SAINT ELIZABETHS HOSPITAL OF WABASHA INC: Form 990, tax year 2021
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- Organization
- SAINT ELIZABETHS HOSPITAL OF WABASHA INC (EIN 41-0693877)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-15
- IRS object ID
- 202203199349301545
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-15T08:26:14-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | 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 | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410693877 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAINT ELIZABETH'S HOSPITAL OF WABASHA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SAIN | BusinessNameControlTxt |
| Phone | 6515654531 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 GRANT BLVD WEST | AddressLine1Txt |
| City | WABASHA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55981 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN WOLFE | PersonNm |
| Person Title | FINANCE ADMINISTRATOR | PersonTitleTxt |
| Phone | 6515654531 | PhoneNum |
| Signature | 2022-11-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JOHN | PersonFirstNm |
| Person Last | WOLFE | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2022-11-11 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAINT ELIZABETH'S MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JIM ROOT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 GRANT BLVD WEST | AddressLine1Txt |
| City | WABASHA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55981 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $44,816,868 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GUNDERSENHEALTH.ORG/ST-ELIZABETHS/HOSPITAL/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1955 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | WE WILL DISTINGUISH OURSELVES THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, RESEARCH, AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 498 | TotalEmployeeCnt |
| Total Volunteers | 50 | TotalVolunteersCnt |
| Total Gross UBI | $571,436 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $312,781 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $321,309 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,104,764 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $20,054,250 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $42,592,722 | CYProgramServiceRevenueAmt |
| PY Investment Income | $6,633 | PYInvestmentIncomeAmt |
| CY Investment Income | $5,596 | CYInvestmentIncomeAmt |
| PY Other Revenue | $162,816 | PYOtherRevenueAmt |
| CY Other Revenue | $113,786 | CYOtherRevenueAmt |
| PY Total Revenue | $20,545,008 | PYTotalRevenueAmt |
| CY Total Revenue | $44,816,868 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $73,312 | 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 | $13,746,638 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $29,094,596 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,473,392 | PYOtherExpensesAmt |
| CY Other Expenses | $15,108,449 | CYOtherExpensesAmt |
| PY Total Expenses | $21,293,342 | PYTotalExpensesAmt |
| CY Total Expenses | $44,203,045 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$748,334 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $613,823 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $25,174,071 | TotalAssetsBOYAmt |
| Total Assets EOY | $25,407,052 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,590,393 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,209,551 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,583,678 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $17,197,501 | NetAssetsOrFundBalancesEOYAmt |
| Mission | WE WILL DISTINGUISH OURSELVES THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, RESEARCH, AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $39,329,374 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $42,021,286 | RevenueAmt |
| Desc | SAINT ELIZABETH'S HOSPITAL OF WABASHA, INC. IS A 163-BED HOSPITAL CAMPUS (25 HOSPITAL BEDS, 100 NURSING HOME BEDS, 38 ASSISTED LIVING APARTMENT BEDS) PROVIDING SERVICES WITHOUT REGARD TO PATIENT RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. DURING FISCAL YEAR 2021, SAINT ELIZABETH'S HOSPITAL OF WABASHA, INC. HAD A TOTAL OF 38,956 PATIENT DAYS (INCLUDES NH/APT DAYS) OF SERVICE. THE HOSPITAL ALSO PROVIDED SERVICES FOR 24,033 OUTPATIENT VISITS, WHICH INCLUDED 2,670 OF EMERGENCY ROOM VISITS AND 340 OUTPATIENT SURGERIES. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. | Desc |
| Total Program Service Expenses | $39,329,374 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 33 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 498 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 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 | 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 | JOHN WOLFE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6515654531 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 GRANT BLVD WEST | AddressLine1Txt |
| City | WABASHA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55981 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| DENNIS SPANO | |||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $0 | $515,894 | $60,032 | |||
| RUTH TIFFAULT | |||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $0 | $388,145 | $52,188 | |||
| PHILLIP SCHWEND | |||||||||
| SURGEON | 40.00 | 0.00 | Yes (X) | $0 | $376,172 | $61,040 | |||
| EARLE MUNNS | |||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $0 | $298,810 | $60,005 | |||
| AMANDA J STERRY | |||||||||
| APRN | 40.00 | 0.00 | Yes (X) | $269,991 | $0 | $10,800 | |||
| ANDREA L HAUSER | |||||||||
| ADMINISTRATOR DIRECTOR | 0.00 | 40.00 | $0 | $202,741 | $44,880 | Yes (X) | |||
| JIM ROOT | |||||||||
| ADMINISTRATOR | 40.00 | 0.00 | $0 | $183,294 | $28,929 | Yes (X) | |||
| JOHN WOLFE | |||||||||
| FINANCE ADMINISTRATOR | 40.00 | 0.00 | $0 | $163,029 | $42,154 | Yes (X) | |||
| KURT L HENN | |||||||||
| MANAGER, PHARM & PROV LIAISON | 40.00 | 0.00 | $167,246 | $0 | $32,749 | Yes (X) | |||
| KIMBERLY D WOLTER | |||||||||
| DIRECTOR, NURSING | 40.00 | 0.00 | $154,777 | $0 | $10,358 | Yes (X) | |||
| PAUL FISCH | |||||||||
| DIRECTOR | 1.00 | 40.00 | $0 | $124,910 | $38,503 | Yes (X) | |||
| LLOYD HAAS | |||||||||
| DIRECTOR | 1.00 | 40.00 | $0 | $91,163 | $45,370 | Yes (X) | |||
| KIMBERLY A BESELER | |||||||||
| DIRECTOR | 1.00 | 40.00 | $0 | $103,044 | $30,533 | Yes (X) | |||
| DR MICHAEL EBERSOLD | |||||||||
| DIRECTOR | 1.00 | 40.00 | $0 | $63,275 | $0 | Yes (X) | |||
| RICHARD ZABEL | |||||||||
| CHAIR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| DARLENE THEISMANN | |||||||||
| VICE-CHAIR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| CINDY DENK | |||||||||
| SECRETARY | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| LEIGHTON J WILKIE | |||||||||
| BOARD MEMBER | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $592,014 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,510,477 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $517,541 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 32 | 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 |
|---|---|---|---|---|---|
| GUNDERSEN HEALTH SYSTEM | |||||
| 1900 SOUTH AVE | LA CROSSE | WI | 54601 | CONTRACT LABOR/MEDICAL SERVICES | $8,787,078 |
| SELECT REHABILIATION LLC | |||||
| PO BOX 71985 | CHICAGO | IL | 60694 | CONTRACTED REHAB SERVICES | $440,662 |
| TRIMEDX | |||||
| PO BOX 636129 | CINCINNATI | OH | 45263 | BIOMEDICAL CONTRACTED SERVICES | $392,071 |
| MEDXCEL FACILITIES MANAGEMENT | |||||
| PO BOX 638867 | CINCINNATI | OH | 45263 | FACILITIES MANAGEMENT | $364,070 |
| MAYO CLINIC | |||||
| 200 FIRST ST SW | ROCHESTER | MN | 55905 | EKG MEDICAL SERVICES | $126,833 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,577,282 | GovernmentGrantsAmt |
| All Other Contributions | $527,482 | AllOtherContributionsAmt |
| Total Contributions | $2,104,764 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621990 | $38,489,778 | $38,489,778 | |
| PHARMACY REVENUE | 446110 | $4,102,944 | $3,531,508 | $571,436 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $42,592,722 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,596 | TotalRevenueColumnAmt |
| Exclusion | $5,596 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $70,424 | 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 | $70,424 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $70,424 | TotalRevenueColumnAmt |
| Exclusion | $70,424 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA REVENUE | Desc |
| Business | 722514 | BusinessCd |
| Total Revenue Column | $22,151 | TotalRevenueColumnAmt |
| Exclusion | $22,151 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,211 | TotalRevenueColumnAmt |
| Exclusion | $21,211 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $43,362 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $44,816,868 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $42,021,286 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $571,436 | UnrelatedBusinessRevenueAmt |
| Exclusion | $119,382 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $782,536 | TotalAmt |
| Management And General | $782,536 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,795,800 | TotalAmt |
| Program Services | $20,843,099 | ProgramServicesAmt |
| Management And General | $952,701 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $426,441 | TotalAmt |
| Program Services | $426,441 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,681,243 | TotalAmt |
| Program Services | $4,209,339 | ProgramServicesAmt |
| Management And General | $471,904 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,408,576 | TotalAmt |
| Program Services | $1,313,039 | ProgramServicesAmt |
| Management And General | $95,537 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,630,426 | TotalAmt |
| Management And General | $1,630,426 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,514 | TotalAmt |
| Management And General | $29,514 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,373,080 | TotalAmt |
| Program Services | $3,149,938 | ProgramServicesAmt |
| Management And General | $223,142 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,563 | TotalAmt |
| Program Services | $375 | ProgramServicesAmt |
| Management And General | $62,188 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $707,264 | TotalAmt |
| Program Services | $497,539 | ProgramServicesAmt |
| Management And General | $209,725 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,855 | TotalAmt |
| Program Services | $89,281 | ProgramServicesAmt |
| Management And General | $12,574 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $814,533 | TotalAmt |
| Program Services | $801,995 | ProgramServicesAmt |
| Management And General | $12,538 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,448 | TotalAmt |
| Program Services | $103,805 | ProgramServicesAmt |
| Management And General | $1,643 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,803 | TotalAmt |
| Program Services | $25,018 | ProgramServicesAmt |
| Management And General | $10,785 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,164 | TotalAmt |
| Management And General | $51,164 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,812,454 | TotalAmt |
| Program Services | $1,803,985 | ProgramServicesAmt |
| Management And General | $8,469 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $163,650 | TotalAmt |
| Program Services | $140 | ProgramServicesAmt |
| Management And General | $163,510 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $4,068,928 | $4,063,378 | $5,550 |
| BAD DEBTS | $1,171,269 | $1,171,269 | |
| FOOD | $434,383 | $434,311 | $72 |
| REPAIRS AND MAINTENANCE | $300,362 | $277,655 | $22,707 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $245,753 | TotalAmt |
| Program Services | $118,767 | ProgramServicesAmt |
| Management And General | $126,986 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,203,045 | TotalAmt |
| Program Services | $39,329,374 | ProgramServicesAmt |
| Management And General | $4,873,671 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,354,217 | BOYAmt |
| EOY | $1,727,380 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,006 | BOYAmt |
| EOY | $501,219 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,136,903 | BOYAmt |
| EOY | $9,442,488 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,203 | BOYAmt |
| EOY | $12,146 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $784,475 | BOYAmt |
| EOY | $773,613 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,060,012 | BOYAmt |
| EOY | $914,891 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $13,649,038 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,530,318 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,645,746 | BOYAmt |
| EOY | $11,118,720 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $162,509 | BOYAmt |
| EOY | $916,595 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,174,071 | BOYAmt |
| EOY | $25,407,052 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,972,850 | BOYAmt |
| EOY | $5,769,796 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $96,728 | BOYAmt |
| EOY | $661,684 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,520,815 | BOYAmt |
| EOY | $1,778,071 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,590,393 | BOYAmt |
| EOY | $8,209,551 | 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 | $16,583,678 | BOYAmt |
| EOY | $17,197,501 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,583,678 | BOYAmt |
| EOY | $17,197,501 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,174,071 | BOYAmt |
| EOY | $25,407,052 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $613,823 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 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 D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $250,000 | OtherCostOrOtherBasisAmt |
| Book Value | $250,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,607,671 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,337,140 | DepreciationAmt |
| Book Value | $9,270,531 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,477,630 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,144,915 | DepreciationAmt |
| Book Value | $1,332,715 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $313,737 | OtherCostOrOtherBasisAmt |
| Depreciation | $48,263 | DepreciationAmt |
| Book Value | $265,474 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $11,118,720 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO/FROM GLAS | $1,188,225 |
| ASSET RETIREMENT OBLIGATION | $59,399 |
| LEASE LIABILITY | $33,285 |
| 3RD PARTY SETTLEMENTS PAYABLE | $497,162 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,778,071 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | GUNDERSEN HEALTH SYSTEM HAS REVIEWED TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS. THE SYSTEM'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR 2016 AND PRIOR YEARS. | ExplanationTxt |
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 |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| 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 | $141,115 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $141,115 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00320 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,717,053 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,498,595 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $218,458 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00490 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,858,168 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,498,595 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $359,573 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00810 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,787 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,787 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $900 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $200 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $700 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,659,579 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,966,191 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,693,388 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10620 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $970 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $970 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,671,236 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,966,391 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,704,845 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10640 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,529,404 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,464,986 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,064,418 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11450 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense | $847,947 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,029,339 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,021,027 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $8,312 | 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 | SAINT ELIZABETH'S HOSPITAL OF WABASHA INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 GRANT BLVD WEST | AddressLine1Txt |
| City | WABASHA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55981 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.GUNDERSENHEALTH.ORG/ST-ELIZABETHS | WebsiteAddressTxt |
| State License | 371485 | 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 | SAINT ELIZABETH'S HOSPITAL OF WABASHA IN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SUPPLEMENTAL SECTION | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-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 | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| 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.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.GUNDERSENHEALTH.ORG/APP/FILES/PUBLIC/CL39890F-890B-408D-8E5D-7 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SAINT ELIZABETH'S HOSPITAL OF WABASHA INC | PART V, SECTION B, LINE 5: FACILITY NAME: SAINT ELIZABETH'SHOSPITAL OF WABASHA, INCDESCRIPTION: SAINT ELIZABETH'S IS COMMITTED TO ADDRESSING COMMUNITY HEALTH NEEDS COLLABORATIVELY WITH LOCAL PARTNERS. SAINT ELIZABETH'S AND THE WABASHA COUNTY PUBLIC HEALTH DEPARTMENT USED THE FOLLOWING METHODS TO LISTEN TO COMMUNITY MEMBERS' THOUGHTS ON THE STRENGTHS AND CHALLENGES OF BEING A HEALTHY COMMUNITY. THESE METHODS PROVIDED US WITH ADDITIONAL PERSPECTIVES ON HOW TO SELECT AND ADDRESS TOP HEALTH ISSUES FACING OUR COMMUNITIES.INPUT FROM COMMUNITY LEADERS:INPUT WAS RECEIVED FROM COMMUNITY STAKEHOLDERS IN MULTIPLE WAYS. A COMMUNITY STAKEHOLDER MEETING WAS HELD ON JULY 26, 2018. THE MEETING WAS CONVENED BY SAINT ELIZABETH'S AND THE WABASHA COUNTY PUBLIC HEALTH DEPARTMENT. DURING THE MEETING, EXPERTS PRESENTED THE DATA AND ENGAGED ATTENDEES IN DISCUSSION AND A FACILITATED PRIORITIZATION PROCESS.LISTED BELOW ARE THE COMMUNITY LEADERS WHO PROVIDED INPUT ABOUT THE NEEDS OF THE COMMUNITY, INCLUDING AN INDICATION OF WHICH MEDICALLY UNDERSERVED, LOW INCOME OR MINORITY POPULATIONS (IF ANY) THEY SPECIFICALLY REPRESENTED. (NOTE: THE ORGANIZATIONS IN WABASHA COUNTY LARGELY FOCUS ON THE ENTIRE POPULATION. DUE TO THE SMALL POPULATION, FEW ORGANIZATIONS FOCUS EXCLUSIVELY ON MEDICALLY UNDERSERVED OR LOW-INCOME INDIVIDUALS. THERE ARE NO ORGANIZATIONS THAT FOCUS EXCLUSIVELY ON MINORITY POPULATIONS GIVEN THE DEMOGRAPHICS. RESOURCES FOR INDIVIDUALS WHO ARE HISPANIC ARE AVAILABLE IN THE NEIGHBORING COUNTY.)-WABASHA COUNTY PUBLIC HEALTH DEPARTMENT-SAINT ELIZABETH'S MEDICAL CENTER-HIAWATHA VALLEY MENTAL HEALTH CENTER*-UNITED WAY-THREE RIVERS COMMUNITY ACTION**-SOUTH COUNTRY HEALTH ALLIANCE***-WINONA STATE UNIVERSITY-CREST REGIONAL MENTAL HEALTH COALITION-MINNESOTA DEPARTMENT OF HEALTH*DENOTES ORGANIZATIONS OR PROGRAMS REPRESENTING MEDICALLY UNDERSERVED POPULATIONS.**DENOTES ORGANIZATIONS OR PROGRAMS REPRESENTING LOW INCOME POPULATIONS.***DENOTES ORGANIZATIONS OR PROGRAMS REPRESENTING MINORITY POPULATIONS.AT THE JULY STAKEHOLDER MEETING, A WORKSHEET WAS DISTRIBUTED TO ALL ATTENDEES. THE WORKSHEET PROVIDED A FRAMEWORK FOR TAKING NOTES THAT WOULD ASSIST ATTENDEES IN ASKING QUESTIONS, OFFERING FEEDBACK AND ENGAGING IN A PRIORITIZATION PROCESS. STAKEHOLDERS WHO COULD NOT ATTEND THE JULY MEETING WERE GIVEN THE DATA PACKET, WORKSHEET, PRIORITIZATION CRITERIA AND RANKING TOOL FOR SELECTING PRIORITIES.PRIOR TO THE ASSESSMENT, TWO COMMUNITY ORGANIZATIONS, THREE RIVERS COMMUNITY ACTION AND UNITED WAY, HAD RECENTLY COMPLETED THEIR OWN NEEDS ASSESSMENTS. THE THREE RIVERS COMMUNITY ACTION ASSESSMENT WAS COMPLETED IN AUGUST 2017 AND THE UNITED WAY ASSESSMENT WAS COMPLETED IN SPRING 2018. THEIR PROCESSES INCLUDED INPUT FROM LOW-INCOME CLIENTS, SENIORS, COMMUNITY BUSINESSES AND ORGANIZATIONS AND SERVICE PROVIDERS. THE INPUT OBTAINED THROUGH THOSE ASSESSMENTS WAS REVIEWED BY SAINT ELIZABETH'S AND THE WABASHA COUNTY PUBLIC HEALTH DEPARTMENT, AS WELL AS THE ATTENDEES AT THE COMMUNITY STAKEHOLDER MEETING.FOLLOWING THE JULY STAKEHOLDER MEETING, THE CHNA EXECUTIVE TEAM MET TO REVIEW THE RESULTS OF THE MEETING AND FINALIZE THE PRIORITIES. ORGANIZATIONS REPRESENTED ON THE EXECUTIVE TEAM INCLUDED SAINT ELIZABETH'S, WABASHA COUNTY PUBLIC HEALTH AND MINNESOTA DEPARTMENT OF HEALTH.INPUT FROM MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS AND/OR ORGANIZATIONS THAT REPRESENT THOSE POPULATIONSST. ELIZABETH'S HOSPITAL OF WABASHA, INC. IS FUELED BY A COMMITMENT TO HUMAN DIGNITY, THE COMMON GOOD, JUSTICE AND SOLIDARITY. WE BELIEVE THE CHNA PROCESS MUST BE INFORMED BY DIRECT INPUT FROM PERSONS WHO EXPERIENCE HEALTH DISPARITIES BASED ON INCOME AND/OR RACE AND ETHNICITY. WITH THAT IN MIND, SAINT ELIZABETH'S INCLUDED AND HIGHLIGHTED THE DATA FROM NEEDS ASSESSMENTS CONDUCTED BY THREE RIVERS COMMUNITY ACTION AND UNITED WAY, BOTH SERVING VULNERABLE AND LOW-INCOME INDIVIDUALS. DATA WAS COLLECTED THROUGH SURVEYS, FOCUS GROUPS, AND INFORMANT INTERVIEWS. AS PART OF THE PROCESS TO SELECT THE HEALTH PRIORITIES, STRONG CONSIDERATION WAS GIVEN TO HOW INDIVIDUALS WHO ARE MORE VULNERABLE ARE IMPACTED BY THE HEALTH ISSUES. |
| SAINT ELIZABETH'S HOSPITAL OF WABASHA INC | PART V, SECTION B, LINE 6B: SAINT ELIZABETH'S CONDUCTED THE CHNA AND IMPROVEMENT PLAN DEVELOPMENT JOINTLY WITH WABASHA COUNTY PUBLIC HEALTH DEPARTMENT. IN ADDITION, OTHER AGENCIES, ORGANIZATIONS, AND CITIZENS ACTIVELY PARTICIPATE IN THE DEVELOPMENT OF IMPROVEMENT STRATEGIES FOR THE PRIORITIES SELECTED. |
| SAINT ELIZABETH'S HOSPITAL OF WABASHA INC | PART V, SECTION B, LINE 11: THE CURRENT CHNA/COMMUNITY HEALTH IMPROVEMENT PLAN CYCLE (2019-2022) WILL BE COMPLETED ON DECEMBER 31, 2022. THIS DATE WAS POSTPONED FROM JUNE 30, 2022 DUE TO A CHANGE IN THE FISCAL YEAR OF SAINT ELIZABETH'S HOSPITAL OF WABASHA, INC. BECAUSE OF A NEW SPONSORSHIP WITH GUNDERSEN HEALTH SYSTEM. THE CURRENT GOALS, STRATEGIES AND INDICTORS FOLLOW:MENTAL HEALTH (2019-2022)GOAL: IMPROVE THE MENTAL HEALTH OF INDIVIDUALS IN WABASHA COUNTYLONG-TERM PERFORMANCE INDICATOR: BY 2023, THE RESIDENTS OF WABASHA COUNTY WILL REDUCE THE AVERAGE NUMBER OF POOR MENTAL HEALTH DAYS IN THE LAST 30 DAYS FROM 2.8 (2016) TO 2.6. (SOURCE: COUNTY HEALTH RANKINGS)STRATEGY: SUICIDE PREVENTION TRAININGTHE WABASHA COUNTY MENTAL HEALTH ACTION TEAM WILL IMPLEMENT SUICIDE PREVENTION TRAINING IN THE COMMUNITY. ONE EXAMPLE OF A TRAINING IS QUESTION, PERSUADE, REFER (QPR). THE QPR TRAINING IS USED TO EDUCATE ANYONE IN THE COMMUNITY - TEACHERS, COACHES, PARENTS AND OTHERS - TO LEARN HOW TO ASK ABOUT SUICIDALITY, PERSUADE INDIVIDUALS THEY HAVE VALUE AND TO SEEK HELP AND HOW TO EFFECTIVELY ASSIST WITH REFERRING SOMEONE FOR HELP. AS PART OF THE WABASHA COUNTY MENTAL HEALTH ACTION TEAM, THE MEDICAL CENTER WILL: IDENTIFY AND RECRUIT INTENDED AUDIENCES (E.G., HEALTH AND SOCIAL SERVICES PROFESSIONALS, LAW ENFORCEMENT AND FIRST RESPONDERS, CLERGY AND FAITH COMMUNITIES, AND THE PUBLIC) CONDUCT SUICIDE PREVENTION TRAININGS ANNUALLY ACROSS AUDIENCESCOLLABORATIVE PARTNERS: WABASHA COUNTY MENTAL HEALTH ACTION TEAM ZUMBRO VALLEY MENTAL HEALTH WABASHA COUNTY SOCIAL SERVICES HIAWATHA VALLEY MENTAL HEALTH NAMI GUNDERSEN ST. ELIZABETH'S HOSPITAL AND CLINICS RESOURCES COMMITTED: STAFF TIMEMEDIUM-TERM INDICATOR: BY JUNE 30, 2022, 90 PERCENT OF TRAINING PARTICIPANTS WILL REPORT AN INCREASED UNDERSTANDING OF WHEN AND HOW TO UTILIZE GATEKEEPER SKILLS (E.G., ABILITY TO ENGAGE IN ACTIVE LISTENING, ASK CLARIFYING QUESTIONS AND MAKE AN APPROPRIATE REFERRAL).STRATEGY: PROMOTE AWARENESS OF MENTAL HEALTH CRISIS RESOURCESWABASHA COUNTY CURRENTLY HAS ACCESS TO REGIONAL RESOURCES THAT INCLUDE A TRAINED MOBILE CRISIS RESPONSE TEAM AND A 24-HOUR MENTAL HEALTH CRISIS HOTLINE. THE MENTAL HEALTH ACTION TEAM WILL WORK WITH ITS PARTNERS TO INCREASE THE UTILIZATION OF THESE RESOURCES. INITIATIVES INCLUDE: DEVELOP A COMMUNICATION PLAN TO BUILD GREATER AWARENESS OF MOBILE CRISIS RESOURCES AMONG INTENDED AUDIENCES (HEALTH AND SOCIAL SERVICES PROFESSIONALS, LAW ENFORCEMENT AND FIRST RESPONDERS, WORKPLACES, CLERGY AND FAITH COMMUNITIES AND THE PUBLIC) IMPLEMENT THE PLAN TRACK HOTLINE CALL VOLUMES AND NUMBER OF MOBILE CRISIS TEAM DISPATCHESCOLLABORATIVE PARTNERS: WABASHA COUNTY MENTAL HEALTH ACTION TEAM ZUMBRO VALLEY MENTAL HEALTH HIAWATHA VALLEY MENTAL HEALTH WABASHA COUNTY SOCIAL SERVICES NAMI GUNDERSEN ST. ELIZABETH'S HOSPITAL AND CLINICS RESOURCES COMMITTED: STAFF TIMEMEDIUM-TERM INDICATORS: BY JUNE 30, 2022, MOBILE CRISIS RESPONSE TEAMS WILL REPORT A 10 PERCENT INCREASE IN USE OF THE MOBILE CRISIS TEAM BY WABASHA COUNTY RESIDENTS. (BASELINE TBD.) BY JUNE 30, 2022, MOBILE CRISIS RESPONSE TEAMS WILL REPORT A 10 PERCENT INCREASE IN USE OF THE CRISIS HOTLINE BY WABASHA COUNTY RESIDENTS. (BASELINE TBD.) BY JUNE 30, 2022, VISITS TO GUNDERSEN ST. ELIZABETH'S EMERGENCY DEPARTMENT WITH A MENTAL HEALTH DIAGNOSIS WILL DECLINE BY FIVE PERCENT DUE TO AN INCREASE IN THE USE OF THE MOBILE UNIT AND CRISIS HOTLINE. (BASELINE TBD.)STRATEGY: PROMOTE MENTAL HEALTH PEER SUPPORT GROUPSTHE LOCAL NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI) CONNECTION RECOVERY SUPPORT GROUP IS A FREE, PEER-LED SUPPORT GROUP FOR ADULTS LIVING WITH MENTAL ILLNESS. PARTICIPANTS GAIN INSIGHT FROM HEARING THE CHALLENGES AND SUCCESSES OF OTHERS. GROUPS ARE LED BY NAMI-TRAINED FACILITATORS, WHO HAVE EXPERIENCED MENTAL ILLNESS. NAMI'S SUPPORT GROUPS ARE UNIQUE BECAUSE THEY FOLLOW A STRUCTURED MODEL TO ENSURE PARTICIPANTS HAVE AN OPPORTUNITY TO BE HEARD AND RECEIVE WHAT THEY NEED. THE GROUPS MEET ON A BI-WEEKLY, WEEKLY, OR MONTHLY BASIS. PEER SUPPORT IS CURRENTLY NOT AVAILABLE IN WABASHA COUNTY. THE MENTAL HEALTH ACTION TEAM WILL: INITIATE A PEER SUPPORT PROGRAM IN WABASHA COUNTY RECRUIT A TRAINED PEER SUPPORT FACILITATOR PROMOTE THE PEER SUPPORT PROGRAM IN THE WABASHA AREA MEASURE THE IMPACT OF THE PEER SUPPORT GROUPCOLLABORATIVE PARTNERS: WABASHA COUNTY MENTAL HEALTH ACTION TEAM ZUMBRO VALLEY MENTAL HEALTH HIAWATHA VALLEY MENTAL HEALTH WABASHA COUNTY SOCIAL SERVICES NAMI GUNDERSEN ST. ELIZABETH'S RESOURCES COMMITTED: STAFF TIMEMEDIUM-TERM INDICATOR: BY JUNE 30, 2022, 75 PERCENT OF PEER SUPPORT PARTICIPANTS WILL REPORT APPLYING NEWLY LEARNED COPING SKILLS THAT IMPROVE THEIR ABILITY TO BETTER MANAGE THEIR CHRONIC MENTAL ILLNESS.STRATEGY: STRENGTHEN HEALTHCARE'S ROLE IN IMPROVING MENTAL HEALTHGUNDERSEN ST. ELIZABETH'S IS EXPANDING ITS INTERNAL CAPACITY TO IMPROVE MENTAL HEALTH IN WABASHA COUNTY. GUNDERSEN ST. ELIZABETH'S WILL IMPROVE ITS INTERNAL TRAINING, PROTOCOLS, AND SYSTEMS TO BETTER SCREEN, REACH AND TREAT INDIVIDUALS WITH MENTAL HEALTH ISSUES.AS PART OF THAT EFFORT, GUNDERSEN ST. ELIZABETH'S WILL: ONBOARD A PSYCHIATRIST / PSYCHIATRIC NURSE TEAM; THE TEAM WILL PROVIDE MENTAL HEALTH ASSESSMENTS, MEDICATION MANAGEMENT AND COUNSELING TO PATIENTS WITHIN THE PRIMARY CARE SETTING DEVELOP AND IMPLEMENT A MENTAL HEALTH TRAINING AND EDUCATION PLAN FOCUSED ON PRIMARY CARE, EMERGENCY DEPARTMENT AND HOSPITAL PROVIDERS IMPLEMENT A MULTI-DISCIPLINARY COLLABORATIVE APPROACH TO MENTAL HEALTH CARE WITHIN THE CLINIC WORK WITH EXTERNAL AGENCIES (E.G., HIAWATHA VALLEY MENTAL HEALTH) TO ASSURE APPROPRIATE RESOURCES AND REFERRALSRESOURCES COMMITTED: STAFF TIMEMEDIUM-TERM INDICATORS: BY JUNE 2022, 100 PERCENT OF PRIMARY CARE, EMERGENCY DEPARTMENT, HOSPITAL PROVIDERS AND STAFF WILL HAVE RECEIVED TRAINING IN MENTAL HEALTH SCREENING, MANAGEMENT, AND REFERRAL. BY JUNE 2022, DEPRESSION SCREENING AND REMISSION SYSTEMS/PROTOCOLS USED IN PRIMARY CARE SETTING WILL BE TRACKED, MONITORED, AND REPORTED TO MINNESOTA COMMUNITY MEASURES. SENIOR HEALTH (2019-2022)GOAL: BUILD A DEMENTIA FRIENDLY WABASHA COUNTYLONG-TERM PERFORMANCE INDICATOR(S): BY JUNE 30, 2023, THE NUMBER OF WABASHA COUNTY AGENCIES/ORGANIZATIONS THAT HAVE BECOME 'DEMENTIA FRIENDLY OR OTHERWISE ADDRESSED DEMENTIA WILL INCREASE FROM 0 TO 10.STRATEGY: EQUIP WABASHA COUNTY COMMUNITIES TO BE "DEMENTIA FRIENDLY"DEMENTIA FRIENDS IS AN INTERNATIONAL MOVEMENT THAT IS STRIVING TO CREATE MORE DEMENTIA-FRIENDLY COMMUNITIES BY CHANGING THE WAY PEOPLE THINK, ACT, AND TALK ABOUT DEMENTIA. THE EFFORT FOCUSES ON RAISING AWARENESS, REDUCING STIGMA, AND SUPPORTING RESIDENTS WHO ARE TOUCHED BY DEMENTIA. BY HELPING EVERYONE IN A COMMUNITY UNDERSTAND WHAT DEMENTIA IS AND HOW IT AFFECTS PEOPLE, EACH PERSON CAN MAKE A DIFFERENCE FOR SOMEONE LIVING WITH DEMENTIA. THE SENIOR HEALTH ACTION TEAM WILL: LAUNCH DEMENTIA FRIENDS THROUGHOUT WABASHA COUNTY, INCLUDING THE FACILITATION OF DEMENTIA FRIENDS CHAMPION TRAINING COURSES AND INFORMATION SESSIONS HOST DEMENTIA FRIENDS TRAINING AND INFORMATION SESSIONS IN THE WABASHA AREA TO INCREASE THE COMMUNITY'S ABILITY TO ADDRESS DEMENTIA ESTABLISH "SPARK!" CULTURAL PROGRAM FOR PEOPLE WITH MEMORY LOSS IN PARTNERSHIP WITH INTERESTED ORGANIZATIONS. SPARK! PROGRAMS ARE DESIGNED TO KEEP PARTICIPANTS ACTIVELY ENGAGED IN THEIR COMMUNITIES BY PROVIDING EXPERIENCES THAT STIMULATE CONVERSATIONS, PROVIDE PEER SUPPORT, AND INSPIRE CREATIVITY THROUGH ENGAGEMENT IN MUSEUM EXPERIENCES, WORKSHOPS, AND PROGRAMSMEDIUM-TERM INDICATOR: BY JUNE 30, 2022, AT LEAST 10 AGENCIES REPRESENTING HEALTHCARE, SOCIAL SERVICES, LAW AND LEGAL, FAITH, BUSINESS AND COMMUNITY SECTORS WILL HAVE PARTICIPATED IN DEMENTIA FRIENDS TRAINING. STRATEGY: SUSTAIN CAREGIVERS BY OFFERING INFORMATION, RESOURCES AND SUPPORTINCREASING ACCESS TO RESOURCES AND SOCIAL CONNECTIONS CAN HELP IMPROVE CAREGIVERS' QUALITY OF LIFE. ONE WAY TO DO THIS IS THROUGH MEMORY CAFS. MEMORY CAFS ARE EVIDENCE-BASED SOCIAL GATHERINGS FOR PATIENTS WITH DEMENTIA AND THEIR CAREGIVERS THAT OFFER SOCIAL INTERACTION, RESOURCES, AND SUPPORT.THE SENIOR HEALTH ACTION TEAM WILL: ESTABLISH UP TO THREE MEMORY CAFS THROUGHOUT WABASHA COUNTY THAT PROVIDE ONGOING SOCIAL SUPPORT GATHERINGS FOR INDIVIDUALS LIVING WITH DEMENTIA AND THEIR CARE PARTNERS CONTINUE TO PROMOTE AND OFFER RESOURCES AND PROGRAMMING THAT BENEFIT CAREGIVERSMEDIUM-TERM INDICATORS: BY JUNE 30, 2022, THREE MEMORY CAFS WILL BE OPERATIONAL IN WABASHA COUNTY. BY JUNE 30, 2022, 90 PERCENT OF MEMORY CAF CAREGIVER PARTICIPANTS WILL REPORT BEING SUPPORTED SOCIALLY AND WITH RESOURCES AT THE MEMORY CAF. BY JUNE 30, 2022, 90 PERCENT OF MEMORY CAF CAREGIVER PARTICIPANTS WILL REPORT REDUCED STRESS BECAUSE OF THE MEMORY CAF.STRATEGY: INCREASE DETECTION OF DEMENT |
| PART V, LINE 7A | HTTPS://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - SAINT ELIZABETH NURSING HOME | ||||
| 1200 GRANT BLVD WEST | WABASHA | MN | 55981 | NURSING HOME |
| 2 - SAINT ELIZABETH ASSISTED LIVING APTS | ||||
| 1200 GRANT BLVD WEST | WABASHA | MN | 55981 | RESIDENTAL HOUSING WITH SERVICES |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | PATIENTS WITH DEMONSTRATED FINANCIAL NEEDS WITH INCOME GREATER THAN 400% OF THE FPL MAY BE ELIGIBLE FOR CONSIDERATION UNDER A "MEANS TEST" FOR SOME DISCOUNT OF THEIR CHARGES FOR SERVICES FROM THE ORGANIZATION BASED ON A SUBSTANTIVE ASSESSMENT OF THEIR ABILITY TO PAY. THIS TEST CAPS TOTAL BALANCE DUE AT 25% OF TOTAL INCOME. A PATIENT ELIGIBLE FOR THE "MEANS TEST" DISCOUNT WILL NOT BE CHARGED MORE THAN THE CALCULATED AGB CHARGES. |
| PART I, LINE 7: | THE COST OF PROVIDING CHARITY CARE, MEANS-TESTED GOVERNMENT PROGRAMS, AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA, AND IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION ("CHA") GUIDELINES. THE ORGANIZATION USES A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, OR SELF PAY). THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. FOR THE INFORMATION IN THE TABLE, A COST-TO-CHARGE RATIO WAS CALCULATED AND APPLIED. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | SAINT ELIZABETH'S MEDICAL CENTER SUPPORTS A YOUTH READING PROGRAM. ACCORDING TO THE COUNTY HEALTH RANKINGS SITE, BETTER EDUCATED INDIVIDUALS LIVE LONGER, HEALTHIER LIVES THAN THOSE WITH LESS EDUCATION, AND THEIR CHILDREN ARE MORE LIKELY TO THRIVE. THIS IS TRUE EVEN WHEN FACTORS LIKE INCOME ARE TAKEN INTO ACCOUNT. SAINT ELIZABETH'S LEADERS PARTICIPATE IN MANY LOCAL ORGANIZATIONS AND COLLABORATIVE EFFORTS THAT HELP IMPROVE THE COMMUNITY. THESE INCLUDE THE LOCAL CHAMBER OF COMMERCE AND THE WABASHA AREA COMMUNITY RESOURCE CENTER. BY WORKING TOGETHER WITH OTHER ORGANIZATIONS IN THE COMMUNITY, WE EXPECT TO HAVE A GREATER IMPACT ON HEALTH. ACCORDING TO THE COUNTY HEALTH RANKINGS SITE, WITH A SHARED VISION AND COMMITMENT TO IMPROVED HEALTH, WORKING TOGETHER CAN YIELD BETTER RESULTS THAN WORKING ALONE. SAINT ELIZABETH MEDICAL CENTER PROVIDED JOB SHADOWING EXPERIENCES TO STUDENTS. ASSURING THAT RURAL COMMUNITIES HAVE A VIBRANT HEALTH CARE WORKFORCE IN THE FUTURE WILL HELP INCREASE ACCESS TO QUALITY OF CARE IN THE FUTURE.SAINT ELIZABETH MEDICAL CENTER ALSO CONDUCTS A COMMUNITY SHARPS PROGRAM. BY SAFELY REMOVING SHARPS FROM THE ENVIRONMENT, WE MAKE THE COMMUNITY SAFER IN TERMS OF INJURY AND INFECTION. |
| PART III, LINE 2: | AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE CORPORATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITHIN COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY GUNDERSEN HEALTH SYSTEM. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE CORPORATION'S POLICIES. AFTER APPLYING THECOST-TO-CHARGE RATIO, THE SHARE OF THE BAD DEBT EXPENSE IS $1,139,117, ($847,947 AT COST). |
| PART III, LINE 3: | THE ORGANIZATION HAS A VERY ROBUST FINANCIAL ASSISTANCE PROGRAM; THEREFORE, NO ESTIMATE IS MADE FOR BAD DEBT ATTRIBUTED TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. |
| PART III, LINE 4: | THE ORGANIZATION IS PART OF THE GUNDERSEN HEALTH SYSTEM'S CONSOLIDATED AUDIT IN WHICH THE FOOTNOTE THAT DISCUSSES THE BAD DEBT (IMPLICIT PRICE CONCESSIONS) EXPENSE IS LOCATED IN FOOTNOTE #2, PAGES 18. |
| PART III, LINE 8: | A COST TO CHARGE RATIO IS APPLIED TO THE ORGANIZATION'S MEDICARE EXPENSE TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT. ST. ELIZABETH'S HOSPITAL OF WABASHA, INC. FOLLOWS THE CATHOLIC HEALTH ASSOCIATION (CHA) GUIDELINES FOR DETERMINING COMMUNITY BENEFIT. CHA COMMUNITY BENEFIT REPORTING GUIDELINES SUGGEST THAT MEDICARE SHORTFALL IS NOT TREATED AS COMMUNITY BENEFIT. |
| PART III, LINE 9B: | THE ORGANIZATION FOLLOWS GUNDERSEN HEALTH SYSTEM'S GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED. |
| PART VI, LINE 2: | IN ADDITION TO THE CHNA REPORTED IN PART V, SECTION B, SAINT ELIZABETH'S MEDICAL CENTER USES BOTH HOSPITAL DATA AND RELIABLE, THIRD PARTY REPORTS, INCLUDING DATA FROM GOVERNMENT SOURCES, TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. THESE REPORTS PROVIDE INFORMATION ABOUT KEY HEALTH, SOCIOECONOMIC, AND DEMOGRAPHIC INDICATORS THAT POINT TO AREAS OF NEED. SAINT ELIZABETH'S MEDICAL CENTER UTILIZES THIS INFORMATION TO DETERMINE DEVELOP PROGRAMS AND SERVICES TO BE PROVIDED FOR THE COMMUNITY. THESE NEEDS AND INITIATIVES ARE PRESENTED TO SENIOR LEADERSHIP AND BOARD MEMBERS TO ENSURE THE FINDINGS ARE CONSIDERED IN DEVELOPING THE ORGANIZATION'S STRATEGY, POLICY DEVELOPMENT, AND INTERNAL FINANCIAL AND OPERATIONAL DECISIONS. |
| PART VI, LINE 3: | THE ORGANIZATION GOES TO GREAT LENGTHS IN ORDER TO INFORM AND EDUCATE PATIENTS/PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS AND UNDER THE ORGANIZATION'S CHARITY CARE POLICY. THE CHARITY CARE POLICY AND APPLICATION IS POSTED ON THE ORGANIZATION'S WEBSITE. ADMISSIONS, SOCIAL SERVICES, AND OTHER KEY AREAS CONTAIN SUMMARY INFORMATION OF THE CHARITY CARE POLICY. AS PART OF THE INTAKE/DISCHARGE PROCESS, PATIENTS ARE PROVIDED WITH A COPY OF THE POLICY AND OTHER IMPORTANT INFORMATION FOR FINANCIAL ASSISTANCE. IF DURING THE COURSE OF THE PATIENT REGISTRATION PROCESS, CARE ENCOUNTER, TREATMENT, OR UPON DISCHARGE IT BECOMES EVIDENT THAT A PATIENT MAY NEED FINANCIAL ASSISTANCE; THE PATIENT SHALL BE REFERRED TO THE ORGANIZATION'S COMMUNITY CARE PROGRAM. PATIENTS MAY BE IDENTIFIED AS NEEDING FINANCIAL ASSISTANCE AT ANY TIME DURING THE COURSE OF AN ENCOUNTER. A REFERRAL FOR CONSIDERATION OF COMMUNITY CARE FINANCIAL ASSISTANCE CAN BE INITIATED BY ANY MEMBER OF THE HOSPITAL'S WORKFORCE, INCLUDING MEDICAL STAFF MEMBERS, WHO BECOME AWARE OF THE PATIENT'S POTENTIAL NEED FOR COMMUNITY CARE FINANCIAL ASSISTANCE. THE COMMUNITY CARE POLICY WAS ALSO TRANSLATED INTO DIALECTS PREVALENT IN THE COMMUNITY IN ORDER TO REACH OUT TO THOSE THAT MAY SPEAK ANOTHER LANGUAGE (SPANISH). PATIENT REGISTRATION STAFF AND FINANCIAL COUNSELORS ARE PROVIDED WITH SCRIPTS TO FOLLOW WHEN INTERACTING WITH PATIENTS. AS PART OF THE CHARITY CARE PROCESS, PATIENTS MUST REGISTER WITH THE COUNTY PUBLIC ASSISTANCE TO SEE IF THEY MAY QUALIFY UNDER ANY OTHER FEDERAL OR STATE PROGRAMS. |
| PART VI, LINE 4: | SAINT ELIZABETH'S MEDICAL CENTER PRIMARILY SERVES THE RESIDENTS OF WABASHA COUNTY, MINNESOTA, AND THE SURROUNDING COUNTIES IN A RURAL AREA OF EASTERN MINNESOTA AND WESTERN WISCONSIN. THE POPULATION OF WABASHA COUNTY IS APPROXIMATELY 21,000, WITH 7% OF RESIDENTS LIVING AT OR BELOW THE FEDERAL POVERTY THRESHOLD. THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $62,000. APPROXIMATELY 5% OF THE INDIVIDUALS LIVING IN THE COUNTY ARE UNINSURED AND 12.7% RECEIVE MEDICAID. WABASHA COUNTY IS A DESIGNATED PRIMARY CARE SHORTAGE AREA. THERE IS ONE HOSPITAL (SAINT ELIZABETH'S MEDICAL CENTER) IN WABASHA COUNTY. |
| PART VI, LINE 5: | THE ORGANIZATION STRIVES TO FURTHER ITS EXEMPT PURPOSES BY THE FOLLOWING:-THE ORGANIZATION'S GOVERNING BOARD CONSISTS PRIMARILY OF PERSONS WHO RESIDE WITHIN THE PRIMARY SERVICE AREA WHO ARE NOT EMPLOYEES OF THE ORGANIZATION.-AS MENTIONED, THE ORGANIZATION PROVIDES SEVERAL SERVICES WHICH ARE NOT OTHERWISE AVAILABLE BEING IN A RURAL SETTING.-BASED ON THE ORGANIZATION'S MISSION, EMERGENCY ROOMS ARE MADE AVAILABLE TO ALL PATIENTS REGARDLESS OF THE ABILITY TO PAY.-THE ORGANIZATION ALSO PARTICIPATES IN THE EDUCATION AND TRAINING OF HEALTHCARE PROFESSIONALS THROUGH INTERNSHIP PROGRAMS.-THE HOSPITAL PARTICIPATES IN GOVERNMENT-SPONSORED HEALTH PROGRAMS (MEDICARE, MEDICAID, CHAMPUS, TRICARE).-THE HOSPITAL OFFERS VOLUNTEER OPPORTUNITIES TO THE COMMUNITY OR EVIDENCE OF THE ORGANIZATION'S RESPONSIVENESS TO THE COMMUNITY, INCLUDING OPPORTUNITIES FOR COMMUNITY INVOLVEMENT IN GOVERNANCE AND ADVISORY GROUPS. EXAMPLES OF PROGRAMS THAT WERE ESTABLISHED IN THE TAX YEAR THAT RESPONDED TO COMMUNITY NEEDS INCLUDE:-THE FACILITY STRIVES TO BE A LOW-COST/LOW-CHARGE FACILITY.-ADVOCATE COMMUNITY WIDE, STATE OR NATIONAL EFFORTS TO IMPROVE HEALTH OF THE POPULATION AND INCREASE ACCESS. - PARTNERSHIPS WITH OTHERS IN THE COMMUNITY (INCLUDING PUBLIC HEALTH DEPARTMENTS) TO IMPROVE COMMUNITY HEALTH AND WELL-BEING.- THE ROLE OF THE EMERGENCY DEPARTMENT AND URGENT CARE UNITS IN SERVING ALL PERSONS REGARDLESS OF ABILITY TO PAY.- AVAILABILITY OF FINANCIAL ASSISTANCE AND SLIDING SCALE DISCOUNTS AND CHANGES TO FINANCIAL ASSISTANCE OR COLLECTION POLICIES THAT WOULD BE VIEWED AS CONSTRUCTIVE.- THE ORGANIZATION IS A SOLE COMMUNITY HOSPITAL.- COMMUNITY MEMBERS UTILIZE THE HOSPITAL AS A VEHICLE TO CONNECT WITH AND CONTRIBUTE TO INDIVIDUALS AND THE OVERALL COMMUNITY THROUGH PHILANTHROPY AND VOLUNTEERING.- PROGRAMS ARE HAVING AN IMPACT ON COMMUNITY HEALTH ESPECIALLY PREVENTION ACTIVITIES, EFFORTS TO IMPROVE HEALTH AND INCREASE ACCESS TO HEALTH CARE SERVICES AND REDUCING HEALTH CARE COSTS. BEYOND INPATIENT HOSPITALIZATIONS, WE PROVIDE LOCAL ACCESS TO DIALYSIS, DIAGNOSTICS, EMERGENCY SERVICES AND URGENT CARE, SURGICAL SERVICES, EXTENDED CARE, LABORATORY AND RADIOLOGY SERVICES, REHAB SERVICE, PRIMARY CARE, SPECIALTY MEDICINE, SLEEP ASSESSMENT SERVICES, RETAIL PHARMACY AND RESPIRATORY THERAPY SERVICES. |
| PART VI, LINE 6: | SAINT ELIZABETH'S HOSPITAL OF WABASHA, INC IS AFFILIATED WITH GUNDERSEN LUTHERAN HEALTH SYSTEM. GUNDERSEN LUTHERAN HEALTH SYSTEM IS AN INTEGRATED HEALTH CARE SYSTEM THAT PROVIDES COMPREHENSIVE MEDICAL CARE TO PATIENTS PRIMARILY IN WISCONSIN, AS WELL AS IN IOWA AND MINNESOTA, BY OPERATING HOSPITALS, CLINICS, HEALTH PLANS, LONG-TERM CARE FACILITIES, AMBULANCE SERVICES, A FOUNDATION, AND AN ENERGY-PRODUCING COMPANY, IN ADDITION TO PROVIDING MEDICAL AND HEALTH/WELLNESS EDUCATION AND COMMUNITY OUTREACH, AND CONDUCTING MEDICAL EDUCATION AND CLINICALLY BASED RESEARCH. AS PART OF ITS OVERALL STRATEGY, THE SYSTEM HAS AFFILIATED WITH SEVERAL CRITICAL ACCESS HOSPITALS (CAHS) THAT ENABLE HIGHLY TRAINED PHYSICIANS TO PROVIDE COMPREHENSIVE INPATIENT, OUTPATIENT, AND CLINICAL CARE SERVICES TO PATIENTS IN THEIR COMMUNITIES. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | MN |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DENNIS SPANO | ||||||||||||||
| PHYSICIAN | $0 | $507,705 | $0 | $4,000 | $0 | $4,189 | $0 | $42,050 | $0 | $17,982 | $0 | $575,926 | $0 | $0 |
| RUTH TIFFAULT | ||||||||||||||
| PHYSICIAN | $0 | $383,012 | $0 | $1,800 | $0 | $3,333 | $0 | $30,450 | $0 | $21,738 | $0 | $440,333 | $0 | $0 |
| PHILLIP SCHWEND | ||||||||||||||
| SURGEON | $0 | $374,137 | $0 | $2,000 | $0 | $35 | $0 | $42,050 | $0 | $18,990 | $0 | $437,212 | $0 | $0 |
| EARLE MUNNS | ||||||||||||||
| PHYSICIAN | $0 | $293,725 | $0 | $2,000 | $0 | $3,085 | $0 | $41,890 | $0 | $18,115 | $0 | $358,815 | $0 | $0 |
| AMANDA J STERRY | ||||||||||||||
| APRN | $267,991 | $0 | $2,000 | $0 | $0 | $0 | $10,800 | $0 | $0 | $0 | $280,791 | $0 | $0 | $0 |
| ANDREA L HAUSER | ||||||||||||||
| ADMINISTRATOR DIRECTOR | $0 | $183,421 | $0 | $10,870 | $0 | $8,450 | $0 | $29,046 | $0 | $15,834 | $0 | $247,621 | $0 | $0 |
| JIM ROOT | ||||||||||||||
| ADMINISTRATOR | $0 | $179,210 | $0 | $2,000 | $0 | $2,084 | $0 | $26,366 | $0 | $2,563 | $0 | $212,223 | $0 | $0 |
| JOHN WOLFE | ||||||||||||||
| FINANCE ADMINISTRATOR | $0 | $155,318 | $0 | $2,000 | $0 | $5,711 | $0 | $23,206 | $0 | $18,948 | $0 | $205,183 | $0 | $0 |
| KURT L HENN | ||||||||||||||
| MANAGER, PHARM & PROV LIAISON | $163,230 | $0 | $4,000 | $0 | $16 | $0 | $6,785 | $0 | $25,964 | $0 | $199,995 | $0 | $0 | $0 |
| KIMBERLY D WOLTER | ||||||||||||||
| DIRECTOR, NURSING | $150,777 | $0 | $4,000 | $0 | $0 | $0 | $6,351 | $0 | $4,007 | $0 | $165,135 | $0 | $0 | $0 |
| PAUL FISCH | ||||||||||||||
| DIRECTOR | $0 | $113,959 | $0 | $2,000 | $0 | $8,951 | $0 | $18,157 | $0 | $20,346 | $0 | $163,413 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | GROSS-UP PAYMENTS RELATED TO EMPLOYEE RECOGNITION, FOR JIM ROOT, JOHN WOLFE, JOHN CIERZAN, KURT HENN, ANDREA HAUSER, PAUL FISCH, LLOYD HAAS, INCLUDED IN TAXABLE COMPENSATION |
| PART I, LINE 3 | A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY, AND -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PLEASE REFER TO THE FORM 990, PART VI, LINE 15A DISCLOSURE IN SCHEDULE O FOR ADDITIONAL DETAILS ON HOW COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED. |
| PART I, LINE 4B | ELIGIBLE EXECUTIVES PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990. SCHEDULE J, PART II, COLUMN B. NO INDIVIDUALS RECEIVED CURRENT YEAR DISTRIBUTIONS. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TRACY HENN | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | FAMILY MEMBER TO KEY EMPLOYEE - KURT L. HENN | RelationshipDescriptionTxt |
| Transaction | $139,600 | TransactionAmt |
| Transaction | EMPLOYEE OF HOSPITAL | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | SAINT ELIZABETH'S HOSPITAL OF WABASHA, INC. HAS A SINGLE CORPORATE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | SAINT ELIZABETH'S HOSPITAL OF WABASHA, INC HAS A SINGLE CORPORATE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., WHO CAN ELECT MEMBERS TO THE GOVERNING BODY OF SAINT ELIZABETH'S HOSPITAL OF WABASHA, INC. |
| FORM 990, PART VI, SECTION A, LINE 7B | ALL DECISIONS THAT HAVE A MATERIAL IMPACT TO SAINT ELIZABETH'S HOSPITAL OF WABASHA, INC., FINANCIAL INFORMATION, OR CORPORATION ARE SUBJECT TO APPROVAL BY ITS SOLE CORPORATE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WILL BE AVAILABLE FOR ALL BOARD MEMBERS ONCE REVIEWED BY THE CFO AND 990 IS APPROVED AND FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES MONITORS CONFLICTS ON BEHALF OF ST. ELIZABETH'S HOSPITAL OF WABASHA INC. ON AN ANNUAL BASIS BY REVIEWING DISCLOSURES ON COMPLETED CONFLICT OF INTEREST STATEMENTS. THE CONFLICT OF INTEREST REVIEW PANEL MEETS TO REVIEW ALL DISCLOSURES AND DETERMINE AN APPROPRIATE RESOLUTION TO BE ISSUED. IF A BOARD MEMBER WERE TO HAVE A RELATIONSHIP WITH ANOTHER COMPANY, THEY WOULD BE INSTRUCTED TO NOT MAKE DECISIONS WITH RESPECT TO PURCHASING PRODUCTS OR SERVICES FROM THAT COMPANY OR SUPPLIERS OR POTENTIAL SUPPLIERS OF THAT COMPANY WHILE SERVING ON THE BOARD. THEY MAY PARTICIPATE IN DISCUSSIONS RELATED TO SUCH PURCHASES, BUT THEY MUST DISCLOSE THEIR RELATIONSHIP DURING THESE DISCUSSIONS. |
| FORM 990, PART VI, SECTION B, LINE 15 | ALL PERSONNEL SERVICES FOR ST. ELIZABETH'S MEDICAL CENTER, INC. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. THE COMPENSATION OF THE CEO IS DETERMINED ANNUALLY BY A COMMITTEE MADE UP OF THE COMMUNITY MEMBERS OF THE BOARD OF TRUSTEES. THEIR DETERMINATION IS MADE AFTER A REVIEW OF MARKET DATA OBTAINED FROM SEVERAL ORGANIZATIONS AND CEO PERFORMANCE. MEETING MINUTES ARE TAKEN AND KEPT AT THE MEETINGS WHERE SUCH DISCUSSIONS TAKE PLACE. RECOMMENDATIONS FOR COMPENSATION FOR THE ORGANIZATIONS' KEY MANAGEMENT EMPLOYEES ARE DEVELOPED ANNUALLY BY THE CEO, AFTER A REVIEW OF PERFORMANCE AND COMPARABLE MARKET DATA. THE PROPOSED SALARIES ARE INDEPENDENTLY REVIEWED BY AN OUTSIDE AUDITING FIRM. THE COMPENSATION RECOMMENDATIONS, AUDIT REPORTS, ALONG WITH THE MARKET DATA, ARE PRESENTED TO A COMMITTEE MADE UP OF THE COMMUNITY MEMBERS OF THE BOARD OF TRUSTEES. THE COMPENSATION AMOUNTS ARE NOT EFFECTIVE UNTIL THE BOARD COMMITTEE APPROVES THEM. MEETING MINUTES ARE TAKEN AND KEPT AT THE MEETINGS WHERE THE BOARD REVIEWS AND APPROVES THE COMPENSATION OF THE KEY EMPLOYEES. |
| FORM 990, PART VI, SECTION C, LINE 19 | REQUESTS FOR ALL DOCUMENTS ARE MADE THROUGH THE LEGAL DEPARTMENT AND THE APPROPRIATE DOCUMENTS ARE MADE AVAILABLE FOR INSPECTION IN THE LEGAL DEPARTMENT. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (21 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| COMMUNITY HOUSING OF LA CROSSE INC | |||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391586700 | INDEPENDENT LIVING | WI | 501(C)(3) | LINE 10 | LUTHERAN REAL ESTATE HOLDING CORP | Yes (1) | |
| GUNDERSEN ADMINISTRATIVE SERVICES INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391606449 | SUPPORTING ORGANIZATION | WI | 501(C)(3) | LINE 12B, II | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| GUNDERSEN CLINIC LTD | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391028657 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| GUNDERSEN LUTHERAN CREDENTIALING SERVICES INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391856898 | CREDENTIALING SERVICES | WI | 501(C)(3) | LINE 12C, III-FI | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391866425 | SUPPORTING ORGANIZATION | WI | LINE 12B, II | 0 | N/A | ||
| GUNDERSEN LUTHERAN MEDICAL CENTER INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 390813416 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391249705 | FOUNDATION | WI | 501(C)(3) | LINE 7 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| HARMONY COMMUNITY HEALTHCARE INC | |||||||||||
| 815 MAIN AVENUE S | HARMONY | MN | 55939 | 410711606 | HEALTH CARE | MN | 501(C)(3) | LINE 10 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| LUTHERAN HOUSING OF LA CROSSE INC | |||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391751934 | INDEPENDENT LIVING | WI | 501(C)(3) | LINE 10 | LUTHERAN REAL ESTATE HOLDING CORP | Yes (1) | |
| LUTHERAN REAL ESTATE HOLDING CORPORATION | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 56401 | 391480826 | HOUSING | WI | 501(C)(3) | LINE 12C, III-FI | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| MEMORIAL HEALTHCARE FOUNDATION INC | |||||||||||
| PO BOX 40 | FRIENDSHIP | WI | 53934 | 391775074 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC | Yes (1) | |
| MEMORIAL HOSPITAL OF BOSCOBEL | |||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 53805 | 390845590 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC | |||||||||||
| 402 W LAKE STREET | FRIENDSHIP | WI | 53934 | 390944012 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTERHAN HEALTH SYSTEM INC | Yes (1) | |
| PALMER LUTHERAN HEALTH CENTER | |||||||||||
| 112 JEFFERSON STREET | WEST UNION | IA | 52175 | 421320763 | HEALTH CARE | IA | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| ST JOSEPH'S HEALTH SERVICES INC | |||||||||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | 390929538 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| ST JOSEPH'S MEMORIAL FOUNDATION INC | |||||||||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | 391455787 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | ST JOSEPH'S HEALTH SERVICES INC | Yes (1) | |
| TRI-COUNTY MEMORIAL FOUNDATION INC | |||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 300093022 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | TRI-COUNTY MEMORIAL HOSPITAL INC | Yes (1) | |
| TRI-COUNTY MEMORIAL HOSPITAL INC | |||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 390704510 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| TRI-STATE AMBULANCE INC | |||||||||||
| 235 CAUSEWAY BLVD | LA CROSSE | WI | 54603 | 391965415 | MEDICAL TRANSPORTATION | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| TRI-STATE REGIONAL AMBULANCE INC | |||||||||||
| 235 CAUSEWAY BLVD | LA CROSSE | WI | 54603 | 391962965 | MEDICAL TRANSPORTATION | WI | 501(C)(3) | LINE 10 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| TWEETEN LUTHERAN HEALTHCARE CENTER INC | |||||||||||
| 125 FIFTH AVENUE SE | SPRING GROVE | MN | 55974 | 411565003 | HEALTH CARE | MN | 501(C)(3) | LINE 10 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| GUNDERSEN LUTHERAN ENVISION LLC | |||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 264706546 | RENEWABLE ENERGY | WI | N/A | C | Yes (1) |
| 3REALESTATE LLC | |||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | RENTAL | WI | N/A | C | Yes (1) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | 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 | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES INC | ||
| E | $1,000,000 | FMV |
| GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES INC | ||
| M | $2,848,083 | FMV |
| GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES INC | ||
| O | $3,250,202 | FMV |
| GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES INC | ||
| P | $186,524 | FMV |