ST CROIX REGIONAL MEDICAL CENTER: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- ST CROIX REGIONAL MEDICAL CENTER (EIN 39-0890676)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2021-04-07
- IRS object ID
- 202100979349301600
- Schema version
- 2019v5.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-04-07T14:56:30-05:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390890676 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CROIX REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STCR | BusinessNameControlTxt |
| Phone | 7154830556 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SALLY BAJAK | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7154830556 | PhoneNum |
| Signature | 2021-03-27 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2021-03-27 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVE DOBOSENSKI | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $122,161,632 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SCRMC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1954 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | WE HELP PEOPLE TO LIVE HEALTHIER, HAPPIER AND LONGER LIVES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 898 | TotalEmployeeCnt |
| Total Volunteers | 150 | TotalVolunteersCnt |
| Total Gross UBI | $4,665,966 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $145,264 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,890,194 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $123,997,967 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $117,452,710 | CYProgramServiceRevenueAmt |
| PY Investment Income | $79,439 | PYInvestmentIncomeAmt |
| CY Investment Income | $221,815 | CYInvestmentIncomeAmt |
| PY Other Revenue | $332,333 | PYOtherRevenueAmt |
| CY Other Revenue | $293,182 | CYOtherRevenueAmt |
| PY Total Revenue | $124,555,003 | PYTotalRevenueAmt |
| CY Total Revenue | $121,857,901 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $7,970 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $280 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $56,323,072 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $56,715,790 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $63,733,953 | PYOtherExpensesAmt |
| CY Other Expenses | $59,233,662 | CYOtherExpensesAmt |
| PY Total Expenses | $120,064,995 | PYTotalExpensesAmt |
| CY Total Expenses | $115,949,732 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,490,008 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,908,169 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $83,964,969 | TotalAssetsBOYAmt |
| Total Assets EOY | $103,196,260 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $15,375,684 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $28,698,806 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $68,589,285 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $74,497,454 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WE HELP PEOPLE TO LIVE HEALTHIER, HAPPIER AND LONGER LIVES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $77,379,155 | ExpenseAmt |
| Grant | $280 | GrantAmt |
| Revenue | $84,386,659 | RevenueAmt |
| Desc | OUTPATIENT SERVICES - SURGICAL, LABORATORY, BASIC, AND ADVANCED RADIOLOGY PROCEDURES. DURING FISCAL YEAR 2020, THERE WERE 9,496 EMERGENCY ROOM VISITS RECORDED, 1,103 OUTPATIENT SURGERIES, AND 109,686 CLINICAL VISITS.INPATIENT SERVICES - OBSTETRIC, MEDICAL-SURGICAL, INTENSIVE CARE, AND SHORT STAY INPATIENT CARE. DURING FISCAL YEAR 2020, THERE WERE 240 BIRTHS, 1,278 INPATIENT ADMISSIONS, AND A TOTAL OF 4,136 INPATIENT DAYS FOR AN AVERAGE LENGTH OF 3.24 DAYS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $11,480,121 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $14,154,470 | RevenueAmt |
| Desc | ST. CROIX REGIONAL MEDICAL CENTER OPERATES FOUR PROVIDER BASED CLINICS AND ONE FREE STANDING CLINIC. TOGETHER, THE CLINICS STRIVE TO MEET THE HEALTHCARE NEEDS OF PATIENTS AND FAMILIES WHO LIVE AND WORK IN THE COMMUNITIES THEY SERVE. A TOTAL OF 109,686 CLINIC VISITS OCCURRED IN FISCAL YEAR 2020. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,774,308 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $7,119,461 | RevenueAmt |
| Desc | CONTRACT PHARMACY - ST. CROIX REGIONAL MEDICAL CENTER BECAME ELIGIBLE TO PARTICIPATE IN THE 340B DRUG PRICING PROGRAM, WHICH IS MANAGED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OFFICE OF PHARMACY AFFAIRS (OPA), RESULTING IN THE REALIZATION OF A CONTRACT PHARMACY SERVICE. PARTICIPATION IN THE 340B DRUG PRICING PROGRAM RESULTS IN SIGNIFICANT SAVINGS, ESTIMATED TO BE 20-50%, ON THE COST OF PHARMACEUTICALS FOR USE BY OUTPATIENTS OF THE FACILITY. THROUGH THIS PROGRAM, ST. CROIX REGIONAL MEDICAL CENTER IS ABLE TO REACH MORE ELIGIBLE PATIENTS AND PROVIDE MORE COMPREHENSIVE SERVICES. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,510,199 | ExpenseAmt |
| Revenue | $6,793,825 | RevenueAmt |
| Desc | ST. CROIX VALLEY PHARMACIES PROVIDE LOCAL PHARMACY CARE TO THE SERVICE AREA OF ST. CROIX REGIONAL MEDICAL CENTER. ST. CROIX VALLEY PHARMACIES IS THE SOLE MEMBER OF THE FOLLOWING COMMUNITY PHARMACIES: UNITY PHARMACY LOCATED IN THE UNITY CLINIC BUILDING NEAR BALSAM, WI, FREDERIC PHARMACY LOCATED IN THE FREDERIC CLINIC BUILDING IN FREDERIC, WI, AND, ST. CROIX FALLS PHARMACY LOCATED IN THE ST. CROIX FALLS CLINIC BUILDING IN ST. CROIX FALLS, WI. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $5,510,199 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $6,793,825 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $100,143,783 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 90 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 898 | 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 | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SALLY BAJAK | PersonNm |
| Phone | 7154830556 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| MARISA SPENCER | |||||||
| PHYSICIAN | 40.00 | Yes (X) | $540,242 | $0 | $7,996 | ||
| MUHAMMAD KHAN | |||||||
| PHYSICIAN | 40.00 | Yes (X) | $475,143 | $0 | $33,712 | ||
| VITTAL NAGAR | |||||||
| PHYSICIAN | 40.00 | Yes (X) | $469,356 | $0 | $32,533 | ||
| DANIELLE REDBURN | |||||||
| PHYSICIAN | 40.00 | Yes (X) | $471,145 | $0 | $40,980 | ||
| JAMES WALLACE | |||||||
| PHYSICIAN | 40.00 | Yes (X) | $439,160 | $0 | $43,660 | ||
| DAVE DOBOSENSKI | |||||||
| CEO | 40.00 | $389,510 | $0 | $28,847 | Yes (X) | ||
| SALLY BAJAK | |||||||
| CFO | 40.00 | $187,886 | $0 | $29,009 | Yes (X) | ||
| JOSEPH THIMM | |||||||
| CHAIR | 0.50 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| PATRICK MCDONOUGH MD | |||||||
| VICE CHAIR | 40.00 | $274,060 | $0 | $39,881 | Yes (X) | Yes (X) | |
| MICHAEL BUCHITE | |||||||
| TREASURER | 0.50 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| GURDESH BEDI | |||||||
| SECRETARY/PHYSICIAN OF SCRMC | 40.00 | $870,386 | $0 | $46,800 | Yes (X) | Yes (X) | |
| JOHN DRISCOLL | |||||||
| TRUSTEE | 0.50 | $0 | $0 | $0 | Yes (X) | ||
| CONNIE ERICKSON | |||||||
| TRUSTEE | 0.50 | $0 | $0 | $0 | Yes (X) | ||
| ANDREA JERRICK | |||||||
| TRUSTEE (THRU AUG) | 0.50 | $36,393 | $0 | $1,490 | Yes (X) | ||
| REBECCA LYMAN MD | |||||||
| TRUSTEE | 40.00 | $225,760 | $0 | $37,029 | Yes (X) | ||
| WILLIAM TIES | |||||||
| TRUSTEE | 0.50 | $0 | $0 | $0 | Yes (X) | ||
| JOSEPH WHITE | |||||||
| TRUSTEE | 0.50 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,379,041 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $341,937 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 81 | 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 |
|---|---|---|---|---|---|
| MIDWEST RADIOLOGY PA | |||||
| 2355 HWY 35 WEST SUITE 100 | ROSEVILLE | MN | 55113 | RADIOLOGY SERVICES | $1,805,611 |
| ST CROIX VALLEY ANESTHESIA LLC | |||||
| BOX 45 | OSCEOLA | WI | 54020 | CRNA SERVICES | $1,483,432 |
| TWIN CITIES ORTHOPEDICS PA | |||||
| 4200 DAHLBERG DR SUITE 300 | GOLDEN VALLEY | MN | 55422 | ORTHOPEDIC SURGICAL SERVICES | $1,291,600 |
| MIDWEST SPINE & BRAIN INSTITUTE | |||||
| 1950 NORTHWESTERN AVE SUITE 102 | STILLWATER | MN | 55082 | SPINAL SURGICAL SERVICES | $953,122 |
| NORTH SUBURBAN EYE SPECIALISTS | |||||
| 3777 COON RAPIDS BLVD NW SUITE 100 | COON RAPIDS | MN | 55433 | OPTHALMOLOGY SERVICES | $927,534 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $3,691,748 | GovernmentGrantsAmt |
| All Other Contributions | $198,446 | AllOtherContributionsAmt |
| Total Contributions | $3,890,194 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT SERVICES | 624100 | $98,541,129 | $98,541,129 | |
| CONTRACT PHARMACY | 624100 | $7,119,461 | $7,119,461 | |
| FREDERIC PHARMACY | 624100 | $4,514,134 | $2,393,068 | $2,121,066 |
| SCF PHARMACY | 624100 | $3,421,896 | $2,174,188 | $1,247,708 |
| UNITY PHARMACY | 624100 | $2,234,610 | $1,183,745 | $1,050,865 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,621,480 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,008,824 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $246,327 | UnrelatedBusinessRevenueAmt |
| Exclusion | $366,329 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $117,452,710 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $254,129 | TotalRevenueColumnAmt |
| Exclusion | $254,129 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $17,700 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $11,564 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $6,136 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,136 | TotalRevenueColumnAmt |
| Exclusion | $6,136 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $259,853 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $292,167 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$32,314 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$32,314 | TotalRevenueColumnAmt |
| Exclusion | -$32,314 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| JOINT VENTURE REVENUE | 900099 | $253,046 | $253,046 | |
| EHR INCENTIVE | 900099 | $34,000 | $34,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $287,046 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $121,857,901 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $112,454,415 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $4,665,966 | UnrelatedBusinessRevenueAmt |
| Exclusion | $847,326 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $280 | TotalAmt |
| Program Services | $280 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $614,291 | TotalAmt |
| Management And General | $614,291 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,893,923 | TotalAmt |
| Program Services | $37,219,229 | ProgramServicesAmt |
| Management And General | $7,674,694 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,987,229 | TotalAmt |
| Program Services | $1,607,454 | ProgramServicesAmt |
| Management And General | $379,775 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,258,854 | TotalAmt |
| Program Services | $4,986,681 | ProgramServicesAmt |
| Management And General | $1,272,173 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,961,493 | TotalAmt |
| Program Services | $2,375,643 | ProgramServicesAmt |
| Management And General | $585,850 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $203,441 | TotalAmt |
| Program Services | $9,320 | ProgramServicesAmt |
| Management And General | $194,121 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,883 | TotalAmt |
| Management And General | $49,883 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,372,753 | TotalAmt |
| Program Services | $14,809,584 | ProgramServicesAmt |
| Management And General | $1,563,169 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $204,369 | TotalAmt |
| Program Services | $6,631 | ProgramServicesAmt |
| Management And General | $197,738 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $527,425 | TotalAmt |
| Program Services | $306,861 | ProgramServicesAmt |
| Management And General | $220,564 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,624,162 | TotalAmt |
| Program Services | $1,021,717 | ProgramServicesAmt |
| Management And General | $1,602,445 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,166,333 | TotalAmt |
| Program Services | $1,850,292 | ProgramServicesAmt |
| Management And General | $316,041 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,166 | TotalAmt |
| Program Services | $61,320 | ProgramServicesAmt |
| Management And General | $43,846 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $247,847 | TotalAmt |
| Program Services | $199,755 | ProgramServicesAmt |
| Management And General | $48,092 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,328 | TotalAmt |
| Program Services | $4,902 | ProgramServicesAmt |
| Management And General | $426 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,042,725 | TotalAmt |
| Program Services | $3,708,448 | ProgramServicesAmt |
| Management And General | $334,277 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $324,761 | TotalAmt |
| Program Services | $234,312 | ProgramServicesAmt |
| Management And General | $90,449 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $15,162,151 | $15,162,151 | |
| DRUGS AND MEDS | $13,532,506 | $13,310,122 | $222,384 |
| PROVISION FOR BAD DEBTS | $2,092,421 | $2,092,421 | |
| DUES AND PUBLICATIONS | $946,684 | $838,690 | $107,994 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $625,707 | TotalAmt |
| Program Services | $337,970 | ProgramServicesAmt |
| Management And General | $287,737 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,949,732 | TotalAmt |
| Program Services | $100,143,783 | ProgramServicesAmt |
| Management And General | $15,805,949 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $761,742 | BOYAmt |
| EOY | $1,068,304 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,481,786 | BOYAmt |
| EOY | $45,204,488 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,089,805 | BOYAmt |
| EOY | $12,524,938 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $237,911 | BOYAmt |
| EOY | $345,496 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,303,994 | BOYAmt |
| EOY | $3,175,806 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $660,819 | BOYAmt |
| EOY | $954,538 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $72,825,747 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $42,634,338 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,512,580 | BOYAmt |
| EOY | $30,191,409 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,455,563 | BOYAmt |
| EOY | $1,504,209 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $575,000 | BOYAmt |
| EOY | $517,500 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,885,769 | BOYAmt |
| EOY | $7,709,572 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,964,969 | BOYAmt |
| EOY | $103,196,260 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,109,773 | BOYAmt |
| EOY | $18,731,729 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $4,547,846 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,000 | BOYAmt |
| EOY | $95,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,132,911 | BOYAmt |
| EOY | $5,324,231 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,375,684 | BOYAmt |
| EOY | $28,698,806 | 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 | $68,589,285 | BOYAmt |
| EOY | $74,497,454 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,589,285 | BOYAmt |
| EOY | $74,497,454 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,964,969 | BOYAmt |
| EOY | $103,196,260 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $5,908,169 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $12,207 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $12,207 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | ST CROIX REGIONAL MEDICAL CENTER (THE ORGANIZATION") PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. A PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. THE ORGANIZATION IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE ORGANIZATION PAYS MEMBERSHIP FEES TO THE RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO DOES PROVIDE ANALYSIS ON CURRENT HEALTH CARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTH CARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. THE ORGANIZATION IS ALSO A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION. THESE DUES PAID ARE PRIMARILY USED TO ENSURE THEIR MEMBERS' PERSPECTIVES AND NEEDS ARE HEARD AND ADDRESSED IN NATIONAL HEALTH POLICY DEVELOPMENT, LEGISLATIVE AND REGULATORY DEBATES AND JUDICIAL MATTERS. THE ORGANIZATION IS ALSO A MEMBER OF THE NATIONAL RURAL HEALTH ASSOCIATION. THESE DUES PAID ARE PRIMARILY USED TO SUPPORT RURAL HEALTH ISSUES THROUGH ADVOCACY, COMMUNICATIONS, EDUCATION AND RESEARCH. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,491,495 | OtherCostOrOtherBasisAmt |
| Book Value | $1,491,495 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $44,563,914 | OtherCostOrOtherBasisAmt |
| Depreciation | $24,367,819 | DepreciationAmt |
| Book Value | $20,196,095 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $50,236 | OtherCostOrOtherBasisAmt |
| Depreciation | $45,466 | DepreciationAmt |
| Book Value | $4,770 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $26,720,102 | OtherCostOrOtherBasisAmt |
| Depreciation | $18,221,053 | DepreciationAmt |
| Book Value | $8,499,049 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $30,191,409 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| UNEMPLOYMENT RESERVE FUND | $411,890 |
| DEFERRED COMPENSATION PLAN | $4,199,027 |
| AMOUNTS RECEIVABLE FROM THIRD-PARTY REIMBURSEMENT PROGRAMS | $3,098,655 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $7,709,572 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| ASSET RETIREMENT OBLIGATION | $217,741 |
| DEFERRED COMPENSATION PLAN | $4,639,090 |
| DEFERRED PAYROLL TAXES | $467,400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $5,324,231 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $119,765,480 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $119,765,480 | RevenueSubtotalAmt |
| Other Revenues Not Included | $2,092,421 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $2,092,421 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $121,857,901 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $113,857,311 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $113,857,311 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $2,092,421 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $2,092,421 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $115,949,732 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 2,092,421. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 2,092,421. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $367,677 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $367,677 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00320 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,971,228 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,101,895 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,869,333 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03400 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,338,905 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,101,895 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,237,010 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03720 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $21,400,210 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,569,821 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,830,389 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07760 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $21,400,210 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,569,821 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,830,389 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07760 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $33,739,115 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $20,671,716 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,067,399 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11480 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,103,898 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $551,949 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $26,871,176 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,553,261 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $19,317,915 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CROIX REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SCRMC.ORG | WebsiteAddressTxt |
| State License | 1043240922 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CROIX REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SUPPLEMENTAL INFORMATION | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | WWW.HEALTHYPOLKCOUNTY.COM | OtherWebsiteURLTxt |
| 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 | SEE SUPPLEMENTAL INFORMATION | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://SCRMC.ORG/PATIENTS-VISITORS/INSURANCE-BILLING/FINANCIAL-ASSISTANCE/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://SCRMC.ORG/PATIENTS-VISITORS/INSURANCE-BILLING/FINANCIAL-ASSISTANCE/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://SCRMC.ORG/PATIENTS-VISITORS/INSURANCE-BILLING/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 Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 5: THE 2019 POLK COUNTY COMMUNITY HEALTH ASSESSMENT (CHA) IS THE RESULT OF A JOINT EFFORT BY EIGHT KEY PARTNERS WHO PROVIDED OVERSIGHT TO THE PROCESS, ASSURED COLLECTION AND COMPILATION OF SHARED DATA, AND ENGAGED RESIDENTS OF POLK COUNTY THROUGH A SERIES OF COMMUNITY MEETINGS AND SURVEYS. THESE EIGHT PARTNERS, REPRESENTING GOVERNMENTAL AGENCIES, LOCAL MEDICAL CENTERS AND HOSPITALS, UW-EXTENSION AND NONPROFIT ORGANIZATIONS, FORMED A CHA LEADERSHIP TEAM THAT WORKED TOGETHER TO ASSESS THE HEALTH OF POLK COUNTY RESIDENTS. THE PURPOSE OF A COMMUNITY HEALTH ASSESSMENT IS TO EVALUATE AND PRIORITIZE HEALTH CONCERNS IN ORDER TO EMPOWER THE COMMUNITY TO SOLVE HEALTH PROBLEMS AND IMPROVE HEALTH OUTCOMES. THE ULTIMATE GOAL IS FOR THE COMMUNITY TO COLLECTIVELY AND STRATEGICALLY TARGET EVIDENCE BASED INTERVENTIONS TO IMPROVE THE HEALTH OF THE POPULATION. THE CHA LEADERSHIP TEAM COLLECTED BOTH QUANTITATIVE AND QUALITATIVE DATA TO IDENTIFY THE TOP HEALTH PRIORITIES IN POLK COUNTY. METHODS USED INCLUDED A SURVEY, COMMUNITY FORUMS, A KEY PARTNER MEETING AND COMPREHENSIVE COLLECTION AND REVIEW OF SECONDARY HEALTH DATA. PARTNERS DISTRIBUTED THE COMMUNITY HEALTH SURVEY TO RESIDENTS THROUGHOUT POLK COUNTY FROM MID DECEMBER 2018 TO MID-FEBRUARY 2019. THE SURVEY WAS HOSTED BY THE SAME ONLINE DEVELOPMENT TOOL, SURVEY MONKEY, AS IN 2015 TO COMPARE SURVEY RESULTS. QUESTIONS WERE ADDED FOR THE 2019 VERSION TO ASSESS THE RESPONDENTS THOUGHTS ON THE SOCIAL DETERMINANTS OF HEALTH. THE LINK TO THE ONLINE SURVEY WAS WIDELY DISTRIBUTED THROUGH THE NETWORKS OF EACH OF THE PARTNER ORGANIZATIONS. THE SURVEY LAUNCH WAS ANNOUNCED BY A PRESS RELEASE AND WAS REPEATEDLY ADVERTISED IN LOCAL NEWSPAPERS, SOCIAL MEDIA, PARTNER WEBSITES AND FLYERS POSTED THROUGHOUT THE COUNTY. HARD COPIES OF THE SURVEY WERE AVAILABLE IN MEDICAL CENTER AND GOVERNMENT CENTER WAITING ROOMS WITH RECEPTION STAFF ENCOURAGING COMPLETION. SPECIAL EFFORT WAS MADE TO ENSURE THE SURVEY WAS AVAILABLE TO UNDERREPRESENTED GROUPS WHO CAN BE AT THE HIGHEST RISK OF SUFFERING FROM HEALTH DISPARITIES. THESE GROUPS INCLUDED WIC, PRENATAL CARE COORDINATION (PNCC), ECONOMIC SUPPORT AND BEHAVIORAL HEALTH PROGRAM PARTICIPANTS FROM POLK COUNTY, VETERANS SEEKING SERVICES FROM THE COUNTY VETERANS SERVICES OFFICE AND SENIORS ACCESSING SERVICES AT THE AGING AND DISABILITY RESOURCE CENTER (ADRC). FLYERS WERE LEFT IN LOCAL VILLAGE LAUNDROMATS, FOOD PANTRIES, AND GROCERY STORES WITH INFORMATION ON HOW TO ACCESS THE ONLINE SURVEY. SCHOOL SUPERINTENDENTS WERE SENT LINKS TO THE SURVEY AND ENCOURAGED TO FORWARD TO SCHOOL STAFF AND TO INCLUDE IN THEIR RESPECTIVE SCHOOL NEWSLETTERS. THE COUNTY LOCAL PASTOR GROUP WAS ALSO OUTREACHED AND PROVIDED LINKS TO THE ONLINE SURVEY. DATA FROM THE COMMUNITY SURVEY AND SECONDARY REVIEW WAS PRESENTED AND DISCUSSED AT BOTH THE COMMUNITY FORUMS AND KEY PARTNER MEETINGS WITH VOTING CONDUCTED FOR THE TOP HEALTH PRIORITIES. A TOTAL OF 907 POLK COUNTY RESIDENTS COMPLETED THE SURVEY. THIS WAS A 31% INCREASE IN THE RESPONSE RATE OVER THE 2016 COMMUNITY SURVEY. SURVEY RESPONDENTS REPRESENTED A WIDE RANGE OF COUNTY RESIDENTS, INCLUDING A VARIETY OF INCOME AND EDUCATIONAL LEVELS, AGE, AND HOUSEHOLD SIZE. OTHER THAN GENDER (A DISPROPORTIONATELY HIGH PERCENTAGE OF FEMALES COMPLETED THE SURVEY), THE DEMOGRAPHICS OF THE SURVEY RESPONDENTS OVERALL ALIGNED WITH THOSE OF POLK COUNTY AS A WHOLE. |
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 6A: THE MEDICAL CENTER WORKED IN COLLABORATION WITH AMERY HOSPITAL AND CLINIC AND OSCEOLA MEDICAL CENTER WITH THE ULTIMATE GOAL TO IDENTIFY PRIORITY HEALTH ISSUES AND TO DEVELOP STRATEGIES TO ADDRESS THE COMMUNITY'S HEALTH NEEDS. |
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 6B: IN ADDITION TO THE HOSPITAL FACILITIES MENTIONED ABOVE, THE MEDICAL CENTER WORKED IN COLLABORATION WITH THE POLK COUNTY HEALTH DEPARTMENT, MENTAL HEALTH TASK FORCE OF POLK COUNTY, UNITED WAY OF ST. CROIX VALLEY AND UNIVERSITY OF WISCONSIN. |
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 7D: HTTPS://WWW.SCRMC.ORG/DOCUMENTS/CHNA_CHA-FINAL-6_26_19.PDFSECTION B, LINE 10A:HTTPS://WWW.SCRMC.ORG/LEGAL-NOTICES/ |
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 11: THE COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE HEALTH FOCUS AREAS. AT EACH OF THESE VENUES, ATTENDEES HAD THE OPPORTUNITY TO PROVIDE INPUT ON THE TOP HEALTH FOCUS AREAS. THE FINAL TOP HEALTH FOCUS AREAS SELECTED WERE:1. MENTAL HEALTH2. SUBSTANCE ABUSE3. NUTRITION AND PHYSICAL ACTIVITY4. ACCESS TO CAREAFTER REVIEWING THE DATA AND MAPPING EXISTING RESOURCES, SCRMC DEVELOPED AN IMPLEMENTATION STRATEGY. THE SCRMC GOVERNING BOARD APPROVED THE IMPLEMENTATION STRATEGY ON JUNE, 2020. THE ABOVE NEEDS WERE PRIORITIZED BASED ON SIZE, SEVERITY, AVAILABLE DATA, AND THE HOSPITAL'S ABILITY TO HAVE AN IMPACT. IN ORDER TO ADDRESS PRIORITY NEEDS, SCRMC WILL ENGAGE KEY COMMUNITY PARTNERS IN IMPLEMENTING STRATEGIES ACROSS THE SERVICE AREA. THESE STRATEGIES INCLUDE MODIFYING POLICIES, PROVIDING SUPPORT, ENHANCING ACCESS, CHANGING CONSEQUENCES AND INCENTIVES, PROVIDING INFORMATION, AND ENHANCING SKILLS. USING THE PRINCIPLES OF THE WISCONSIN WAY MODEL, WHICH HAS ITS ROOTS IN THE COUNTY HEALTH RANKINGS, THE COMMUNITY TOOL BOX, AND HEALTHIEST WISCONSIN 2020, THE CHNA LEADERSHIP TEAM WILL ACT ON THE RESULTS OF THE 2019 CHNA TO SPEARHEAD THE NEXT PHASE OF THE COMMUNITY HEALTH IMPROVEMENT PROCESS, ACTION PLANNING. ADDITIONAL PARTNERS AND COMMUNITY MEMBERS WILL BE MOBILIZED UNDER THE UMBRELLA OF POLK UNITED, A COMMUNITY COALITION DEDICATED TO HEALTH IMPROVEMENT ACTIVITIES. PARTNERS AND MEMBERS WILL SERVE ON HEALTH PRIORITY WORKGROUPS THAT WILL DEVELOP ACTION ORIENTED THREE YEAR PLANS TO ADDRESS THE FOUR HEALTH PRIORITY AREAS WITH THE GOAL OF REDUCING HEALTH DISPARITIES AND IMPROVING POPULATION HEALTH. SCRMC WORKS COLLABORATIVELY WITH AMERY HOSPITAL AND CLINIC, OSCEOLA MEDICAL CENTER, MENTAL HEALTH TASK FORCE OF POLK COUNTY, POLK COUNTY HEALTH DEPARTMENT, UNITED WAY OF ST. CROIX VALLEY, AND UW-EXTENSION TO DETERMINE THE FOUR MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. SCRMC WOULD ALSO LIKE TO CONTRIBUTE EFFORTS TO OTHER COMMUNITY HEALTH NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. SCRMC IS ADDRESSING MENTAL HEALTH BY: - INTEGRATING STIGMA REDUCTION CAMPAIGNS SYSTEM-WIDE, ACROSS SECTORS, AND TO THE PUBLIC.- TRAINING STAFF IN MENTAL HEALTH FIRST AID.- STRATEGICALLY ALIGNING WITH COMMUNITY PARTNERS AND MENTAL HEALTH TASK FORCE TEAMS TO MAXIMIZE IMPACT AND REACH. SCRMC IS ADDRESSING SUBSTANCE ABUSE BY:- INTEGRATING STRATEGICALLY WITH PUBLIC HEALTH AND COMMUNITY PARTNERS.- SUPPORTING "DRUG FREE COMMUNITIES" THROUGH COALITION ENGAGEMENT AND GRANT FUNDING. SCRMC IS ADDRESSING NUTRITION AND PHYSICAL ACTIVITY BY:- SUPPORTING AND IMPLEMENTING REGION-WIDE ACTIVITIES WITH COMMUNITY PARTNERS (EXP. POWER OF PRODUCE). - CREATING AN INTERNAL IDENTIFICATION AND REFERRAL PROCESS THAT HELPS FAMILIES WITH NUTRITIONAL INADEQUACIES BE ROUTED TO THE APPROPRIATE COMMUNITY FOOD RESOURCES. - EDUCATING AREA YOUTH IN GARDENING AND HARVESTING. - CREATING A REGIONAL PHYSICAL ACTIVITY RESOURCE PLATFORM THAT IS USER FRIENDLY FOR PATIENTS, STAFF, AND COMMUNITY PARTNERS. SCRMC IS ADDRESSING ACCESS TO CARE BY: - OFFERING DENTAL SERVICES AS PART OF OUR CLINICAL SERVICES. - EXPANDING ACCESS TO AFFORDABLE INHALERS.- EXPANDING VACCINATION CAPABILITIES AT COMMUNITY PHARMACIES. SCRMC IS ADDRESSING SOCIAL DETERMINANTS OF HEALTH TO REDUCE HEALTH DISPARITIES THAT AFFECTS ALL HEALTH FOCUS AREAS, IS BY:- COLLABORATING WITH COMMUNITY PARTNERS TO ESTABLISH A PATHWAYS COMMUNITY HUB.- INTEGRATING A COMMUNITY HEALTH WORKER INTO THE SCRMC HEALTH SYSTEM. OTHER AREAS SCRMC IS ADDRESSING, NOT LISTED ABOVE OR IDENTIFIED AS A TOP FOCUS AREA, IS:- HEALTHY GROWTH AND DEVELOPMENT PROVIDERS WILL REVIEWING AND DISCUSS DEVELOPMENTAL MILESTONES AT WELL-CHILD VISITS. SCRMC IS, CURRENTLY, IN THE PROCESS OF APPLYING AND IMPLEMENTING THE "LITTLE MOMENTS COUNT" INITIATIVE BY INCORPORATING "REACH OUT AND READ" AT 6 MONTHS 5 YEARS OLD WELL-CHILD VISITS. - TOBACCO PREVENTION SCRMC IS COMMITTED TO PLAYING AN ACTIVE ROLE IN TOBACCO PREVENTION. STRATEGIES AND ACTIVITIES ARE AIMED AT PREVENTING, ELIMINATING, AND REDUCING SUBSTANCE USE. TOBACCO SCREENINGS, WHETHER FIRST HAND OR SECOND HAND SMOKE, IS AN ESSENTIAL QUESTION THAT IS ASKED AT EACH CLINIC AND HOSPITAL VISIT. PROVIDERS AND STAFF EDUCATE PATIENTS ON THE DETRIMENTS OF TOBACCO USE AND WILL SEND PATIENTS TO THE APPROPRIATE RESOURCES IF THEY ARE IN NEED OF ASSISTANCE. - INJURY AND VIOLENCE PREVENTION COMMUNITY INQUIRY HAS SURROUNDED A "TEXTING WHILE DRIVING" SCREENING QUESTION INTO THE ELECTRONIC HEALTH RECORD. FURTHER DISCUSSION MUST TAKE PLACE. WITH VIOLENCE PREVENTION, THERE IS STRONG SUPPORT FROM SCRMC IN TRAUMA-INFORMED CARE. SCRMC IS COLLABORATING EXTENSIVELY WITH COMMUNITY COMMITTEES SURROUNDING TRAUMA AND ADVERSE CHILDHOOD EXPERIENCES (ACE). THROUGH AWARENESS, EDUCATION, AND TREATMENT, SCRMC IS COMMITTED TO BEING A LEADER IN THIS AREA. - SEXUAL AND REPRODUCTIVE HEALTH SEXUAL AND REPRODUCTIVE HEALTH IS VERY IMPORTANT TO SCRMC. COUNSELING IS OFFERED FOR ANY ISSUE IN SEXUAL AND REPRODUCTIVE HEALTH. "TEEN HEALTH" INFORMATION IS INCLUDED IN ALL TEEN PRIMARY CARE VISITS IN THE AFTER VISIT SUMMARY (AVS). ALL PRIMARY CARE PROVIDERS SCREEN PATIENTS BETWEEN THE AGE OF 16-24 FOR CHLAMYDIA AND GONORRHEA IF THEY ARE DEEMED SEXUALLY ACTIVE. CERVICAL AND BREAST CANCER SCREENINGS ARE ADDRESSED AT EACH PRIMARY CARE VISIT. PATIENT EDUCATION MATERIALS ARE DISTRIBUTED THROUGH THE FACILITY IN A HEALTH LITERATE LANGUAGE. - ORAL HEALTH SCRMC KNOWS HOW IMPORTANT ORAL HEALTH IS TO A PERSON'S OVERALL WELL-BEING. PROVIDERS PROMOTE THE IMPORTANCE OF ORAL HEALTH TO PATIENTS AND WHERE THEY CAN SEEK SERVICES IN THE AREA. SCRMC NOW PROVIDES DENTAL SERVICES IN BURNETT COUNTY AT THE WEBSTER DENTAL CLINIC LOCATED IN THE WEBSTER HEALTH CENTER. - OCCUPATIONAL AND ENVIRONMENTAL HEALTH SCRMC PROVIDERS PROMOTE THE POSITIVE HEALTH BENEFITS OF GOOD OCCUPATIONAL AND ENVIRONMENTAL HEALTH AT PATIENT VISITS. SCRMC RUNS EMERGENCY PREPAREDNESS DRILLS TO ENSURE QUALITY COLLABORATION IF UNFORTUNATE EVENTS TAKE PLACE IN THE FUTURE. IN JULY 2019, SCRMC ENTERED INTO A PARTNERSHIP WITH HEALTHPARTNERS AND HARVARD UNIVERSITY TO IMPLEMENT A TOTAL WORKER HEALTH APPROACH WITHIN THE ORGANIZATION. SCRMC ACKNOWLEDGES THE WIDE RANGE OF SIGNIFICANT HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS AND DETERMINED THAT IT COULD EFFECTIVELY FOCUS ON ONLY THOSE HEALTH NEEDS WHICH IT DEEMED MOST PRESSING, UNDER-ADDRESSED, AND WITHIN ITS ABILITY TO INFLUENCE. SCRMC WILL BE ADDRESSING ALL HEALTH NEEDS RECOGNIZED IN THE CHNA. |
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 13H: ST. CROIX REGIONAL MEDICAL CENTER MAY PRESUMPTIVELY DETERMINE ELIGIBILITY OF PATIENTS BASED ON EXTERNAL SOURCES AND DATABASES WITHOUT A FAP-APPLICATION. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - ST CROIX FALLS CLINIC | ||||
| 216 SOUTH ADAMS STREET | ST CROIX FALLS | WI | 54024 | RHC PROVIDER BASED CLINIC |
| 2 - WEBSTER HEALTH CENTER | ||||
| 26425 LAKELAND AVE SOUTH | WEBSTER | WI | 54893 | RHC PROVIDER BASED CLINIC |
| 3 - LINDSTROM CLINIC | ||||
| 12375 LINDSTROM LANE | LINDSTROM | MN | 55045 | FREE STANDING CLINIC |
| 4 - FREDERIC CLINIC | ||||
| 205 OAK STREET WEST | FREDERIC | WI | 54837 | RHC PROVIDER BASED CLINIC |
| 5 - UNITY CLINIC | ||||
| 1504 190TH AVENUE | BALSAM LAKE | WI | 54810 | RHC PROVIDER BASED CLINIC |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | ST. CROIX REGIONAL MEDICAL CENTER, THROUGH ITS PATIENT ADVOCATES, EVALUATES EACH APPLICANT'S SITUATION IN ACCORDANCE WITH CRITERIA ESTABLISHED ANNUALLY BY THE BOARD OF DIRECTORS. THE CRITERIA INCLUDES:{1) INDIVIDUAL OR FAMILY INCOME{2) FAMILY SIZE{3) OTHER SOURCES OF PAYMENT FOR SERVICES.QUALIFICATION IS BASED ON ASSET LEVELS ESTABLISHED BY MEDICAL ASSISTANCE, FAMILY SIZE, AND INCOME LEVELS BASED ON 100% OF THE FEDERAL POVERTY GUIDELINES AS PUBLISHED ANNUALLY BY THE FEDERAL GOVERNMENT.IN ADDITION TO THE ABOVE LISTED ELIGIBILITY REQUIREMENTS DEPENDENT UPON INCOME, SCRMC MAY ALSO PRESUMPTIVELY DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. PORTIONS OF OR THE ENTIRE FINANCIAL APPLICATION PROCESS MAY BE WAIVED FOR CERTAIN PATIENTS/GUARANTORS WHO PRESUMPTIVELY QUALIFY FOR FINANCIAL ASSISTANCE AND ARE SUBSEQUENTLY VERIFIED BASED ON SCRMC POLICIES AND PROCEDURES. EXAMPLES MAY INCLUDE PATIENTS/GUARANTORS WHO ARE HOMELESS, DECEASED WITHOUT AN ESTATE, BANKRUPTCY, FOOD STAMPS AND/OR PATIENTS/GUARANTORS WHO QUALIFY BY EXTERNAL AVAILABLE DATA SOURCES SUCH AS CREDIT AGENCIES OR SOCIAL ECONOMIC STATUS OF QUALIFYING FOR FINANCIAL ASSISTANCE. |
| PART I, LINE 7: | THE COSTING METHODOLOGY USED ON FROM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. |
| PART I, LINE 7G: | THE ORGANIZATION INCLUDED THE ACTIVITY OF FOUR RURAL HEALTH CLINICS FOR SUBSIDIZED HEALTH SERVICES. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2,092,421. |
| PART III, LINE 2: | THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. |
| PART III, LINE 3: | MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. |
| PART III, LINE 4: | SEE THE "PATIENT RECEIVABLES AND CREDIT POLICY" SECTION IN NOTE 1 TO THE FINANCIAL STATEMENTS FOR INFORMATION ABOUT THE CALCULATION OF BAD DEBTS. |
| PART III, LINE 8: | THE MEDICAL CENTER PROVIDES CARE TO INDIVIDUALS WHERE GOVERNMENT DEPARTMENTS DETERMINE THE AMOUNT OF REIMBURSEMENT OF SERVICE REGARDLESS OF THE COST TO PROVIDE THE SERVICE. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES GROSS MEDICARE REVENUE BUT DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE ALSO DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS RADIOLOGIST, RESPIRATORY THERAPY, URGENT CARE, OR ANESTHESIA PROFESSIONAL SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT THE HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREA. THE CALCULATION IS ALSO NOT INCLUDING THE ACTIVITY FROM FOUR RURAL HEALTH CLINICS AS THOSE AMOUNTS ARE BEING INCLUDED AS SUBSIDIZED SERVICES. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTH CARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. |
| PART III, LINE 9B: | THE FOLLOWING PROCEDURES ARE SECTION 8 IN SCRMC'S BILLING AND COLLECTION POLICY INCLUDED ON THEIR WEBSITE AND DESCRIBE THE POLICY AND PROCEDURES USED FOR PATIENTS THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE. ST. CROIX REGIONAL MEDICAL CENTER WILL MAKE REASONABLE EFFORTS TO PATIENT/GUARANTORS THAT FINANCIAL ASSISTANCE IS AVAILABLE, WHERE TO GET THE INFORMATION, HOW TO APPLY, AND ASSISTANCE AVAILABLE WITH APPLYING. ST. CROIX REGIONAL MEDICAL CENTER WILL ALLOW AND PROCESS A FINANCIAL ASSISTANCE APPLICATION UP TO 240 DAYS AFTER THE PATIENT/GUARANTOR'S FIRST BILLING STATEMENT AFTER A DATE OF SERVICE. ST. CROIX REGIONAL MEDICAL CENTER WILL TAKE STEPS TO NOTIFY PATIENT/GUARANTOR ABOUT OUR FINANCIAL ASSISTANCE POLICY AND WILL NOT TAKE EXTRAORDINARY COLLECTION ACTIONS BEFORE 120 DAYS FROM PATIENT/GUARANTOR'S FIRST BILLING STATEMENT AFTER A DATE OF SERVICE. IF A FINANCIAL ASSISTANCE APPLICATION IS RECEIVED DURING THE APPLICATION PERIOD, ST. CROIX REGINAL MEDICAL CENTER WILL SUSPEND ANY EXTRAORDINARY COLLECTION ACTIONS TO OBTAIN PAYMENT, MAKE AN ELIGIBILITY DETERMINATION AS TO WHETHER THE PATIENT/GUARANTOR IS ELIGIBLE FOR FINANCIAL ASSISTANCE AND NOTIFY THE PATIENT/GUARANTOR IN WRITING. IF ELIGIBLE, THE FINAL NOTIFICATION PERIOD WILL BE RESET FOR ANOTHER 30 DAY PERIOD. IF A PATIENT/GUARANTOR DOES NOT APPLY FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY BY THE LAST DAY OF THE FINAL NOTIFICATION PERIOD, AND THE PATIENT/GUARANTOR HAS RECEIVED THE 30-DAY NOTICE DESCRIBED IN FINAL NOTIFICATION PERIOD, THEN ST. CROIX REGIONAL MEDICAL CENTER MAY INITIATE EXTRAORDINARY COLLECTION ACTIONS. IF A PATIENT/GUARANTOR HAS APPLIED FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY IN THE LAST SIX MONTHS, AND IT WAS DETERMINED THAT THE PATIENT/GUARANTOR IS NOT ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY, THEN SCRMC MAY INITIATE EXTRAORDINARY COLLECTION ACTIONS. IF AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION UNDER THE FINANCIAL ASSISTANCE POLICY IS RECEIVED PRIOR TO THE FINAL NOTICE, THEN EXTRAORDINARY COLLECTION ACTIONS WILL BE SUSPENDED AND PATIENT/GUARANTOR WILL BE PROVIDED A WRITTEN NOTICE THAT DESCRIBES ADDITIONAL INFORMATION REQUIRED UNDER THE FINANCIAL ASSISTANCE POLICY. IF ADDITIONAL INFORMATION REQUESTED IS NOT PROVIDED, THEN THE FINAL NOTIFICATION PERIOD WILL BE RESET. |
| PART VI, LINE 2: | OVERALL MARKETPLACE DEMOGRAPHICS AND COMPETITIVE ANALYSIS IS CONDUCTED ON A REGULAR BASIS. WHEN DEMAND FOR NEW SERVICE LINES IS INTENSIFIED, THEY ARE ADDED SLOWLY UNTIL DEMAND CAPACITY REACH CRITICAL LEVELS. |
| PART VI, LINE 3: | ALL PATIENTS HAVE ACCESS TO WRITTEN MATERIALS AND PAMPHLETS AT OR NEAR THE POINT OF REGISTRATION. IN ADDITION, PATIENTS HAVE ACCESS TO PATIENT ADVOCATES WITH FULL KNOWLEDGE OF RESOURCES AVAILABLE. |
| PART VI, LINE 4: | SCRMC SERVICES A GEOGRAPHIC AREA OF APPROXIMATELY 300 SQUARE MILES IN WESTERN WISCONSIN THAT INCLUDES THE TOWNS OF ST. CROIX FALLS, BALSAM LAKE, LUCK, MILLTOWN, FREDERIC, AND GRANTSBURG IN WISCONSIN AND TAYLOR FALLS AND LINDSTROM IN EASTERN MINNESOTA. |
| PART VI, LINE 5: | SCRMC WORKS COLLABORATIVELY WITH AMERY HOSPITAL AND CLINIC, OSCEOLA MEDICAL CENTER, MENTAL HEALTH TASK FORCE OF POLK COUNTY, POLK COUNTY HEALTH DEPARTMENT, UNITED WAY OF ST. CROIX VALLEY, AND UW-EXTENSION TO DETERMINE THE FOUR MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. SCRMC CONTRIBUTES EFFORTS TO OTHER COMMUNITY HEALTH NEEDS IDENTIFIED IN THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARISA SPENCER | ||||||||||||||
| PHYSICIAN | $539,756 | $0 | $0 | $0 | $486 | $0 | $7,996 | $0 | $0 | $0 | $548,238 | $0 | $0 | $0 |
| MUHAMMAD KHAN | ||||||||||||||
| PHYSICIAN | $474,657 | $0 | $0 | $0 | $486 | $0 | $16,800 | $0 | $16,912 | $0 | $508,855 | $0 | $0 | $0 |
| VITTAL NAGAR | ||||||||||||||
| PHYSICIAN | $468,870 | $0 | $0 | $0 | $486 | $0 | $16,800 | $0 | $15,733 | $0 | $501,889 | $0 | $0 | $0 |
| DANIELLE REDBURN | ||||||||||||||
| PHYSICIAN | $470,605 | $0 | $0 | $0 | $540 | $0 | $31,800 | $0 | $9,180 | $0 | $512,125 | $0 | $0 | $0 |
| JAMES WALLACE | ||||||||||||||
| PHYSICIAN | $437,818 | $0 | $100 | $0 | $1,242 | $0 | $31,800 | $0 | $11,860 | $0 | $482,820 | $0 | $0 | $0 |
| DAVE DOBOSENSKI | ||||||||||||||
| CEO | $387,983 | $0 | $0 | $0 | $1,527 | $0 | $16,770 | $0 | $12,077 | $0 | $418,357 | $0 | $48,911 | $0 |
| SALLY BAJAK | ||||||||||||||
| CFO | $187,472 | $0 | $0 | $0 | $414 | $0 | $12,111 | $0 | $16,898 | $0 | $216,895 | $0 | $0 | $0 |
| PATRICK MCDONOUGH MD | ||||||||||||||
| VICE CHAIR | $273,250 | $0 | $0 | $0 | $810 | $0 | $29,148 | $0 | $10,733 | $0 | $313,941 | $0 | $0 | $0 |
| GURDESH BEDI | ||||||||||||||
| SECRETARY/PHYSICIAN OF SCRMC | $869,900 | $0 | $0 | $0 | $486 | $0 | $46,800 | $0 | $0 | $0 | $917,186 | $0 | $0 | $0 |
| REBECCA LYMAN MD | ||||||||||||||
| TRUSTEE | $224,888 | $0 | $0 | $0 | $872 | $0 | $26,878 | $0 | $10,151 | $0 | $262,789 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | DAVE DOBOSENSKI PARTICIPATES IN A 457(F) PLAN. IN FISCAL YEAR 2020, $35,825 WAS DEFERRED. NO CONTRIBUTIONS WERE MADE DURING CALENDAR YEAR 2019 AS REPORTED IN SCHEDULE J, PART II. SALLY BAJAK PARTICIPATED IN A 457(F) PLAN. NO CONTRIBUTIONS WERE MADE DURING CALENDAR YEAR 2019 AS REPORTED IN SCHEDULE J, PART II. DR. REBECCA LYMAN, DR. PATRICK MCDONOUGH, DR. GURDESH BEDI, DR. MUHAMMAD KHAN, DR. DANIELLE REDBURN, DR. CLAUDIO NUNES AND DR. JAMES WALLACE ARE ALL PARTICIPANTS IN A 457(F) PLAN. $15,000 TO EACH EMPLOYEE WAS CONTRIBUTED BY THE EMPLOYER DURING CALENDAR YEAR 2019 AS REPORTED IN SCHEDULE J, PART II. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JILL TIES | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | FAMILY MEMBER OF WILLIAM TIES (BOARD MEMBER) | RelationshipDescriptionTxt |
| Transaction | $406,040 | TransactionAmt |
| Transaction | EMPLOYEE OF THE HOSPITAL, FAMILY MEMBER OF THE BOARD MEMBER - WILLIAM TIES. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THERE IS ONE CLASS OF MEMBERSHIP IN THE CORPORATION. MEMBERSHIP WILL EXPIRE ON SEPTEMBER 1 OF EACH YEAR, UNLESS PRIOR TO THAT DATE THE MEMBERSHIP IS RENEWED BY TURNING IN THE COMPLETED ANNUAL MEMBERSHIP RENEWAL FORM PRIOR TO THE SEPTEMBER 1 EXPIRATION DATE. AN ANNUAL $5.00 HANDLING FEE MAY BE DONATED ON AN OPTIONAL BASIS. MEMBERSHIP MAY NOT BE TRANSFERRED OR ASSIGNED DURING THE LIFE OF THE MEMBER. MEMBERSHIP SHALL NOT PASS BY INHERITANCE OR BEQUEST UPON THE DEATH OF THE MEMBER. A SINGLE MEMBERSHIP MAY BE HELD JOINTLY BY SPOUSES, BUT ONLY ONE SHALL BE ENTITLED TO VOTE AT ANY TIME. OTHERWISE, A MEMBERSHIP IS NOT DIVISIBLE INTEREST AND MAY NOT BE HELD BY MORE THAN ONE PERSON. |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMBERS HAVE THE ABILITY TO VOTE IN THE ELECTION OF TRUSTEES. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE BOARD OF DIRECTORS OF THE GOVERNING BOARD HAS DELEGATED OPERATIONAL LEADERSHIP AND OVERSIGHT TO THE EXECUTIVE COUNCIL, THE PRACTICE MANAGEMENT COUNCIL (PMC) AND THE MEDICAL EXECUTIVE COMMITTEE OF THE BOARD. THE EXECUTIVE COUNCIL IS COMPRISED OF THE SENIOR LEADERSHIP TEAM INCLUDING THE CEO, CMO, CFO, CNO, CAO|GC AND VP OF PRACTICE ADMINISTRATION. THIS TEAM IS STRATEGIC IN NATURE AND REQUIRES SHORT AND LONG TERM DECISION-MAKING THAT ALIGNS WITH THE ORGANIZATION'S VALUES, MISSION AND VISION. THE PMC COUNCIL IS COMPRISED OF THE CMO, THE VP OF PRACTICE ADMINISTRATION, SPECIALTY AND PRIMARY CARE DIRECTORS AND 4 PROVIDER LEADERS. THIS TEAM REVIEWS AND APPROVES THE POLICIES AND PROCEDURES AS THEY RELATE TO THE CLINICAL OPERATIONS OF THE ORGANIZATION. THE MEDICAL EXECUTIVE COMMITTEE IS COMPRISED OF THE CMO, CHIEF OF STAFF AND THE MEDICAL COMMITTEE CHAIRS. THIS TEAM REVIEWS AND APPROVES THE POLICIES AND PROCEDURES AS THEY RELATE TO THE HOSPITAL MEDICAL OPERATIONS OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WENT THROUGH THE FOLLOWING REVIEW PROCESS BEFORE FILING WITH THE IRS: A DETAILED REVIEW WAS CONDUCTED BY THE ORGANIZATION'S CFO. THE FORM 99O WAS PRESENTED TO THE FINANCE COMMITTEE IN MARCH, 2020 FOR REVIEW AND APPROVAL. UPON THE FINANCE COMMITTEE'S APPROVAL, THE FORM 990 WAS PRESENTED TO THE GOVERNING BOARD IN MARCH, 2020 FOR FINAL APPROVAL. UPON THE BOARD'S APPROVAL, THE FORM 990 WAS THEN FILED ELECTRONICALLY. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERSHIP IS CONTINGENT UPON ANNUAL DISCLOSURE OF POTENTIAL AND ACTUAL CONFLICTS OF INTEREST. THE DETERMINATION IS MADE AT THE BOARD LEVEL AND ALL BOARD MEMBERS MUST CERTIFY ANNUALLY. IF A BOARD MEMBER HAS A CONFLICT, THEY REFRAIN FROM VOTING OR PARTICIPATING IN DISCUSSIONS CONCERNING THE TOPIC. |
| FORM 990, PART VI, SECTION B, LINE 15 | CEO ANNUAL PERFORMANCE AND SALARY REVIEW IS CONDUCTED THROUGH THE COMPENSATION COMMITTEE USING OUTSIDE CONSULTANTS AND VARIOUS COMPENSATION SURVEYS AS DEEMED NECESSARY. REVIEWS ARE TYPICALLY DONE IN JANUARY/FEBRUARY OF EACH CALENDAR YEAR. BASED UPON THE COMPENSATION COMMITTEE'S RECOMMENDATION, IT IS PRESENTED TO THE GOVERNING BOARD FOR FINAL REVIEW AND APPROVAL. OTHER OFFICERS THE HUMAN RESOURCE DIRECTOR CONDUCTS OUTSIDE RESEARCH USING COMPENSATION SURVEYS AND DATA TO DETERMINE REASONABLE COMPENSATION. THE CEO IN CONJUNCTION WITH THE HUMAN RESOURCE DIRECTOR'S RECOMMENDATION DETERMINES THE COMPENSATION OF THESE EMPLOYEES. REVIEWS ARE TYPICALLY DONE IN NOVEMBER/DECEMBER OF EACH CALENDAR YEAR. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE MEDICAL CENTER'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 9,445,605. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,445,605. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,391,162. MANAGEMENT AND GENERAL EXPENSES 1,036,504. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,427,666. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 1,695,679. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,695,679. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 45,164. MANAGEMENT AND GENERAL EXPENSES 526,665. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 571,829. OTHER SERVICES: PROGRAM SERVICE EXPENSES 231,974. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 231,974. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| UNITY PHARMACY LLC | |||||||||
| 1504 190TH AVENUE SUITE 100 | BALSAM LAKE | WI | 54810 | 454471131 | PHARMACEUTICALS | WI | $2,234,610 | $324,128 | SCV PHARMACIES |
| FREDERIC PHARMACY LLC | |||||||||
| 201 OAK STREET WEST | FREDERIC | WI | 54837 | 464469897 | PHARMACEUTICALS | WI | $4,514,134 | $1,147,873 | SCV PHARMACIES |
| ST CROIX VALLEY PHARMACY LLC | |||||||||
| 235 STATE STEET | ST CROIX FALLS | WI | 54024 | 464463191 | PHARMACEUTICALS | WI | $0 | $6,110 | ST CROIX REGIONAL MEDICAL CENTER |
| ST CROIX FALLS PHARMACY LLC | |||||||||
| 216 SOUTH ADAMS STREET | ST CROIX FALLS | WI | 54024 | 464487348 | PHARMACEUTICALS | WI | $3,421,896 | $438,193 | SCV PHARMACIES |
| WEBSTER DENTAL CLINIC LLC | |||||||||
| 26425 LAKELAND AVENUE S | WEBSTER | WI | 54893 | 371911164 | DENTAL SERVICES | WI | $246,327 | $207,649 | ST CROIX DENTAL HEALTH LLC |
| ST CROIX DENTAL HEALTH LLC | |||||||||
| 26425 LAKELAND AVENUE S | WEBSTER | WI | 54893 | 831635026 | DENTAL SERVICES | WI | $0 | $0 | ST CROIX REGIONAL MEDICAL CENTER |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ST CROIX VALLEY EMERGENCY MEDICAL SERVICES INC | |||||||||||
| 235 EAST STATE STREET | ST CROIX FALLS | WI | 54024 | 452872803 | TO LEASE, MAINTAIN, AND OPERATE AN EMERGENCY AMBULANCE SERVICE | WI | 501(C)(3) | LINE 10 | ST CROIX REGIONAL MEDICAL CENTER | Yes (1) | |
| CANCER CENTER OF WESTERN WISCONSIN | |||||||||||
| 501 HOSIPTAL ROAD | NEW RICHMOND | WI | 54017 | 273238660 | TO PROVIDE CARE TO CANCER PATIENTS | WI | 501(C)(3) | LINE 12A, I | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |