNA/CHNA-AND-IMPLEMENTATION-STRATEGY-6.27.22-PDFA.PDFSECTION B, LINE 7B:HTTPS://CMS5.REVIZE.COM/REVIZE/POLK/POLKCOUNTYHEALTH/2022%20POLK%20COUNTY%20COMMUNITY%20HEALTH%20ASSESSMENT.PDFSECTION B, LINE 10A:HTTPS://WWW.SCRMC.ORG/LEGAL-NOTICES/ |
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 11: THE PRIORITY AREAS FOR THE JULY 1, 2019 JUNE 30, 2022 CHNA AND IMPLEMENTATION PLAN WERE AS FOLLOWS:- MENTAL HEALTH- SUBSTANCE ABUSE- NUTRITION AND PHYSICAL ACTIVITY- ACCESS TO CAREACTIONS TAKEN BY SCRMC TO IMPROVE THESE AREAS:MENTAL HEALTH FIRST AID TRAINING- NATIONAL SKILLS-BASED TRAINING COURSE THAT TEACHES PARTICIPANTS ABOUT MENTAL HEALTH AND SUBSTANCE USE ISSUES.- 32 EMPLOYEES TRAINED; 93% OF TRIAGE NURSES; 100% OF ATHLETIC TRAINERS PRIOR TO PANDEMIC.- COMMUNITY PARTNER: UNITED WAY ST. CROIX VALLEYANNUAL MAKE IT OK CAMPAIGN- INTERNAL COMMUNICATION AND EXTERNAL SOCIAL MEDIA CAMPAIGN TO REDUCE THE STIGMA ASSOCIATED WITH MENTAL ILLNESS.- WEEKLY CAMPAIGN PROMOTION IN MAY (MENTAL HEALTH MONTH) EACH YEAR- COMMUNITY PARTNERS: HEALTHPARTNERS, UNITED WAY ST. CROIX VALLEYCOMMUNITY GARDEN CLASS- A CURRICULUM APPROVED CLASS, "MUDDY FEET AND HEALTHY EATS," WAS OFFERED IN CONJUNCTION WITH THE ST. CROIX FALLS SCHOOL DISTRICT TO HELP KIDS LEARN HOW TO TEND A GARDEN WHILE LEARNING ABOUT GROWING HEALTHY FOOD, THE BENEFITS OF EATING HEALTHY, AND THE IMPORTANCE OF CARING FOR THE ENVIRONMENT.- 11 STUDENTS ENROLLED IN CLASS; COMMUNITY GARDEN CREATED; 4.64/5.00 EXPERIENCE RATING; 100% LIKELIHOOD TO RECOMMEND - COMMUNITY PARTNER: ST. CROIX FALLS SCHOOL DISTRICTPOWER OF PRODUCE- ST. CROIX FALLS PRIMARY CARE PROVIDERS PARTICIPATED IN A PILOT INITIATIVE IN COLLABORATION WITH COMMUNITY PARTNERS TO PROMOTE FRESH, HEALTHY FRUITS AND VEGETABLES TO CHILDREN. SELECT SCRMCPROVIDERS HANDED OUT A "COUPON" AT WELL CHILD VISITS WITH THE INTENT FOR THE CHILD, AND THEIR FAMILY, TO REDEEM IT ANY OF THE LOCAL FARMERS MARKETS FOR A $2 POWER OF PRODUCE TOKEN. THE TOKEN COULD THENBE REDEEMED WITH ANY OF THE ONSITE FARMERS.- REDEMPTION RATE: POOR (LESS THAN 10)- COMMUNITY PARTNERS: AMERY FARMERS' MARKET, AMERY MEDICAL CENTER, OSCEOLA MEDICAL CENTER, OSCEOLA FARMERS' MARKET, POLK COUNTY PUBLIC HEALTH, ST. CROIX FALLS FARMERS' MARKET, UNITED WAY ST. CROIX, UNIVERSITY OF WISCONSIN-EXTENSION HEALTHY OR TRANSPARENT FOOD OPTIONS- NUTRITIONAL VALUES ADDED TO CAFETERIA ITEMS (STATE STREET CAF)- CONTINUE TO OFFER GLUTEN-FREE AND VEGETARIAN OPTIONS AND USE WHOLE GRAINS WHENEVER POSSIBLE.- WEEKLY DROP OFF AND PICK UP SITE FOR CSA (COMMUNITY SUPPORTED AGRICULTURE) PROGRAM. COMMUNITY MEMBERS WOULD BUY FOOD SHARES THROUGH CSA PROGRAM, STEADY HAND FARM WOULD DELIVER PRODUCE, COMMUNITY MEMBERS HAD LOCAL DESTINATION TO PICK IT UP- GARDEN PLANTED AND MAINTAINED BY NUTRITION SERVICES STAFF. PRODUCE GROWN USED IN MEALS.- SPONSORED LOCAL FARMERS MARKET.FRESH FOOD VENDING- OPPORTUNITY FOR ALL SHIFTS TO HAVE ACCESS TO HEALTHY OPTIONS.- WORKING WITH VENDOR TO HONOR THEIR COMMITMENT TO "HEALTHY OPTIONS AND KEEPING ITEMS STOCKED- COMMUNITY PARTNER: MIDWEST VENDINGWELLNESS CENTER(S)- OVER THIRTY FITNESS CLASSES OFFERED WEEKLY TO THE PUBLIC AT LINDSTROM WELLNESS CENTER (LOCATED IN THE LINDSTROM CLINIC) AND WEBSTER WELLNESS CENTER (LOCATED IN THE WEBSTER HEALTH CENTER) UNTILSHUTDOWN DUE TO PANDEMIC IN MARCH 2020.- MONTHLY WORKSHOPS OFFERED AND PLANNED/STAFFED THROUGH 2021. WORKSHOPS TARGETED HEALTHY EATING, CHRONIC DISEASE PREVENTION, STRESS MANAGEMENT, AND PHYSICAL ACTIVITY. TERMINATED THESE OFFERINGS IN LIEU OF PANDEMIC.HEALTHY HABITS AND PROGRAMMING ENHANCEMENTS- IMPLEMENTED EMPLOYEE WELLBEING PLATFORM WITH ASSOCIATED INCENTIVES IN 2021; PAID OUT $79,950 IN 2021- ADDED MYSTRENGTH AS AN ACTIVITY OPTION IN LATE 2021, A COMPREHENSIVE DIGITAL PROGRAM WITH PROVEN TOOLS AND ACTIVITIES FOR STRESS, DEPRESSION, SLEEP AND MORE.- CHANGED EMPLOYEE ASSISTANCE PROGRAM (EAP) VENDOR IN 2021 AND INTEGRATED EAP INTO ONLINEWELLBEING PLATFORM IN 2022.- WELLBEATS APP ADDED FOR UTILIZATION CONVENIENCE. WELLBEATS HAS VIRTUAL FITNESS, NUTRITION, ANDMINDFULNESS CLASSES FOR EVERY AGE, INTEREST, AND ABILITY LEVEL.- ADDED COMPUTERIZED COGNITIVE BEHAVIOR THERAPY (CCBT) TO EAP TO HELP DECREASE STRESS.- ADDED PRE-DIABETES AND PRE-HYPERTENSION DIAGNOSES TO OMADA PROGRAM.- COMMUNITY PARTNERS: HEALTHPARTNERS, OMADA, LIVONGOHEALTHIER TOGETHER MOMENT/MINDFUL MOMENT- THE PURPOSE IS TO TAKE AN INTENTIONAL PAUSE, A MOMENT TO HELP ONE RELAX, RENEW, AND RESTORE DURING THE DAY. IT CAN BE AS SIMPLE AS AN ICE BREAKER ACTIVITY, A STRETCH, OR JUST TAKING A FEW DEEP BREATHS.-GUIDE CREATED AND ON MYWELLNESS INTRANET SITE; INCORPORATED INTO MONTHLY POWER POINT ANDENCOURAGED TO BE USED AT MONTHLY MEETINGS (NEW SUGGESTION/RECOMMENDATION EACH MONTH.-COMMUNITY PARTNER: HEALTHPARTNERSCULTURE OF HEALTH SYSTEMS DESIGN APPROACH; RESEARCH/EDUCATION-SCRMC WAS SELECTED AND PARTICIPATED IN A TOTAL WORKER HEALTH RESEARCH PILOT PROJECT WITH HEALTHPARTNERS AND THE HARVARD T.H. CHAN SCHOOL OF PUBLIC HEALTH. TOTAL WORKER HEALTH STRATEGIES INTEGRATE SAFETY AND WELLBEING FUNCTIONS IN A COORDINATED TEAM EFFORT TO DRIVE HEALTH IMPROVEMENT. IT SHIFTS THE FOCUS FROM BEHAVIOR CHANGE TO ADDRESSING WORKING CONDITIONS THROUGH POLICIES, PRACTICES AND PROCEDURES. TOTAL WORKER HEALTH TARGETS ROOT CAUSES.-PUBLISHED RESEARCH ARTICLE FROM STUDY: JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE (MAY 2021, VOL 63, ISSUE 5, PP:411-421) TITLED "BUILDING CAPACITY FOR INTEGRATED OCCUPATIONAL SAFETY, HEALTH, AND WELL-BEING INITIATIVES USING GUIDELINES FOR TOTAL WORKER HEALTH APPROACHES."-SCRMC SERVED AS A CO-PRESENTER AT THE NATIONAL HEALTH ENHANCEMENT RESEARCH ORGANIZATION (HERO) CONFERENCE IN COLLABORATION WITH THE HEALTHPARTNERS CHIEF SCIENCE OFFICER/PRESIDENT OF HEALTHPARTNERS INSTITUTE, ADJUNCT PROFESSOR AT HARVARD T.H. CHAN SCHOOL OF PUBLIC HEALTH, AND COCHAIR OF THE U.S. SECRETARY OF HEALTH AND HUMAN SERVICES' ADVISORY COMMITTEE ON NATIONAL HEALTH PROMOTION AND DISEASE PREVENTION OBJECTIVES FOR 2030 (AKA HEALTH PEOPLE 2030). THE SESSION WAS TITLED "INTEGRATING SAFETY AND WELLBEING TO DRIVE IMPROVEMENT.REACH OUT AND READ (PART OF LITTLE MOMENTS COUNT INITIATIVE)-AGE-APPROPRIATE BOOK DISTRIBUTION AT WELL CHILD VISITS. EIGHTY PERCENT OF A CHILD'S BRAIN IS FORMED BETWEEN BIRTH AND AGE THREE. ALSO LINKED WITH WELL CHILD VISIT COMPLIANCE.-PRIMARY CARE PROVIDERS TRAINED AND PROGRAM IS IMPLEMENTED AT LINDSTROM CLINIC; APPLIED FOR ALL WISCONSIN CLINICS, AS WELL, BUT THEY WERE AT MAXIMUM CAPACITY AND COULD NOT EXECUTE.-COMMUNITY PARTNERS: HEALTHPARTNERS, ALLINA HEALTH, SANFORD HEALTH, HENNEPIN HEALTH, CHILDREN'S-MN, THE PEOPLE'S CENTER, BETHEL UNIVERSITY DENTAL CLINIC-OPENED DENTAL CLINIC AT WEBSTER HEALTH CENTER IN WEBSTER, WI, IN JULY 2019.-AS OF MAY 2022, SCRMC HAS HAD 5,658 TOTAL VISITS (ALMOST 1,500 UNIQUE PATIENTS) WITH NEW PATIENTS BEING ADDED EACH MONTH; 20% OF TOTAL VISITS HAVE BEEN TO SUPPORT THE MA POPULATION.GIVE KIDS A SMILE EVENT-ANNUAL DENTAL EVENT HELPING UNDERSERVED CHILDREN.-2022 9 CHILDREN TREATED, $3,462 IN CLEANINGS, SEALANTS, EXAMS, FILLINGS, AND AN EXTRACTION-COMMUNITY PARTNERS: AMERICAN DENTAL ASSOCIATIONTELEHEALTH-EXPEDITED TELEHEALTH SERVICES IN LIEU OF PANDEMIC TO CONTINUE OFFERING CARE WHILE KEEPING PROVIDERS, STAFF, AND COMMUNITY MEMBERS SAFE. BEGAN APRIL 2020. SCRMC CONTINUES TO UTILIZE THIS SERVICE FOR PATIENTS AND PLANS TO PROVIDE ENHANCEMENTS IN THE NEAR FUTURE.RESPIRATORY CLINIC-WHEN COVID TESTING BEGAN, ST. CROIX REGIONAL MEDICAL CENTER RESPONDED WITH DRIVE-THROUGH TESTING AT OUR ST. CROIX FALLS LOCATION. THE FIRST VERSION OF THE DRIVE-THROUGH WAS HELD OUTDOORS TO HELP PREVENT EXPOSURE TO STAFF AND OTHER PATIENTS. AS WEATHER BECAME A CHALLENGE, THE DRIVE-THROUGH ADDED THE CAPABILITY FOR PATIENTS TO BE TESTED AND SCREENED INDOORS IN A SECTIONED OFF AREA OF THE HOSPITAL. THE DEMAND TO ADDRESS A MORE LONG-TERM RESPONSE TO THIS TYPE OF TESTING BECAME OBVIOUS. TO RESPOND TO THIS NEED, SCRMC PLANNED, BUILT, AND OPENED THE RESPIRATORY ILLNESS CLINIC ON THE ST. CROIX FALLS CAMPUS TO REPLACE THE DRIVE-THROUGH. THE RESPIRATORY ILLNESS CLINIC OFFERS PATIENTS A SAFE PLACE TO BE SEEN FOR SYMPTOMS INCLUDING FEVER, COUGH, SORE THROAT, CONGESTION, MUSCLE/BODY ACHES, RUNNY NOSE, LOSS OF SMELL, AND FATIGUE; SYMPTOMS ASSOCIATED WITH COVID, BUT ALSO OTHER HIGHLY CONTAGIOUS VIRUSES. THE CLINIC, WHICH OPENED IN NOVEMBER 2020, OFFERS A SEPARATE ENTRANCE FOR PATIENTS EXPERIENCING VIRUS AND FLU-LIKE SYMPTOMS TO LIMIT EXPOSURE. IT ALSO HAS A SEPARATE AIR HANDLING SYSTEM INDEPENDENT OF THE REST OF THE ST. CROIX FALLS CLINIC TO RESTRICT ANY AIRBORNE ILLNESSES FROM BEING TRANSPORTED THROUGHOUT THE BUILDING.-BEGINNING IN JANUARY OF 2021, SCRMC WAS ONE OF THE FEW MEDICAL CENTERS IN THE AREA OFFERING MONOCLONAL ANTIBODIES TREATMENT FOR COIVD-19. THE FDA AUTHORIZED THE USE OF MONOCLONAL ANTIBODIES THAT ARE GIVEN BY IV INFUSION. THESE ANTIBODIES CAN ATTACH TO PARTS OF THE CORONAVIRUS AND CAN HELP THE IMMUNE SYSTEM RECOGNIZE AND RESPOND MORE EFFECTIVELY TO THE VIRUS. |
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 13H: ST. CROIX REGIONAL MEDICAL CENTER MAY PRESUMPTIVELY DETERMINE ELIGIBILITY OF PATIENTS BASED ON EXTERNAL SOURCES AND DATABASES WITHOUT A FAP-APPLICATION. |
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 16J: PART V, LINES 16A-C:HTTPS://WWW.SAINTCROIXHEALTH.ORG/PATIENTS-VISITORS/INSURANCE-BILLING/FINANCIAL-ASSISTANCE/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - ST CROIX FALLS CLINIC | ||||
| 216 SOUTH ADAMS STREET | ST CROIX FALLS | WI | 54024 | RHC PROVIDER BASED CLINIC |
| 2 - WEBSTER HEALTH CENTER | ||||
| 26425 LAKELAND AVE SOUTH | WEBSTER | WI | 54893 | RHC PROVIDER BASED CLINIC |
| 3 - LINDSTROM CLINIC | ||||
| 12375 LINDSTROM LANE | LINDSTROM | MN | 55045 | FREE STANDING CLINIC |
| 4 - FREDERIC CLINIC | ||||
| 205 OAK STREET WEST | FREDERIC | WI | 54837 | RHC PROVIDER BASED CLINIC |
| 5 - UNITY CLINIC | ||||
| 1504 190TH AVENUE | BALSAM LAKE | WI | 54810 | RHC PROVIDER BASED CLINIC |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | ST. CROIX REGIONAL MEDICAL CENTER, THROUGH ITS PATIENT ADVOCATES, EVALUATES EACH APPLICANT'S SITUATION IN ACCORDANCE WITH CRITERIA ESTABLISHED ANNUALLY BY THE BOARD OF DIRECTORS. THE CRITERIA INCLUDE:{1) INDIVIDUAL OR FAMILY INCOME{2) FAMILY SIZE{3) OTHER SOURCES OF PAYMENT FOR SERVICES. QUALIFICATION IS BASED ON ASSET LEVELS ESTABLISHED BY MEDICAL ASSISTANCE, FAMILY SIZE, AND INCOME LEVELS BASED ON 100% OF THE FEDERAL POVERTY GUIDELINES AS PUBLISHED ANNUALLY BY THE FEDERAL GOVERNMENT. IN ADDITION TO THE ABOVE LISTED ELIGIBILITY REQUIREMENTS DEPENDENT UPON INCOME, SCRMC MAY ALSO PRESUMPTIVELY DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. PORTIONS OF OR THE ENTIRE FINANCIAL APPLICATION PROCESS MAY BE WAIVED FOR CERTAIN PATIENTS/GUARANTORS WHO PRESUMPTIVELY QUALIFY FOR FINANCIAL ASSISTANCE AND ARE SUBSEQUENTLY VERIFIED BASED ON SCRMC POLICIES AND PROCEDURES. EXAMPLES MAY INCLUDE PATIENTS/GUARANTORS WHO ARE HOMELESS, DECEASED WITHOUT AN ESTATE, BANKRUPTCY, FOOD STAMPS AND/OR PATIENTS/GUARANTORS WHO QUALIFY BY EXTERNAL AVAILABLE DATA SOURCES SUCH AS CREDIT AGENCIES OR SOCIAL ECONOMIC STATUS OF QUALIFYING FOR FINANCIAL ASSISTANCE. |
| PART I, LINE 7: | THE COSTING METHODOLOGY USED ON FROM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. |
| PART I, LINE 7G: | THE ORGANIZATION INCLUDED THE ACTIVITY OF FOUR RURAL HEALTH CLINICS FOR SUBSIDIZED HEALTH SERVICES. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 937,890. |
| PART III, LINE 2: | THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. |
| PART III, LINE 3: | MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. |
| PART III, LINE 4: | SEE THE "PATIENT RECEIVABLES AND CREDIT POLICY" SECTION IN NOTE 1 TO THE FINANCIAL STATEMENTS FOR INFORMATION ABOUT THE CALCULATION OF BAD DEBTS. |
| PART III, LINE 8: | THE MEDICAL CENTER PROVIDES CARE TO INDIVIDUALS WHERE GOVERNMENT DEPARTMENTS DETERMINE THE AMOUNT OF REIMBURSEMENT OF SERVICE REGARDLESS OF THE COST TO PROVIDE THE SERVICE. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES GROSS MEDICARE REVENUE BUT DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE ALSO DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS RADIOLOGIST, RESPIRATORY THERAPY, URGENT CARE, OR ANESTHESIA PROFESSIONAL SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT THE HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREA. THE CALCULATION IS ALSO NOT INCLUDING THE ACTIVITY FROM FOUR RURAL HEALTH CLINICS AS THOSE AMOUNTS ARE BEING INCLUDED AS SUBSIDIZED SERVICES. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTH CARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. |
| PART III, LINE 9B: | THE FOLLOWING PROCEDURES ARE SECTION 8 IN SCRMC'S BILLING AND COLLECTION POLICY INCLUDED ON THEIR WEBSITE AND DESCRIBE THE POLICY AND PROCEDURES USED FOR PATIENTS THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE. ST. CROIX REGIONAL MEDICAL CENTER WILL MAKE REASONABLE EFFORTS TO PATIENT/GUARANTORS THAT FINANCIAL ASSISTANCE IS AVAILABLE, WHERE TO GET THE INFORMATION, HOW TO APPLY, AND ASSISTANCE AVAILABLE WITH APPLYING. ST. CROIX REGIONAL MEDICAL CENTER WILL ALLOW AND PROCESS A FINANCIAL ASSISTANCE APPLICATION UP TO 240 DAYS AFTER THE PATIENT/GUARANTOR'S FIRST BILLING STATEMENT AFTER A DATE OF SERVICE. ST. CROIX REGIONAL MEDICAL CENTER WILL TAKE STEPS TO NOTIFY PATIENT/GUARANTOR ABOUT OUR FINANCIAL ASSISTANCE POLICY AND WILL NOT TAKE EXTRAORDINARY COLLECTION ACTIONS BEFORE 120 DAYS FROM PATIENT/GUARANTOR'S FIRST BILLING STATEMENT AFTER A DATE OF SERVICE. IF A FINANCIAL ASSISTANCE APPLICATION IS RECEIVED DURING THE APPLICATION PERIOD, ST. CROIX REGINAL MEDICAL CENTER WILL SUSPEND ANY EXTRAORDINARY COLLECTION ACTIONS TO OBTAIN PAYMENT, MAKE AN ELIGIBILITY DETERMINATION AS TO WHETHER THE PATIENT/GUARANTOR IS ELIGIBLE FOR FINANCIAL ASSISTANCE AND NOTIFY THE PATIENT/GUARANTOR IN WRITING. IF ELIGIBLE, THE FINAL NOTIFICATION PERIOD WILL BE RESET FOR ANOTHER 30-DAY PERIOD. IF A PATIENT/GUARANTOR DOES NOT APPLY FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY BY THE LAST DAY OF THE FINAL NOTIFICATION PERIOD, AND THE PATIENT/GUARANTOR HAS RECEIVED THE 30-DAY NOTICE DESCRIBED IN FINAL NOTIFICATION PERIOD, THEN ST. CROIX REGIONAL MEDICAL CENTER MAY INITIATE EXTRAORDINARY COLLECTION ACTIONS. IF A PATIENT/GUARANTOR HAS APPLIED FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY IN THE LAST SIX MONTHS, AND IT WAS DETERMINED THAT THE PATIENT/GUARANTOR IS NOT ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY, THEN SCRMC MAY INITIATE EXTRAORDINARY COLLECTION ACTIONS. IF AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION UNDER THE FINANCIAL ASSISTANCE POLICY IS RECEIVED PRIOR TO THE FINAL NOTICE, THEN EXTRAORDINARY COLLECTION ACTIONS WILL BE SUSPENDED, AND PATIENT/GUARANTOR WILL BE PROVIDED A WRITTEN NOTICE THAT DESCRIBES ADDITIONAL INFORMATION REQUIRED UNDER THE FINANCIAL ASSISTANCE POLICY. IF ADDITIONAL INFORMATION REQUESTED IS NOT PROVIDED, THEN THE FINAL NOTIFICATION PERIOD WILL BE RESET. |
| PART VI, LINE 2: | OVERALL MARKETPLACE DEMOGRAPHICS AND COMPETITIVE ANALYSIS IS CONDUCTED ON A REGULAR BASIS. WHEN DEMAND FOR NEW SERVICE LINES IS INTENSIFIED, THEY ARE ADDED SLOWLY UNTIL DEMAND CAPACITY REACH CRITICAL LEVELS. WE HOLD ANNUAL RHC MEETINGS THAT INCLUDE COMMUNITY MEMBERS TO SPEAK ON BEHALF OF THE NEEDS OF THE COMMUNITY. THIS DATA IS COLLECTED AND REPORTED TO MEDICAL AND EXECUTIVE LEADERSHIP FOR CONSIDERATION. |
| PART VI, LINE 3: | ALL PATIENTS HAVE ACCESS TO WRITTEN MATERIALS AND PAMPHLETS AT OR NEAR THE POINT OF REGISTRATION. IN ADDITION, PATIENTS HAVE ACCESS TO PATIENT ADVOCATES WITH FULL KNOWLEDGE OF RESOURCES AVAILABLE. |
| PART VI, LINE 4: | SCRMC SERVICES A GEOGRAPHIC AREA OF APPROXIMATELY 300 SQUARE MILES IN WESTERN WISCONSIN THAT INCLUDES THE TOWNS OF ST. CROIX FALLS, BALSAM LAKE, LUCK, MILLTOWN, FREDERIC, AND GRANTSBURG IN WISCONSIN AND TAYLOR FALLS AND LINDSTROM IN EASTERN MINNESOTA. |
| PART VI, LINE 5: | SCRMC WORKS COLLABORATIVELY WITH AMERY HOSPITAL AND CLINIC, OSCEOLA MEDICAL CENTER, MENTAL HEALTH TASK FORCE OF POLK COUNTY, POLK COUNTY HEALTH DEPARTMENT, UNITED WAY OF ST. CROIX VALLEY, AND UW-EXTENSION TO DETERMINE THE FOUR MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. SCRMC CONTRIBUTES EFFORTS TO OTHER COMMUNITY HEALTH NEEDS IDENTIFIED IN THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| 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 | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | 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 (10 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GURDESH BEDI | ||||||||||||||
| TRUSTEE/PHYSICIAN OF SCRMC | $1,165,646 | $0 | $4,200 | $0 | $5,363 | $0 | $6,800 | $0 | $1,029 | $0 | $1,183,038 | $0 | $0 | $0 |
| JOHN KAMPA | ||||||||||||||
| SCRMC PHYSICIAN | $753,520 | $0 | $2,450 | $0 | $5,309 | $0 | $5,800 | $0 | $21,100 | $0 | $788,179 | $0 | $0 | $0 |
| DAVE DOBOSENSKI | ||||||||||||||
| CEO | $400,356 | $0 | $80,000 | $0 | $83,685 | $0 | $17,000 | $0 | $29,097 | $0 | $610,138 | $0 | $77,655 | $0 |
| MUHAMMAD KHAN | ||||||||||||||
| SCRMC PHYSICIAN | $534,207 | $0 | $4,200 | $0 | $5,363 | $0 | $17,400 | $0 | $32,194 | $0 | $593,364 | $0 | $0 | $0 |
| MARISA SPENCER | ||||||||||||||
| SCRMC PHYSICIAN | $534,999 | $0 | $4,200 | $0 | $5,309 | $0 | $17,400 | $0 | $1,029 | $0 | $562,937 | $0 | $0 | $0 |
| VITTAL NAGAR | ||||||||||||||
| SCRMC PHYSICIAN | $464,330 | $0 | $4,200 | $0 | $5,363 | $0 | $17,400 | $0 | $31,937 | $0 | $523,230 | $0 | $0 | $0 |
| CLAUDIO NUNES | ||||||||||||||
| SCRMC PHYSICIAN | $459,385 | $0 | $4,200 | $0 | $5,633 | $0 | $17,000 | $0 | $28,074 | $0 | $514,292 | $0 | $0 | $0 |
| PATRICK MCDONOUGH | ||||||||||||||
| FORMER VC/SPORTS MED MD | $269,856 | $0 | $4,200 | $0 | $5,451 | $0 | $16,877 | $0 | $28,980 | $0 | $325,364 | $0 | $0 | $0 |
| SALLY BAJAK | ||||||||||||||
| CFO | $216,320 | $0 | $3,000 | $0 | $47,611 | $0 | $13,064 | $0 | $29,770 | $0 | $309,765 | $0 | $48,202 | $0 |
| REBECCA LYMAN MD | ||||||||||||||
| TRUSTEE/PHYSICIAN OF SCRMC | $224,747 | $0 | $4,200 | $0 | $4,791 | $0 | $12,658 | $0 | $28,379 | $0 | $274,775 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | DAVE DOBOSENSKI, SALLY BAJAK, DR. REBECCA LYMAN, DR. PATRICK MCDONOUGH, DR. GURDESH BEDI, DR. MUHAMMAD KHAN, DR. CLAUDIO NUNES AND DR. JAMES WALLACE ARE ALL PARTICIPANTS IN A 457(F) PLAN. DEFERRALS DURING FISCAL YEAR 2022: DAVE DOBOSENSKI - $47,708 SALLY BAJAK - $29,597 DEFERRALS DURING CALENDAR YEAR 2021: DAVE DOBOSENSKI - $77,655 SALLY BAJAK - $48,202 | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JILL TIES | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | FAMILY MEMBER OF WILLIAM TIES (BOARD MEMBER) | RelationshipDescriptionTxt |
| Transaction | $433,227 | TransactionAmt |
| Transaction | EMPLOYEE OF THE HOSPITAL | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THERE IS ONE CLASS OF MEMBERSHIP IN THE CORPORATION. MEMBERSHIP WILL EXPIRE ON SEPTEMBER 1 OF EACH YEAR, UNLESS PRIOR TO THAT DATE THE MEMBERSHIP IS RENEWED BY TURNING IN THE COMPLETED ANNUAL MEMBERSHIP RENEWAL FORM PRIOR TO THE SEPTEMBER 1 EXPIRATION DATE. AN ANNUAL $5.00 HANDLING FEE MAY BE DONATED ON AN OPTIONAL BASIS. MEMBERSHIP MAY NOT BE TRANSFERRED OR ASSIGNED DURING THE LIFE OF THE MEMBER. MEMBERSHIP SHALL NOT PASS BY INHERITANCE OR BEQUEST UPON THE DEATH OF THE MEMBER. A SINGLE MEMBERSHIP MAY BE HELD JOINTLY BY SPOUSES, BUT ONLY ONE SHALL BE ENTITLED TO VOTE AT ANY TIME. OTHERWISE, A MEMBERSHIP IS NOT DIVISIBLE INTEREST AND MAY NOT BE HELD BY MORE THAN ONE PERSON. |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMBERS HAVE THE ABILITY TO VOTE IN THE ELECTION OF TRUSTEES. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE BOARD OF DIRECTORS OF THE GOVERNING BOARD HAS DELEGATED OPERATIONAL LEADERSHIP AND OVERSIGHT TO THE EXECUTIVE COUNCIL AND THE MEDICAL EXECUTIVE COMMITTEE OF THE BOARD. THE EXECUTIVE COUNCIL IS COMPRISED OF THE SENIOR LEADERSHIP TEAM INCLUDING THE CEO, CMO, CFO, CNO, CAO|GC AND VP OF PRACTICE ADMINISTRATION. THIS TEAM IS STRATEGIC IN NATURE AND REQUIRES SHORT- AND LONG-TERM DECISION-MAKING THAT ALIGNS WITH THE ORGANIZATION'S VALUES, MISSION, AND VISION. THE MEDICAL EXECUTIVE COMMITTEE IS COMPRISED OF THE CMO, CHIEF OF STAFF AND THE MEDICAL COMMITTEE CHAIRS. THIS TEAM REVIEWS AND APPROVES THE POLICIES AND PROCEDURES AS THEY RELATE TO THE HOSPITAL MEDICAL OPERATIONS OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WENT THROUGH THE FOLLOWING REVIEW PROCESS BEFORE FILING WITH THE IRS: A DETAILED REVIEW WAS CONDUCTED BY THE ORGANIZATION'S CFO AND INTERIM CEO. A COPY OF THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS ELECTRONICALLY PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERSHIP IS CONTINGENT UPON ANNUAL DISCLOSURE OF POTENTIAL AND ACTUAL CONFLICTS OF INTEREST. THE DETERMINATION IS MADE AT THE BOARD LEVEL AND ALL BOARD MEMBERS MUST CERTIFY ANNUALLY. IF A BOARD MEMBER HAS A CONFLICT, THEY REFRAIN FROM VOTING OR PARTICIPATING IN DISCUSSIONS CONCERNING THE TOPIC. |
| FORM 990, PART VI, SECTION B, LINE 15 | CEO - ANNUAL PERFORMANCE AND SALARY REVIEW IS CONDUCTED THROUGH THE COMPENSATION COMMITTEE USING OUTSIDE CONSULTANTS AND VARIOUS COMPENSATION SURVEYS AS DEEMED NECESSARY. REVIEWS ARE TYPICALLY DONE IN JANUARY/FEBRUARY OF EACH CALENDAR YEAR. BASED UPON THE COMPENSATION COMMITTEE'S RECOMMENDATION, IT IS PRESENTED TO THE GOVERNING BOARD FOR FINAL REVIEW AND APPROVAL. OTHER OFFICERS - THE HUMAN RESOURCE DIRECTOR CONDUCTS OUTSIDE RESEARCH USING COMPENSATION SURVEYS AND DATA TO DETERMINE REASONABLE COMPENSATION. THE CEO IN CONJUNCTION WITH THE HUMAN RESOURCE DIRECTOR'S RECOMMENDATION DETERMINES THE COMPENSATION OF THESE EMPLOYEES. REVIEWS ARE TYPICALLY DONE IN NOVEMBER/DECEMBER OF EACH CALENDAR YEAR. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE MEDICAL CENTER'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 9,614,398. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,614,398. INDEPENDENT CONTRACTORS & OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 8,378,875. MANAGEMENT AND GENERAL EXPENSES 1,506,052. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,884,927. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 175,478. MANAGEMENT AND GENERAL EXPENSES 441,174. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 616,652. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 204,622. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 204,622. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| UNITY PHARMACY LLC | |||||||||
| 1504 190TH AVENUE SUITE 100 | BALSAM LAKE | WI | 54810 | 454471131 | PHARMACEUTICALS | WI | $3,026,025 | $397,442 | SCV PHARMACIES |
| FREDERIC PHARMACY LLC | |||||||||
| 201 OAK STREET WEST | FREDERIC | WI | 54837 | 464469897 | PHARMACEUTICALS | WI | $5,149,139 | $1,090,242 | SCV PHARMACIES |
| ST CROIX VALLEY PHARMACY LLC | |||||||||
| 235 STATE STEET | ST CROIX FALLS | WI | 54024 | 464463191 | PHARMACEUTICALS | WI | $0 | $5,511 | ST CROIX REGIONAL MEDICAL CENTER |
| ST CROIX FALLS PHARMACY LLC | |||||||||
| 216 SOUTH ADAMS STREET | ST CROIX FALLS | WI | 54024 | 464487348 | PHARMACEUTICALS | WI | $4,942,536 | $818,732 | SCV PHARMACIES |
| WEBSTER DENTAL CLINIC LLC | |||||||||
| 26425 LAKELAND AVENUE S | WEBSTER | WI | 54893 | 371911164 | DENTAL SERVICES | WI | $710,166 | $220,255 | ST CROIX DENTAL HEALTH LLC |
| ST CROIX DENTAL HEALTH LLC | |||||||||
| 26425 LAKELAND AVENUE S | WEBSTER | WI | 54893 | 831635026 | DENTAL SERVICES | WI | $0 | $0 | ST CROIX REGIONAL MEDICAL CENTER |
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 | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ST CROIX VALLEY EMERGENCY MEDICAL SERVICES INC | |||||||||||
| 235 EAST STATE STREET | ST CROIX FALLS | WI | 54024 | 452872803 | TO LEASE, MAINTAIN, AND OPERATE AN EMERGENCY AMBULANCE SERVICE | WI | 501(C)(3) | LINE 10 | ST CROIX REGIONAL MEDICAL CENTER | Yes (1) | |
| CANCER CENTER OF WESTERN WISCONSIN | |||||||||||
| 501 HOSIPTAL ROAD | NEW RICHMOND | WI | 54017 | 273238660 | TO PROVIDE CARE TO CANCER PATIENTS | WI | 501(C)(3) | LINE 12A, I | 0 | N/A | |
| 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 | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |