2019-11-15T14:27:15-06:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 818 SECOND ST SO SUITE 320 WAITE PARK MN 56387 990 2018-01-01 273238660 CANCER CENTER OF WESTERN WISCONSIN INC CANC 7152432800 501 HOSPITAL ROAD NEW RICHMOND WI 54017 STEVE MASSEY PRESIDENT 7152432800 2019-11-15 1 KRISTIN L SCHMIDT P01487323 3202035500 67.137.57.251 2019-11-15 14:23:34 CS P 686920C3F46CC5392801DA2797427A2283521C1F 30E6DC03B842C69081736085B62342742A9B7338 2018 2020-03-31 21:24:44Z STEVE MASSEY 501 HOSPITAL ROAD NEW RICHMOND WI 54017 4030996 0 X WWW.CC-WW.ORG X 2010 WI TO IMPROVE HEALTH, HEALING AND LIFE FOR THOSE EXPERIENCING CANCER WITH THE COMPASSION THAT DEFINES OUR COMMUNITIES. 5 5 0 20 0 0 34241 38774 2773385 3548009 75295 444213 0 0 2882921 4030996 14371 7123 0 0 0 0 0 0 0 2849253 3201308 2863624 3208431 19297 822565 1960042 2861039 222332 300764 1737710 2560275 X TO IMPROVE HEALTH, HEALING AND LIFE FOR THOSE EXPERIENCING CANCER WITH THE COMPASSION THAT DEFINES OUR COMMUNITIES. THIS REGIONAL PARTNERSHIP OF HEALTHCARE ORGANIZATIONS BRINGS HIGH-CALIBER AND TIMELY TREATMENT INTO EACH PATIENT'S FAMILIAR AND TRUSTED HOME COMMUNITY. 0 0 1722923 1606059 ONCOLOGIST SERVICES - PURCHASE OF MD TIME TO SERVE THE OWNER COMMUNITIES 1447898 1790010 RADIATION TREATMENT SERVICES - PROVIDE RADIATION TREATMENT SERVICES THROUGH OUR PARTNERSHIP 7123 7123 GENETIC COUNSELOR - THE CANCER CENTER OF WESTERN WISCONSIN WAS GRANTED DOLLARS FROM THE OTTO BREMER TRUST IN 2016 TO HELP WITH THE COST OF IMPLEMENTING GENETICS COUNSELING SERVICES IN WESTERN WI. THE GRANT AMOUNT WAS $48,728 AND ALLOWED US TO BRING THE PROGRAM TO A RURAL SETTING. GENETICS IS NEEDED TO HELP PATIENTS AND DOCTORS MAKE TREATMENT DECISIONS TOGETHER. PRIOR TO THE GRANT, THE PATIENTS WOULD HAVE TO DRIVE FOR AT LEAST AN HOUR FOR THE SERVICES. 151940 ONCOLOGY SERVICES; NEW RICHMOND - PROIVDE MEDICAL ONCOLOGY SERVICES IN NEW RICHMOND WISCONSIN 151940 3177944 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 0 0 0 0 0 WI X X X JASON LUHRS 7152432852 535 HOSPITAL RD NEW RICHMOND WI 54017 STEVE MASSEY PRESIDENT 2.00 40.00 X X 0 374447 0 ALISON PAGE VICE PRESIDENT 1.00 40.00 X X 0 306634 0 DAVE DOBOSENSKI BOARD MEMBER 1.00 40.00 X 0 421060 0 THOMAS BOROWSKI BOARD MEMBER 1.00 40.00 X 0 304866 0 DEBRA RUDQUIST BOARD MEMBER 1.00 40.00 X 0 386703 0 JASON LUHRS TREASURER 2.00 40.00 X 0 267792 0 0 2061502 0 0 0 1 0 GROUP HEALTH INC PO BOX 64059 ST PAUL MN 55164 ONCOLOGIST SERVICES 1606059 REGIONS HOSPITAL 640 JACKSON STREET ST PAUL MN 55101 CANCER REGISTRY SERVICES & PHARMACY SUPP 116864 2 38774 38774 RADIATION TREATMENT 621110 1790010 1790010 PHYSICIAN SERVICES 621110 1606059 1606059 ONCOLOGY SERVICES WEST 621110 151940 151940 3548009 444213 444213 4030996 3548009 0 444213 X 7123 7123 5790 5790 1722923 1722923 7427 7427 2430 2430 RADIATION TREATMENT EXP 1447898 1447898 14840 14840 3208431 3177944 30487 0 453929 847997 214478 114141 394237 416463 203917 203917 0 0 897398 1482438 1960042 2861039 222332 300764 222332 300764 X 1737710 2560275 1737710 2560275 1960042 2861039 822565 0 X 0 0 0 X X X 6 AMERY REGIONAL MEDICAL CENTER INC 390908320 3 1 0 0 BALDWIN AREA MEDICAL CENTER 390808526 3 1 0 0 HUDSON HOSPITAL INC 390804125 3 1 0 0 OSCEOLA MEDICAL CENTER 390773970 3 1 0 0 ST CROIX REGIONAL MEDICAL CENTER INC 390890676 3 1 0 0 WESTFIELDS HOSPITAL INC 390808442 3 1 0 0 6 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 203917 203917 0 0 INVESTMENT IN WWRTC 1239511 F BREMER INVESTMENTS 242927 F 1482438 1 GENETICS COUNSELING SERVICES 114 7123 TRACKED THROUGH EPIC SCHEDULING. TOTAL CONSISTS OF ALL VISITS LOGGED. PART I, LINE 2: THE CANCER CENTER OF WESTERN WISCONSIN (CCWW) MANAGEMENT STAFF REVIEW THE MISSION AND PURPOSE OF POTENTIAL GRANTEE ORGANIZATIONS TO ASSURE CONSISTENCY WITH THE CCWW'S MISSION AND PURPOSE. AMOUNTS SUBSEQUENTLY GRANTED ARE SUBJECT TO THE CCWW'S FORMAL SPENDING APPROVAL AND DOCUMENTATION PROCESS BASED ON AMOUNT OF THE EXPENDITURE. 0 0 0 0 0 0 0 0 0 STEVE MASSEY PRESIDENT 0 263330 0 39553 0 71564 0 0 0 0 0 374447 0 0 ALISON PAGE VICE PRESIDENT 0 278805 0 27829 0 0 0 0 0 0 0 306634 0 0 DAVE DOBOSENSKI BOARD MEMBER 0 309665 0 35000 0 76395 0 0 0 0 0 421060 0 0 THOMAS BOROWSKI BOARD MEMBER 0 251216 0 13358 0 40292 0 0 0 0 0 304866 0 0 DEBRA RUDQUIST BOARD MEMBER 0 268899 0 40083 0 77721 0 0 0 0 0 386703 0 0 JASON LUHRS TREASURER 0 186683 0 18552 0 62557 0 0 0 0 0 267792 0 0 FORM 990, PART VI, SECTION A, LINE 6 THIS CORPORATION HAS SIX MEMBERS WITH VOTING RIGHTS: AMERY REGIONAL MEDICAL CENTER, INC,; BALDWIN AREA MEDICAL CENTER; HUDSON MEMORIAL HOSPITAL, INC.; OSCEOLA MEDICAL CENTER; ST. CROIX REGIONAL MEDICAL CENTER, INC.; AND WESTFIELDS HOSPITAL,INC. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF THIS CORPORATION SHALL CONSIST OF THE NUMBER OF DIRECTORS EQUAL TO THE NUMBER OF MEMBERS OF THIS CORPORATION. THE INITIAL BOARD OF DIRECTORS CONSISTS OF THE PERSONS LISTED IN THE ARTICLES OF INCORPORATION OF THIS CORPORATION, WHO SHALL SERVE UNTIL THE CONCLUSION OF THE ANNUAL MEETING OF THE BOARD OF DIRECTORS IN THE YEARS INDICATED IN THE ARTICLES OF INCORPORATION, OR UNTIL THEIR PRIOR DEATH, RESIGNATION OR REMOVAL. UPON THE EXPIRATION OF A DIRECTOR'S TERM, THE MEMBER THAT APPOINTED SUCH DIRECTOR SHALL APPOINT HIS OR HER SUCCESSOR. FORM 990, PART VI, SECTION A, LINE 8B THE CENTER DOES NOT HAVE ANY COMMITTEES WITH BROAD AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS DISTRIBUTED TO THE BOARD MEMBERS AND APPROVED PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES ALL BOARD MEMBERS AND OPERATIONS COMMITTEE MEMBERS TO ANNUALLY ACKNOWLEDGE REVIEWING THE CONFLICT OF INTEREST POLICY BY SIGNING THE CONFLICT OF INTEREST STATEMENT. IF A CONFLICT OF INTEREST EXISTS, HE OR SHE SHALL REFRAIN FROM PARTICIPATION IN ANY DECISION ON SUCH A MATTER WITH REMAINING MEMBERS DETERMINING WHETHER A CONFLICT EXISTS. PROCEEDINGS RELATED TO CONFLICTS OF INTEREST ARE DOCUMETNED IN THE MEETING MINUTES OR AS OTHERWISE APPROPRIATE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC. FORM 990, PART IX, LINE 11G PROVIDER CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,606,059. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,606,059. CANCER PHARMACY SUPPORT: PROGRAM SERVICE EXPENSES 36,732. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,732. CANCER REGISTRY SERVICES: PROGRAM SERVICE EXPENSES 80,132. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 80,132. AMERY REGIONAL MEDICAL CENTER INC 265 GRINFIN STREET EAST AMERY WI 54001 390908320 MEDICAL SERVICES WI 501(C)(3) LINE 3 N/A 0 BALDWIN AREA MEDICAL CENTER INC 730 10TH AVENUE BALDWIN WI 540020300 390808526 MEDICAL SERVICES WI 501(C)(3) LINE 3 N/A 0 HUDSON HOSPITAL INC 405 STAGELINE ROAD HUDSON WI 54016 390804125 MEDICAL SERVICES WI 501(C)(3) LINE 3 N/A 0 OSCEOLA MEDICAL CENTER 2600 65TH AVENUE PO BOX 218 OSCEOLA WI 54020 390773970 MEDICAL SERVICES WI 501(C)(3) LINE 3 N/A 0 ST CROIX REGIONAL MEDICAL CENTER INC 235 STATE STREET ST CROIX FALLS WI 54024 390890676 MEDICAL SERVICES WI 501(C)(3) LINE 3 N/A 0 WESTFIELDS HOSPITAL INC 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554011309 390808442 MEDICAL SERVICES MN 501(C)(3) LINE 3 N/A 0 RADIATION TREATMENT CENTER OF WESTERN WISCONSIN 6950 FRANCE AVENUE SOUTH SUITE200 EDINA MN 55435 272836404 RADIATION TREATMENT MN N/A RADIATION TREATMENT 342112 233309 0 0 0.50000 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 RADIATION TREATMENT CENTER OF WESTERN WISCONSIN M 450000 FAIR MARKET VALUE