MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC (EIN 39-0944012)
- Tax period
- 2023-10-01 to 2024-09-30
- Filed
- 2025-08-13
- IRS object ID
- 202532259349300348
- Schema version
- 2023v6.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-08-13T10:57:04-05:00 | ReturnTs |
| Tax Period End | 2024-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390944012 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOUNDVIEW MEMORIAL HOSPITAL & CLINICS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MOUN | BusinessNameControlTxt |
| Phone | 6083393331 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 402 WEST LAKE STREET | AddressLine1Txt |
| City | FRIENDSHIP | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53934 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | FRANK PEREZ-GUERRA | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6083393331 | PhoneNum |
| Signature | 2025-08-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2025-08-06 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GUNDERSEN MOUNDVIEW HOSPITAL & CLINICS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | FRANK PEREZ-GUERRA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 402 WEST LAKE STREET | AddressLine1Txt |
| City | FRIENDSHIP | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53934 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $36,914,548 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GUNDERSENHEALTH.ORG/MOUNDVIEW | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1959 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TOGETHER, WE INSPIRE YOUR BEST LIFE BY RELENTLESSLY CARING, LEARNING AND INNOVATING. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 175 | TotalEmployeeCnt |
| Total Volunteers | 70 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $92,084 | PYContributionsGrantsAmt |
| CY Contributions Grants | $122,479 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $24,924,368 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $35,884,432 | CYProgramServiceRevenueAmt |
| PY Investment Income | $359,449 | PYInvestmentIncomeAmt |
| CY Investment Income | $699,809 | CYInvestmentIncomeAmt |
| PY Other Revenue | $159,664 | PYOtherRevenueAmt |
| CY Other Revenue | $194,687 | CYOtherRevenueAmt |
| PY Total Revenue | $25,535,565 | PYTotalRevenueAmt |
| CY Total Revenue | $36,901,407 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $600 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,400,294 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $18,352,667 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $15,846,048 | PYOtherExpensesAmt |
| CY Other Expenses | $16,115,872 | CYOtherExpensesAmt |
| PY Total Expenses | $24,246,342 | PYTotalExpensesAmt |
| CY Total Expenses | $34,469,139 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,289,223 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,432,268 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,024,749 | TotalAssetsBOYAmt |
| Total Assets EOY | $24,370,099 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,702,190 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,618,761 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $18,322,559 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $20,751,338 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | LEADING WITH LOVE, WE COURAGEOUSLY COMMIT TO A FUTURE OF HEALTHY PEOPLE AND THRIVING COMMUNITIES. THIS IS OUR VISION. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $21,114,658 | ExpenseAmt |
| Grant | $600 | GrantAmt |
| Revenue | $22,357,772 | RevenueAmt |
| Desc | THE HOSPITAL IS A GENERAL MEDICAL CRITICAL ACCESS HOSPITAL LICENSED FOR 25 BEDS. DURING FISCAL YEAR 2024, THE HOSPITAL HAD 402 ACUTE INPATIENT DAYS AND 1,110 SWING-BED DAYS. THE HOSPITAL ALSO HAD 7,781 EMERGENCY ROOM/URGENT CARE AND 10,715 CLINIC VISITS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $9,207,053 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $13,592,747 | RevenueAmt |
| Desc | THE HOSPITAL ALSO HAS AN OUTPATIENT PHARMACY THAT IS THE ONLY IN ITS COUNTY (ADAMS, WI), AND IN 2024 FILLED 94,453 PRESCRIPTIONS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $30,321,711 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 209 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 175 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRANK PEREZ-GUERRA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6083393331 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 402 WEST LAKE STREET | AddressLine1Txt |
| City | FRIENDSHIP | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53934 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| SARAH ROSSMAN | |||||||||
| TREASURER/SECRETARY | 2.00 | 48.00 | Yes (X) | Yes (X) | $158,797 | $0 | $27,560 | ||
| STEPHANIE CARROLL | |||||||||
| BOARD TRUSTEE/MD HOSPITALIST | 2.00 | 48.00 | Yes (X) | $312,603 | $0 | $65,146 | |||
| BRYAN ERDMANN | |||||||||
| BOARD TRUSTEE/COO | 2.00 | 48.00 | Yes (X) | $409,876 | $0 | $74,345 | |||
| ROXANNE POTTS | |||||||||
| BOARD TRUSTEE/CLINICAL OPS. DIRECTOR | 2.00 | 48.00 | Yes (X) | $168,885 | $0 | $46,658 | |||
| TADD WORMET | |||||||||
| CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| PAUL FISCH | |||||||||
| VICE CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| LAURIE INDA | |||||||||
| BOARD TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| KAREN MILLER | |||||||||
| BOARD TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| JOE THEISEN | |||||||||
| BOARD TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| FRANK PEREZ-GUERRA | |||||||||
| CEO | 48.00 | 2.00 | Yes (X) | $198,119 | $0 | $54,078 | |||
| SCOTT RATHGABER | |||||||||
| CEO-BGHS | 2.00 | 48.00 | Yes (X) | $0 | $1,644,221 | $68,728 | |||
| STEVE LITTLE | |||||||||
| CFO-BGHS (THRU 02/2024) | 2.00 | 48.00 | Yes (X) | $0 | $333,317 | $0 | |||
| JOHN CEELEN | |||||||||
| CFO-BGHS (BEG. 02/2024) | 2.00 | 48.00 | Yes (X) | $0 | $0 | $0 | |||
| DEENA KEDROWSKI | |||||||||
| OUTPATIENT PHARMACY MANAGER | 40.00 | $197,266 | $0 | $38,061 | Yes (X) | ||||
| DAVID BROWN | |||||||||
| PHARMACIST | 40.00 | $188,852 | $0 | $6,576 | Yes (X) | ||||
| NEIL DONNER | |||||||||
| PHARMACIST | 40.00 | $181,812 | $0 | $13,202 | Yes (X) | ||||
| PRESTON PIETRZAK | |||||||||
| PHARMACIST | 40.00 | $155,181 | $0 | $18,585 | Yes (X) | ||||
| BRAD SHAW | |||||||||
| INPATIENT PHARMACY MANAGER | 40.00 | $202,982 | $0 | $5,226 | Yes (X) | ||||
| GERALD OETZEL | |||||||||
| FORMER CFO-BGHS | 0.00 | 0.00 | $0 | $555,068 | $18,108 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,174,373 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,532,606 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $436,273 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 19 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| COMPHEALTH | |||||
| PO 972651 | DALLAS | TX | 753972651 | CONTRACT STAFFING SERVICES | $690,702 |
| STAFFENCY | |||||
| 221 W COLLEGE AVE FLOOR 2 | APPLETON | WI | 54911 | CONTRACT RN/LAB SERVICES | $621,524 |
| NUWEST GROUP HOLDINGS | |||||
| PO BOX 9410 | SEATTLE | WA | 981246404 | CONTRACT NURSING SERVICES | $510,674 |
| MEDICAL SOLUTIONS LLC | |||||
| PO BOX 850737 | MINNEAPOLIS | MN | 554850737 | CONTRACT NURSING SERVICES | $469,717 |
| SOUND CHOICE IMAGING LLC | |||||
| 36976 BRIDLEWOOD LANE | OCONOMOWOC | WI | 53066 | CONTRACT RN/LAB/IMAGING SERVICES | $364,753 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $109,783 | RelatedOrganizationsAmt |
| Government Grants | $12,696 | GovernmentGrantsAmt |
| Total Contributions | $122,479 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621300 | $22,228,625 | $22,228,625 |
| PHARMACY | 456110 | $13,592,747 | $13,592,747 |
| MEDICAL BUILDING RENT | 531120 | $53,859 | $53,859 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,201 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,201 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $35,884,432 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $699,809 | TotalRevenueColumnAmt |
| Exclusion | $699,809 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $18,610 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $13,141 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $5,469 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,469 | TotalRevenueColumnAmt |
| Exclusion | $5,469 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| E.H.R INCENTIVE | 900099 | $66,087 | $66,087 | |
| CAFETERIA | 722514 | $31,125 | $31,125 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $92,006 | TotalRevenueColumnAmt |
| Exclusion | $92,006 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $189,218 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,901,407 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35,950,519 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $828,409 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $600 | TotalAmt |
| Program Services | $600 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,516,069 | TotalAmt |
| Management And General | $1,516,069 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,081,952 | TotalAmt |
| Program Services | $13,536,647 | ProgramServicesAmt |
| Management And General | $545,305 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $824,267 | TotalAmt |
| Program Services | $824,267 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,216,913 | TotalAmt |
| Program Services | $1,136,657 | ProgramServicesAmt |
| Management And General | $80,256 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $713,466 | TotalAmt |
| Program Services | $621,520 | ProgramServicesAmt |
| Management And General | $91,946 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $990,696 | TotalAmt |
| Management And General | $990,696 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,467 | TotalAmt |
| Management And General | $14,467 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,230 | TotalAmt |
| Management And General | $42,230 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,703 | TotalAmt |
| Management And General | $4,703 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,929,818 | TotalAmt |
| Program Services | $1,845,603 | ProgramServicesAmt |
| Management And General | $84,215 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,633 | TotalAmt |
| Program Services | $569 | ProgramServicesAmt |
| Management And General | $42,064 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $432,822 | TotalAmt |
| Program Services | $322,802 | ProgramServicesAmt |
| Management And General | $110,020 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,564 | TotalAmt |
| Program Services | $9,564 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $661,583 | TotalAmt |
| Program Services | $617,569 | ProgramServicesAmt |
| Management And General | $44,014 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,170 | TotalAmt |
| Program Services | $106,682 | ProgramServicesAmt |
| Management And General | $1,488 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,816 | TotalAmt |
| Program Services | $16,234 | ProgramServicesAmt |
| Management And General | $5,582 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,432 | TotalAmt |
| Management And General | $5,432 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $616,392 | TotalAmt |
| Program Services | $328,461 | ProgramServicesAmt |
| Management And General | $287,931 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,278 | TotalAmt |
| Management And General | $65,278 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $10,109,407 | $10,109,407 | |
| PHARMACY DRUGS AND VACC | $617,322 | $617,322 | |
| BAD DEBT EXPENSE | $149,876 | $16,143 | $133,733 |
| DUES AND SUBSCRIPTIONS | $79,798 | $24,634 | $55,164 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $213,865 | TotalAmt |
| Program Services | $187,030 | ProgramServicesAmt |
| Management And General | $26,835 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,469,139 | TotalAmt |
| Program Services | $30,321,711 | ProgramServicesAmt |
| Management And General | $4,147,428 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,175 | BOYAmt |
| EOY | $1,065 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,781,880 | BOYAmt |
| EOY | $13,432,114 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,049,390 | BOYAmt |
| EOY | $3,687,711 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $702,338 | BOYAmt |
| EOY | $854,301 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,154 | BOYAmt |
| EOY | $84,246 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $9,704,381 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,176,598 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,593,555 | BOYAmt |
| EOY | $5,527,783 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $731,667 | BOYAmt |
| EOY | $715,000 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $84,590 | BOYAmt |
| EOY | $67,879 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,024,749 | BOYAmt |
| EOY | $24,370,099 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,559,189 | BOYAmt |
| EOY | $1,890,174 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,658 | BOYAmt |
| EOY | $4,058 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $201,991 | BOYAmt |
| EOY | $168,775 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $937,352 | BOYAmt |
| EOY | $1,555,754 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,702,190 | BOYAmt |
| EOY | $3,618,761 | 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 | $17,783,559 | BOYAmt |
| EOY | $20,137,338 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $539,000 | BOYAmt |
| EOY | $614,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,322,559 | BOYAmt |
| EOY | $20,751,338 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,024,749 | BOYAmt |
| EOY | $24,370,099 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,432,268 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$3,489 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $4,703 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,703 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | MOUNDVIEW MEMORIAL HOSPITAL & CLINICS PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA) & AMERICAN HOSPITAL ASSOCIATION VIA WHA, AND THE RURAL WISCONSIN HEALTH COOPERATIVE. THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT BUT DISCUSSIONS WITH EACH ENTITY REVEAL A PERCENTAGE OF THEIR WORK, AND THUS A PERCENTAGE OF THE DUES EXPENSE IS DEDICATED TO LOBBYING SERVICES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $76,500 | OtherCostOrOtherBasisAmt |
| Book Value | $76,500 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,199,280 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,812,444 | DepreciationAmt |
| Book Value | $4,386,836 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,041,201 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,987,208 | DepreciationAmt |
| Book Value | $1,053,993 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $387,400 | OtherCostOrOtherBasisAmt |
| Depreciation | $376,946 | DepreciationAmt |
| Book Value | $10,454 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,527,783 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO RELATED PARTY | $466,961 |
| 403 (B) PLAN | $663,145 |
| PAYABLES TO THIRD-PARTY REIMBURSEMENT PROGRAMS | $425,648 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,555,754 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | GUNDERSEN HEALTH SYSTEM HAS REVIEWED TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS. THE SYSTEM'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR 2018 AND PRIOR YEARS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $703,693 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $703,693 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02050 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,853,620 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,606,876 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,246,744 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06550 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,557,313 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,606,876 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,950,437 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08600 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $234,269 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,150 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $218,119 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00640 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $31,583 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $31,583 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,232,648 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,963,093 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,269,555 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03700 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,498,500 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,979,243 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,519,257 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04430 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,055,813 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,586,119 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,469,694 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13030 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $78,361 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $3,291 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,420,958 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,456,304 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$35,346 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOUNDVIEW MEMORIAL HOSPITAL & CLINICS | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 402 WEST LAKE STREET PO BOX 40 | AddressLine1Txt |
| City | FRIENDSHIP | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53934 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.GUNDERSENHEALTH.ORG/MOUNDVIEW | WebsiteAddressTxt |
| State License | 1014 | 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 | MOUNDVIEW MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 23 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SUPPLEMENTAL INFORMATION | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 23 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SUPPLEMENTAL INFORMATION | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MOUNDVIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: MOUNDVIEW MEMORIAL HOSPITAL & CLINICS DID NOT CONDUCT A NEW SURVEY IN 2024. WE USED THE 52 QUESTION SURVEY THAT WAS PART OF THE CHNA THAT WE PARTICIPATED IN WITH ADAMS COUNTY HEALTH AND HUMAN SERVICES. THE SURVEY PRIMARILY INCLUDED A MIX OF RANKING QUESTIONS AND "CHECK ALL THAT APPLY" QUESTIONS. SOME EXAMPLES OF THE QUESTIONS INCLUDED: DEMOGRAPHICS, RATING OF THE COMMUNITY AND OPPORTUNITIES AVAILABLE IN THE COMMUNITY (JOBS, SOCIAL/RECREATIONS, SCHOOLS, CHILDCARE PROVIDERS, AFFORDABLE HOUSING, SAFETY, POLICE/SHERIFF, AVAILABLE RESOURCES) THE NEED FOR TRANSPORTATION, HEALTH SERVICES, FOOD; THEIR CONCERN FOR VARIOUS HEALTH ISSUES IN THE COMMUNITY SUCH AS MENTAL HEALTH, JOB LOSS, POVERTY, ALCOHOL AND DRUG USE), THEIR CONCERN FOR SAFETY RELATED ISSUES, WHAT THEY FELT WERE THE MOST IMPORTANT HEALTH PROBLEMS IN THE COMMUNITY. THE SURVEY TOOK PLACE THROUGHOUT THE SUMMER OF 2021 NOT 2024. WE USED THE 2021 SURVEY AS PART OF THE DATA FOR OUR 2024 NEEDS ASSESSMENT. WE THEN COLLECTED ADDITIONAL DATA IN 2024 THROUGH KEY INFORMANT INTERVIEWS, A COMMUNITY FOCUS GROUP AND KEY STAKEHOLDER MEETING WITH HEALTH NEEDS RANKINGS. |
| MOUNDVIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6A: GUNDERSEN HEALTH SYSTEM |
| MOUNDVIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: ADAMS COUNTY HEALTH AND HUMAN SERVICES - DIVISION OF PUBLIC HEALTH |
| MOUNDVIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: MENTAL HEALTHOVERALL GOAL: DEVELOP INITIATIVES TO IMPROVE THE MENTAL HEALTH OF AREA RESIDENTS. REDUCE THE AVERAGE NUMBER OF POOR MENTAL HEALTH DAYS IN THE LAST 30 DAYS TO LESS THAN THE 5.1 DAYS REPORTED IN THE 2024 COUNTY HEALTH RANKINGS.ACTION: MENTAL HEALTH SUPPORT FOR THOSE EXPERIENCING LOSSPROGRAMS/INITIATIVES:- ESTABLISH A STRUCTURED, RESEARCH BASED LOCAL GRIEF SUPPORT PROGRAM FOR THE DEATH OF LOVED ONE.ACTION: RESILIENCY FOR DISADVANTAGED YOUTHPROGRAMS/INITIATIVES:- GROW THE SCHOOL MENTOR PROGRAM TO INCLUDE STAFF FROM TWO COMMUNITY BUSINESSES OR AGENCIES THAT ARE NOT AFFILIATED WITH GUNDERSEN.ACTION: WORK WITH COMMUNITY PARTNERS ON MENTAL HEALTH INITIATIVES.- CONTINUE TO SERVE ON AND PARTICIPATE IN THE COUNTY MENTAL HEALTH COMMUNITY ACTION TEAM AND RELATED INITIATIVES.- ESTABLISH A ONESTOP LOCATION FOR AREA RESOURCES AND EVENTS FOR THE BENEFIT OF AREA RESIDENTS' OVERALL MENTAL AND PHYSICAL HEALTH.ACCESS TO CAREOVERALL GOAL: IMPROVE ACCESS TO HEALTHCARE PROVIDERS THROUGH RECRUITMENT AND RETENTION EFFORTS AND ENCOURAGING AREA YOUTH TO ENTER HEALTHCARE CAREERS. IMPROVE NUTRITION AND PHYSICAL ACTIVITY TO RESULT IN DECREASED CHRONIC ILLNESS, THEREBY REDUCING THE NEED FOR CARE.ACTION: IMPROVE ACCESS TO AREA RESOURCES AND SERVICESPROGRAMS/INITIATIVES:- IMPROVE LOCAL TRANSPORTATION OPTIONS THROUGH A MULTIAGENCY APPROACH. CONTINUE SERVING ON THE TRANSPORTATION COMMUNITY ACTION TEAM.ACTION: IMPROVE NUTRITION AND PHYSICAL ACTIVITY TO DECREASE CHRONIC ILLNESS, THEREBY REDUCING THE NEED FOR CARE.PROGRAMS/INITIATIVES:PROGRAMS/INITIATIVES:- INCREASE AWARENESS AND ENCOURAGE USE OF LOCAL PHYSICAL ACTIVITY AND NUTRITION RESOURCES TO DECREASE OBESITY.- DEVELOP TARGETED PROGRAMS/INITIATIVES THROUGH THE COMMUNITY ACTION TEAMACTION: IMPROVE ACCESS TO HEALTHCARE SERVICESPROGRAMS/INITIATIVES:- IMPLEMENT PEDIATRIC MOBILE CARE VAN PILOT PROGRAM IN FRIENDSHIP.- CONTINUE RECRUITMENT OF SPECIALISTS AND PRIMARY CARE PHYSICIANS.- IMPROVE ACCESS TO SURGICAL SERVICES.ACTION: ADDRESS CAREER SHORTAGE AREAS BY OFFERING JOB EXPLORATION, CLINICALS AND INTERNSHIP OPPORTUNITIES.PROGRAMS/INITIATIVES:- GROW THE HEALTH CAREER ACADEMY AT AF HIGH SCHOOL- OFFER 8TH GRADE CAREER TOURS AND ESTABLISH NEW CAREER EXPLORATION OPPORTUNITIES FOR YOUNGER STUDENTS.- CONTINUE TO OFFER JOB SHADOWS, INTERNSHIPS AND SUBSTANCE ABUSEOVERALL GOAL: DECREASE THE DRUG OVERDOSE DEATHS TO LESS THAN THE 26 OVERDOSE DEATHS REPORTED FROM 20192023 BY THE ADAMS COUNTY SHERRIFF'S DEPARTMENT.ACTION: PARTNER WITH LOCAL AGENCIES ON TREATMENT PLANS FOR DRUG OFFENDERSPROGRAMS/INITIATIVES:- LAB SUPPORT FOR DRUG COURT SCREENINGS- PROVIDE SPACE AND SUPPORT TO NOBLE COMMUNITY CLINIC (BEHAVIORAL HEALTH)ACTION: PARTICIPATE IN LOCAL EDUCATION AND DECREASE AVAILABILITY OF PRESCRIPTION DRUGSPROGRAMS/INITIATIVES:- PARTICIPATE IN DRUG FREE ADAMS COUNTY PROGRAMS AND OTHER INITIATIVES.- PROMOTE DRUG TAKE BACK PROGRAMS.- MAINTAIN THE MEDICATION DROP BOX SPONSORED BY HOSPITAL PHARMACY.SOCIAL DETERMINANTS OF HEALTH (THAT SIMULTANEOUSLY IMPACT ECONOMIC HEALTH, PARTICULARLY HOUSING, WORKFORCE & ECONOMIC DEVELOPMENT, TRANSPORTATION, EDUCATION & CHILDCARE)OVERALL GOAL: IMPROVE THE HEALTH AND WELLBEING OF RESIDENTS AND THE COUNTY'S ECONOMY. THE ROOT CAUSE OF MANY HEALTH BEHAVIORS AND OUTCOMES CAN BE TIED TO POVERTY/LOW INCOME. IN ADAMS COUNTY THIS IS COMPOUNDED BY OVER HALF OF THE WORKFORCE NOT LIVING IN THE AREA, IMPACTING THE ECONOMY AND OVERALL HEALTH OUTCOMES. WE SEEK TO INCREASE THE COUNTY'S MEDIAN HOUSEHOLD INCOME ($55,223) AND DECREASE THE MEDIAN WORKFORCE AGE (55.1 YEARS) BY WORKING WITH OTHERS ON INITIATIVES TO ATTRACT/KEEP YOUNGER RESIDENTS AND FAMILIES AND ENCOURAGE BUSINESS DEVELOPMENT.ACTION: PARTNER WITH OTHERS IN THE COMMUNITY ON THE CREATION OF LOCAL ECONOMIC DEVELOPMENTPROGRAMS/INITIATIVES:- SERVE ON THE RURAL PARTNERS NETWORK HOUSING COMMITTEE (GOAL OF INCREASING AVAILABLE, ATTRACTIVE WORKFORCE HOUSING AS OVER HALF OF THE COUNTY WORKFORCE DOES NOT LIVE IN THE AREA AND THEREFORE DOES NOT SUBSTANTIALLY CONTRIBUTE TO THE LOCAL ECONOMY)- SERVE ON THE RURAL PARTNERS NETWORK DOWNTOWN IMPROVEMENT COMMITTEE (GOAL OF IMPROVING THE LOOK, FEEL, OFFERINGS AND ACTIVITIES OF DOWNTOWN ADAMS AND FRIENDSHIP TO MAKE THE CENTER OF THE COUNTY A MORE APPEALING PLACE TO HELP RETAIN AND RECRUIT WORKERS AND IMPROVE THE AREA ECONOMY)- SERVE ON THE RURAL PARTNERS WORKFORCE DEVELOPMENT COMMITTEE (GOAL OF ATTRACTING NEW BUSINESSES TO THE AREA AND HELPING EXISTING BUSINESSES RECRUIT AND RETAIN QUALIFIED STAFF TO IMPROVE THE AREA ECONOMY)- SERVE ON THE COUNTY ECONOMIC DEVELOPMENT BOARD AND/OR OTHER RELATED INITIATIVES.ACTION: ADDRESS THE CHILDCARE SHORTAGEPROGRAMS/INITIATIVES:- SERVE ON THE ADAMS COUNTY CHILDCARE ALLIANCE COMMITTEE TO HELP IMPROVE THE AVAILABILITY OF LOCAL CHILDCARE OPTIONSACTION: ADDRESS TRANSPORTATION NEEDSPROGRAMS/INITIATIVES:- LISTED UNDER HEALTHCARE ACCESS ACTION: PROVIDE SUPPORT FOR LOCAL SCHOOLSPROGRAMS/INITIATIVES:- ASSIST WITH SCHOOL IMPROVEMENT AND/OR REFERENDUM COMMITTEES AS NEEDED. (SCHOOLS ARE ONE OF THE CORNERSTONES OF A SUCCESSFUL COMMUNITY)ACTION: OFFER INCENTIVES AND SCHOLARSHIPS WITH A FOCUS ON LOCAL, NON-TRADITIONAL STUDENTS PURSUING HIGH-NEED HEALTHCARE CAREERSPROGRAMS/INITIATIVES:- PROVIDE HEALTHCARE SCHOLARSHIPS WITH THE CONTINGENCY THAT THE STUDENT WORKS LOCALLY.- PROVIDE MENTORING FOR YOUTH RECEIVING SCHOLARSHIPS |
| MOUNDVIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 13H: HOSPITAL PATIENTS NOT MEETING FINANCIAL ASSISTANCE ELIGIBILITY THRESHOLDS MAY BE ELIGIBLE FOR ASSISTANCE UNDER CIRCUMSTANCES WHEN HOSPITAL MEDICAL BILLS WOULD RESULT IN SEVERE FINANCIAL HARDSHIP. PATIENTS, OR THEIR GUARANTORS, MAY BE ELIGIBLE FOR CATASTROPHIC CARE ASSISTANCE IF THEY HAVE INCURRED OUT-OF-POCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GMV THAT EXCEED 25% OF FAMILY INCOME AND HAVE ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL THRESHOLD. |
| PART V, SECTION B LINE 7A | HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/48911 |
| PART V, SECTION B LINE 10A | HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/48906 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - GUNDERSEN FRIENDSHIP CLINIC | ||||
| 402 WEST LAKE STREET PO BOX 40 | FRIENDSHIP | WI | 53934 | RURAL HEALTH CLINIC |
| 2 - GUNDERSEN WESTFIELD CLINIC | ||||
| 207 NORTH PIONEER PARK ROAD | WESTFIELD | WI | 53964 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | HOSPITAL PATIENTS NOT MEETING FINANCIAL ASSISTANCE ELIGIBILITY THRESHOLDS MAY BE ELIGIBLE FOR ASSISTANCE UNDER CIRCUMSTANCES WHEN HOSPITAL MEDICAL BILLS WOULD RESULT IN SEVERE FINANCIAL HARDSHIP. PATIENTS, OR THEIR GUARANTORS, MAY BE ELIGIBLE FOR CATASTROPHIC CARE ASSISTANCE IF THEY HAVE INCURRED OUT-OF-POCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GMV THAT EXCEED 25% OF FAMILY INCOME AND HAVE ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL THRESHOLD. |
| PART I, LINE 7: | THE RATIO OF PATIENT COST TO CHARGES WAS CALCULATED BY DIVIDING HOSPITAL EXPENSES NET OF NON-PATIENT REVENUE AND IDENTIFIED COMMUNITY BENEFIT EXPENSE BY GROSS PATIENT REVENUE. THE PERCENTAGE WAS THEN MULTIPLIED BY THE GROSS REVENUES ON BAD DEBT ACCOUNTS. |
| PART I, LINE 7G: | THE ORGANIZATION OPERATES 2 RURAL HEALTH CLINICS, AN OBSERVATION ROOM AND EMERGENCY ROOM WHERE THE COSTS EXCEED THE NET PATIENT SERVICE REVENUE. THESE SERVICES WOULD NOT BE PROVIDED TO THE COMMUNITY IF NOT FOR THE LEADERSHIP OF THE HOSPITAL. THE ORGANIZATION UTILIZED THEIR COST REPORT AND OTHER INTERNAL INFORMATION TO DETERMINE THE AMOUNTS TO BE RECORDED PER WORKSHEET 6 OF THE IRS FORM SCHEDULE H INSTRUCTIONS. AMOUNTS RECORDED HERE HAVE NOT BEEN DUPLICATED IN OTHER AREAS OF THE FORM, MEDICAID, BAD DEBT, FINANCIAL ASSISTANCE HAS BEEN REMOVED FROM THE AMOUNTS REPORTED AND THESE SERVICES WERE EXCLUDED FROM THE MEDICARE SURPLUS/SHORTFALL CALCULATION. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 149,876. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THE HOSPITAL'S COMMUNITY BUILDING ACTIVITIES PROMOTES HEALTH OF THE COMMUNITIES IT SERVES THROUGH LOCAL ADVERTISEMENTS, INVOLVEMENT WITH CHAMBER OF COMMERCE, DEPARTMENT OF AGING AND OTHER COMMUNITY ORGANIZATIONS. THE AMOUNT OF SUPPORT IS DIFFICULT TO QUANTIFY. |
| PART III, LINE 2: | THE RATIO OF PATIENT COST TO CHARGES WAS CALCULATED BY DIVIDING HOSPITAL EXPENSES NET OF NON-PATIENT REVENUE AND IDENTIFIED COMMUNITY BENEFIT EXPENSE BY GROSS PATIENT REVENUE. THE PERCENTAGE WAS THEN MULTIPLIED BY THE GROSS REVENUES ON BAD DEBT ACCOUNTS. |
| PART III, LINE 3: | IT IS CONSIDERED COMMUNITY BENEFIT AS THE HOSPITAL IS REIMBURSED ON MEDICARE ALLOWABLE COSTS. MEDICARE ALLOWABLE COSTS ARE DEFINED BY MEDICARE. THEY DO NOT NECESSARILY CAPTURE ALL COSTS OF THE HOSPITAL PROVIDING SERVICES TO THE COMMUNITY. CONSEQUENTLY, THERE ARE COSTS NOT REIMBURSED BY EITHER PATIENT OR THE PROGRAM. |
| PART III, LINE 4: | PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, THAT REFLECTS MANAGEMENT'S BEST ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS PATIENT SERVICE REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND CURRENT STATUS OF INDIVIDUAL ACCOUNTS.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 COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL 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 SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON ITS 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 COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. |
| PART III, LINE 8: | THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H TO THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUE DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE ORGANIZATION AS WELL AS ANESTHESIA PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, AND REVENUE 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, SURGICAL, AND CLINICAL 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 MOUNDVIEW MEMORIAL HOSPITAL & 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, 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, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. |
| PART III, LINE 9B: | PATIENTS UPON REGISTRATION ARE GIVEN THE POLICY AND REQUIREMENTS TO BE ELIGIBLE FOR CHARITY CARE. THEY ARE ENCOURAGED BY A FINANCIAL ADVISOR TO REVIEW THEIR SITUATION FOR ELIGIBILITY. |
| PART VI, LINE 2: | THE HOSPITAL COMMUNICATES REGULARLY WITH PUBLIC HEALTH TO ADDRESS COMMUNITY HEALTH NEEDS. WE ANNUALLY REVIEW LOCAL, REGIONAL AND STATE DATA SOURCES. THE HOSPITAL COMPLETES REPORTS ON INFECTIOUS AND COMMUNICABLE DISEASE AND MONITORS FOR OUTBREAKS. ANNUAL RISK ASSESSMENTS ARE COMPLETED ON TB AND INFECTION CONTROL ISSUES. THE HOSPITAL MEASURES CHRONIC DISEASE SCREENING RATES. THE HOSPITAL REVIEWS DATA RELEVANT TO WORK BEING COMPLETED THROUGH THE LOCAL COMMUNITY ACTION TEAMS WHO ARE ADDRESSING THE PRIORITIZED HEALTH NEEDS. |
| PART VI, LINE 3: | THE HOSPITAL ANNUALLY UPDATES THE AVAILABILITY OF ITS CHARITY PLAN AND QUALIFYING INCOME NEEDS TO QUALIFY ON THE HOSPITAL WEBSITE. THE EXISTENCE OF A CHARITY PLAN IS POSTED IN THE ADMITTING AREA. UPON REGISTRATION, THE PATIENT IS INFORMED OF THE HOSPITAL'S CHARITY PLAN, ELIGIBILITY, AND METHODS FOR APPLYING. ANYONE INTERESTED IN FURTHER INFORMATION IS REFERRED TO THE PATIENT ACCOUNT COORDINATOR FOR QUESTIONS AND ELIGIBILITY. THIS PERSON WORKS WITH THE PATIENT IN APPLICATION AS WELL AS EXPLORING THE POSSIBLE ELIGIBILITY OF ANY OTHER GOVERNMENT PROGRAM THAT MAY BE APPLICABLE, I.E. MEDICAID, BADGER CARE. |
| PART VI, LINE 4: | GUNDERSEN MOUNDVIEW SERVES ALL RESIDENTS OF ADAMS COUNTY (POPULATION 21,226 PER CENSUS 2022 QUICK FACTS). WE ALSO SERVE WESTFIELD AREA RESIDENTS, LOCATED IN MARQUETTE COUNTY. HOWEVER, OUR PRIMARY SERVICE AREA IS THE CENTRAL PORTION OF ADAMS COUNTY INCLUDING THE ZIP CODES OF ADAMS, FRIENDSHIP, ARKDALE AND GRAND MARSH WHICH MAKE UP OVER 74% OF OUR REVENUE. THE MAJORITY OF ADAMS COUNTY RESIDENTS ARE WHITE (93.1%) AND A HIGH PERCENTAGE (31%) ARE AGE 65 AND OVER. THE MEDIAN HOUSEHOLD INCOME ($51,878) IS CONSIDERABLY LOWER THAN THE STATE. TOURISM AND AGRICULTURE ARE AMONG THE COUNTY'S LARGEST INDUSTRIES. THE COUNTY IS MEDICALLY UNDERSERVED AND HAS RANKED IN THE BOTTOM OF THE WI COUNTY HEALTH RANKINGS IN TERMS OF HEALTH OUTCOMES AND FACTORS. |
| PART VI, LINE 5: | THE HOSPITAL IS A STRONG COMMUNITY PARTNER IN MANY LOCAL HEALTH EFFORTS. WE PROVIDE MONETARY AND IN-KIND SUPPORT TO SEVERAL INITIATIVES SUCH AS DONATIONS TO RECREATIONAL/WELLNESS PROGRAMS (EXAMPLE-PROVIDING FREE BIKE HELMETS TO YOUTH AND FUNDING TENNIS RACKETS TO BE USED BY SCHOOL STUDENTS AND AT YMCA TENNIS CLASSES). WE ALSO HAVE A PHYSICIAN SERVING ON THE LOCAL HEALTH BOARD, STAFF SERVING ON NUMEROUS COMMUNITY COALITIONS, COLLECT DONATIONS FOR AREA FOOD PANTRIES AND MUCH MORE. THESE ARE JUST A FEW AREAS WE HAVE ASSISTED. THE HOSPITAL BOARD ALSO INCLUDES COMMUNITY MEMBERS WHO ARE UNPAID. |
| PART VI, LINE 6: | THE ORGANIZATION IS A PART OF EMPLIFY HEALTH WHICH IS THE COMBINATION OF GUNDERSEN HEALTH AND BELLIN HEALTH SYSTEMS. IT IS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO ENHANCING THE PHYSICAL AND EMOTIONAL WELL-BEING OF INDIVIDUALS IN. IN COLLABORATION WITH COMMUNITIES, EMPLOYERS, SCHOOLS, AND GOVERNMENT OFFICIALS, WE SUPPORT INDIVIDUALS AND FAMILIES ON THEIR LIFELONG JOURNEY TOWARD OPTIMAL HEALTH. OUR COMMITMENT LIES IN DELIVERING SAFE, RELIABLE, AND COST-EFFECTIVE COMPREHENSIVE HEALTH SOLUTIONS, ALL WHILE UPHOLDING THE VALUES OF RESPECT AND COMPASSION. THROUGH OUR INNOVATIVE INITIATIVES, WE AIM TO TRANSFORM HEALTHCARE DELIVERY NOT ONLY IN OUR REGION BUT ALSO ON A GLOBAL SCALE. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (13 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SCOTT RATHGABER | ||||||||||||||
| CEO-BGHS | $0 | $1,274,504 | $0 | $200,000 | $0 | $169,717 | $0 | $45,225 | $0 | $23,503 | $0 | $1,712,949 | $0 | $0 |
| GERALD OETZEL | ||||||||||||||
| FORMER CFO-BGHS | $0 | $480,094 | $0 | $70,000 | $0 | $4,974 | $0 | $12,220 | $0 | $5,888 | $0 | $573,176 | $0 | $0 |
| BRYAN ERDMANN | ||||||||||||||
| BOARD TRUSTEE/COO | $408,646 | $0 | $0 | $0 | $1,230 | $0 | $45,225 | $0 | $29,120 | $0 | $484,221 | $0 | $0 | $0 |
| STEPHANIE CARROLL | ||||||||||||||
| BOARD TRUSTEE/MD HOSPITALIST | $312,018 | $0 | $0 | $0 | $585 | $0 | $38,790 | $0 | $26,356 | $0 | $377,749 | $0 | $0 | $0 |
| STEVE LITTLE | ||||||||||||||
| CFO-BGHS (THRU 02/2024) | $0 | $258,317 | $0 | $75,000 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $333,317 | $0 | $0 |
| FRANK PEREZ-GUERRA | ||||||||||||||
| CEO | $193,521 | $0 | $0 | $0 | $4,598 | $0 | $29,075 | $0 | $25,003 | $0 | $252,197 | $0 | $0 | $0 |
| DEENA KEDROWSKI | ||||||||||||||
| OUTPATIENT PHARMACY MANAGER | $196,234 | $0 | $0 | $0 | $1,032 | $0 | $5,967 | $0 | $32,094 | $0 | $235,327 | $0 | $0 | $0 |
| ROXANNE POTTS | ||||||||||||||
| BOARD TRUSTEE/CLINICAL OPS. DIRECTOR | $160,292 | $0 | $0 | $0 | $8,593 | $0 | $24,659 | $0 | $21,999 | $0 | $215,543 | $0 | $0 | $0 |
| BRAD SHAW | ||||||||||||||
| INPATIENT PHARMACY MANAGER | $202,742 | $0 | $0 | $0 | $240 | $0 | $3,948 | $0 | $1,278 | $0 | $208,208 | $0 | $0 | $0 |
| DAVID BROWN | ||||||||||||||
| PHARMACIST | $187,820 | $0 | $0 | $0 | $1,032 | $0 | $5,298 | $0 | $1,278 | $0 | $195,428 | $0 | $0 | $0 |
| NEIL DONNER | ||||||||||||||
| PHARMACIST | $180,859 | $0 | $0 | $0 | $953 | $0 | $208 | $0 | $12,994 | $0 | $195,014 | $0 | $0 | $0 |
| SARAH ROSSMAN | ||||||||||||||
| TREASURER/SECRETARY | $156,674 | $0 | $0 | $0 | $2,123 | $0 | $23,193 | $0 | $4,367 | $0 | $186,357 | $0 | $0 | $0 |
| PRESTON PIETRZAK | ||||||||||||||
| PHARMACIST | $154,965 | $0 | $0 | $0 | $216 | $0 | $4,421 | $0 | $14,164 | $0 | $173,766 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY, AND -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PLEASE REFER TO THE FORM 990, PART VI, LINE 15A DISCLOSURE IN SCHEDULE O FOR ADDITIONAL DETAILS ON HOW COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 2 | REINTRODUCTION OF AN ORTHOPEDIC SERVICES PROGRAM, INCLUDING IN-HOUSE PROCEDURES. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE HOSPITAL HAS A NINE MEMBER BOARD OF DIRECTORS COMPRISED OF FIVE MEMBERS FROM THE HEALTH SYSTEM AND FOUR COMMUNITY DIRECTORS CHOSEN FROM OUR LOCAL SERVICE AREA. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD OF DIRECTORS SOLICITS NOMINATIONS FROM CANDIDATES TO FILL OPEN BOARD SEATS. THE FULL BOARD THEN VOTES TO APPROVE OR DISAPPROVE THE NEW POSITION. |
| FORM 990, PART VI, SECTION A, LINE 7B | MEMBERS OF THE BOARD OF DIRECTORS MUST APPROVE ANY BYLAW CHANGES. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE IRS FORM 990 IS REVIEWED BY MANAGEMENT AND PROVIDED TO THE FINANCE COMMITTEE AND THEN ENTIRE BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY IS REVIEWED EVERY YEAR BY THE POLICY AND PROCEDURE COMMITTEE AND BY THE CEO. OFFICERS AND DIRECTORS ARE REQUIRED TO REVIEW THE POLICY AND DISCLOSE CONFLICTS. THE CEO REVIEWS THE SIGNED STATEMENTS. IF THERE IS A CONFLICT, THE CONFLICT WOULD BE DECLARED, AND THE MEMBER WOULD ABSTAIN FROM VOTING. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE HEALTH SYSTEM RELAYS ON MARKET COMPARABLE SALARY DATA TO SET THE RANGE OF COMPENSATION FOR THE CEO POSITION. THE RANGES ARE ADJUSTED AND REVIEWED ANNUALLY BY THE BOARD'S COMPENSATION COMMITTEE, WITH FINAL APPROVAL BY THE SYSTEM BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION BELIEVES THE GOVERNING DOCUMENTS AND POLICIES ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. THE AUDITED FINANCIAL STATEMENTS ARE NOW REQUIRED TO BE ATTACHED TO FORM 990. AUDITED FINANCIAL INFORMATION IS POSTED ANNUALLY ON THE HOSPITAL'S WEBSITE. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (28 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BELLIN COLLEGE INC | |||||||||||
| 3201 EATON ROAD | GREEN BAY | WI | 54311 | 391620530 | NURSING AND RADIOLOGIC SCIENCE COLLEGE | WI | 501(C)(3) | LINE 2 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| BELLIN GUNDERSEN HEALTH SYSTEM INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 920504278 | PARENT | WI | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| BELLIN HEALTH SYSTEMS INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391512904 | SUPPORT OF HEALTHCARE ORGANIZATIONS | WI | 501(C)(3) | LINE 12B, II | BELLIN GUNDERSEN HEALTH SYSTEMS INC | Yes (1) | |
| BELLIN MEMORIAL HOSPITAL INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 390884478 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| BELLIN PSYCHIATRIC CENTER INC | |||||||||||
| PO BOX 23725 | GREEN BAY | WI | 54305 | 391657627 | PSYCHIATRIC HOSPITAL | WI | 501(C)(3) | LINE 3 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| COMMUNITY HOUSING OF LA CROSSE INC | |||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391586700 | INDEPENDENT LIVING | WI | 501(C)(3) | LINE 10 | LUTHERAN REAL ESTATE HOLDING CORP | Yes (1) | |
| GUNDERSEN CLINIC LTD | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391028657 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| GUNDERSEN LUTHERAN ADMINISTRATIVE SVC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391606449 | SUPPORTING ORG | WI | 501(C)(3) | LINE 12B, II | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391866425 | SUPPORTING ORG | WI | 501(C)(3) | LINE 12B, II | BELLIN GUNDERSEN HEALTH SYSTEM INC | Yes (1) | |
| GUNDERSEN LUTHERAN MEDICAL CENTER INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 390813416 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391249705 | FOUNDATION | WI | 501(C)(3) | LINE 7 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| HARMONY COMMUNITY HEALTHCARE INC | |||||||||||
| 815 MAIN AVENUE | SOUTH HARMONY | MN | 55939 | 410711606 | HEALTHCARE | MN | 501(C)(3) | LINE 10 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| LAKE MICHIGAN HEALTH SERVICES INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391512903 | SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL | WI | 501(C)(3) | LINE 12B, II | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| LUTHERAN HOUSING OF LA CROSSE | |||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391751934 | INDEPENDENT LIVING | WI | 501(C)(3) | LINE 10 | LUTHERAN REAL ESTATE HOLDING CORP | Yes (1) | |
| LUTHERAN REAL ESTATE HOLDING CORP | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391480826 | HOUSING | WI | 501(C)(3) | LINE 12C, III-FI | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| MEMORIAL HEALTHCARE FOUNDATION INC | |||||||||||
| PO BOX 40 | FRIENDSHIP | WI | 53934 | 391775074 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | MOUNDVIEW MEMORIAL HOSPITALS AND CLINICS | Yes (1) | |
| MEMORIAL HOSPITAL OF BOSCOBEL | |||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 53805 | 390845590 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| OCONTO HOSPITAL & MEDICAL CENTER INC | |||||||||||
| 820 ARBUTUS AVENUE | OCONTO | WI | 54153 | 061745397 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | BELLIN MEMORIAL HOSPITAL INC | Yes (1) | |
| PALMER LUTHERAN HEALTH CENTER INC | |||||||||||
| 112 JEFFERSON STREET | WEST UNION | IA | 52175 | 421320763 | HEALTHCARE | IA | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| SAINT ELIZABETH'S HOSPITAL OF WABASHA | |||||||||||
| 1200 GRANT BLVD WEST | WABASHA | MN | 55981 | 410693877 | HEALTHCARE | MN | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| ST JOSEPH'S HEALTH SERVICES INC | |||||||||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | 390929538 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| ST JOSEPH'S MEMORIAL FOUNDATION INC | |||||||||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | 391455787 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | ST JOSEPH'S HEALTH SERVICES | Yes (1) | |
| THE BELLIN HEALTH FOUNDATION INC | |||||||||||
| PO BOX 23400 | GREEN BAY | WI | 54301 | 391809171 | FOUNDATION | WI | 501(C)(3) | LINE 7 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| TRI-COUNTY MEMORIAL FOUNDATION INC | |||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 300093022 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | TRI-COUNTY MEMORIAL HOSPITAL | Yes (1) | |
| TRI-COUNTY MEMORIAL HOSPITAL | |||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 390704510 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| TRI-STATE AMBULANCE INC | |||||||||||
| 235 CAUSEWAY BOULEVARD | LA CROSSE | WI | 54603 | 391965415 | MEDICAL TRANSPORT | WI | 501(C)(3) | LINE 10 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| TRI-STATE REGIONAL AMBULANCE INC | |||||||||||
| 235 CAUSEWAY BOULEVARD | LA CROSSE | WI | 54603 | 391962965 | MEDICAL TRANSPORT | WI | 501(C)(3) | LINE 10 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| TWEETEN LUTHERAN HEALTHCARE CENTER INC | |||||||||||
| 125 FIFTH AVENUE SE | SPRING GROVE | MN | 55974 | 411565003 | HEALTHCARE | WI | 501(C)(3) | LINE 10 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BEL-REGIONAL HOME MEDICAL INC | ||||||||||||||
| 617 S ROOSEVELT | GREEN BAY | WI | 54301 | 391504766 | DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS | WI | N/A | C | 0 | |||||
| GUNDERSEN LUTHERAN ENVISION LLC | ||||||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 264706546 | RENEWABLE ENERGY | WI | N/A | C | 0 | |||||
| GUNDERSEN EDGE LLC | ||||||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 921783811 | INNOVATION | WI | N/A | C | 0 | |||||
| BG ASSURANCE COMPANY | ||||||||||||||
| SELF INSURANCE | N/A | C | 0 | 20 GENESIS CLOSE PO BOX 30600 | GEORGE TOWN | CJ | KY1-1203 | CJ | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HEALTHCARE FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $109,783 | InvolvedAmt |
| Method Of Amount Determination | CASH | MethodOfAmountDeterminationTxt |