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SPOONER HEALTH SYSTEM INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
SPOONER HEALTH SYSTEM INC (EIN 39-0892183)
Tax period
2020-04-01 to 2021-03-31
Filed
2022-02-11
IRS object ID
202220429349300307
Schema version
2020v4.2
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 ReturnHeader

FieldValueIRS element (for citing)
Return2022-02-11T07:21:07-06:00ReturnTs
Tax Period End2021-03-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1220 S 6TH STREET SUITE 300AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55402ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-04-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN390892183EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SPOONER HEALTH SYSTEM INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlSPOOBusinessNameControlTxt
Phone7156352111PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11280 CHANDLER DRIVEAddressLine1Txt
CitySPOONERCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54801ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMICHAEL D SCHAFERPersonNm
Person TitleCHIEF EXECUTIVE OFFICERPersonTitleTxt
Phone7156352111PhoneNum
Signature2022-02-10SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstMICHAELPersonFirstNm
Person LastSCHAFERPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonRYAN STRUSZPreparerPersonNm
PTINP01604381PTIN
Phone6123764500PhoneNum
Preparation2022-02-09PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerMICHAEL D SCHAFERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11280 CHANDLER DRIVEAddressLine1Txt
CitySPOONERCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54801ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$30,564,168GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.SPOONERHEALTH.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1955FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionTO PROVIDE HIGH QUALITY HEALTHCARE.ActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee176TotalEmployeeCnt
Total Volunteers40TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,144,364PYContributionsGrantsAmt
CY Contributions Grants$5,972,634CYContributionsGrantsAmt
PY Program Service Revenue$25,327,558PYProgramServiceRevenueAmt
CY Program Service Revenue$23,584,083CYProgramServiceRevenueAmt
PY Investment Income$580,389PYInvestmentIncomeAmt
CY Investment Income$817,608CYInvestmentIncomeAmt
PY Other Revenue$123,187PYOtherRevenueAmt
CY Other Revenue$183,335CYOtherRevenueAmt
PY Total Revenue$27,175,498PYTotalRevenueAmt
CY Total Revenue$30,557,660CYTotalRevenueAmt
PY Grants And Similar Paid$7,000PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$10,000CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$10,936,739PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$11,387,602CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$14,181,384PYOtherExpensesAmt
CY Other Expenses$13,170,786CYOtherExpensesAmt
PY Total Expenses$25,125,123PYTotalExpensesAmt
CY Total Expenses$24,568,388CYTotalExpensesAmt
PY Revenues Less Expenses$2,050,375PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$5,989,272CYRevenuesLessExpensesAmt
Total Assets BOY$55,814,008TotalAssetsBOYAmt
Total Assets EOY$69,652,889TotalAssetsEOYAmt
Total Liabilities BOY$22,430,466TotalLiabilitiesBOYAmt
Total Liabilities EOY$27,186,563TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$33,383,542NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$42,466,326NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO PROVIDE HIGH QUALITY HEALTHCARE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant ChangeYes (1)SignificantChangeInd
Expense$20,011,962ExpenseAmt
Grant$10,000GrantAmt
Revenue$23,272,771RevenueAmt
DescSPOONER HEALTH SYSTEM IS A 25 BED CRITICAL ACCESS HOSPITAL THAT PLAYS A VITAL ROLE IN THE HEALTH AND WELL-BEING OF THE COMMUNITY BY OFFERING SERVICES TO PATIENTS SUCH AS 24-HOUR EMERGENCY CARE, ACUTE CARE, SURGICAL, REHABILITATION, DIAGNOSTIC, HOSPICE AND WOUND CARE. FOR THE FISCAL YEAR ENDING 3/31/2021, THERE WERE 1,520 INPATIENT DAYS, 330 INPATIENT DISCHARGES, 19,867 OUTPATIENT VISITS, 5,930 EMERGENCY ROOM VISITS, AND 296 SURGERIES ALONG WITH 337 SCOPE PROCEDURES. SPOONER HEALTH SYSTEM PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS SUCH AS MEDICARE AND MEDICAID AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. A FINANCIAL ASSISTANCE PROGRAM, WHICH INCLUDES FEE DISCOUNTS AS WELL AS 100% FREE CARE, IS ALSO AVAILABLE FOR PATIENTS FINANCIALLY UNABLE TO PAY FOR SERVICES.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$720,072ExpenseAmt
Grant$0GrantAmt
Revenue$311,312RevenueAmt
DescTHE HOME HEALTH AGENCY PROVIDES ESSENTIAL NURSING AND REHABILITATION SERVICES TO PATIENTS IN THEIR HOME. FOR THE FISCAL YEAR ENDING 3/31/2021, THERE WERE 2,152 HOME HEALTH VISITS SERVING 221 PATIENTS, 91 ADMITTED CASES, AND 86 DISCHARGED CASES.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$20,732,034TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document22IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee176EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1REBECCA BUSCH CFOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7159391732PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11280 CHANDLER DRIVEAddressLine1Txt
CitySPOONERCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54801ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
JAMIE MORALES
BOARD PRESIDENT1.00Yes (X)Yes (X)$0$0$0
TIM REEDY
BOARD VICE PRESIDENT1.00Yes (X)Yes (X)$0$0$0
ADAM LEIGL
BOARD TREASURER1.00Yes (X)Yes (X)$0$0$0
MARK VAN ETTEN MD
BOARD SECRETARY/MEDICAL DIRECTOR5.00Yes (X)Yes (X)$0$0$0
BRIAN GASKILL MD
BOARD MEMBER/CHIEF OF STAFF1.00Yes (X)$0$0$0
SUE CHURCHILL
BOARD MEMBER1.00Yes (X)$0$0$0
NICOLE TIMMS
BOARD MEMBER1.00Yes (X)$0$0$0
MICHAEL SCHAFER
CHIEF EXECUTIVE OFFICER40.00Yes (X)$0$0$0
REBECCA BUSCH
CHIEF FINANCIAL OFFICER40.00Yes (X)$127,481$0$24,802
PATRICK MCCANN MD
ER MEDICAL DIRECTOR40.00$187,487$0$44,230Yes (X)
TIMOTHY SCHMIDT CRNA
CERT. NURSE ANESTHETIST40.00$182,997$0$44,117Yes (X)
ANNE MENTELE CRNA
CERT. NURSE ANESTHETIST40.00$169,862$0$43,716Yes (X)
TIMOTHY BASSETT
PHARMACY DIRECTOR40.00$156,930$0$13,800Yes (X)
THERESA HUTZLER
APNP40.00$149,268$0$35,280Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$974,025TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$205,945TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K6IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
WAPITI MEDICAL GROUP-WOOD RIVER LLC
107 FLYNN DR STE 600MILBANKSD57252ER PHYSICIAN COVERAGE$1,603,786
ARAMARK
27310 NETWORK PLACECHICAGOIL60673CULINARY/LAUNDRY$1,163,872
ESSENTIA HEALTH
1180 CHANDLER DRIVESPOONERWI54801CONTRACTED LABOR$916,948
HEALTHTECH MANAGEMENT SERVICES
5110 MARYLAND WAY STE 200BRENTWOODTN37027MANAGEMENT FEES$630,679
SHARED MEDICAL TECHNOLOGY INC
2020 W NEWTON STRICE LAKEWI54868DIAGNOSTIC RADIOLOGY$406,122
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K7CntrctRcvdGreaterThan100KCnt
Government Grants$5,966,391GovernmentGrantsAmt
All Other Contributions$6,243AllOtherContributionsAmt
Total Contributions$5,972,634TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENUE621400$22,879,681$22,879,681
OTHER PATIENT REVENUE FROM JV621400$704,402$704,402
FieldValueIRS element (for citing)
Total Program Service Revenue$23,584,083TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$454,361TotalRevenueColumnAmt
Exclusion$454,361ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$36,879RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$36,879RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$36,879TotalRevenueColumnAmt
Exclusion$36,879ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$369,755SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$6,508OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$369,755SecuritiesAmt
Other-$6,508OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$363,247TotalRevenueColumnAmt
Exclusion$363,247ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
MISCELLANEOUS900099$91,914$91,914
MEAL INCOME900099$54,542$54,542
FieldValueIRS element (for citing)
Other Revenue Total$146,456OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$30,557,660TotalRevenueColumnAmt
Related Or Exempt Func Income$23,584,083RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$1,000,943ExclusionAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$10,000TotalAmt
Program Services$10,000ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$147,502TotalAmt
Management And General$147,502ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$8,575,825TotalAmt
Program Services$7,507,903ProgramServicesAmt
Management And General$1,067,922ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$341,704TotalAmt
Program Services$294,094ProgramServicesAmt
Management And General$47,610ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,702,060TotalAmt
Program Services$1,464,911ProgramServicesAmt
Management And General$237,149ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$620,511TotalAmt
Program Services$534,055ProgramServicesAmt
Management And General$86,456ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$693,692TotalAmt
Management And General$693,692ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$44,054TotalAmt
Management And General$44,054ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$59,342TotalAmt
Management And General$59,342ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$4,832TotalAmt
Management And General$4,832ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,973,558TotalAmt
Program Services$1,815,958ProgramServicesAmt
Management And General$157,600ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$202,518TotalAmt
Management And General$202,518ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$220,545TotalAmt
Program Services$123,064ProgramServicesAmt
Management And General$97,481ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$781,127TotalAmt
Program Services$233,367ProgramServicesAmt
Management And General$547,760ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,215,458TotalAmt
Program Services$1,189,789ProgramServicesAmt
Management And General$25,669ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$31,249TotalAmt
Program Services$31,249ProgramServicesAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$11,796TotalAmt
Program Services$11,796ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$707,529TotalAmt
Program Services$707,529ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,439,108TotalAmt
Program Services$2,439,108ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$111,468TotalAmt
Management And General$111,468ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
DRUGS$2,479,647$2,479,647
MEDICAL SUPPLIES$1,183,466$1,163,598$19,868
BAD DEBT EXPENSE$646,015$646,015
MISCELLANEOUS$238,660$1,034$237,626

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$126,722TotalAmt
Program Services$78,917ProgramServicesAmt
Management And General$47,805ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$24,568,388TotalAmt
Program Services$20,732,034ProgramServicesAmt
Management And General$3,836,354ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$4,233,932BOYAmt
EOY$16,527,514EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,432,607BOYAmt
EOY$1,456,301EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,776,359BOYAmt
EOY$3,273,841EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$503,129BOYAmt
EOY$607,903EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$246,179BOYAmt
EOY$255,579EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$35,337,281LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$12,455,280LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$25,012,628BOYAmt
EOY$22,882,001EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$19,636,973BOYAmt
EOY$23,403,285EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$972,201BOYAmt
EOY$1,246,465EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$55,814,008BOYAmt
EOY$69,652,889EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,079,265BOYAmt
EOY$3,641,734EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
EOY$5,830,767EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$18,434,201BOYAmt
EOY$17,697,062EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$917,000BOYAmt
EOY$17,000EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$22,430,466BOYAmt
EOY$27,186,563EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$33,383,542BOYAmt
EOY$42,466,326EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$33,383,542BOYAmt
EOY$42,466,326EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$55,814,008BOYAmt
EOY$69,652,889EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$5,989,272ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$3,093,512NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$4,832OtherActivitiesAmt
Total Lobbying Expenditures$4,832TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationA PORTION OF THE MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, RURAL WISCONSIN HEALTH COOPERATIVE AND WISCONSIN HOSPITAL ASSOCIATION WERE USED BY THOSE ASSOCIATIONS TO LOBBY ON BEHALF OF SPOONER HEALTH SYSTEM AND OTHER MEMBERS.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,215,671OtherCostOrOtherBasisAmt
Book Value$1,215,671BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$20,273,644OtherCostOrOtherBasisAmt
Depreciation$5,607,287DepreciationAmt
Book Value$14,666,357BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$815,951OtherCostOrOtherBasisAmt
Depreciation$370,501DepreciationAmt
Book Value$445,450BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$13,032,015OtherCostOrOtherBasisAmt
Depreciation$6,477,492DepreciationAmt
Book Value$6,554,523BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$22,882,001TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescTHIRD PARTY PAYOR PAYABLEDesc
Amt$17,000Amt
FieldValueIRS element (for citing)
Total Liability$17,000TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$33,005,157TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$3,093,512NetUnrealizedGainsInvstAmt
Revenue Not Reported$3,093,512RevenueNotReportedAmt
Revenue Subtotal$29,911,645RevenueSubtotalAmt
Other Revenues Not Included$646,015OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$646,015RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$30,557,660TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$23,922,373TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$23,922,373ExpensesSubtotalAmt
Other Expenses Not Included$646,015OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$646,015ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$24,568,388TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART X, LINE 2:THE SYSTEM IS CLASSIFIED BY THE INTERNAL REVENUE SERVICE AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS SUBJECTED TO FEDERAL INCOME TAX ONLY ON NET UNRELATED BUSINESS INCOME. THE SYSTEM FOLLOWS THE GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE SYSTEM FOLLOWS THE ACCOUNTING STANDARD FOR INCOME TAXES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE APPLICATION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS.
PART XI, LINE 4B - OTHER ADJUSTMENTS:PROVISION FOR BAD DEBTS 646,015.
PART XII, LINE 4B - OTHER ADJUSTMENTS:PROVISION FOR BAD DEBTS 646,015.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (1)ExpensesExceedBudgetInd
Unable To Provide Care0UnableToProvideCareInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Persons Served238PersonsServedCnt
Total Community Benefit Expns$170,592TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$170,592NetCommunityBenefitExpnsAmt
Total Expense0.00710TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,689,525TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,315,163DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,374,362NetCommunityBenefitExpnsAmt
Total Expense0.05740TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Persons Served238PersonsServedCnt
Total Community Benefit Expns$3,860,117TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,315,163DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,544,954NetCommunityBenefitExpnsAmt
Total Expense0.06450TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs7ActivitiesOrProgramsCnt
Persons Served4402PersonsServedCnt
Total Community Benefit Expns$42,225TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,570DirectOffsettingRevenueAmt
Net Community Benefit Expns$31,655NetCommunityBenefitExpnsAmt
Total Expense0.00130TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Activities Or Programs11ActivitiesOrProgramsCnt
Persons Served49PersonsServedCnt
Total Community Benefit Expns$31,815TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$31,815NetCommunityBenefitExpnsAmt
Total Expense0.00130TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Persons Served247PersonsServedCnt
Total Community Benefit Expns$719,149TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$309,541DirectOffsettingRevenueAmt
Net Community Benefit Expns$409,608NetCommunityBenefitExpnsAmt
Total Expense0.01710TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Activities Or Programs22ActivitiesOrProgramsCnt
Persons Served50PersonsServedCnt
Total Community Benefit Expns$28,750TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$28,750NetCommunityBenefitExpnsAmt
Total Expense0.00120TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs42ActivitiesOrProgramsCnt
Persons Served4748PersonsServedCnt
Total Community Benefit Expns$821,939TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$320,111DirectOffsettingRevenueAmt
Net Community Benefit Expns$501,828NetCommunityBenefitExpnsAmt
Total Expense0.02090TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs42ActivitiesOrProgramsCnt
Persons Served4986PersonsServedCnt
Total Community Benefit Expns$4,682,056TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,635,274DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,046,782NetCommunityBenefitExpnsAmt
Total Expense0.08540TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$15,450TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$15,450NetCommunityBenefitExpnsAmt
Total Expense0.00060TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Total Community Benefit Expns$773TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$773NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Total Community Benefit Expns$272TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$272NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Total Community Benefit Expns$16,495TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$16,495NetCommunityBenefitExpnsAmt
Total Expense0.00060TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$646,015BadDebtExpenseAmt
Reimbursed By Medicare$12,326,288ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$12,340,661CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$14,373MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SPOONER HEALTH SYSTEM INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11280 CHANDLER DRIVEAddressLine1Txt
CitySPOONERCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54801ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.SPOONERHEALTH.COMWebsiteAddressTxt
State License1024StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherHOME HEALTH AGENCYOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1SPOONER HEALTH SYSTEMBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted18CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE PART V, PAGE 8OwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt19ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLSEE PART V, PAGE 8StrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care100.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.000000000000FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLSEE LINE 16JFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSEE LINE 16JFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSEE LINE 16JFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SPOONER HEALTH SYSTEMPART V, SECTION B, LINE 5: SPOONER HEALTH SYSTEM (SH) WORKED WITH THE NATIONAL RURAL HEALTH RESOURCE CENTER (THE CENTER) OF DULUTH, MN TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT IN THE SUMMER OF 2018. COMMUNITY INPUT WAS GATHERED THROUGH A PUBLIC COMMUNITY SURVEY AND A SERIES OF KEY INFORMANT PHONE INTERVIEWS WITH INDIVIDUALS SELECTED BASED ON THE VARIOUS CONSUMER GROUPS OF LOCAL HEALTH SERVICES INCLUDING SENIOR CITIZENS, YOUNG PARENTS, HEALTH CARE PROVIDERS AND COMMUNITY LEADERS. A NEWS RELEASE WAS SENT TO THE LOCAL PAPERS TO INFORM AND INVITE THE PUBLIC TO BE PART OF THE PROCESS. THE SURVEY WAS DEVELOPED TO ASSESS THE HEALTH CARE NEEDS AND PREFERENCES IN THE SERVICE AREA OF WASHBURN COUNTY. THE CENTER HELPED DEVELOP, DISTRIBUTE AND COLLATE THE SURVEY RESULTS. SURVEYS WERE MAILED TO A RANDOM STRATIFIED SAMPLE OF 800 COMMUNITY RESIDENCES. ADITIONALLY, THE SURVEY LINK WAS PUBLICIZED AND AVAILABLE ON THE SH WEBSITE.
SPOONER HEALTH SYSTEMPART V, SECTION B, LINE 6B: SPOONER HEALTH SYSTEM CONTRACTED WITH THE NATIONAL RURAL HEALTH RESOURCE CENTER OF DULUTH, MN TO COMPLETE THEIR CHNA.
SPOONER HEALTH SYSTEMPART V, SECTION B, LINE 11: DECREASE USE OF ALCOHOL, TOBACCO AND OTHER DRUG ABUSE: PROGRESS TOWARD THIS GOAL INCLUDES CONTINUED REPORTING OF OPIOID DISPENSING TO WISCONSIN VIA THE PRESCRIPTION DRUG MONITORING PROGRAM. SH HAS INCREASED THE AMOUNT OF INFORMATION ABOUT OPIOIDS THAT IS INCLUDED IN EVERY POST-DISCHARGE SUMMARY. SH PROVIDES REPRESENTATION ON SEVERAL COLLABORATIVE COMMUNITY GROUPS SUCH AS THE WASHBURN COUNTY COMMUNITY ALLIANCE FOR PREVENTION COMMITTEE AND THE DRUG ENDANGERED CHILDREN M-TEAM, WHICH IS A MULTI-DISCIPLINARY TEAM TO PROVIDE SERVICES FOR CHILDREN FOUND AT DRUG LAB SITES. THE SH PAIN MANAGEMENT CLINIC OPENED IN 2018 AND HAD 90 VISITS IN FISCAL YEAR 2021. THE CLINIC HELPS PEOPLE TAKE AN ACTIVE ROLE IN MANAGING CHRONIC PAIN WITH A COMBINATION OF THERAPIES RATHER THAN TURNING TO OTHER SUBSTANCES TO FIND RELIEF FROM PAIN. AN UPDATED LIST OF RESOURCES FOR PATIENTS IS AVAILABLE ON THE SH WEBSITE AND THROUGH OUR CAREGIVERS. INCREASE AWARENESS, UTILIZATION & ACCESS TO BEHAVIORAL HEALTH SERVICES: SH SUPPORTS A DEMENTIA FRIENDLY COMMUNITY THROUGH LEADING AND MANAGING THE APHASIA SUPPORT GROUP AND THE MEMORY CLINIC. THE APHASIA SUPPORT GROUP PROVIDES INDIVIDUALS TANGIBLE TOOLS TO ASSIST IN COPING WITH APHASIA AS WELL AS A FORUM TO SHARE SIMILAR EXPERIENCES WITH OTHERS. THE MEMORY CLINIC IS OFFERED TWICE A MONTH AND TREATED 26 PATIENTS THIS YEAR. SH ALSO PROVIDES REPRESENTATION ON THE MENTAL HEALTH TASK FORCE OF WASHBURN COUNTY, CREATED IN 2018 TO SUPPORT MENTAL HEALTH PREVENTION AND AWARENESS PROGRAMMING. AN UPDATED LIST OF RESOURCES FOR PATIENTS IS AVAILABLE ON THE SH WEBSITE AND THROUGH OUR CAREGIVERS. THESE SERVICES CAN BE INCORPORATED INTO DISCHARGE PLANNING AND CASE MANAGEMENT AS APPLICABLE AND WILL BE COMMUNICATED TO THE PUBLIC THROUGH THE SH WEBSITE, SOCIAL MEDIA AND COMMUNITY NEWSLETTER. COMMUNITY IS AWARE OF AND ACCESSES HEALTH CARE SERVICES: SH OFFERS MANY SPECIALTY SERVICES AT ITS DESIGNATED OUTPATIENT CLINIC. PHYSICIANS HOLD CLINICS SEVERAL DAYS A WEEK INCLUDING SERVICES SUCH AS OPHTHALMOLOGY, PODIATRY, GASTROENTEROLOGY, PAIN MEDICINE, UROLOGY AND EAR, NOSE AND THROAT. SH RECOGNIZES THE NEED FOR LOCAL PATIENTS TO BE ABLE TO RECEIVE SPECIALTY CARE CLOSE TO HOME AND THE DIFFERENCE THIS CAN MAKE ON HEALTH OUTCOMES. THESE SERVICES ARE ADVERTISED THROUGH NEWSPAPERS, THE SH WEBSITE, NEWSLETTERS AND SOCIAL MEDIA POSTS AS WELL AS AN ELECTRONIC SIGN BOARD INSIDE THE HOSPITAL ENTRANCE SCROLLING UPCOMING CLINICS. SH MAKES INFORMATION ON FINANCIAL ASSISTANCE WIDELY AVAILABLE THROUGH OUR WEBSITE AND EMPLOYS A PATIENT FINANCIAL COUNSELOR TO WORK DIRECTLY WITH PATIENTS TO EDUCATE THEM ON AVAILABLE OPTIONS. SH CONTINUES FINANCIAL AND IN-KIND SUPPORT FOR THE RICE LAKE AREA FREE CLINIC AND THE LOCAL REGIONAL HOSPICE SERVICES, AS WELL AS FAITH IN ACTION WASHBURN COUNTY. SH HOLDS NUMEROUS FLU SHOT CLINICS AT VARIOUS LOCATIONS IN THE COMMUNITY. SH ORGANIZES AN ANNUAL HEALTH FAIR WHERE FREE LAB CHOLESTEROL SCREENINGS ARE PROVIDED ONSITE. IN FISCAL YEAR 2021, 48 PERSONS TOOK ADVANTAGE OF THE FREE LAB SCREENINGS AND THE HEALTH FAIR WAS HELD OUTDOORS DUE TO COVID. SH WILL CONTINUE TO ADVOCATE TO THE CENTERS FOR MEDICARE AND MEDICAID SERVICES TO REDEFINE THEIR MIXED-USE SPACE INTERPRETATION SO URGENT CARE CAN BE IMPLEMENTED AT THE SH FACILITY IN THE FUTURE.TWO COMMUNITY HEALTH NEEDS WERE IDENTIFIED IN THE 2018 CHNA PROCESS THAT SH HAS CHOSEN NOT TO FOCUS THEIR EFFORTS ON. 1. INCREASE AWARENESS OF PREVENTION AND MANAGEMENT OF CHRONIC DISEASE - THE TEAM DISCUSSED THAT THESE ARE ALREADY SERVICES INCORPORATED INTO THE CARE AT SH AND PREVENTION EFFORTS ARE LED DOMINANTLY BY LOCAL PUBLIC HEALTH. 2. IMPROVE UNDERSTANDING OF COMMUNITY RESOURCES REGARDING HEALTH CARE COSTS - THE TEAM DISCUSSED THAT THE HOSPITAL COULD HAVE ONLY A SMALL IMPACT ON THE COST OF HEALTH CARE AND INSURANCE COVERAGE. THE HOSPITAL WILL HOWEVER INCREASE AWARENESS OF FINANCIAL SUPPORT PROGRAMS AND OUTREACH TO BUILD RELATIONSHIPS WITH HEALTH INSURANCE COVERAGE NAVIGATORS IN THE LOCAL AREA.
SPOONER HEALTH SYSTEMPART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON THE WEBSITE AT HTTPS://WWW.SPOONERHEALTH.COM/PATIENTS-VISITORS/PATIENT-VISITOR-INFORMATION/FINANCIAL-ASSISTANCE/. THE APPLICATION IS ON THE WEBSITE HTTPS://SPOONERHEALTH.WPENGINE.COM/WP-CONTENT/UPLOADS/2021/09/395-100-FAP-ATTACHMENT-E-APPLICATION-2021.PDF. THE PLAIN LANGUAGE SUMMARY IS ON THE WEBSITE HTTPS://WWW.SPOONERHEALTH.COM/PATIENTS-VISITORS/PATIENT-VISITOR-INFORMATION/PLAIN-LANGUAGE-SUMMARY/. THE INFORMATION ON THE WEBSITES EXPLAINS EXACTLY WHAT TO DO IN ORDER TO APPLY FOR FINANCIAL ASSISTANCE. THE APPLICATION FORM IS ALSO AVAILABLE AT REGISTRATION. A FINANCIAL ASSISTANCE APPLICATION AND LETTER IS SENT OUT TO PATIENTS WHO ARE NOT ABLE TO PAY THEIR BALANCES DUE.
PART V, LINE 7A, CHNA REPORT HOSPITAL FACILITY'S WEBSITE:HTTPS://SPOONERHEALTH.WPENGINE.COM/WP-CONTENT/UPLOADS/2021/08/SPOONER-CHNA-SURVEY-FINDINGS_FINAL.PDF (CHANGE CAPITAL LETTERS TO LOWERCASE TO ACCESS)
PART V, LINE 10A, IMPLEMENTATION STRATEGY WEBSITE:HTTPS://SPOONERHEALTH.WPENGINE.COM/WP-CONTENT/UPLOADS/2021/08/SPOONER-HEALTH-COMMUNITY-HEALTH-ASSESSMENT-ACTION-PLAN_WEBSITE.PDF

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3C:ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED PRIMARILY ON HOUSEHOLD INCOME COMPARED TO FEDERAL POVERTY GUIDELINES. HOWEVER, QUALIFIED HOUSEHOLD ASSETS ARE ALSO CONSIDERED WHEN DETERMINING AN INDIVIDUAL'S ABILITY TO PAY FOR HEALTHCARE SERVICES. FINALLY, INSURANCE STATUS CAN IMPACT A PERSON'S ELIGIBILITY IF THEY HAVE ACCESS TO HEALTH INSURANCE, THIRD-PARTY REIMBURSEMENT OR GOVERNMENTAL ASSISTANCE BUT FAIL TO TAKE ADVANTAGE OF IT OR FAIL TO MAINTAIN ELIGIBILITY.
PART I, LINE 7:THE AMOUNTS REPORTED IN PART I, LINE 7A-C WERE COMPUTED USING THE COST TO CHARGE RATIO FROM WORKSHEET 2 OF THE SCHEDULE H, IRS INSTRUCTIONS. THE AMOUNTS REPORTED IN LINES 7E-I WERE REPORTED BASED ON DIRECT COSTS INCURRED BY SH.
PART I, LINE 7G:INCLUDED IN PART I, LINE 7G ARE THE MEMORY CLINIC, WHICH IS A PHYSICIAN CLINIC, AND THE HOME HEALTH AGENCY. BOTH SERVICES ARE LISTED AS SUBSIDIZED HEALTH SERVICES BECAUSE THEY ARE OPERATED BY SHS TO PROVIDE A SERVICE THAT IS NEEDED IN THE COMMUNITY BUT THAT CANNOT BE SUSTAINED ON THEIR OWN. THE TOTAL COMMUNITY BENEFIT EXPENSE FOR THE HOME HEALTH AGENCY WAS $706,984 WITH DIRECT OFFSETTING REVENUE OF $299,437 RESULTING IN A NET COMMUNITY BENEFIT EXPENSE OF $407,547. THE TOTAL COMMUNITY BENEFIT EXPENSE FOR THE MEMORY CLINIC WAS $12,165 WITH DIRECT OFFSETTING REVENUE OF $10,104, RESULTING IN A NET COMMUNITY EXPENSE OF $2,061.
PART I, LN 7 COL(F):THE HOSPITAL IS REPORTING $1,092,849 OF BAD DEBT EXPENSE IN FORM 990, PART IX, LINE 24B. TOTAL EXPENSE, LESS THIS AMOUNT, ARE $24,032,284. THIS AMOUNT IS USED TO CALCULATE THE PERCENTAGE OF TOTAL EXPENSE IN SCHEDULE H, PART I, LINE 7, COLUMN F.
PART II, COMMUNITY BUILDING ACTIVITIES:SPOONER HEALTH (SH) PROVIDES REPRESENTATION ON MANY COMMUNITY HEALTH RELATED BOARDS INCLUDING WASHBURN COUNTY COMMUNITY COORDINATED RESPONSE TEAM, WASHBURN COUNTY TRANSITIONS OF CARE COALITION, BURNETT COUNTY CRISIS OVERSIGHT COMMITTEE AND FAITH IN ACTION WASHBURN COUNTY. IN FISCAL YEAR 2021, ADMINISTRATIVE AND CLINICAL STAFF AT SH SPENT MANY HOURS ACTIVELY WORKING WITH THE STATE OF WI, WASHBURN COUNTY PUBLIC HEALTH, NEIGHBORING MEDICAL FACILITIES AND OTHER COMMUNITY PARTNERS TO PREVENT, PREPARE FOR AND RESPOND TO THE COVID PANDEMIC. IN A NORMAL YEAR, SH PROVIDES FREE MEETING ROOM SPACE TO MANY NON-PROFIT COMMUNITY GROUPS, HOWEVER DURING THE PANDEMIC THIS WAS NOT POSSIBLE. SH CONTINUES TO BE A COMMUNITY DROP OFF LOCATION FOR INFECTIOUS WASTE, WHICH IS ROUTINELY COLLECTED AND PROPERLY DISPOSED OF FOR ENVIRONMENTAL SAFETY IN THE REGION. ADDITIONAL ACTIVITIES RELATED TO COMMUNITY BUILDING ARE REPORTED IN THE COMMUNITY HEALTH IMPROVEMENT CATEGORY.
PART III, LINE 2:THE AMOUNT OF BAD DEBT EXPENSE REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS.
PART III, LINE 3:A PORTION OF THE BAD DEBT EXPENSE REPORTED IN LINE 2 WOULD BE CONSIDERED CHARITY CARE IF THE PROPER PAPERWORK WAS COMPLETED BY THE PATIENTS, HOWEVER THIS AMOUNT CANNOT BE QUANTIFIED.
PART III, LINE 4:FOR INFORMATION ABOUT BAD DEBT EXPENSE, SEE THE "PATIENT RECEIVABLES, NET" SECTION OF NOTE 1 ON PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS.
PART III, LINE 8:FROM PART III, LINE 6, THE TOTAL ALLOWABLE COST REPORTED TO MEDICARE WAS BASED ON THE 2021 FILED MEDICARE COST REPORT.FROM PART III, LINE 7, SPOONER HEALTH SYSTEM BELIEVES THAT THE SHORTFALL OF $14,373 SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE THESE ARE THE COSTS OF PROVIDING MEDICALLY NECESSARY SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IF THE HOSPITAL DIDN'T PROVIDE THESE SERVICES, NO OTHER ORGANIZATION IN THE COMMUNITY WOULD.
PART III, LINE 9B:AFTER FINANCIAL ASSISTANCE IS PROVIDED, SPOONER HEALTH SYSTEM WILL CONTINUE TO WORK WITH PATIENTS TO RESOLVE THE REMAINDER OF THEIR BALANCE AFTER FINANCIAL ASSISTANCE. SPOONER HEALTH SYSTEM MAKES ALL REASONABLE ATTEMPTS TO CONFIRM THAT PATIENTS ARE NOT ELIGIBLE FOR OTHER ASSISTANCE PROGRAMS PRIOR TO COLLECTION AGENCY ASSIGNMENT. PRIOR TO TRANSFER TO A COLLECTION AGENCY, SPOONER HEALTH SYSTEM WILL SEND STATEMENTS AND COLLECTION LETTERS TO THE PATIENT AT THE ADDRESS PROVIDED BY THE PATIENT. STATEMENTS AND COMMUNICATIONS WILL INFORM THE PATIENT OF THEIR FINANCIAL RESPONSIBILITY AFTER FINANCIAL ASSISTANCE. AFTER PAYMENT PLAN ARRANGEMENTS HAVE BEEN MADE AND BEFORE TRANSFER TO A COLLECTION AGENCY, SPOONER HEALTH SYSTEM WILL SEND A NOTICE TO PATIENTS WHO HAVE FAILED TO MAKE PAYMENT ARRANGEMENTS OR WHO DO NOT COMPLY WITH MUTUALLY AGREED UPON PAYMENT PLANS. THE NOTICE WILL ALERT THE PATIENT OF THEIR BALANCE AND THAT IF THEIR FINANCIAL SITUATION HAS CHANGED, THEY MAY HAVE THE OPPORTUNITY FOR A NEW PAYMENT PLAN.
PART VI, LINE 2:THE 2018 COMMUNITY HEALTH NEEDS ASSESSMENT REPORTED IN PART V, SECTION B WAS THE ONLY ASSESSMENT OF THE COMMUNITY'S HEALTH NEEDS CONDUCTED DURING THE FISCAL YEAR.
PART VI, LINE 3:PATIENTS WITHOUT INSURANCE ARE GIVEN THE FINANCIAL ASSISTANCE (FA) APPLICATION. OUR FINANCIAL COUNSELOR CALLS THEM AFTER DISCHARGE AND EXPLAINS WHAT ASSISTANCE (FROM THE GOVERNMENT OR SHS) MAY BE AVAILABLE TO THEM. SHE ASKS THEM TO FILL IT OUT AND MAKES AN APPOINTMENT WITH THEM IN THE OFFICE IF THEY NEED ASSISTANCE WITH THE FA APPLICATION OR GOING TO WWW.ACCESS.WISCONSIN.GOV TO APPLY FOR GOVERNMENTAL ASSISTANCE. WHEN THEY COME IN, SHE WILL ASSIST THEM WITH THE APPLICATION PROCESS AS MUCH AS SHE CAN. IF THEY NEED FURTHER ASSISTANCE, ARE OF RETIREMENT AGE, OR IF THERE IS A DISABILITY INVOLVED, SHE REFERS THEM TO THE WASHBURN COUNTY AGING AND DISABILITY RESOURCE CENTER WHERE THEY WILL HELP THE PATIENTS IN GETTING ADDITIONAL ASSISTANCE. OUR FINANCIAL COUNSELOR ALSO REFERS PATIENTS TO THE COUNTY'S PUBLIC HEALTH DEPARTMENT IF THEY NEED FAMILY OR WOMEN'S HEALTH ASSISTANCE. WE ALSO PUBLICIZE THE AVAILABILITY OF FA IN OUR ANNUAL REPORT TO THE COMMUNITY THAT IS SENT OUT TO EVERY ADDRESS IN OUR PRIMARY SERVICE AREA.
PART VI, LINE 4:SPOONER HEALTH SYSTEM PRIMARILY SERVES THE COMMUNITIES WITHIN WASHBURNCOUNTY IN NORTHWESTERN WISCONSIN. WASHBURN COUNTY IS THE 30TH LARGESTCOUNTY BY LAND AREA IN WISCONSIN WITH AN ESTIMATED POPULATION OF 16,623 (PER APRIL 2020 US CENSUS BUREAU). THE MEDIAN HOUSEHOLD INCOME IS $50,280 WITH 12.8% OF PERSONS BELOW POVERTY LEVEL (PER 2014-2018 DATA). WASHBURN COUNTY HAD A 2.4% UNEMPLOYMENT RATE IN OCTOBER 2021 PER THE WISCONSIN DEPARTMENT OF WORKFORCE DEVELOPMENT.
PART VI, LINE 6:SPOONER HEALTH SYSTEM IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.
PART VI, LINE 7, REPORTS FILED WITH STATESWI

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmt
HIGH SCHOOL STUDENT SCHOLARSHIPS6$8,000
EMPLOYEE TUITION ASSISTANCE1$2,000

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationSPOONER HEALTH SYSTEM AWARDS SCHOLARSHIPS TO HIGH SCHOOL SENIORS WHO ARE GOING ON TO COLLEGE IN A HEALTH CARE FIELD. THE FUNDS ARE PAID DIRECTLY TO THE COLLEGE TO ENSURE THEY ARE USED FOR THE PURPOSE OF TUITION. SPOONER HEALTH SYSTEM ALSO OFFERS TUITION ASSISTANCE FOR EMPLOYEES THAT ARE FURTHERING THEIR EDUCATION TO ENHANCE THEIR JOB RELATED SKILLS, KNOWLEDGE AND IMPROVE THEIR POTENTIAL FOR PROMOTION OR CAREER DEVELOPMENT OPPORTUNITIES. TO RECEIVE TUITION REIMBURSEMENT FROM THE HOSPITAL, AN EMPLOYEE MUST SUBMIT A TUITION ASSISTANCE IN EXCHANGE FOR SERVICE FROM THE HUMAN RESOURCES DEPARTMENT ALONG WITH THE APPROPRIATE DOCUMENTATION. THIS INCLUDES WRITTEN PROOF OF SUCCESSFUL COMPLETION OF THE COURSE PER THE COURSE REQUIREMENTS AND ITEMIZED BILLS, RECEIPTS OR STATEMENTS WITH PROOF OF PAYMENT FOR EXPENSES.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
PATRICK MCCANN MD
ER MEDICAL DIRECTOR$187,487$0$0$0$0$0$9,900$0$34,330$0$231,717$0$0$0
TIMOTHY SCHMIDT CRNA
CERT. NURSE ANESTHETIST$182,997$0$0$0$0$0$9,681$0$34,436$0$227,114$0$0$0
ANNE MENTELE CRNA
CERT. NURSE ANESTHETIST$169,862$0$0$0$0$0$9,084$0$34,632$0$213,578$0$0$0
THERESA HUTZLER
APNP$149,268$0$0$0$0$0$0$0$35,280$0$184,548$0$0$0
TIMOTHY BASSETT
PHARMACY DIRECTOR$156,930$0$0$0$0$0$8,030$0$5,770$0$170,730$0$0$0
REBECCA BUSCH
CHIEF FINANCIAL OFFICER$127,481$0$0$0$0$0$6,633$0$18,169$0$152,283$0$0$0

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1WI HEALTH AND EDUCATIONAL FACILITIES AUTHORITYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN391337855BondIssuerEIN
Bond Issued2014-10-23BondIssuedDt
Issue Price$21,200,000IssuePriceAmt
PurposeCONSTRUCTING REPLACEMENT HOSPITALPurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$3,080,000RetiredAmt
Total Proceeds$21,240,408TotalProceedsAmt
Capital Expenditures$21,240,408CapitalExpendituresAmt
Substantial Completion2016SubstantialCompletionYr
Refunding Tax Exempt Bonds0RefundingTaxExemptBondsInd
Refunding Taxable Bonds0RefundingTaxableBondsInd
Final Allocation MadeYes (1)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (1)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedPropertyInd
Any Lease ArrangementsYes (1)AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop0MgmtContractBondFincdPropInd
Any Research Agreements0AnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt Test0BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop0ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (1)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiledInd
Rebate Not Due Yet0RebateNotDueYetInd
Exception To Rebate0ExceptionToRebateInd
No Rebate DueYes (1)NoRebateDueInd
Variable Rate IssueYes (1)VariableRateIssueInd
Hedge Identified In Bks And Rec0HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGICInd
Gross Proceeds Invested0GrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (1)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (1)ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceDATE REBATE COMPUTATION PERFORMEDFormAndLineReferenceDesc
ExplanationISSUER NAME: WI HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 11/13/2019ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 3WE NOW STAFF OUR OWN CARDIAC REHAB PROGRAM, PRIOR TO 10/1/2020 IT WAS STAFFED BY ESSENTIA.
FORM 990, PART VI, SECTION A, LINE 1THE EXECUTIVE COMMITTEE CONSISTS OF THE BOARD PRESIDENT, VICE-PRESIDENT, SECRETARY AND TREASURER. THE EXECUTIVE COMMITTEE HAS AND EXERCISES THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE ORGANIZATION DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 3SPOONER HEALTH SYSTEM CONTRACTS WITH HEALTHTECH MANAGEMENT SERVICES TO PROVIDE MANAGEMENT SERVICES. INCLUDED IN THE FEES PAID TO HEALTHTECH MANAGEMENT SERVICES IS THE COMPENSATION FOR THE CEO. DURING 2020, THE CEO RECEIVED $244,877 OF TAXABLE PAY, $10,860 OF NONTAXABLE DEFERRED COMPENSATION AND $23,695 OF OTHER NONTAXABLE BENEFITS FROM HEALTHTECH MANAGEMENT SERVICES FOR HIS SERVICES TO SPOONER HEALTH SYSTEM.
FORM 990, PART VI, SECTION B, LINE 11BTHE RETURN WAS REVIEWED BY MANAGEMENT BEFORE BEING FORWARDED TO THE BOARD OF DIRECTORS. AT THE BOARD OF DIRECTORS MEETING, THE 990 WAS REVIEWED WITH BOARD MEMBERS WHO APPROVED IT. THE 990 WAS THEN FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CIT IS THE POLICY OF SPOONER HEALTH SYSTEM THAT ALL POTENTIAL CONFLICTS OF INTEREST SHOULD BE IDENTIFIED BY ANY OFFICER, BOARD MEMBER, OR KEY EMPLOYEE OF THE ORGANIZATION ON AN ANNUAL BASIS. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE PERSON WITH THE CONFLICT SHALL LEAVE MEETINGS DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15AMICHAEL SCHAFER, CEO, IS AN EMPLOYEE OF THE UNRELATED MANAGEMENT COMPANY THAT PROVIDES SERVICES TO SPOONER HEALTH SYSTEM. SPOONER HEALTH SYSTEM PAYS THE MANAGEMENT COMPANY A MANAGEMENT FEE FOR MICHAEL SCHAFER'S SERVICES AS CEO. THE MANAGEMENT COMPANY PERFORMS A SALARY REVIEW OF THE CEO OF SPOONER HEALTH SYSTEM EACH YEAR AND PROVIDES THE APPROPRIATE INFORMATION, INCLUDING COMPENSATION SURVEYS, TO SPOONER HEALTH SYSTEM'S BOARD OF DIRECTORS. THROUGH THIS REVIEW, THE BOARD OF DIRECTORS IS ABLE TO REVIEW THE COMPARABILITY DATA RELIED UPON IN DETERMINING THE CEO'S COMPENSATION. THE INFORMATION IS PRESENTED BY THE MANAGEMENT COMPANY TO THE BOARD OF DIRECTORS OF SPOONER HEALTH SYSTEM, ALONG WITH A PERFORMANCE EVALUATION AND A RECOMMENDATION OF A SALARY LEVEL, WHICH IS THEN APPROVED BY THE BOARD OF DIRECTORS OF SPOONER HEALTH SYSTEM. ALL OFFICERS AND KEY EMPLOYEES' COMPENSATION IS REVIEWED ON AN ANNUAL BASIS AND COMPARED TO MARKET DATA GATHERED BY THE HUMAN RESOURCES DEPARTMENT.
FORM 990, PART VI, SECTION C, LINE 19THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC.