LADD MEMORIAL HOSPITAL: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- LADD MEMORIAL HOSPITAL (EIN 39-0773970)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-11-15
- IRS object ID
- 202323199349319447
- Schema version
- 2022v5.0
- 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 K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-11-15T15:02:09-06:00 | ReturnTs |
| Tax Period End | 2022-12-31 | 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 | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390773970 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LADD MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LADD | BusinessNameControlTxt |
| Phone | 7152942111 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2600 65TH AVENUE PO BOX 218 | AddressLine1Txt |
| City | OSCEOLA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54020 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KELLY MACKEN-MARBLE | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7152942111 | PhoneNum |
| Signature | 2023-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | KELLY | PersonFirstNm |
| Person Last | MACKEN-MARBLE | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2023-11-10 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSCEOLA MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KELLY MACKEN-MARBLE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2600 65TH AVENUE PO BOX 218 | AddressLine1Txt |
| City | OSCEOLA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54020 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $53,425,365 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MYOMC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1947 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | ASPIRE TO DELIVER THE BEST COMPREHENSIVE AND RELIABLE COMMUNITY HEALTHCARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 318 | TotalEmployeeCnt |
| Total Volunteers | 17 | TotalVolunteersCnt |
| Total Gross UBI | $2,648,741 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $7,679,002 | PYContributionsGrantsAmt |
| CY Contributions Grants | $653,161 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $49,003,877 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $52,475,633 | CYProgramServiceRevenueAmt |
| PY Investment Income | $100,410 | PYInvestmentIncomeAmt |
| CY Investment Income | $163,385 | CYInvestmentIncomeAmt |
| PY Other Revenue | $480,321 | PYOtherRevenueAmt |
| CY Other Revenue | $128,586 | CYOtherRevenueAmt |
| PY Total Revenue | $57,263,610 | PYTotalRevenueAmt |
| CY Total Revenue | $53,420,765 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $17,154,016 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $18,609,025 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $127,135 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $26,776,287 | PYOtherExpensesAmt |
| CY Other Expenses | $28,974,225 | CYOtherExpensesAmt |
| PY Total Expenses | $43,930,303 | PYTotalExpensesAmt |
| CY Total Expenses | $47,583,250 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $13,333,307 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,837,515 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $50,238,162 | TotalAssetsBOYAmt |
| Total Assets EOY | $55,634,810 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $15,647,079 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $15,948,495 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $34,591,083 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $39,686,315 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO INSPIRE AND IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY THROUGH HOME-TOWN CUSTOMER SERVICE, QUALITY HEALTHCARE AND STRATEGIC PARTNERSHIPS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $39,155,268 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $49,826,892 | RevenueAmt |
| Desc | DURING 2022, LADD MEMORIAL HOSPITAL PROVIDED INPATIENT, OUTPATIENT, AND CLINICAL CARE SERVICES TO THE RESIDENTS OF THE GREATER OSCEOLA AREA, REGARDLESS OF ABILITY TO PAY.INPATIENT SERVICES WERE PROVIDED TO 394 PATIENTS AND TOTALED 1,686 DAYS OF SERVICE. INPATIENT SERVICES INCLUDED GENERAL MEDICINE, SURGERY, PEDIATRIC, AND OBSTETRIC.OUTPATIENT SERVICES INCLUDED 3,993 EMERGENCY ROOM VISITS, AND 1,687 OP SURGERIES. CLINICAL CARE SERVICES INCLUDED 25,070 CLINIC VISITS, 8,877 WALK IN VISITS, TOTALING 33,947. | Desc |
| Total Program Service Expenses | $39,155,268 | 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 | 0 | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | 0 | 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 | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 31 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 318 | 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 | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | 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 | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 | 0 | 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 |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TAMMY WALSH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7152942111 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2600 65TH AVENUE PO BOX 218 | AddressLine1Txt |
| City | OSCEOLA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54020 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| KIMBERLY ERICSON | ||||||||
| CFO | 40.00 | 1.00 | Yes (X) | $209,077 | $0 | $17,329 | ||
| MISTY CHARLIER | ||||||||
| CAO | 40.00 | 1.00 | Yes (X) | $172,850 | $0 | $40,080 | ||
| JEANETTE BOISSY | ||||||||
| REGISTERED NURSE | 36.00 | $163,976 | $0 | $27,179 | Yes (X) | |||
| MATT FORGE | ||||||||
| CEO (THRU JULY 2022) | 40.00 | 1.00 | Yes (X) | $162,303 | $0 | $10,719 | ||
| WILLIAM RYAN | ||||||||
| PHYSICIAN ASSISTANT | 36.00 | $149,415 | $0 | $20,888 | Yes (X) | |||
| NATALIA CROPPER | ||||||||
| NURSE PRACTITONER | 36.00 | $124,447 | $0 | $37,275 | Yes (X) | |||
| MEGAN SANDREN | ||||||||
| CRO | 40.00 | Yes (X) | $139,465 | $0 | $4,533 | |||
| ERYCCA OSTERBAUER | ||||||||
| REGISTERED NURSE | 36.00 | $138,266 | $0 | $5,228 | Yes (X) | |||
| KIMBERLY WELLUMSON | ||||||||
| SURGICAL NURSE NAVIGATOR | 36.00 | $129,254 | $0 | $4,001 | Yes (X) | |||
| KELSEY DERRICK | ||||||||
| COO | 40.00 | Yes (X) | $117,472 | $0 | $4,416 | |||
| KELLY MACKEN-MARBLE | ||||||||
| CEO (FROM SEP 2022) | 40.00 | 1.00 | Yes (X) | $73,963 | $0 | $2,822 | ||
| ANNE MARIE PUESHNER | ||||||||
| CHAIRPERSON | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| PETER MANSHIP | ||||||||
| VICE-CHAIRPERSON (THRU DEC 2022) | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| DEBORAH PETERS | ||||||||
| VICE-CHAIRPERSON | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| BECKY STYLES | ||||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| PENNY AUSTAD | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| FELIX BLANCO MD | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| JOHN CLARK | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| MARK ERICKSON | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| JOHN GEARIN | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| KIERSTEN JUSTINGER | ||||||||
| BOARD MEMBER | 1.00 | 0.50 | $0 | $0 | $0 | Yes (X) | ||
| GREG KUMLIEN DC | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| TYLER SCHMIDTZ | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| ERIK SEVERSON MD | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| AMIN UDDEN DDS | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,580,488 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $174,470 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 23 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | 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 |
|---|---|---|---|---|---|
| HEALTHPARTNERS | |||||
| MAIL STOP 21109A | ST PAUL | MN | 55164 | PHYSICIANS | $5,919,637 |
| TWIN CITIES ORTHOPEDICS | |||||
| 4200 DAHLBERG DR | GOLDEN VALLEY | MN | 55422 | ORTHOPEDIC SERVICES | $1,332,618 |
| RIVER VALLEY ANESTHESIA | |||||
| PO BOX 118 | NEW RICHMOND | WI | 54017 | CRNA SERVICES | $1,017,510 |
| CMDI | |||||
| PO BOX 64756 | ST PAUL | MN | 55164 | DIAGNOSTIC IMAGING | $908,202 |
| MARSHFIELD LABS | |||||
| 1000 NORTH OAK AVE | MARSHFIELD | WI | 54449 | LABORATORY SERVICES | $789,354 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 15 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $133,137 | RelatedOrganizationsAmt |
| Government Grants | $258,199 | GovernmentGrantsAmt |
| All Other Contributions | $261,825 | AllOtherContributionsAmt |
| Total Contributions | $653,161 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT SERVICE REV | 621990 | $52,221,927 | $49,573,186 | $2,648,741 |
| FITNESS CENTER | 713940 | $253,706 | $253,706 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $52,475,633 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $167,985 | TotalRevenueColumnAmt |
| Exclusion | $167,985 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $4,076 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $4,076 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,076 | TotalRevenueColumnAmt |
| Exclusion | $4,076 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $4,600 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$4,600 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$4,600 | TotalRevenueColumnAmt |
| Exclusion | -$4,600 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | GIFT SHOP | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $33,300 | TotalRevenueColumnAmt |
| Exclusion | $33,300 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $91,210 | TotalRevenueColumnAmt |
| Exclusion | $91,210 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $124,510 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $53,420,765 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $49,826,892 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,648,741 | UnrelatedBusinessRevenueAmt |
| Exclusion | $291,971 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $955,029 | TotalAmt |
| Management And General | $955,029 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,006,828 | TotalAmt |
| Program Services | $10,619,149 | ProgramServicesAmt |
| Management And General | $3,297,362 | ManagementAndGeneralAmt |
| Fundraising | $90,317 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $345,135 | TotalAmt |
| Program Services | $264,683 | ProgramServicesAmt |
| Management And General | $78,201 | ManagementAndGeneralAmt |
| Fundraising | $2,251 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,284,638 | TotalAmt |
| Program Services | $1,668,827 | ProgramServicesAmt |
| Management And General | $601,618 | ManagementAndGeneralAmt |
| Fundraising | $14,193 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,017,395 | TotalAmt |
| Program Services | $725,971 | ProgramServicesAmt |
| Management And General | $285,250 | ManagementAndGeneralAmt |
| Fundraising | $6,174 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,608 | TotalAmt |
| Management And General | $19,608 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,453,382 | TotalAmt |
| Program Services | $12,159,894 | ProgramServicesAmt |
| Management And General | $293,488 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $128,017 | TotalAmt |
| Program Services | $123,337 | ProgramServicesAmt |
| Management And General | $4,680 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $427,708 | TotalAmt |
| Program Services | $312,378 | ProgramServicesAmt |
| Management And General | $114,779 | ManagementAndGeneralAmt |
| Fundraising | $551 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,637,790 | TotalAmt |
| Program Services | $74,633 | ProgramServicesAmt |
| Management And General | $1,563,157 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $648,486 | TotalAmt |
| Program Services | $459,447 | ProgramServicesAmt |
| Management And General | $189,039 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,171 | TotalAmt |
| Program Services | $21,574 | ProgramServicesAmt |
| Management And General | $2,597 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $276,079 | TotalAmt |
| Program Services | $220,823 | ProgramServicesAmt |
| Management And General | $53,088 | ManagementAndGeneralAmt |
| Fundraising | $2,168 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,462,320 | TotalAmt |
| Program Services | $1,169,645 | ProgramServicesAmt |
| Management And General | $281,194 | ManagementAndGeneralAmt |
| Fundraising | $11,481 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,981 | TotalAmt |
| Management And General | $76,981 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DRUGS | $4,468,693 | $4,468,137 | $556 |
| MEDICAL SUPPLIES | $4,093,656 | $4,091,216 | $2,440 |
| BAD DEBT EXPENSE | $1,808,156 | $1,808,156 | |
| EQUIPMENT RENTAL AND MA | $438,443 | $419,043 | $19,400 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,010,735 | TotalAmt |
| Program Services | $548,355 | ProgramServicesAmt |
| Management And General | $462,380 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,583,250 | TotalAmt |
| Program Services | $39,155,268 | ProgramServicesAmt |
| Management And General | $8,300,847 | ManagementAndGeneralAmt |
| Fundraising | $127,135 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,375,832 | BOYAmt |
| EOY | $17,772,368 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,696,213 | BOYAmt |
| EOY | $9,226,035 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,308,693 | BOYAmt |
| EOY | $5,892,598 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $942,205 | BOYAmt |
| EOY | $1,094,594 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $408,366 | BOYAmt |
| EOY | $520,801 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $37,752,007 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $21,204,813 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,064,933 | BOYAmt |
| EOY | $16,547,194 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,780 | BOYAmt |
| EOY | $44,765 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $901,224 | BOYAmt |
| EOY | $915,670 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $490,916 | BOYAmt |
| EOY | $420,785 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $3,200,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,238,162 | BOYAmt |
| EOY | $55,634,810 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,794,211 | BOYAmt |
| EOY | $5,076,098 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,192 | BOYAmt |
| EOY | $325,810 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,843,996 | BOYAmt |
| EOY | $9,752,619 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $910,691 | BOYAmt |
| EOY | $793,968 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $95,989 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,647,079 | BOYAmt |
| EOY | $15,948,495 | 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 | $34,591,083 | BOYAmt |
| EOY | $39,686,315 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,591,083 | BOYAmt |
| EOY | $39,686,315 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,238,162 | BOYAmt |
| EOY | $55,634,810 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $5,837,515 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$742,283 | NetUnrlzdGainsLossesInvstAmt |
| 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 | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
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 | $1,141 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,141 | 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 | LADD MEMORIAL HOSPITAL 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. THE WHA HAS NOTIFIED LADD MEMORIAL HOSPITAL THAT $1,141 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,545,900 | OtherCostOrOtherBasisAmt |
| Book Value | $1,545,900 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $27,156,643 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,103,116 | DepreciationAmt |
| Book Value | $13,053,527 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,049,464 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,101,697 | DepreciationAmt |
| Book Value | $1,947,767 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $16,547,194 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | AMOUNTS RECEIVABLE FROM 3RD PARTY REIMBURSEMENT PROGRAMS | Desc |
| Book Value | $3,200,000 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,200,000 | TotalBookValueOtherAssetsAmt |
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 |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $244,654 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $244,654 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00510 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,943,882 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,925,045 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,018,837 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02140 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,188,536 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,925,045 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,263,491 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02650 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,158,535 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,725,587 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,432,948 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,158,535 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,725,587 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,432,948 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03010 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,347,071 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,650,632 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,696,439 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05660 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $774,323 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $387,162 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,953,709 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,850,661 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $103,048 | 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 | LADD MEMORIAL HOSPITAL INC DBA OSCEOLA MED | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2600 65TH AVENUE | AddressLine1Txt |
| City | OSCEOLA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54020 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MYOMC.ORG | WebsiteAddressTxt |
| State License | 1021 | 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 | OSCEOLA 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 | 22 | 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 | HTTPS://MYOMC.ORG/IMAGES/PDF/CHA%20FINAL.PDF | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | HTTP://WWW.POLKCOUNTYHEALTHDEPT.ORG/REPORTS/COMMUNITY-HEALTH-ASSESSMENT/ | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://WWW.POLKCOUNTYHEALTHDEPT.ORG/REPORTS/COMMUNITY-HEALTH-ASSESSMENT/ | 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 | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| 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 |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.MYOMC.ORG/FINANCIAL-POLICIES | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.MYOMC.ORG/FINANCIAL-POLICIES | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.MYOMC.ORG/FINANCIAL-POLICIES | 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 |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| 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 (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| OSCEOLA MEDICAL CENTER | PART V, SECTION B, LINE 5: THE 2022 COMMUNITY HEALTH NEEDS ASSESSEMENT PROCESS ENGAGED BROAD COMMUNITY OF INTERESTS AND A COUNTY WIDE SURVEY OF POLK COUNTY RESIDENTS WITH MORE THAN 600 RESPONDENTS.COMMUNITY FOCUS AREAS INCLUDED:1. MENTAL HEALTH 2. ADDICTION AND SUBSTANCE ABUSE3. ACCESS TO CARETHE ORGANIZATION PARTNERED WITH AMERY AND ST CROIX FALLS TO COMPLETE THE ASSESSMENT. |
| OSCEOLA MEDICAL CENTER | PART V, SECTION B, LINE 6A: A COMMUNITY HEALTH IMPROVEMENT PROCESS WAS INITIATED IN PARTNERSHIP WITH AMERY REGIONAL MEDICAL CENTER AND ST CROIX REGIONAL MEDICAL CENTER. |
| OSCEOLA MEDICAL CENTER | PART V, SECTION B, LINE 6B: POLK COUNTY HEALTH DEPARTMENT |
| OSCEOLA MEDICAL CENTER | PART V, SECTION B, LINE 7D: POLK COUNTY HEALTH DEPARTMENT |
| OSCEOLA MEDICAL CENTER | PART V, SECTION B, LINE 11: AS PART OF OUR CHNA ACTION PLAN, OMC PRIORITIZED INITIATIVES TO SUPPORT THE MOST IMPORTANT NEEDS OF THE COMMUNITY. INTEGRATED BEHAVIORAL HEALTH PROGRAM:1. PROGRAM DEVELOPMENT OF AN IBH PROGRAM WITH A 2023 GO LIVE DATE.2. INTERNAL MENTAL HEALTH RESOURCES TO SUPPORT PHYSICIANS IN SUPPORTING PATIENTS AND FAMILY MEMBERS IN NEED OF INTERVENTION, ONGOING SUPPORT OR OTHER NEEDS. 3. FUNDRAISING TO SUPPORT EXPANSION INTO THE INPATIENT AND ED SETTINGS. ACCESS TO CARE:1. EXPANSION OF PRIMARY CARE SERVICES TO BETTER MEET DEMAND. SIX ADDITIONAL CLINICIANS HIRED TO SUPPORT EXPANSION. 2. LAUNCH OF LOW COST VIRTUAL CARE PROGRAM CALLED CLICKCLINIC AT $45.00 PER VISIT. LIFESTYLE MEDICINE PROGRAM:1. PROVIDES INFRASTRUCTURE AND SUPPORT TO ADDRESS OBESITY AND WEIGHT MANAGEMENT SERVICES. ADDRESSING DAY CARE NEEDS IS A SIGNIFICANT FOCUS FOR OMC IN 2023 AND 2024. |
| OSCEOLA MEDICAL CENTER | PART V, SECTION B, LINE 13B: IN A CASE BY CASE REVIEW, OSCEOLA MEDICAL CENTER HOLDS THE RIGHT TO MAKE EXCEPTIONS TO THE GUIDELINES LISTED IN THE COMMUNITY CARE POLICY (SUCH AS BUT NOT LIMITED TO PRESUMPTIVE GRANTING) WHEN IT IS FOUND TO BE IN THE BEST INTEREST OF THE PATIENT. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - CLINIC PHARMACY | ||||
| 2600 65TH AVENUE | OSCEOLA | WI | 54020 | RETAIL PHARMACY |
| 2 - OSCEOLA CLINIC | ||||
| 2600 65TH AVENUE | OSCEOLA | WI | 54020 | PROVIDER BASED CLINIC |
| 3 - WILD RIVER FITNESS CENTER | ||||
| 2630 65TH AVENUE | OSCEOLA | WI | 54020 | FITNESS CENTER |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6A: | THE COMMUNITY BENEFIT REPORT IS AVAILABLE UPON REQUEST. |
| PART I, LINE 7: | THE COSTING METHOD USED ON FORM 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 DEBTS 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 COSTING METHODS FOR THE FORM 990. THE COST OF COMMUNITY HEALTH IMPROVEMENT, HEALTH PROFESSIONALS EDUCATION, AND IN-KIND CONTRIBUTIONS REFLECTS THE DIRECT AND INDIRECT COSTS AS DETERMINED BY THE HOSPITAL. |
| PART I, LINE 7G: | THE COST OF SUBSIDIZED HEALTH SERVICES IS BASED ON COST ALLOCATIONS FROM THE MEDICARE COST REPORT. SERVICES INCLUDE NURSERY, OCCUPATIONAL HEALTH, CLINIC SERVICES, EMERGENCY ROOM, AND PHYSICIAN SERVICES. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | OUR HOSPITAL PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY THAT WITHOUT OUR HOSPITAL, WOULD NOT BE AVAILABLE TODAY.BEYOND INPATIENT HOSPITALIZATIONS, WE PROVIDE LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES, WALK-IN CLINIC, INFUSION SERVICES, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH AND SURGICAL SERVICES. |
| 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: | ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, OSCEOLA MEDICAL CENTER ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, OSCEOLA MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), OSCEOLA MEDICAL CENTER RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF THEIR PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE TO OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. |
| PART III, LINE 8: | OSCEOLA MEDICAL CENTER HAS BEEN DESIGNATED AS A CRITICAL ACCESS HOSPITAL.THE COST-TO-CHARGE RATIOS USED TO CALCULATE THE COST OF MEDICARE SERVICES WERE TAKEN FROM THE MEDICARE COST REPORT.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 HEALTHCARE 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: | ONCE APPROVED FOR FINANCIAL ASSISTANCE, THAT FINANCIAL ASSISTANCE IS VALID FOR ONE YEAR FROM THE APPROVAL DATE WITH FOLLOW UP VERIFICATION COMPLETED AFTER 6 MONTHS. IT IS THE PATIENT'S RESPONSIBILITY TO NOTIFY OMC IMMEDIATELY SHOULD THERE BE ANY CHANGE IN THE DETERMINING FACTORS WITHIN THE APPROVED YEAR PERIOD. |
| PART VI, LINE 2: | OSCEOLA MEDICAL CENTER IS ACTIVE IN SUPPORTING OUR COMMUNITY THROUGH PARTICIPATION IN LOCAL AND REGIONAL BOARDS, COMMUNITY ORGANIZATIONS, THE AREA SCHOOL DISTRICT AND AREA BUSINESSES. THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), ALSO PROVIDES GUIDANCE AS TO THE ISSUES MOST IMPACTING OUR COMMUNITY AND HOW WE CAN BEST PROVIDE SERVICES AND SUPPORT AND IMPROVE HEALTH AND WELLNESS. |
| PART VI, LINE 3: | OSCEOLA MEDICAL CENTER PROVIDES RESOURCES TO ENSURE PATIENTS ARE AWARE OF RESOURCES THEY MAY BE ELIGIBLE FOR, INCLUDING THE FOLLOWING:1. CHARITY CARE POLICY THAT OUTLINES SUPPORT AVAILABLE FOR THOSE THAT ARE UNDER OR UNINSURED. 2. ELIBIGILITY AND INSURANCE VERIFICATION PRIOR OR AT THE TIME OF SERVICE TO ENSURE UNDERSTANDING OF WHAT IS BEING BILLED AND WHAT REFERRAL FOR RESOURCES AVAILBLE TO THEM EITHER INTERNALLY OR EXTERNALLY.3. FINANCIAL ASSISTANCE POLICY IS PUBLICLY AVAILABLE AT THE TIME OF REGISTRATION AND IN THE COMMUNITY. 4. OMC WEBSITE ALSO PROVIDES GUIDANCE AND RESOURCES TO PATIENTS AND FAMILIES. |
| PART VI, LINE 4: | OSCEOLA MEDICAL CENTER SERVICES A WIDE GEOGRAPHIC AREA THAT CONSTITUTES OUR PRIMARY SERVICE AREA IN NORTHWEST WISCONSIN AND INTO EASTERN MINNESOTA, WHICH INCLUDES A POPULATION OF OVER 200,000 PEOPLE. THE AVERAGE AGE OF RESIDENTS IS 45.9 YEARS. MEDIAN HOUSEHOLD INCOME IS $67,878.00. THOSE MEETING POVERTY GUIDELINES ARE AT 8.5% AND INCREASING. HOUSING, TRANSPORTATION, ACCESS TO MENTAL HEALTH SERVICES AND DAY CARE SUPPORT CONTINUE TO BE SIGNIFICANT NEEDS IN THE COMMUNITY. |
| PART VI, LINE 5: | OSCEOLA MEDICAL CENTER IS A NON PROFIT ORGANIZATION IN NORTHWEST WISCONSIN. ANY REVENUES IN EXCESS OF EXPENSES ARE REINVESTED IN THE FACILITIES, MEDICAL EQUIPMENT TO EXPAND SERVICES PROVIDED TO PATIENTS, SERVICE EXPANSION AND RECRUITMENT TO EXPAND ACCESS TO CARE. IN THE PRIOR FISCAL YEAR WE PROVIDED IN EXCESS OF $600,000 IN CHARTIY CARE TO THOSE IN NEED. THE OSCEOLA COMMUNTIY HEALTH FOUNDATION, FOUNDATION THAT IS A PART OF OSCEOLA MEDICAL CENTER, PROVIDES COMMUNTIY GRANTS TO LOCAL ORGANIZATIONS AS WELL AS RAISES FUNDS TO SUPPORT PURCHASE OF NEEDED SURIGICAL EQUIPMENT AND THIS YEAR-FUNDS TO START A COMMUNITY WORKFORCE DEVELOPMENT AND CLINICAL EDUCATION PROGRAM. OSCEOLA MEDICAL CENTER HAS A BOARD MADE UP OF A MAJORITY OF COMMUNITY DIRECTORS ENSURNG THE VOICE THE COMMUNITY IS A PART OF THE GOVERNANCE STRUCTURE. OUR CAMPUS INCLUDES THE WILD RIVER FITNESS CENTER AND EMERGENCY SERVICES 24/7. WE ALSO PROVIDE MANY COMMUNITY BASED SERVICES LIKE FLU SHOT CLINIC AND SPORTS PHYSICALS. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | 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 (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KIMBERLY ERICSON | ||||||||||||||
| CFO | $208,377 | $0 | $700 | $0 | $0 | $0 | $6,494 | $0 | $10,835 | $0 | $226,406 | $0 | $0 | $0 |
| MISTY CHARLIER | ||||||||||||||
| CAO | $172,150 | $0 | $700 | $0 | $0 | $0 | $5,436 | $0 | $34,644 | $0 | $212,930 | $0 | $0 | $0 |
| JEANETTE BOISSY | ||||||||||||||
| REGISTERED NURSE | $163,976 | $0 | $0 | $0 | $0 | $0 | $4,615 | $0 | $22,564 | $0 | $191,155 | $0 | $0 | $0 |
| MATT FORGE | ||||||||||||||
| CEO (THRU JULY 2022) | $162,303 | $0 | $0 | $0 | $0 | $0 | $4,673 | $0 | $6,046 | $0 | $173,022 | $0 | $0 | $0 |
| WILLIAM RYAN | ||||||||||||||
| PHYSICIAN ASSISTANT | $120,283 | $0 | $29,132 | $0 | $0 | $0 | $4,167 | $0 | $16,721 | $0 | $170,303 | $0 | $0 | $0 |
| NATALIA CROPPER | ||||||||||||||
| NURSE PRACTITONER | $123,745 | $0 | $702 | $0 | $0 | $0 | $3,969 | $0 | $33,306 | $0 | $161,722 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| VILLAGE OF OSCEOLA HOSPITAL FACILITIES REVENUE BOND | |||||||
| A | 396006338 | 2007-06-13 | $8,000,000 | REFINANCE EXISTING BONDS & CONSTRUCT NEW HOSPITAL BUILDING | 0 | 0 | 0 |
| TOWN OF OSCEOLA HOSPITAL FACILITIES REVENUE BOND | |||||||
| B | 396006044 | 2007-06-28 | $7,040,000 | CONSTRUCT NEW HOSPITAL BUILDING | 0 | 0 | 0 |
| TOWN OF FARMINGTON HOSPITAL FACILITIES REVENUE BOND | |||||||
| C | 390990620 | 2007-07-13 | $6,040,000 | CONSTRUCT NEW HOSPITAL BUILDING | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $423,979 | $8,000,000 | $138,545 | $4,581,314 | $3,280,141 | 2008 | Yes (1) | 0 | Yes (1) | Yes (1) |
| B | $380,679 | $7,040,000 | $80,850 | $6,959,150 | 2008 | 0 | 0 | Yes (1) | Yes (1) | |
| C | $302,564 | $6,040,000 | $65,800 | $5,974,200 | 2008 | 0 | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.01270 | 0.01270 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0.01270 | 0.01270 | 0 | 0 | 0 |
| C | 0 | 0 | 0 | 0 | 0.01270 | 0.01270 | 0 | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 |
| C | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
| C | 0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE K, PART II, LINE 11, COLUMN A: | THE AMOUNT LISTED WAS USED TO REFINANCE EXISTING DEBT. |
| SCHEDULE K, PART IV, LINE 2: | THERE IS NO REBATE BECAUSE THERE ARE NO PROCEEDS AVAILABLE FOR INVESTMENT. ALL PROCEEDS HAVE BEEN USED FOR CAPITAL EXPENDITURES. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE COMPLETED FORM WAS REVIEWED AND APPROVED BY THE ADMINISTRATOR AND CHIEF FINANCIAL OFFICER BEFORE THE FORM WAS FILED. THE BOARD OF DIRECTORS FINANCE COMMITTEE MEETING AND THE FULL BOARD OF DIRECTORS RECEIVED A COPY AFTER THE RETURN WAS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY THAT IS MONITORED THROUGHOUT THE YEAR. ANNUALLY THE BOARD OF DIRECTORS MUST ATTEST TO ANY KNOWN CONFLICTS AS DEFINED BY THE POLICY. IF AT THAT TIME, OR DURING THE YEAR, A MEMBER BELIEVES THERE TO BE A CONFLICT THEY MUST DISCLOSE SUCH EXISTENCE TO THE BOARD OR COMMITTEE THAT THE OPPORTUNITY PERTAINS TO. THE REMAINING BOARD OR COMMITTEE THEN MUST DETERMINE IF A CONFLICT ACTUALLY EXISTS. IF SO, THE CONFLICTED BOARD MEMBER HAS THE ABILITY TO PRESENT TO THE BOARD ON THE MATTER BUT THEN MUST ABSTAIN FROM FURTHER DISCUSSION OR VOTING ON THE MATTER. |
| FORM 990, PART VI, SECTION B, LINE 15 | IN SETTING THE COMPENSATION OF THE CEO AND CFO, THE EXECUTIVE COMMITTEE SHALL COMPLY WITH LADD MEMORIAL HOSPITAL, INC.'S CONFLICT OF INTEREST POLICY AND, WITHOUT LIMITING THAT COMPLIANCE, WILL: (A) ACT ONLY WITH THE PARTICIPATION OF EXECUTIVE COMMITTEE MEMBERS WHO DO NOT HAVE A CONFLICT OF INTEREST CONCERNING THE MATTER, (B) WILL OBTAIN AND RELY UPON APPROPRIATE DATA AS TO COMPARABILITY, AND (C) WILL ADEQUATELY AND TIMELY DOCUMENT THE BASIS FOR ITS DETERMINATION, CONCURRENTLY WITH MAKING THAT DETERMINATION. APPROPRIATE DATA AS TO COMPARABILITY CAN INCLUDE, BUT IS NOT NECESSARILY LIMITED TO: COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR FUNCTIONALLY COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA OF THE CORPORATION; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; OR ACTUAL WRITTEN OFFERS FROM SIMILAR INSTITUTIONS COMPETING FOR THE SERVICES OF THE SAME INDIVIDUAL. ADEQUATE AND TIMELY DOCUMENTATION WILL GENERALLY BE MINUTES OR OTHER RECORDS OF THE EXECUTIVE COMMITTEE MEETING THAT STATE: THE COMPENSATION AND WHEN IT WAS APPROVED; THE EXECUTIVE COMMITTEE MEMBERS WHO WERE PRESENT AND HOW EACH VOTED; THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE EXECUTIVE COMMITTEE AND A SUMMARY OF HOW THE DATA WAS OBTAINED, AND ANY ACTION TAKEN IN SPECIFIC COMPLIANCE WITH THE MEDICAL CENTER'S CONFLICT OF INTEREST POLICY. IF THE EXECUTIVE COMMITTEE APPROVES A COMPENSATION PACKAGE FOR THE CEO OR CFO THAT IS HIGHER OR LOWER THAN THE RANGE OF COMPARABILITY DATA OBTAINED, THE BASIS FOR THE DETERMINATION OUTSIDE THE RANGE MUST BE RECORDED. MINUTES OR OTHER RECORDS OF THE EXECUTIVE COMMITTEE THAT DOCUMENT A DECISION ON CEO OR CFO COMPENSATION MUST BE PREPARED BEFORE THE LATER OF THE NEXT MEETING OF THE EXECUTIVE COMMITTEE OR 60 DAYS AFTER THE DECISION, AND MUST BE REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE WITHIN A REASONABLE PERIOD THEREAFTER. |
| FORM 990, PART VI, SECTION C, LINE 19 | LADD MEMORIAL HOSPITAL, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 8,663,575. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,663,575. ANESTHESIA SERVICES: PROGRAM SERVICE EXPENSES 1,017,510. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,017,510. LAB SERVICES: PROGRAM SERVICE EXPENSES 900,333. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 900,333. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 1,240,483. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,240,483. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 337,993. MANAGEMENT AND GENERAL EXPENSES 293,488. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 631,481. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSCEOLA COMMUNITY HEALTH FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2600 65TH AVENUE | AddressLine1Txt |
| City | OSCEOLA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54020 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 392029106 | EIN |
| Primary Activities | FOUNDATION | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12B, II | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| 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 | Yes (1) | 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 | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | 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 |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSCEOLA COMMUNITY HEALTH FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $133,137 | InvolvedAmt |
| Method Of Amount Determination | ACTUAL | MethodOfAmountDeterminationTxt |