MEMORIAL HOSPITAL OF BOSCOBEL: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL HOSPITAL OF BOSCOBEL (EIN 39-0845590)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-19
- IRS object ID
- 202113239349300836
- Schema version
- 2020v4.1
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-19T14:38:10-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 155 N Wacker Drive | AddressLine1Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60606 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390845590 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL OF BOSCOBEL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % RONDA FOSTERLING | InCareOfNm |
| Business Name Control | MEMO | BusinessNameControlTxt |
| Phone | 6083754112 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 205 PARKER STREET | AddressLine1Txt |
| City | BOSCOBEL | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53805 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEN BOIGENZAHN | PersonNm |
| Person Title | FINC ADMINISTRATOR | PersonTitleTxt |
| Phone | 6083754112 | PhoneNum |
| Signature | 2021-11-19 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JEN | PersonFirstNm |
| Person Last | BOIGENZAHN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JESS WAGENER | PreparerPersonNm |
| PTIN | P01622613 | PTIN |
| Phone | 3128792000 | PhoneNum |
| Preparation | 2021-11-19 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | 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 | SEE SCHEDULE O | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEN BOIGENZAHN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 205 PARKER STREET | AddressLine1Txt |
| City | BOSCOBEL | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53805 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $25,517,982 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.gundersenhealth.org/boscobel | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1952 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | WE WILL IMPROVE THE HEALTH OF OUR COMMUNITY THROUGH EXCELLENCE IN HIGH QUALITY, PATIENT CENTERED CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 185 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $270,690 | PYContributionsGrantsAmt |
| CY Contributions Grants | $567,097 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $22,781,410 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $24,617,302 | CYProgramServiceRevenueAmt |
| PY Investment Income | $18,253 | PYInvestmentIncomeAmt |
| CY Investment Income | $26,168 | CYInvestmentIncomeAmt |
| PY Other Revenue | $141,097 | PYOtherRevenueAmt |
| CY Other Revenue | $306,886 | CYOtherRevenueAmt |
| PY Total Revenue | $23,211,450 | PYTotalRevenueAmt |
| CY Total Revenue | $25,517,453 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,478,296 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,930,221 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,559,776 | PYOtherExpensesAmt |
| CY Other Expenses | $12,390,070 | CYOtherExpensesAmt |
| PY Total Expenses | $20,038,072 | PYTotalExpensesAmt |
| CY Total Expenses | $22,320,291 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,173,378 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,197,162 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,966,731 | TotalAssetsBOYAmt |
| Total Assets EOY | $32,413,174 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,206,250 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,273,921 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,760,481 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $20,139,253 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WE WILL ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES WHILE ENRICHING EVERY LIFE WE TOUCH, INCLUDING PATIENTS, FAMILIES AND STAFF. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $18,331,169 | ExpenseAmt |
| Revenue | $21,540,520 | RevenueAmt |
| Desc | GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS (THE "ORGANIZATION") PROVIDES INPATIENT, OUTPATIENT, EMERGENCY HEALTH CARE SERVICES AND OTHER FINANCIAL SUPPORT THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED, AMONG OTHER MATTERS, TO ENHANCE THE HEALTH OF THE COMMUNITY INCLUDING THE HEALTH OF LOW-INCOME PATIENTS. SERVICES PROVIDED TO PATIENTS INCLUDE COLONOSCOPIES, LAPAROSCOPIC SURGERIES, AND KNEE REPLACEMENTS, AMONG OTHERS. THE ORGANIZATION IS AFFILIATED WITH GUNDERSEN HEALTH SYSTEM. THIS AFFILIATION PROVIDES LOCAL SERVICES IN CARDIOLOGY, NEUROLOGY, PODIATRY, DERMATOLOGY, UROLOGY, AND VASCULAR MEDICINE AS WELL AS MANY OTHER SERVICES. CONSISTENT WITH THE MISSION OF THE ORGANIZATION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, INCLUDING PROVIDING SERVICES TO THOSE PERSONS WHO ARE EITHER UNDERINSURED OR WHO CANNOT AFFORD HEALTH INSURANCE BECAUSE OF INADEQUATE RESOURCES. HEALTH CARE SERVICES TO PATIENTS UNDER GOVERNMENT PROGRAMS, SUCH AS THE MEDICAID PROGRAM, ARE ALSO CONSIDERED PART OF THE ORGANIZATION'S BENEFIT PROVIDED TO THE COMMUNITY, SINCE A SUBSTANTIAL PORTION OF SUCH SERVICES ARE REIMBURSED AT AMOUNTS LESS THAN THE COSTS OF PROVIDING CARE. (SEE ADDITIONAL INFORMATION REGARDING THE COST OF PROVIDING SERVICES TO MEDICAID PATIENTS IN SCHEDULE H OF THE FORM 990.) PATIENTS WHO MEET CERTAIN CRITERIA FOR CHARITY CARE, GENERALLY BASED ON FEDERAL POVERTY GUIDELINES, ARE PROVIDED CARE AT A SIGNIFICANTLY REDUCED RATE, DETERMINED BASED ON QUALIFYING CRITERIA AS DEFINED IN THE ORGANIZATION'S CHARITY CARE POLICY AND FROM APPLICATIONS COMPLETED BY PATIENTS AND THEIR FAMILIES. (SEE ADDITIONAL INFORMATION REGARDING THE COST OF PROVIDING SERVICES TO CHARITY CARE RECIPIENTS IN SCHEDULE H OF THE FORM 990.) BENEFITS FOR SERVING THE COMMUNITY ALSO INCLUDE UNPAID COSTS OF TREATING THE ELDERLY, HEALTH SCREENINGS, COMMUNITY EDUCATION THROUGH SEMINARS AND CLASSES, AND OTHER HEALTH-RELATED SERVICES. DURING 2020, HOSPITAL PATIENT DAYS TOTALED 912 AND TOTAL OUTPATIENT ENCOUNTERS WERE 23,776. KEY STATISTICS INCLUDED IN THESE TOTALS WERE 434 MEDICAL/SURGICAL INPATIENT DAYS, 482 SWING BED DAYS, 4,052 EMERGENCY ROOM VISITS, AND 321 SURGICAL OUTPATIENT VISITS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Revenue | $3,381,905 | RevenueAmt |
| Desc | THE ORGANIZATION OPERATES FAMILY PRACTICE CLINICS IN THREE LOCATIONS TO ENSURE COMMUNITY MEMBERS HAVE ACCESS TO CONVENIENT, QUALITY PRIMARY CARE. DURING 2020, TOTAL OUTPATIENT ENCOUNTERS AT THESE CLINICS TOTALED 11,321. THE THREE CLINICS ARE DESIGNATED AS RURAL HEALTH CLINICS BY THE MEDICARE AND MEDICAID PROGRAMS AND BY DEFINITION PROVIDE HEALTH CARE TO AREAS DESIGNATED AS MEDICAL PROFESSIONAL SHORTAGE AREAS WHERE WITHOUT THESE CLINICS THERE WOULD BE LIMITED ACCESS TO PRIMARY CARE CLINICAL SERVICES. IN ADDITION, THE ORGANIZATION'S CHARITY CARE PROGRAM IS ALSO AVAILABLE TO PATIENTS OF THE CLINICS AND IS INCLUDED IN THE CHARITY CARE AMOUNT REPORTED FOR THE HOSPITAL AS CHARITY CARE. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $18,331,169 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 15 | IRPDocumentCnt |
| IRP Document W2 G | 185 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 185 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | 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 | RONDA FOSTERLING | PersonNm |
| Phone | 6083754112 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 205 PARKER STREET | AddressLine1Txt |
| City | BOSCOBEL | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53805 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| MARILU BINTZ MD | |||||||||
| BOARD MEMBER/MED VP GHS | 39.5 | 0.5 | Yes (X) | $0 | $574,361 | $47,619 | |||
| ANDY NAHAS MD | |||||||||
| BOARD MEMBER/OPTOMETRY | 0.5 | 0.0 | Yes (X) | $0 | $202,004 | $45,717 | |||
| SCOTT KNIPRATH | |||||||||
| VICE PRESIDENT/EXEC DIR GH | 39.5 | 0.5 | Yes (X) | $0 | $165,480 | $55,764 | Yes (X) | ||
| THERESA BRAUDT | |||||||||
| ADMINISTRATOR | 39.5 | 0.5 | $0 | $161,137 | $34,049 | Yes (X) | |||
| JAMES KLOCK | |||||||||
| BOARD MEMBER/DIR OF REG IS | 39.5 | 0.5 | Yes (X) | $0 | $131,743 | $35,626 | |||
| TARA WOOD | |||||||||
| PHARMACIST | 40.0 | 0.0 | $136,117 | $0 | $27,937 | Yes (X) | |||
| KEITH FRYE | |||||||||
| SECRETARY/ADMIN DIR - LAB | 39.5 | 0.5 | Yes (X) | $0 | $120,942 | $33,669 | Yes (X) | ||
| MICHELLE PETERSON | |||||||||
| APNP FAMILY MEDICINE | 40.0 | 0.0 | $128,111 | $0 | $20,510 | Yes (X) | |||
| DOUGLAS KNOBLE | |||||||||
| PHARMACIST | 40.0 | 0.0 | $112,955 | $0 | $30,949 | Yes (X) | |||
| JENNIFER BOIGENZAHN | |||||||||
| FINANCE ADMINISTRATOR | 39.5 | 0.5 | $0 | $122,730 | $16,402 | Yes (X) | |||
| DAWN THORSTEN | |||||||||
| BOARD MEMBER/DIR OF QUALITY | 39.5 | 0.5 | Yes (X) | $0 | $106,269 | $32,017 | |||
| BRAD ECKLOR | |||||||||
| PA FAMILY MEDICINE | 40.0 | 0.0 | $111,704 | $0 | $24,048 | Yes (X) | |||
| PETER ESSER | |||||||||
| BOARD MEMBER | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| MICHELLE MUELLER | |||||||||
| BOARD MEMBER | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| LORI BARRY | |||||||||
| TREASURER | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| JERRY BERGE | |||||||||
| PRESIDENT | 0.5 | 0.3 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| CYNDE LARSON | |||||||||
| BOARD MEMBER | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $488,887 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,584,666 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $404,307 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WAPITI MEDICAL STAFFING | |||||
| 107 FLYNN DRIVE STE 600 | MILBANK | SD | 57252 | MEDICAL STAFFING | $1,985,000 |
| BEINBORN ANESTHESIA S C | |||||
| 62598 BLUFFS OF WILDERNEST | PRAIRIE DU CHIEN | WI | 53821 | CRNA PROF. SERVICES | $302,849 |
| STAFFENCY | |||||
| 221 W COLLEGE AVE FLR 2 | APPLETON | WI | 54911 | LAB TECH/PT/ER STAFF | $261,477 |
| ALPHA CONTROLS SERVICES LLC | |||||
| 4104 CHARLES STREET | ROCKFORD | IL | 61108 | EQUIPMENT/SVC CONTR | $136,796 |
| SHARED MEDICAL SERVICES | |||||
| 209 LIMESTONE PASS | COTTAGE GROVE | WI | 53527 | MRI READS | $102,280 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $567,097 | GovernmentGrantsAmt |
| Total Contributions | $567,097 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| HOSPITAL PATIENT REVENUE | 621110 | $19,976,436 | $19,976,436 |
| CLINIC REVENUE | 621110 | $3,381,905 | $3,381,905 |
| PHARMACY REVENUE | 446110 | $1,258,372 | $1,258,372 |
| ALL OTHER PROGRAM SERVICE REVENUE | 621110 | $589 | $589 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $24,617,302 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,168 | TotalRevenueColumnAmt |
| Exclusion | $26,168 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $2,292 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $529 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,763 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,763 | TotalRevenueColumnAmt |
| Exclusion | $1,763 | ExclusionAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| RURAL CRITICAL CARE PAYMENT | 900099 | $189,428 | $189,428 |
| EHR INCENTIVE PAYMENTS | 621990 | $88,434 | $88,434 |
| REIMBURSEMENT FOR MAINTENANCE SVCS | 900099 | $21,000 | $21,000 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,261 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,261 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $305,123 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,517,453 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,922,425 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $27,931 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $334,317 | TotalAmt |
| Management And General | $334,317 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,608,880 | TotalAmt |
| Program Services | $6,193,007 | ProgramServicesAmt |
| Management And General | $1,415,873 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $214,796 | TotalAmt |
| Program Services | $159,317 | ProgramServicesAmt |
| Management And General | $55,479 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,253,958 | TotalAmt |
| Program Services | $784,856 | ProgramServicesAmt |
| Management And General | $469,102 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $518,270 | TotalAmt |
| Program Services | $393,573 | ProgramServicesAmt |
| Management And General | $124,697 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $750 | TotalAmt |
| Management And General | $750 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,140 | TotalAmt |
| Management And General | $38,140 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,198 | TotalAmt |
| Management And General | $4,198 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,157,418 | TotalAmt |
| Program Services | $5,327,438 | ProgramServicesAmt |
| Management And General | $829,980 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,009 | TotalAmt |
| Management And General | $86,009 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $242,381 | TotalAmt |
| Program Services | $159,154 | ProgramServicesAmt |
| Management And General | $83,227 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $332,322 | TotalAmt |
| Program Services | $276,650 | ProgramServicesAmt |
| Management And General | $55,672 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,779 | TotalAmt |
| Program Services | $27,992 | ProgramServicesAmt |
| Management And General | $5,787 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,761 | TotalAmt |
| Program Services | $20,842 | ProgramServicesAmt |
| Management And General | $7,919 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,954 | TotalAmt |
| Program Services | $145,954 | ProgramServicesAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $873,425 | TotalAmt |
| Program Services | $541,815 | ProgramServicesAmt |
| Management And General | $331,610 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,705 | TotalAmt |
| Management And General | $69,705 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| BILLABLE MEDICAL SUPPLIES | $2,653,772 | $2,645,828 | $7,944 | $0 |
| PROVISION FOR BAD DEBTS | $1,141,808 | $1,141,808 | $0 | |
| EQUIPMENT RENTAL | $281,760 | $265,359 | $16,401 | $0 |
| REPAIRS & MAINTENANCE | $225,668 | $225,653 | $15 | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,220 | TotalAmt |
| Program Services | $21,923 | ProgramServicesAmt |
| Management And General | $52,297 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,320,291 | TotalAmt |
| Program Services | $18,331,169 | ProgramServicesAmt |
| Management And General | $3,989,122 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,218 | BOYAmt |
| EOY | $25,438 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,828,114 | BOYAmt |
| EOY | $22,094,919 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,252,296 | BOYAmt |
| EOY | $2,661,659 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $396,773 | BOYAmt |
| EOY | $390,633 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $148,677 | BOYAmt |
| EOY | $236,492 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $20,709,947 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,627,309 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,508,319 | BOYAmt |
| EOY | $6,082,638 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,486 | BOYAmt |
| EOY | $16,864 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $785,848 | BOYAmt |
| EOY | $904,531 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,966,731 | BOYAmt |
| EOY | $32,413,174 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,430,410 | BOYAmt |
| EOY | $4,904,126 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $184,238 | BOYAmt |
| EOY | $4,109,922 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,093,640 | BOYAmt |
| EOY | $2,776,693 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $195,852 | BOYAmt |
| EOY | $133,987 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $302,110 | BOYAmt |
| EOY | $349,193 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,206,250 | BOYAmt |
| EOY | $12,273,921 | 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 | $16,170,485 | BOYAmt |
| EOY | $19,368,178 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $589,996 | BOYAmt |
| EOY | $771,075 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,760,481 | BOYAmt |
| EOY | $20,139,253 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,966,731 | BOYAmt |
| EOY | $32,413,174 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,197,162 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $181,610 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $4,198 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,198 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1, LOBBYING ACTIVITES | FormAndLineReferenceDesc |
| Explanation | GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS (THE "ORGANIZATION") PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PAID PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. THE WHA HAS NOTIFIED THE ORGANIZATION THAT $1,440 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 RWHC. THE 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 COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, RWHC ALSO PROVIDES AN ANALYSIS OF CURRENT HEALTH CARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES A SMALL AMOUNT OF LOBBYING ON THE PART OF THE MEMBER HOSPITALS. THE RWHC DETERMINED THAT $1,940 OF THE FEES PAID BY THE ORGANIZATION IN 2020 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTH CARE ENVIRONMENT IN THE STATE OF WISCONSIN. $818 OF MEMBERSHIP FEES PAID TO THE AMERICAN HOSPITAL ASSOCIATION WERE USED IN CONJUCTION WITH LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $348,441 | OtherCostOrOtherBasisAmt |
| Book Value | $348,441 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,985,611 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,785,111 | DepreciationAmt |
| Book Value | $4,200,500 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,375,895 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,842,198 | DepreciationAmt |
| Book Value | $1,533,697 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Land Buildings | OtherLandBuildingsGrp | |
| Total Book Value Land Buildings | $6,082,638 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| THIRD PARTY REIMBURSEMENT PAYABLE | $322,693 |
| ASSET RETIREMENT OBLIGATION | $26,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $349,193 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, SCHEDULE D, PART X LINE 2 | FormAndLineReferenceDesc |
| Explanation | INCOME TAX MATTERS (IN THOUSANDS) THE SYSTEM QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE), WITH THE EXCEPTION OF GUNDERSEN LUTHERAN ENVISION, LLC, WHICH IS A FOR-PROFIT ENTITY. AT DECEMBER 31, 2020 AND 2019, NET DEFERRED TAX ASSETS OF $7,948 AND $6,900, RESPECTIVELY, WHICH PRIMARILY ARE RELATED TO NET OPERATING LOSS CARRYFORWARDS, HAVE VALUATION ALLOWANCES OF $7,948 AND $6,900, RESPECTIVELY, RECORDED AGAINST THEM DUE TO THE UNCERTAINTY OF REALIZING THOSE BENEFITS IN THE FUTURE. AT DECEMBER 31, 2020, THE SYSTEM'S FEDERAL NET OPERATING LOSS CARRYFORWARDS WERE APPROXIMATELY $29,800, AND THE STATE NET OPERATING LOSS CARRYFORWARDS WERE APPROXIMATELY $27,900, WHICH WILL EXPIRE BETWEEN 2029 AND 2038. THE SYSTEM HAS REVIEWED ITS 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 2015 AND PRIOR YEARS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $180,153 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $180,153 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00850 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,087,855 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,196,205 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,268,008 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,196,205 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $180,153 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00850 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,003 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,003 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,492,309 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,282,458 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $209,851 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00990 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,535 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,535 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,508,847 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,282,458 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $226,389 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01070 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,776,855 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,478,663 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $406,542 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01920 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $413,375 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $201,597 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,613,921 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,577,722 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $36,199 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | 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 | memorial hospital of boscobel | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 205 Parker Street | AddressLine1Txt |
| City | boscobel | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53805 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.GUNDERSENHEALTH.ORG/BOSCOBEL | WebsiteAddressTxt |
| State License | 1048 | 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 | memorial hospital of boscobel | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SUPPLEMENTAL INFORMATION | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SUPPLEMENTAL INFORMATION | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400. | 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 |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | 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 (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, PAGE 8 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, PAGE 8 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, PAGE 8 | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | 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 (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5: | The Community Health Needs Assessment (CHNA) engaged a number of sectors of the community at various levels of participation. Community participants were defined as key partners, stakeholders, or general community. Below are the definitions and roles of each group. Key Partners- Hospitals, Public Health, UW-Extension, ADRC The consortium of key partners met regularly to conduct the Community Health Needs Assessment. Tasks required of this group included identifying process, creating surveys, identifying target audiences for participation in the surveys, assembling and reviewing results of data, identifying communities for focus groups, and conducting focus groups. Stakeholders Individuals with a vested interest in the community, and individuals who represent a larger demographic (ie: social workers, free clinic workers, school principals, government officials). Stakeholders were asked to identify the sector or sectors of the population they represented, including: business, health care, faith-based, education, youth-serving, agriculture, government, aging, disabilities, low income, minority, education or other. The Stakeholder Survey was open from September 15 - October 31, 2018. 192 total responses were collected. All of the above sectors had adequate representation, with the lowest represented sector at 7.4% (minority), the highest at 50.6% (healthcare), and the average category ranging from 20-30% (education, youth, low income, government). General Community Individuals and community members representing their own interests were reached in two ways: A general survey completed via online sources, at public events and focus groups. The General Public Survey was open from October 31 - November 26, 2018. 142 total responses were collected. Respondents identified themselves by age and number of children in household. Focus group participants were identified by age and gender. Thirteen (13) focus groups were conducted in twelve (12) communities to provide qualitative data on topics such as perceived access to health care, barriers to health care, and ways health organizations can reach the public with information and education. Participants were asked brief questions about their general impressions of health and healthcare services in the community in which they live and/or work. SCHEDULE H, PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS: 1. CROSSING RIVERS HEALTH 2. GRANT REGIONAL HEALTH CENTER, INC. SCHEDULE H, PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER ORGANIZATIONS: 1. CRAWFORD COUNTY PUBLIC HEALTH DEPARTMENT 2. GRANT COUNTY PUBLIC HEALTH DEPARTMENT 3. CRAWFORD COUNTY UNIVERSITY OF WISCONSIN - EXTENSION 4. GRANT COUNTY UNIVERSITY OF WISCONSIN - EXTENSION 5. AGING AND DISABILITY RESOURCE CENTER - CRAWFORD AND GRANT COUNTIES SCHEDULE H, PART V, SECTION B, LINE 7D: HTTP://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ SCHEDULE H, PART V, SECTION B, LINE 10A HTTP://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ |
| SCHEDULE H, PART V, SECTION B, LINE 11: | The Community Health Needs Assessment process provided crucial information about the health and wellness needs of the communities we serve, as well as identified gaps and barriers to health and healthcare services. Based on the data, research and validation efforts, the CHNA highlighted three (3) overarching health needs: 1. Empower people to improve their health through awareness and education 2. The need to connect people to services and resources 3. The need to create a healthy environment and a culture of wellness across the lifespan The Implementation Plan that Gundersen Boscobel Area Hospital and Clinics has developed and implemented will aim to address the identified needs. Below is a summary of 2020 initiatives and efforts thus far: Empower people to improve their health through awareness and education: To assist in empowering people to improve their overall health, we've worked diligently to pivot former class offerings and modify programs and outreach services to the area to meet enhanced safety precautions amid the global pandemic, while still making a local health impact and increasing overall awareness. Specifically, we continued to partner with the Boscobel Police Department for the safe disposal of unused medication and promote local Drug Take-Back events. Our in-house pharmacy team also works closely with clinic and registration staff to provide education to patients and families related to our Sharps and Needle Disposal Program and we continue to offer sharps and needle disposal at no cost to GBAHC patients. Much work was placed on developing and executing pain contracts within our Primary Care Clinics - providing education to patients and building plans for improved outcomes. We continued to enhance our diabetic education content and increased program engagement by adding a behavioral health component to the curriculum. This was made possible through a collaborative effort between primary care, phycologist Joni Downs and Chris Swan, RDN, CD. In addition, we partnered with GHS Office of Population Health, to bring the 6-week Health Living with Diabetes (HLWD) course to Boscobel (11/4/20-12/9/20). Connecting people to services and resources: In our pursuit to connect people to needed services and resources, we have focused on the following: Growing the number of specialty providers and conditions treated in the rural setting through partnerships with GHS clinicians and specialists. In 2020, two new specialties were added. We continue to expand telemedicine capabilities that allows greater access for follow-up care with specialty providers and services not offered at our location. 125 telemedicine visits were performed from GBAHC Specialty Clinic. Both have allowed GBAHC to keep care close to home (when appropriate); reducing the patient financial burden associated with traveling for healthcare. This has also afforded area residents, many of whom are low-income, elderly and/or have transportation barriers, improved health as they may have otherwise declined care due to these barriers. Clinical Services most noted in the CHNA as being needed in our rural setting, included: Mental Health, Alzheimer's and Dementia care and increased cancer screening and prevention. To address these needs, the Collaborative Care Model of Care continues to be refined and encouraged within our primary care setting. Through our Phycologist and LCSW, the behavioral health needs of our patients have been better supported and interventions are more quickly identified and encouraged. To reduce the stigma around mental health, our behavioral health team continues to play an active role in the Grant County Mental Health Matters initiative and provides insight through various mental health platforms, as well as providing outreach education for area EMTs/Fire Departments, school district staff, hospital and clinic staff (including new employees). To address available cancer screenings and service access within our primary service area, we worked with GHS to bring in-house 3D mammography to Boscobel. We also participated in various virtual community efforts aimed at raising awareness around the importance of timely screenings (social media, virtual run/walks, dress in pink days). We continue to grow and expand cancer care locally in partnership with GHS. While needing to limit the number of patients coming into the clinic setting during the pandemic to reduce risk of exposure, phone and video visit were launched in March/April 2020. Through innovation and technology, we were able to reimage care delivery where appropriate and still meet the needs of our community despite the challenges presented by the rapidly changing healthcare landscape. In total, 347 virtual visits and 524 telephone visits were completed in 2020. Creating a healthy environment and a culture of wellness across the lifespan: While our efforts to encourage a healthy environment and a culture of wellness had to look differently in 2020, we offered a virtual Safe At Home child safety course on June 30, 2020 in collaboration with GHS Office of Population Health which had 9 attendees. We also moved forward with offering our FLAG Program - a 12-week wellness program for children ages 8-12 and their families - through a hybrid delivery model to ensure families could still access the program's whole-person wellness content regardless of public health guidance (i.e. could engage from the safety of their homes or in-person). Staff were committed to connecting with area youth and shared their reading talents virtually by reading health and emotional well-being topics to elementary school aged children through our social media page. We also filmed a virtual hospital tour for area elementary schools which followed Copper the Bear throughout his hospital journey following a fall from a tree. Our internal Sensory Friendly efforts continued. To address at risk patients, Diabetic Screening letters were sent to the homes of at-risk patients who were due for their screening. 192 patients were also referred to Gundersen's Tobacco Cessation Intervention Program. Health Initiatives not implemented/Needs not met and reasons for each: As the global pandemic wages on, several classes, support groups and efforts to build upon past coalition work, had to be paused. Specially, the below initiatives were paused in 2020: . Onsite Grief Support Group - No meetings held due to COVID-19 pandemic . Attendance of area mental health coalition meetings to improve community access and awareness - No meetings held due to COVID-19 pandemic . Dementia Friendly Boscobel - Put on hold due to agency staffing availability and COVID-19 pandemic . Alzheimer's and Dementia Education - 5 events scheduled, cancelled due to COVID-19 . Development of Movin' & More Voucher Program to support and encourage cardiac rehab patients to continue their wellness journey by enrolling in the maintenance program - Implementation put on hold due to COVID-19 Pandemic and limited occupancy allowed in gym area. . Did not reach our 2020 goal for executed pain contracts with patients on the Chronic Pain Registry with a Chronic Pain Agreement documented - Number of Pain Contracts decreased due to COVID-19 and the inability to make appointments to update contracts. . Education events and tabling for community members, school districts, employers, and local entities was significantly down from years past due to the pandemic. Some of the training that was unable to be held, included: Vaping Education, Safe Sitter, Stop the Bleed, ACEs/TIC/RTIC and CPR trainings, speaking engagements, etc. |
| SCHEDULE H, PART V, SECTION B, LINE 13H | GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINCS (GBAHC) UNDERSTANDS THAT NOT ALL PATIENTS ARE ABLE TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION OR COMPLY WITH REQUESTS FOR DOCUMENTATION. THERE MAY BE INSTANCES UNDER WHICH A PATIENT'S QUALIFICATION FOR FINANCIAL ASSISTANCE IS ESTABLISHED WITHOUT COMPLETING THE FORMAL FINANCIAL ASSISTANCE APPLICATION. OTHER INFORMATION MAY BE UTILIZED BY GBAHC TO DETERMINE WHETHER A PATIENT'S ACCOUNT IS UNCOLLECTIBLE, AND THIS INFORMATION WILL BE USED TO DETERMINE PRESUMPTIVE ELIGIBILITY. PRESUMPTIVE ELIGIBILITY MAY BE GRANTED TO PATIENTS BASED ON THEIR ELIGIBILITY FOR OTHER PROGRAMS OR LIFE CIRCUMSTANCES SUCH AS: 1. PATIENTS OR GUARANTORS WHO HAVE DECLARED BANKRUPTCY. IN CASES INVOLVING BANKRUPTCY, ONLY THE ACCOUNT BALANCE AS OF THE DATE THE BANKRUPTCY IS DISCHARGED WILL BE WRITTEN OFF. 2. PATIENTS OR GUARANTORS WHO ARE DECEASED WITH NO ESTATE IN PROBATE. 3. PATIENTS OR GUARANTORS DETERMINED TO BE HOMELESS. 4. ACCOUNTS RETURNED BY THE COLLECTION AGENCY AS UNCOLLECTIBLE DUE TO ANY OF THE ABOVE REASONS. 5. PATIENTS OR GUARANTORS WHO QUALIFY FOR STATE MEDICAID PROGRAMS, WILL BE ELIGIBLE FOR ASSISTANCE FOR ANY COST-SHARING OBLIGATIONS ASSOCIATED WITH THE PROGRAM OR UNCOVERED SERVICES. GBAHC UNDERSTANDS THAT CERTAIN PATIENTS MAY BE NON-RESPONSIVE TO GBAHC'S APPLICATION PROCESS. UNDER THESE CIRCUMSTANCES, GBAHC MAY UTILIZE OTHER SOURCES OF INFORMATION TO MAKE AN INDIVIDUAL ASSESSMENT OF FINANCIAL NEED. THIS INFORMATION WILL ENABLE GBAHC TO MAKE AN INFORMED DECISION ON THE FINANCIAL NEED OF NON- RESPONSIVE PATIENTS UTILIZING THE BEST ESTIMATES AVAILABLE IN THE ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT. GBAHC MAY UTILIZE A THIRD-PARTY TO CONDUCT AN ELECTRONIC REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THIS PREDICTIVE MODEL INCORPORATES PUBLIC RECORD DATA TO CALCULATE A SOCIO-ECONOMIC AND FINANCIAL CAPACITY SCORE THAT INCLUDES ESTIMATES FOR INCOME, ASSETS AND LIQUIDITY. THE ELECTRONIC TECHNOLOGY IS DESIGNED TO ASSESS EACH PATIENT TO THE SAME STANDARDS AND IS CALIBRATED AGAINST HISTORICAL APPROVALS FOR GBAHC FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. THE ELECTRONIC TECHNOLOGY, WHEN UTILIZED, WILL BE DEPLOYED PRIOR TO BAD DEBT ASSIGNMENT AFTER ALL OTHER ELIGIBILITY AND PAYMENT SOURCES HAVE BEEN EXHAUSTED. THIS ALLOWS GBAHC TO SCREEN ALL PATIENTS FOR FINANCIAL ASSISTANCE PRIOR TO PURSUING ANY EXTRAORDINARY COLLECTION ACTIONS. THE DATA RETURNED FROM THIS ELECTRONIC ELIGIBILITY REVIEW WILL CONSTITUTE ADEQUATE DOCUMENTATION OF FINANCIAL NEED UNDER THIS POLICY. WHEN ELECTRONIC ENROLLMENT IS USED AS THE BASIS FOR PRESUMPTIVE ELIGIBILITY, THE HIGHEST DISCOUNT LEVELS WILL BE GRANTED FOR ELIGIBLE SERVICES FOR RETROSPECTIVE DATES OF SERVICE ONLY. IF A PATIENT DOES NOT QUALIFY UNDER THE ELECTRONIC ENROLLMENT PROCESS, THE PATIENT MAY STILL BE CONSIDERED UNDER THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. PATIENT ACCOUNTS GRANTED PRESUMPTIVE ELIGIBILITY WILL BE RECLASSIFIED UNDER THE FINANCIAL ASSISTANCE POLICY. THEY WILL NOT BE SENT TO COLLECTION AND WILL NOT BE INCLUDED IN THE HOSPITAL'S BAD DEBT EXPENSE. |
| SCHEDULE H, PART V, SECTION B, LINE 16A | https://www.gundersenhealth.org/app/files/public/54813688-1ba8-49fd-b13c-9 d816f097e04/boscobel-financial-assistance-policy. SCHEDULE H, PART V, SECTION B, LINE 16B: https://www.gundersenhealth.org/app/files/public/c139890f-890b-408d-8e5d-7 f6e6f502645/Financial-Assistance-all-locations-financial-assistance-applic ation-English.pdf SCHEDULE H, PART V, SECTION B, LINE 16C: https://www.gundersenhealth.org/app/files/public/17ad7410-f492-4707-8c5b-3 8cf512cab48/financial-assistance-boscobel-plain-language-summary-16.pdf |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| GUNDERSEN BOSCOBEL CLINIC | ||||
| 208 PARKER STREET | BOSCOBEL | WI | 53805 | PROVIDER BASED RURAL HEALTH CLINIC |
| GUNDERSEN FENNIMORE CLINIC | ||||
| 220 LINCOLN AVENUE | FENNIMORE | WI | 53809 | PROVIDER BASED RURAL HEALTH CLINIC |
| GUNDERSEN MUSCODA CLINIC | ||||
| 525 NORTH WISCONSIN AVENUE | MUSCODA | WI | 53573 | PROVIDER BASED RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C: | THE HOSPITAL USES THE FEDERAL POVERTY GUIDELINES AS ONE MEANS OF DETERMINING ELIGIBILITY FOR CHARITY CARE. THE FEDERAL POVERTY GUIDELINES ARE UPDATED AND PUBLISHED ANNUALLY BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. AS A GENERAL RULE, A PATIENT'S INCOME, BASED ON FAMILY SIZE, MUST BE AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES TO BE ELIGIBLE FOR THE CHARITY CARE PROGRAM. A SLIDING SCALE BASED ON THE PATIENT'S INCOME LEVEL UNDER THE FEDERAL POVERTY GUIDELINES WILL BE USED TO DETERMINE THE PRECISE AMOUNT OF CHARITY CARE FOR WHICH A PATIENT WILL BE ELIGIBLE. SOME PATIENTS MAY EXCEED 200% OF THE FEDERAL POVERTY GUIDELINES BUT MAY STILL BE ELIGIBLE FOR CHARITY CARE WHEN ADDITIONAL CRITERIA SUCH AS CATASTROPHIC MEDICAL COSTS ARE CONSIDERED. CATASTROPHIC MEDICAL CARE COSTS ARE DETERMINED ON A CASE-BY-CASE BASIS TO PATIENTS WHO DUE TO A SIGNIFICANT OR RECURRENCE OF MEDICAL BILLS MAY NEED ADDITIONAL COMMUNITY SUPPORT TO HELP A PATIENT OR THEIR FAMILY THROUGH A DIFFICULT TIME. |
| SCHEDULE H, PART I, LINE 7: | THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD 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. THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES IS BASED ON COST ALLOCATIONS FROM THE MEDICARE COST REPORT. THIS ALLOCATION METHOD AND PRINCIPLES OF ALLOCATION WERE USED TO DERIVE A SPECIFIC AMOUNT OF COST ALLOCATION TO THE VARIOUS PROGRAMS AND COST CENTERS OPERATED BY THE HOSPITAL. SCHEDULE H, PART I, LINE 7, COLUMN (F): THE TOTAL BAD DEBT EXCLUDED FROM TOTAL EXPENSES IS $1,141,808 |
| SCHEDULE H, PART I, LINE 7G: | SUBSIDIZED HEALTH SERVICES AT GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS INCLUDE THE OPERATION OF THE EMERGENCY DEPARTMENT AND THE OPERATION OF THREE RURAL HEALTH CLINICS. THE EMERGENCY DEPARTMENT IS STAFFED 24-HOURS PER DAY TO PROVIDE NEEDED ACCESS TO EMERGENCY CARE IN THE BOSCOBEL, WISCONSIN COMMUNITY OR AS REQUIRED BY REGULATIONS TO BE ON-CALL AND AVAILABLE TO PROVIDE ACCESS TO EMERGENCY CARE AS A PART OF OPERATING A HOSPITAL IN THE STATE OF WISCONSIN. THE OPERATION OF THREE RURAL HEALTH CLINICS IS ALSO PROVIDED AS A SUBSIDIZED HEALTH SERVICE IN ORDER TO MEET HEALTH CARE NEEDS IN THE SURROUNDING COMMUNITIES. GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS CURRENTLY OPERATES RURAL HEALTH CLINICS IN BOSCOBEL, FENNIMORE, AND MUSCODA, WISCONSIN. IT IS THE GOAL OF THE HOSPITAL TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. |
| SCHEDULE H, 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. |
| SCHEDULE H, 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 CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES, PATIENTS DO NOT COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE HOSPITAL PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS, A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE. |
| SCHEDULE H, PART III, LINE 4: | ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. |
| SCHEDULE H, PART III, LINE 8: | THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H OF THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE HOSPITAL, AND ALSO DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS HOSPITAL INPATIENT PHYSICIAN PROFESSIONAL SERVICES, RESPIRATORY THERAPY PROFESSIONAL SERVICES, RADIOLOGIST PROFESSIONAL SERVICES, SURGEON PROFESSIONAL SERVICES, AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN PROFESSIONAL SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENTS AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY AND PHYSICIAN 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 GUNDERSEN BOSCOBEL HOSPITAL AND CLINICS PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE PERIOD ENDED DECEMBER 31, 2019, AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. |
| SCHEDULE H, PART III, LINE 9B: | UNDER THE HOSPITAL'S COLLECTION AND CHARITY CARE POLICIES, GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE HOSPITAL'S CHARITY CARE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE. ALL INPATIENT SELF-PAY ADMISSIONS ARE SCREENED BY THE HOSPITAL'S PATIENT FINANCIAL COUNSELOR OR SOCIAL WORKERS TO ALLOW THESE PATIENTS THE ABILITY TO COMPLETE THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL, DEPENDING UPON THE PATIENT'S CONDITION, OR THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPLETE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION. DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICIES AS WELL AS THE CHARITY CARE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. |
| SCHEDULE H, PART VI, LINE 2: | GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES AND AREAS IT SERVES BY REVIEWING LOCAL DEMOGRAPHICS AND TRENDS IN PATIENT SERVICE UTILIZATION TO DETERMINE WHICH SERVICES COULD AND SHOULD BE MADE AVAILABLE TO THE COMMUNITY IN A COST-EFFECTIVE MANNER TO BE CONSISTENT WITH THE HOSPITAL'S MISSION IN THE COMMUNITY. GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS ALSO REVIEWS STATISTICS IN THE HOSPITAL, CLINIC, AND OTHER ORGANIZATIONAL DEPARTMENTS TO REVIEW THE CURRENT SERVICES BEING OFFERED AND ENSURE THAT RESOURCES ARE BEING APPROPRIATELY ALLOCATED TO AREAS IN NEED BY COMMUNITY MEMBERS AND PATIENTS. THE HOSPITAL ALSO MEETS WITH LOCAL COMMUNITY MEMBERS AND ITS PHYSICIAN GROUP TO DETERMINE WHICH SERVICES MAY BENEFIT THE COMMUNITY. DURING FISCAL YEAR 2015, THE HOSPITAL COLLABORATED WITH OTHER AREA HOSPITALS TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THROUGH THE CHNA PROCESS THE HOSPITAL CONSIDERED, COUNTY HEALTH STATISTICS, MEDICAL RESOURCES, SAFETY FACTORS, SOCIO-ECONOMIC INDICATORS, TRANSPORTATION ISSUES, ACCESS TO RESOURCES, AND ENVIRONMENTAL QUALITY. |
| SCHEDULE H, PART VI, LINE 3: | THE PRIMARY SERVICE AREA FOR GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS ENCOMPASSES ALL PERSONS LIVING WITHIN A 20 TO 30 MILE RADIUS OF THE HOSPITAL. THE HOSPITAL ALSO DETERMINED THAT PRIMARY CLINICAL HEALTH CARE WAS A NEEDED SERVICE IN TWO SURROUNDING COMMUNITIES, SO THE HOSPITAL ALSO OPERATES PROVIDER-BASED RURAL HEALTH CLINICS IN FENNIMORE AND MUSCODA, WISCONSIN. OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE WISCONSIN MEDICAID OR BADGERCARE PROGRAMS, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE. THE HOSPITAL ALSO PROVIDES CERTIFIED APPLICATION COUNSELORS FOR ASSISTING PATIENTS WITH OBTAINING COVERAGE THROUGH THE HEALTH INSURANCE MARKETPLACE. |
| SCHEDULE H, PART VI, LINE 4: | THE PRIMARY SERVICE AREA FOR GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS ENCOMPASSES ALL PERSONS LIVING WITHIN A 20 TO 30 MILE RADIUS OF THE HOSPITAL. THE HOSPITAL ALSO DETERMINED THAT PRIMARY CLINICAL HEALTH CARE WAS A NEEDED SERVICE IN TWO SURROUNDING COMMUNITIES, SO THE HOSPITAL ALSO OPERATES PROVIDER-BASED RURAL HEALTH CLINICS IN FENNIMORE AND MUSCODA, WISCONSIN. |
| SCHEDULE H, PART VI, LINE 5: | GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS OFFERS HEALTH SCREENINGS, EDUCATIONAL DISPLAYS, AND PRESENTATIONS ON A VARIETY OF TOPICS SUCH AS HEALTHY EATING, EXERCISE, HEART HEALTH, CHOLESTEROL, ETC. TO MEMBERS OF THE COMMUNITY. PROGRAMS AND SERVICES ARE ALSO CONSIDERED BY THE HOSPITAL'S BOARD OF DIRECTORS, WHICH INCLUDES FIVE LOCAL COMMUNITY MEMBERS WHO RESIDE WITHIN A THIRTY MILE RADIUS OF THE HOSPITAL. THE HOSPITAL ALSO CONSIDERS A RELATIVELY OPEN MEDICAL STAFF POLICY ALLOWING PROPERLY CREDENTIALED PROVIDERS THE ABILITY TO PRACTICE MEDICINE AND FOLLOW-UP WITH PATIENTS UTILIZING THE HOSPITAL'S FACILITIES. |
| SCHEDULE H, PART VI, LINE 6: | GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS IS AFFILIATED WITH GUNDERSEN HEALTH SYSTEM. THIS AFFILIATION PROVIDES LOCAL SERVICES IN CARDIOLOGY, NEUROLOGY, PODIATRY, DERMATOLOGY, UROLOGY, GYNECOLOGY, ENDOCRINOLOGY, HEMATOLOGY/ONCOLOGY, AND VASCULAR MEDICINE AS WELL AS LAPAROSCOPIC AND ORTHOPEDIC SURGERY. |
| SCHEDULE H, PART VI, LINE 7 | LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT: WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARILU BINTZ MD | ||||||||||||||
| BOARD MEMBER/MED VP GHS | $0 | $569,125 | $0 | $0 | $0 | $5,236 | $0 | $41,325 | $0 | $6,294 | $0 | $621,980 | $0 | $0 |
| JAMES KLOCK | ||||||||||||||
| BOARD MEMBER/DIR OF REG IS | $0 | $130,925 | $0 | $0 | $0 | $818 | $0 | $19,780 | $0 | $15,846 | $0 | $167,369 | $0 | $0 |
| SCOTT KNIPRATH | ||||||||||||||
| VICE PRESIDENT/EXEC DIR GH | $0 | $160,206 | $0 | $0 | $0 | $5,274 | $0 | $24,180 | $0 | $31,584 | $0 | $221,244 | $0 | $0 |
| KEITH FRYE | ||||||||||||||
| SECRETARY/ADMIN DIR - LAB | $0 | $119,444 | $0 | $0 | $0 | $1,498 | $0 | $17,823 | $0 | $15,846 | $0 | $154,611 | $0 | $0 |
| ANDY NAHAS MD | ||||||||||||||
| BOARD MEMBER/OPTOMETRY | $0 | $201,504 | $0 | $0 | $0 | $500 | $0 | $29,871 | $0 | $15,846 | $0 | $247,721 | $0 | $0 |
| THERESA BRAUDT | ||||||||||||||
| ADMINISTRATOR | $0 | $151,913 | $0 | $0 | $0 | $9,224 | $0 | $18,360 | $0 | $15,689 | $0 | $195,186 | $0 | $0 |
| DOUGLAS KNOBLE | ||||||||||||||
| PHARMACIST | $112,907 | $0 | $0 | $0 | $48 | $0 | $22,783 | $0 | $8,166 | $0 | $143,904 | $0 | $0 | $0 |
| TARA WOOD | ||||||||||||||
| PHARMACIST | $136,084 | $0 | $0 | $0 | $33 | $0 | $12,949 | $0 | $14,988 | $0 | $164,054 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART 1, LINE 3: | FormAndLineReferenceDesc |
| Explanation | FOR THE PURPOSE OF DETERMINING EXECUTIVE COMPENSATION, GUNDERSEN BOSCOBEL HOSPITAL AND CLINICS RELIED ON ITS AFFILIATED ORGANIZATION, GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC., TO ESTABLISH COMPENSATION OF THE CEO, CFO, AND OTHER OFFICERS. GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION SURVEY OR STUDY, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| CITY OF BOSCOBEL WI | |||||||
| A | 396005403 | 2007-07-26 | $4,200,000 | SEE PART VI | false | false | false |
| CITY OF BOSCOBEL WI | |||||||
| B | 396005403 | 2003-03-01 | $2,719,054 | SEE PART VI | false | false | false |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Bond DefeasedBondDefeasedAmt | Total ProceedsTotalProceedsAmt | In Reserve FundInReserveFundAmt | Capitalized InterestCapitalizedInterestAmt | Refunding EscrowRefundingEscrowAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Credit EnhancementCreditEnhancementAmt | Working Capital ExpendituresWorkingCapitalExpendituresAmt | Capital ExpendituresCapitalExpendituresAmt | Other Spent ProceedsOtherSpentProceedsAmt | UnspentUnspentAmt | Substantial CompletionSubstantialCompletionYr | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $1,857,876 | $0 | $4,200,000 | $0 | $0 | $0 | $84,000 | $0 | $0 | $4,116,000 | $0 | $0 | 2007 | false | false | Yes (true) | Yes (true) |
| B | $2,251,644 | $0 | $2,719,054 | $0 | $0 | $0 | $54,381 | $0 | $0 | $297,952 | $2,366,721 | $0 | 2003 | Yes (true) | false | Yes (true) | Yes (true) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Remedial Action TakenRemedialActionTakenInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|
| A | false | false | false | false | 0 | false | false | false | false |
| B | false | false | false | false | 0 | false | false | false | false |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Business Name Line1GICProviderName/BusinessNameLine1Txt | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|---|
| 0 | ||||||||||
| A | false | false | Yes (true) | false | false | false | false | 0 | false | false |
| 0 | ||||||||||
| B | false | false | Yes (true) | false | false | false | false | 0 | false | false |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | false |
| B | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE K, PART I | FormAndLineReferenceDesc |
| Explanation | (A) ISSUER NAME: CITY OF BOSCOBEL, WI (F) DESCRIPTION OF PURPOSE: EMERGENCY ROOM CONSTRUCTION AND REMODEL (B) ISSUER NAME: CITY OF BOSCOBEL, WI (F) DESCRIPTION OF PURPOSE: PROVIDE FUNDS TO REFUND A PRIOR BOND ISSUE AND PURCHASE EQUIPMENT | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART I, DOING BUSINESS AS: | GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS |
| FORM 990, PART VI, SECTION A, LINE 3: | AS AN AFFILIATE OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS WILL ROUTINELY DELEGATE VARIOUS MANAGEMENT OR SUPPORT FUNCTIONS TO RELATED ENTITIES. FOR EXAMPLE, THE CEO AND CFO OF GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS, AS WELL AS SEVERAL MEMBERS OF THE BOARD OF DIRECTORS, ARE EMPLOYEES OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. AND ITS AFFILIATED ORGANIZATIONS WHICH ARE ALSO TAX-EXEMPT ORGANIZATIONS. |
| FORM 990, PART VI, SECTION A, LINE 6: | THE ARTICLES OF INCORPORATION OF GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS PROVIDES FOR ONE MEMBER OF THE CORPORATION. THE SOLE CORPORATE MEMBER OF GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS IS GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A: | AS THE SOLE CORPORATE MEMBER AND UNDER THE TERMS OF THE AFFILIATION AGREEMENT, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY APPOINT, REMOVE, OR ELECT CERTAIN OFFICERS AND/OR MEMBERS OF THE BOARD OF DIRECTORS OF GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS. GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY APPOINT SIX MEMBERS OF THE BOARD OF DIRECTORS OF GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS. |
| FORM 990, PART VI, SECTION A, LINE 7B: | THE SOLE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., HAS THE FOLLOWING RESERVE RIGHTS OF APPROVAL: THE INCURRENCE OF DEBT (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS OR DEBT INCLUDED IN APPROVED BUDGETS) AND THE GRANT OF ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND DIRECT EXECUTION OF ANY DOCUMENTS AND THE TAKING OF ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT AND THE ANNUAL OPERATING BUDGET AND CAPITAL EXPENDITURES. |
| FORM 990, PART VI, SECTION B, LINE 11B: | THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND THEN REVIEWED BY THE ORGANIZATION'S MANAGEMENT. A FINAL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO SUBMISSION. |
| FORM 990, PART VI, SECTION B, LINE 12C: | THE BOARD OF DIRECTORS DISCLOSES ANY CONFLICTS OF INTEREST BY COMPLETING A QUESTIONNAIRE AND DISCLOSURE FORM ANNUALLY. EMPLOYEES ARE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY UPON HIRE AND AT ANNUAL INTERVALS. IF ANY SIGNIFICANT CONFLICTS ARISE WITH MEMBERS OF THE BOARD OF DIRECTORS, MANAGEMENT, OR KEY EMPLOYEES, IT IS PROPERLY DOCUMENTED AND FOLLOWED UP ON BY THE APPROPRIATE GOVERNING GROUP OR DEPARTMENT WITHIN THE ORGANIZATION ACCORDING TO THE CONFLICT OF INTEREST POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15: | FOR THE PURPOSES OF DETERMINING COMPENSATION, GUNDERSEN AREA BOSCOBEL HOSPITAL AND CLINICS RELIED ON ITS AFFILIATED ORGANIZATION, GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC., TO ESTABLISH COMPENSATION OF THE CEO, CFO, AND OTHER OFFICERS. GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION SURVEY OR STUDY, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| FORM 990, PART VI, SECTION C, LINE 19: | THE ABBREVIATED FINANCIAL STATEMENTS ARE MADE PUBLICLY AVAILABLE THROUGH THE WISCONSIN HOSPITAL ASSOCIATION AND THE COMPLETE AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE ALSO AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VII, LINE 1A, EXPLANATION OF HOURS WORKED: | SOME OFFICERS AND BOARD MEMBERS ARE EMPLOYED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. AND ITS AFFILIATES. GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.'S PURPOSE IS TO SERVE AS A SUPPORTING ORGANIZATION TO MULTIPLE SUBSIDIARY ORGANIZATIONS AS LISTED IN SCHEDULE R AND THESE OFFICERS AND BOARD MEMBERS OFTEN WORK IN EXCESS OF 40 HOURS PER WEEK PROVIDING SERVICES TO AFFILIATED ORGANIZATIONS. THESE HOURS ARE REFLECTED IN LINE 2 OF COLUMN B. |
| FORM 990, PART IX, LINE 11G, OTHER FEES: | ER PHYSICIAN COVERAGE: PROGRAM SERVICE EXPENSES 2,252,510. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,252,510. CLINIC PHYSICIAN COVERAGE: PROGRAM SERVICE EXPENSES 1,005,611. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,005,611. RADIOLOGY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 500,511. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 500,511. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,086,952. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,086,952. ADMINISTRATIVE/MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 593,947. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 593,947. INFORMATION SYSTEMS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 574,548. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 574,548. LAB SERVICES: PROGRAM SERVICE EXPENSES 842,214. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 842,214. |
| FORM 990, PART XI, LINE 9, OTHER CHANGES IN NET ASSETS OR FUND BALANCES | NET CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION: $181,610 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:HEALTHCARE PROFESSIONAL FEES TOTAL FEES:6157418 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (24 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| TRI-COUNTY MEMORIAL FOUNDATION INC | ||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 300093022 | foundation | WI | 501(C)(3) | LINE 12A, I | TRI-COUNTY M | Yes (true) |
| GUNDERSEN LUTHERAN HEALTH SYSTEM INC | ||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391866425 | supporting or | WI | 501(C)(3) | LINE 12B,II | NA | false |
| GUNDERSEN LUTHERAN MEDICAL CENTER INC | ||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 390813416 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | GLHS | Yes (true) |
| GUNDERSEN CLINIC LTD | ||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391028657 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | GLHS | Yes (true) |
| GUNDERSEN LUTHERAN MEDICAL FOUNDATIONIN | ||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391249705 | FOUNDATION | WI | 501(C)(3) | LINE 7 | GLHS | Yes (true) |
| GUNDERSEN LUTHERAN CREDENTIALING SERVICE | ||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391856898 | CREDENTIALING | WI | 501(C)(3) | LINE 12C | GLHS | Yes (true) |
| GUNDERSEN LUTHERAN ADMIN SERVICES INC | ||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391606449 | SUPPORTING OR | WI | 501(C)(3) | LINE 12B,II | GLHS | Yes (true) |
| HARMONY COMMUNITY HEALTHCARE INC | ||||||||||
| 815 MAIN AVENUE S | HARMONY | MN | 55929 | 410711606 | HEALTHCARE | MN | 501(C)(3) | LINE 10 | GLHS | Yes (true) |
| TWEETEN LUTHERAN HEALTHCARE CENTER INC | ||||||||||
| 125 FIFTH AVENUE SE | SPRING GROVE | MN | 55974 | 411565003 | HEALTHCARE | MN | 501(C)(3) | LINE 10 | GLHS | Yes (true) |
| TRI-STATE AMBULANCE INC | ||||||||||
| 235 CAUSEWAY BLVD | LA CROSSE | WI | 56401 | 391965415 | MED TRANSPORT | WI | 501(C)(3) | LINE 3 | GLHS | Yes (true) |
| LUTHERAN REAL ESTATE HOLDING CORPORATION | ||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WA | 54601 | 391480826 | HOUSING | WI | 501(C)(3) | LN 12C, III | GLHS | Yes (true) |
| LUTHERAN HOUSING OF LA CROSSE INC | ||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391751934 | INDP. LIVING | WI | 501(C)(3) | LINE 10 | LREHC | Yes (true) |
| COMMUNITY HOUSING OF LA CROSSE INC | ||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391586700 | INDP. LIVING | WI | 501(C)(3) | LINE 10 | LREHC | Yes (true) |
| TRI-STATE REGIONAL AMBULANCE INC | ||||||||||
| 235 CAUSEWAY BLVD | LA CROSSE | WV | 54603 | 391962965 | MED TRANSPORT | WI | 501(C)(3) | LINE 10 | GLHS | Yes (true) |
| ST JOSEPH'S HEALTH SERVICES INC | ||||||||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | 390929538 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | GLHS | Yes (true) |
| TRI-COUNTY MEMORIAL HOSPITAL INC | ||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 390704510 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | GLHS | Yes (true) |
| MEMORIAL HOSPITAL OF BOSCOBEL FOUNDATION | ||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 53805 | 391688793 | FOUNDATION | WI | 501(C)(3) | LINE 7 | MHB | Yes (true) |
| ST JOSEPH'S MEMORIAL FOUNDATION INC | ||||||||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | 391455787 | FOUNDATION | WI | 501(c)(3) | LINE 12A, I | SJHS | Yes (true) |
| PALMER LUTHERAN HEALTH CENTER | ||||||||||
| 112 JEFFERSON STREET | WEST UNION | IA | 52175 | 421320763 | HEALTHCARE | IA | 501(C)(3) | LINE 3 | GLHS | Yes (true) |
| PALMER MEMORIAL FOUNDATION | ||||||||||
| 112 JEFFERSON STREET | WEST UNION | IA | 52175 | 421032878 | FOUNDATION | IA | 501(C)(3) | LINE 7 | PLHC | Yes (true) |
| MOUNDVIEW MEMORIAL HOSPITAL & CLINICS I | ||||||||||
| 402 W LAKE STREET | FRIENDSHIP | WI | 53934 | 390944012 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | GLHS | Yes (true) |
| MEMORIAL HEALTHCARE FOUNDATION INC | ||||||||||
| PO BOX 40 | FRIENDSHIP | WI | 53934 | 391775074 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | MMHC | Yes (true) |
| SAINT ELIZABETH'S HOSPITAL OF WABASHA | ||||||||||
| 1200 5TH GRANT BOULEVARD WEST | WABASHA | WI | 55981 | 410693877 | HEALTHCARE | MN | 501(C)(3) | LINE 3 | GLHS | false |
| BOSCOBEL AREA HEALTH PARTNERS | ||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 53805 | 450498844 | FUNDRAISING | WI | 501(C)(3) | LINE 7 | NA | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GUNDERSEN ENVISION LLC - | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1836 SOUTH AVENUE | AddressLine1Txt |
| City | LA CROSSE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 264706546 | EIN |
| Primary Activities | RENEWABLE ENERGY | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GLHS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C CORP | EntityTypeTxt |
| Share Of Total Income | $0 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $0 | ShareOfEOYAssetsAmt |
| Ownership | 0.00000 | OwnershipPct |
| Controlled Organization | Yes (true) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |