PRAIRIE RIDGE HEALTH INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization: PRAIRIE RIDGE HEALTH INC (EIN 39-1140373)
Tax period: 2017-10-01 to 2018-09-30
Filed: 2019-07-25
IRS object ID: 201912069349300011
Schema version: 2017v2.3
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 K
Schedule K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2019-07-25T08:46:12-05:00	ReturnTs
Tax Period End	2018-09-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	391140373	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	PO BOX 12237	AddressLine1Txt
City	GREEN BAY	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	543072237	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2017-10-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	391140373	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	COLUMBUS COMMUNITY HOSPITAL INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	COLU	BusinessNameControlTxt
Phone	9206232200	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1515 PARK AVENUE	AddressLine1Txt
City	COLUMBUS	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	539251618	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	FRANCIS J FISH	PersonNm
Person Title	VP OF FINANCE & CFO	PersonTitleTxt
Phone	9206232200	PhoneNum
Signature	2019-07-24	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	TERRI REXRODE CPA MST	PreparerPersonNm
PTIN	P00096513	PTIN
Phone	9206620016	PhoneNum
Preparation	2019-07-24	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	74.87.127.216	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2019-07-24	IPDt
IP Tm	13:24:03	IPTm
IP Timezone	CD	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	DA39A3EE5E6B4B0D3255BFEF95601890AFD80709	AtSubmissionCreationDeviceId
At Submission Filing Device Id	A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2017	TaxYr
Build TS	2019-02-21 02:37:17Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	JOHN D RUSSELL	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1515 PARK AVENUE	AddressLine1Txt
City	COLUMBUS	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	539251618	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$58,941,416	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.CCH-INC.COM	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1970	FormationYr
Legal Domicile State	WI	LegalDomicileStateCd
Activity Or Mission	ACUTE-CARE HOSPITAL	ActivityOrMissionDesc
Voting Members Governing Body	11	VotingMembersGoverningBodyCnt
Voting Members Independent	9	VotingMembersIndependentCnt
Total Employee	376	TotalEmployeeCnt
Total Volunteers	126	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$249,087	PYContributionsGrantsAmt
CY Contributions Grants	$177,422	CYContributionsGrantsAmt
PY Program Service Revenue	$45,720,641	PYProgramServiceRevenueAmt
CY Program Service Revenue	$48,506,921	CYProgramServiceRevenueAmt
PY Investment Income	$462,868	PYInvestmentIncomeAmt
CY Investment Income	$754,156	CYInvestmentIncomeAmt
PY Other Revenue	$251,671	PYOtherRevenueAmt
CY Other Revenue	$0	CYOtherRevenueAmt
PY Total Revenue	$46,684,267	PYTotalRevenueAmt
CY Total Revenue	$49,438,499	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	$22,550,624	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$23,161,927	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$21,459,883	PYOtherExpensesAmt
CY Other Expenses	$22,276,845	CYOtherExpensesAmt
PY Total Expenses	$44,010,507	PYTotalExpensesAmt
CY Total Expenses	$45,438,772	CYTotalExpensesAmt
PY Revenues Less Expenses	$2,673,760	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$3,999,727	CYRevenuesLessExpensesAmt
Total Assets BOY	$69,204,733	TotalAssetsBOYAmt
Total Assets EOY	$73,716,721	TotalAssetsEOYAmt
Total Liabilities BOY	$24,439,569	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$24,844,880	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$44,765,164	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$48,871,841	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	BY BUILDING CARING RELATIONSHIPS WITH THOSE WE SERVE, WE GUIDE THE JOURNEY TO HEALTH AND WELLNESS. OUR TEAM WILL BE YOUR PREFERRED CHOICE FOR PERSONALIZED HIGH QUALITY HEALTH CARE, WELLNESS AND EDUCATION PROVIDED IN A COMPASSIONATE AND INNOVATIVE ENVIRONMENT.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$34,959,356	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$48,404,110	RevenueAmt
Desc	COLUMBUS COMMUNITY HOSPITAL, INC. (CCH) PROVIDES INPATIENT, OUTPATIENT, AND CLINIC MEDICAL SERVICES TO PATIENTS. CCH PROVIDES MEDICAL, OBSTETRIC, SURGICAL, AND INTENSIVE CARE INPATIENT SERVICES. FOR THE FISCAL YEAR ENDED 9/30/18, 887 ACUTE ADMISSIONS RESULTED IN 2,431 INPATIENT DAYS. IN ADDITION, THERE WERE 78 DELIVERIES AND 157 NEWBORN DAYS AND 331 INPATIENT SURGERIES. ON THE OUTPATIENT SIDE, CCH PROVIDES A MULTITUDE OF SERVICES INCLUDING EMERGENCY ROOM, LAB, RADIOLOGY, REHABILITATION, SURGERY, INFUSION THERAPY, AND NUTRITION SERVICES. FOR THE FISCAL YEAR ENDED 9/30/18, CCH SAW 11,447 PATIENTS IN THE EMERGENCY ROOM AND URGENT CARE. 703 PATIENTS HAD OUTPATIENT SURGERY AND 775 GI PROCEDURES WERE PERFORMED. CCH ALSO OPERATES THREE PHYSICIAN CLINICS LOCATED IN COLUMBUS, BEAVER DAM, AND MARSHALL. OUR EXPERIENCED AND CARING PROVIDERS SPECIALIZE IN ORTHOPEDICS, GENERAL SURGERY, OB/GYN, FAMILY MEDICINE, INTERNAL MEDICINE AND PHYSICAL AND OCCUPATIONAL THERAPY AND IMAGING SERVICES. FOR THE FISCAL YEAR ENDED 9/30/18, THERE WERE 12,615 CLINIC VISITS, 4,060 THERAPY VISITS AND 1,208 IMAGING SCANS.	Desc
Total Program Service Expenses	$34,959,356	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
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (1)	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	0	ReportOtherLiabilitiesInd
Include FIN48 Footnote	0	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
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 With Officer Ent	0	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	51	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	376	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
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	11	GoverningBodyVotingMembersCnt
Independent Voting Member	9	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	0	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	WI	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	FRANCIS J FISH VP OF FINANCE & CFO	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	9206231368	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1515 PARK AVENUE	AddressLine1Txt
City	COLUMBUS	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53925	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd
LARRY BARTRUFF
DIRECTOR	0.40	Yes (X)	$0	$0	$0
GARY GALVIN MD
CHIEF OF STAFF (THRU 1/18), DIRECTOR	0.40	Yes (X)	$411,633	$0	$34,053
DANIELLE GINDLESBERGER MD
DIRECTOR	0.40	Yes (X)	$0	$0	$0
BRUCE KRAUS MD
DIRECTOR (THRU 1/18)	0.40	Yes (X)	$219,519	$0	$32,573
ELIZABETH LARSON MD
DIRECTOR, CHIEF OF STAFF (BEG. 1/18)	0.40	Yes (X)	$17,500	$0	$0
DAN MEISTER
DIRECTOR (THRU 6/18)	0.40	Yes (X)	$0	$0	$0
NATHAN ROBERTS
DIRECTOR	0.40	Yes (X)	$0	$0	$0
JON ROZENFELD
DIRECTOR	0.40	Yes (X)	$0	$0	$0
TOM TER HORST
DIRECTOR	0.40	Yes (X)	$0	$0	$0
BRUCE ZANDER
CHAIR	0.40	Yes (X)	$0	$0	$0	Yes (X)
JENNIFER HOMMAN
VICE CHAIR	0.40	Yes (X)	$0	$0	$0	Yes (X)
JO ANN EVANS
SECRETARY	0.40	Yes (X)	$0	$0	$0	Yes (X)
RANDALL BOBHOLZ
TREASURER	0.40	Yes (X)	$0	$0	$0	Yes (X)
JOHN D RUSSELL
PRESIDENT & CEO	40.00		$417,691	$0	$36,053	Yes (X)
PHILLIP G ROBERTS
VP OF FINANCE & CFO	40.00		$261,999	$0	$32,134	Yes (X)
JAMIE E HENDRIX
VP OF PATIENT CARE SERVICE	40.00		$224,028	$0	$31,923		Yes (X)
ANN ROUNDY
VP OF EMPLOYEE SERVICES	40.00		$234,353	$0	$34,691		Yes (X)
ROBERT COE
PHYSICIAN	30.00		$445,530	$0	$34,969			Yes (X)
CRAIG HABERMAN
PHYSICIAN	40.00		$383,064	$0	$31,130			Yes (X)
MATTHEW NIESEN
PHYSICIAN	40.00		$668,461	$0	$34,053			Yes (X)
KATHERINE SKAGGS
PHYSICIAN	40.00		$228,529	$0	$17,716			Yes (X)
KATY GEIGER
DIRECTOR OF OUTPATIENT SERVICES	40.00		$118,400	$0	$28,164			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$3,630,707	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$347,459	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	20	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
MADISON EMERGENCY PHYSICIANS
700 S PARK STREET SUITE A404	MADISON	WI	53715	ER PHYSICIAN SERVICES	$1,997,910
COLUMBIA ANESTHESIA LLC
W12748 HWY 60	LODI	WI	53555	ANESTHESIA SERVICES	$892,715
SHARED IMAGING SERVICES LLC
915 17TH STREET	PRAIRIE DU SAC	WI	53578	NUCLEAR MEDICINE & ULTRASOUND SERVICES	$680,533
SSM HEALTHCARE OF WISCONSIN
2901 LANDMARK PLACE SUITE 300	MADISON	WI	53713	HEALTHCARE SERVICES	$660,944
COMPHEALTH
PO BOX 972651	DALLAS	TX	75397	PHYSICIAN SERVICES	$315,828

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	9	CntrctRcvdGreaterThan100KCnt
Related Organizations	$77,737	RelatedOrganizationsAmt
Government Grants	$20,000	GovernmentGrantsAmt
All Other Contributions	$79,685	AllOtherContributionsAmt
Noncash Contributions	$213	NoncashContributionsAmt
Total Contributions	$177,422	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	ExclusionExclusionAmt
PATIENT SERVICE REVENUE	621110	$47,327,055	$47,327,055
CLINIC RENTAL REVENUE	531120	$404,668	$404,668
CAFETERIA REVENUE	722210	$102,811		$102,811

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$672,387	TotalRevenueColumnAmt
Related Or Exempt Func Income	$672,387	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$48,506,921	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$532,806	TotalRevenueColumnAmt
Exclusion	$532,806	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$9,715,014	SecuritiesAmt
Other	$9,253	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$9,486,817	SecuritiesAmt
Other	$16,100	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$228,197	SecuritiesAmt
Other	-$6,847	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$221,350	TotalRevenueColumnAmt
Exclusion	$221,350	ExclusionAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$49,438,499	TotalRevenueColumnAmt
Related Or Exempt Func Income	$48,404,110	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$856,967	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$1,468,095	TotalAmt
Management And General	$1,468,095	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$16,665,131	TotalAmt
Program Services	$13,250,446	ProgramServicesAmt
Management And General	$3,414,685	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$450,056	TotalAmt
Program Services	$357,840	ProgramServicesAmt
Management And General	$92,216	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$3,432,997	TotalAmt
Program Services	$2,729,576	ProgramServicesAmt
Management And General	$703,421	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$1,145,648	TotalAmt
Program Services	$910,905	ProgramServicesAmt
Management And General	$234,743	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$67,006	TotalAmt
Management And General	$67,006	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$45,750	TotalAmt
Management And General	$45,750	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$5,763,446	TotalAmt
Program Services	$5,433,872	ProgramServicesAmt
Management And General	$329,574	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$481,805	TotalAmt
Management And General	$481,805	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$2,294,603	TotalAmt
Program Services	$1,824,439	ProgramServicesAmt
Management And General	$470,164	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$953,614	TotalAmt
Program Services	$758,218	ProgramServicesAmt
Management And General	$195,396	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$998,067	TotalAmt
Program Services	$793,563	ProgramServicesAmt
Management And General	$204,504	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$58,561	TotalAmt
Program Services	$46,562	ProgramServicesAmt
Management And General	$11,999	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$70,695	TotalAmt
Program Services	$56,210	ProgramServicesAmt
Management And General	$14,485	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$850,767	TotalAmt
Program Services	$676,445	ProgramServicesAmt
Management And General	$174,322	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$3,314,430	TotalAmt
Program Services	$2,635,303	ProgramServicesAmt
Management And General	$679,127	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$172,238	TotalAmt
Program Services	$136,946	ProgramServicesAmt
Management And General	$35,292	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES	$4,991,666	$4,991,666
BAD DEBTS	$1,615,429		$1,615,429
RECRUITMENT	$149,309		$149,309
PROFESSIONAL DUES	$83,437	$66,341	$17,096

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$366,022	TotalAmt
Program Services	$291,024	ProgramServicesAmt
Management And General	$74,998	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$45,438,772	TotalAmt
Program Services	$34,959,356	ProgramServicesAmt
Management And General	$10,479,416	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$4,882,684	BOYAmt
EOY	$6,858,521	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$1,452,909	BOYAmt
EOY	$2,387,168	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$6,666,990	BOYAmt
EOY	$7,014,589	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$344,677	BOYAmt
EOY	$386,261	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$906,217	BOYAmt
EOY	$817,057	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$285,272	BOYAmt
EOY	$294,456	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$64,201,007	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$34,701,131	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$31,320,885	BOYAmt
EOY	$29,499,876	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$22,383,030	BOYAmt
EOY	$7,124,078	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$18,221,158	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$63,950	BOYAmt
EOY	$45,679	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$898,119	BOYAmt
EOY	$1,067,878	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$69,204,733	BOYAmt
EOY	$73,716,721	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$3,826,020	BOYAmt
EOY	$5,260,729	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$20,613,549	BOYAmt
EOY	$19,584,151	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$24,439,569	BOYAmt
EOY	$24,844,880	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$43,877,045	BOYAmt
EOY	$47,830,413	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$688,489	BOYAmt
EOY	$818,855	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$199,630	BOYAmt
EOY	$222,573	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$44,765,164	BOYAmt
EOY	$48,871,841	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$69,204,733	BOYAmt
EOY	$73,716,721	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$3,999,727	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$23,416	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$130,366	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

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	Yes (1)	RalliesDemonstrationsInd
Rallies Demonstrations	$0	RalliesDemonstrationsAmt
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$7,941	OtherActivitiesAmt
Total Lobbying Expenditures	$7,941	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	A PERCENTAGE OF DUES PAID TO AMERICAN HOSPITAL ASSOCIATION, HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION, RURAL WISCONSIN HEALTH COOPERATIVE, WISCONSIN HOSPITAL ASSOCIATION AND WISCONSIN INSTITUTE OF CPAS ARE CONSIDERED LOBBYING. SOME TEAM MEMBERS ATTENDED THE WHA ADVOCACY DAY ALONG WITH SEVERAL OTHER AREA HOSPITALS.	ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$334,410	BeginningYearBalanceAmt
Contributions	$22,943	ContributionsAmt
Investment Earnings Or Losses	$35,388	InvestmentEarningsOrLossesAmt
End Year Balance	$392,741	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$282,972	BeginningYearBalanceAmt
Contributions	$12,086	ContributionsAmt
Investment Earnings Or Losses	$39,352	InvestmentEarningsOrLossesAmt
End Year Balance	$334,410	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$241,143	BeginningYearBalanceAmt
Contributions	$13,111	ContributionsAmt
Investment Earnings Or Losses	$28,718	InvestmentEarningsOrLossesAmt
End Year Balance	$282,972	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$229,929	BeginningYearBalanceAmt
Contributions	$16,297	ContributionsAmt
Investment Earnings Or Losses	-$5,083	InvestmentEarningsOrLossesAmt
End Year Balance	$241,143	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$191,964	BeginningYearBalanceAmt
Contributions	$13,833	ContributionsAmt
Investment Earnings Or Losses	$24,132	InvestmentEarningsOrLossesAmt
End Year Balance	$229,929	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.00000	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.56670	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.43330	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (1)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (1)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$63,509	OtherCostOrOtherBasisAmt
Book Value	$63,509	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$45,936,984	OtherCostOrOtherBasisAmt
Depreciation	$21,974,106	DepreciationAmt
Book Value	$23,962,878	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$17,761,634	OtherCostOrOtherBasisAmt
Depreciation	$12,727,025	DepreciationAmt
Book Value	$5,034,609	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$438,880	OtherCostOrOtherBasisAmt
Book Value	$438,880	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$29,499,876	TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (2 entries)

DescDesc	Book ValueBookValueAmt	Method ValuationMethodValuationCd
U.S. GOVERNMENT, AGENCY, AND MUNICIPAL OBLIGATIONS	$6,040,804	F
CORPORATE BONDS	$12,180,354	F

Field	Value	IRS element (for citing)
Total Book Value Securities	$18,221,158	TotalBookValueSecuritiesAmt
Total Rev Etc Audited Fincl Stmt	$47,930,020	TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst	-$23,416	NetUnrealizedGainsInvstAmt
Other Revenue	-$1,485,063	OtherRevenueAmt
Revenue Not Reported	-$1,508,479	RevenueNotReportedAmt
Revenue Subtotal	$49,438,499	RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt	$0	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$49,438,499	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$43,823,343	TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported	$0	ExpensesNotReportedAmt
Expenses Subtotal	$43,823,343	ExpensesSubtotalAmt
Other Expenses Not Included	$1,615,429	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$1,615,429	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$45,438,772	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART V, LINE 4:	THE ENDOWMENT FUNDS, WHICH ARE HELD BY THE FOUNDATION, CONSIST OF FOUR SEPARATE FUNDS ESTABLISHED TO BENEFIT THE HOSPITAL: FOR WOMEN'S HEALTH, INFRASTRUCTURE IMPROVEMENTS, COMMUNITY HEALTH, AND GENERAL OPERATIONS OF THE HOSPITAL. EACH FUND IS MAINTAINED BY THE FOUNDATION IN VARIOUS INVESTMENTS, AND THE FOUNDATION IS RESPONSIBLE FOR ALL INVESTMENT DECISIONS.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	CHANGE IN INTEREST IN ASSETS OF COLUMBUS COMMUNITY FOUNDATION, INC. 130,366. PROVISION FOR BAD DEBTS -1,615,429.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	PROVISION FOR BAD DEBTS 1,615,429.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
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	0	ExpensesExceedBudgetInd
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	$264,376	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$264,376	NetCommunityBenefitExpnsAmt
Total Expense	0.00600	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,689,135	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,194,997	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,494,138	NetCommunityBenefitExpnsAmt
Total Expense	0.03410	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,953,511	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,194,997	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,758,514	NetCommunityBenefitExpnsAmt
Total Expense	0.04010	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$109,293	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$33,405	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$75,888	NetCommunityBenefitExpnsAmt
Total Expense	0.00170	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$18,288	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$18,288	NetCommunityBenefitExpnsAmt
Total Expense	0.00040	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$7,529,641	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,680,787	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,848,854	NetCommunityBenefitExpnsAmt
Total Expense	0.11060	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$71,272	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$71,272	NetCommunityBenefitExpnsAmt
Total Expense	0.00160	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$7,728,494	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,714,192	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,014,302	NetCommunityBenefitExpnsAmt
Total Expense	0.11430	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$11,682,005	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$4,909,189	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$6,772,816	NetCommunityBenefitExpnsAmt
Total Expense	0.15440	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$1,615,429	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$13,759,307	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$13,686,882	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$72,425	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 (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	COLUMBUS COMMUNITY HOSPITAL INC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1515 PARK AVE	AddressLine1Txt
City	COLUMBUS	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53925	ZIPCd

Field	Value	IRS element (for citing)
Website Address	WWW.COLUMBUSCOMMUNITYHOSPITAL.ORG	WebsiteAddressTxt
State License	1042	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
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	COLUMBUS COMMUNITY HOSPITAL INC	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	15	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	0	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	0	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	SEE RESPONSE FOR PART V LINE 7D	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Rpt Available Thru Other Method	Yes (X)	RptAvailableThruOtherMethodInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	15	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	WWW.CCH-INC.COM/EN/COMMUNITY-HEALTH-NEEDS-ASSESSMENT	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	200.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.000000000000	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	WWW.CCH-INC.COM/EN/PATIENT-BILLING/COMMUNITY-CARE	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	WWW.CCH-INC.COM/EN/PATIENT-BILLING/COMMUNITY-CARE	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	WWW.CCH-INC.COM/EN/PATIENT-BILLING/COMMUNITY-CARE	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicaid Medcr Prvt	Yes (X)	LookBackMedicaidMedcrPrvtInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
COLUMBUS COMMUNITY HOSPITAL, INC.	PART V, SECTION B, LINE 5: CCH BENEFITED FROM INPUT DERIVED THROUGH CONSULTATION OF NUMEROUS COMMUNITY LEADERS REPRESENTING DIVERSE CONSTITUENCIES. IN ADDITION, CCH BENEFITED FROM GUIDANCE AND INPUT FROM INDIVIDUALS WITH EXPERTISE IN PUBLIC/POPULATION HEALTH. THOSE CONSULTED INCLUDED: DAN MEISTER, COLUMBUS CHIEF OF POLICE; JO ANN EVANS, ADMINISTRATION - GOLDEN LIVING CENTER, RANDOLPH; TRULA HENSLER, SENIOR MARKETING MANAGER - BAKER TILLY VIRCHOW KRAUSE LLC; BRUCE KRAUS, MD, INTERNAL MEDICINE PHYSICIAN - PRAIRIE RIDGE HEALTH CLINIC; JAMIE LOGSDON, REGIONAL DIRECTOR OF MARKETING & COMMUNICATIONS - SSM HEALTHCARE OF WI; BRUCE ZANDER, PRESIDENT OF BRZ CONSTRUCTION MANAGEMENT; JENNIFER HOMMAN, INVESTMENT ADVISOR - INVESTMENT CENTRE, LLC; RANDALL BOBHOLZ, CEO OF FARMERS & MERCHANTS UNION BANK; GARY GALVIN, MD, GENERAL SURGEON - PRAIRIE RIDGE HEALTH CLINIC; LARRY BARTRUFF, GENERAL MANAGER - RHODES BAKE-N-SERV; RUSSELL HERMUS, MD, VP OF MEDICAL AFFAIRS - DEAN CLINIC; DAMOND BOATWRIGHT, REGIONAL PRESIDENT OF HOSPITAL OPERATIONS, SSM HEALTHCARE OF WISCONSIN; BERIT POSER, CLINIC MANAGER - POSER CLINIC; SUSAN LORENZ, HEALTH OFFICER - PUBLIC HEALTH DEPT COLUMBIA COUNTY; ANNETTE DEUMAN, ADMINISTRATOR - COLUMBUS SCHOOL DISTRICT; HEIDI WALLACE, SOCIAL WORKER - COLUMBUS COMMUNITY HOSPITAL; CHRIS JOSHEFF, PATIENT FINANCIAL COUNSELOR - COLUMBUS COMMUNITY HOSPITAL; LINDA TAPLIN STATZ, REGIONAL VP OF HUMAN SERVICES - SSM HEALTHCARE OF WISCONSIN.
COLUMBUS COMMUNITY HOSPITAL, INC.	PART V, SECTION B, LINE 7D: WWW.CCH-INC.COM/EN/COMMUNITY-HEALTH-NEEDS-ASSESSMENT
COLUMBUS COMMUNITY HOSPITAL, INC.	PART V, SECTION B, LINE 11: THE FOLLOWING THREE SIGNIFICANT NEEDS AND HOW THE HOSPITAL IS ADDRESSING THESE NEEDS ARE LISTED BELOW:PRIORITIES #1 AND #2 OBESITY AND PHYSICAL INACTIVITY:STRATEGY #1: OPERATION OVERHAUL 2.0- THROUGH THE FORMATION OF YOUR BETTER LIFE COALITION, A WELLNESS PROGRAM WILL BE DEVELOPED, TAILORED TO THE MANUFACTURING INDUSTRY (ASSEMBLY LINE PRODUCTION), TO REDUCE OBESITY AND IMPACT CERTAIN CHRONIC HEALTH CONDITIONS. INTERVENTIONS WITHIN THE OPERATION OVERHAUL 2.0 PROGRAM INCLUDE, BUT ARE NOT LIMITED TO, EDUCATION AND INFORMATION STRATEGIES, BEHAVIORAL AND SOCIAL STRATEGIES, ENVIRONMENTAL AND EMPLOYER POLICY STRATEGIES, AND WORKSITE WEIGHT CONTROL STRATEGIES, INCLUDING MEASURABLE CHANGES OF WEIGHT (CONSIDERING HEIGHT AND MUSCLE MASS), BODY FAT, MINUTES OF EXERCISE, PERCENTAGE OF WEIGHT GAIN/LOSS, WAIST CIRCUMFERENCE, ENDURANCE, FLEXIBILITY, AND BLOOD PRESSURE. SMOKING CESSATION IS OFFERED AS WELL.- ESTIMATED IMPACT IS 380 ADULTS, POTENTIAL IMPACT IS ABOUT 1,197 ADULTS- INSTRUCTORS WILL BE CCH'S EDUCATION MANAGER, REGISTERED DIETICIANS, SMOKING CESSATION SPECIALIST AND OCCUPATIONAL THERAPISTS- METHODS TO INCLUDE FAMILY PARTICIPATION TO GROW THE SUPPORT NETWORK OF PARTICIPANTS - COMPETITION BETWEEN ORGANIZATIONS AND WITHIN ORGANIZATIONS IN ORDER TO IMPROVE MOTIVATION OF PARTICIPANTSSTRATEGY #2: LIVE IT! REAL LIFE NUTRITION FOR TEENS- REACHING CHILDREN AND CORRECTING UNHEALTHY BEHAVIORS IS A PROACTIVE APPROACH TO COMBATING ADULT OBESITY. THE LIVE IT! PROGRAM, ORIGINATED FROM THE OREGON DAIRY COUNCIL AND CUSTOMIZED BY THE FOOD FOR THOUGHT COALITION, IS GEARED TOWARD 6TH GRADERS.- THE PROGRAM CONSISTS OF AN ENGAGING CURRICULUM THAT AIMS TO MOTIVATE STUDENTS TO MAKE NUTRIENT-RICH FOOD CHOICES WHILE PERFORMING PHYSICAL ACTIVITY TO ENHANCE THE WELLNESS OF MIDDLE SCHOOL CHILDREN WITHIN THE COMMUNITY. - 16 LESSON CURRICULUM: 1 INTRODUCTORY, 11 NUTRITION, 3 PHYSICAL ACTIVITY AND 1 WRAP UP FOR 7-8 GROUPS OF STUDENTS - CCH'S EDUCATION MANAGER WILL INSTRUCT PHYSICAL ACTIVITY LESSONS- CCH REGISTERED DIETITIANS, UNIVERSITY OF WISCONSIN DIETETIC STUDENTS AND/OR INTERNS WILL INSTRUCT NUTRITION LESSONS- COMPETITION BETWEEN CLASSES WHERE THE CLASS ACCUMULATING THE MOST POINTS WINS A HEALTHY COOKING CLASS LEAD BY CCH'S EXECUTIVE CHEF TO INCREASE MOTIVATION AND ENGAGEMENT OF STUDENTS- ALL TOOLS USED WILL BE OPEN TO THE PUBLIC THROUGH CCH'S WEBSITE TO ENCOURAGE COMMUNITY PARTICIPATION.PRIORITY #3: MAMMOGRAPHY SCREENINGSBY FACILITATING INCREASED EDUCATION AND AWARENESS WITH PROVIDERS AND THE COMMUNITY AT LARGE, COLUMBUS COMMUNITY HOSPITAL AIMS TO INCREASE THE RATE OF MAMMOGRAPHY SCREENINGS IN ORDER TO DETECT BREAST CANCER EARLY; THUS, DECREASING THE DEATH RATE DUE TO BREAST CANCER.STRATEGY #1: EXPAND PROGRAM TO MEET COMMUNITY NEEDSCOLUMBUS COMMUNITY HOSPITAL CURRENTLY HAS A BREAST CANCER NAVIGATION PROGRAM. THIS PROGRAM WILL BE EXPANDED UPON WITH HELP FROM THE COLUMBUS COMMUNITY HOSPITAL FOUNDATION AND LOCAL HIGH SCHOOL VOLLEYBALL AND BASKETBALL TEAMS THROUGH VOLLEY FOR A CAUSE AND HOOPS FOR A CURE EVENTS.STRATEGY #2: IMPROVE ACCESS IN COLLABORATION WITH THE COLUMBUS COMMUNITY HOSPITAL FOUNDATION, A PROGRAM WILL BE ESTABLISHED TO HELP THOSE WITH FINANCIAL NEED TO OBTAIN MAMMOGRAPHY SCREENINGS REGARDLESS OF ABILITY TO PAY. THIS WILL DECREASE THE ECONOMIC DISPARITY GAP WHILE INCREASING THE HEALTH AND WELLNESS OF THOSE IN NEED THROUGH EARLY DEDICATION. STRATEGY #3: INCREASE AWARENESS INCREASE OUTREACH EFFORTS TO ENHANCE COMMUNITY AWARENESS REGARDING SELF EXAMINATIONS AND DISCUSSIONS WITH PRIMARY CARE PHYSICIANS.EDUCATE THE COMMUNITY REGARDING THE IMPORTANCE OF MAMMOGRAPHY SCREENINGS FOCUSED ON: CHANCE OF HAVING BREAST CANCER, SELF EXAMINATIONS, ENVIRONMENTAL, GENETIC AND BEHAVIORAL FACTORS; SPECIFICALLY EDUCATING ON RECENT DEVELOPMENTS REGARDING OBESITY, ALCOHOL USE AND HEREDITARY FACTORS, AS THESE WOULD INDICATE AN EARLIER SCREEN IS WARRANTED.EDUCATE PRIMARY CARE PROVIDERS TO INCREASE MAMMOGRAPHY SCREENINGS, FOCUSING ON WHO SHOULD BE SCREENED, WHEN, AND WHY, INCLUDING SCREENING THOSE WITH HEREDITARY FACTORS, OBESITY, AND ALCOHOL USE AT AN EARLIER AGE AS THESE ARE FACTORS THAT INCREASE THE INCIDENCE OF BREAST CANCER.NO HOSPITAL FACILITY CAN ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY. COLUMBUS COMMUNITY HOSPITAL'S IMPLEMENTATION STRATEGY FOCUSES ON THE SPECIFIED COMMUNITY HEALTH NEEDS AND NOT ON THE FOLLOWING NEEDS:- ALCOHOL ABUSE AND DRINKING EXCESSIVELY IS CONTINUING TO FLUCTUATE AND HAS BEEN SINCE 2003. THIS IS A STATEWIDE ISSUE AND COLUMBUS COMMUNITY HOSPITAL IS AWARE OF THIS NEED IN THE COUNTY. HOWEVER, AT THIS TIME, COLUMBUS COMMUNITY HOSPITAL DOES NOT HAVE THE STAFF OR RESOURCES TO PROPERLY ADDRESS THIS NEED. RESOURCES ARE AVAILABLE AT THE PAUQUETTE CENTER IN PORTAGE, WHICH IS THE COUNTY SEAT.- SMOKING/TOBACCO USE IS BEING ADDRESSED BY HEALTH EXPERTS AT A STATE LEVEL, THROUGH THE IMPLEMENTATION OF A STATEWIDE SMOKING BAN, EFFECTIVE JULY 2010, AND REMEDIATION PROGRAMS. SINCE 2012, THE PERCENTAGE OF ADULT SMOKERS IN COLUMBIA COUNTY HAS DECREASED. IN ADDITION, COLUMBUS COMMUNITY HOSPITAL OFFERS SMOKING CESSATION CLASSES. AS MORE SPECIFIC DATA BECOMES AVAILABLE REGARDING TOBACCO USE, COLUMBUS COMMUNITY HOSPITAL MAY CONSIDER THIS A POTENTIAL INITIATIVE IN THE 2018 CHNA.- DRUG ABUSE, SPECIFICALLY OPIOID ABUSE, IS CURRENTLY BEING ADDRESSED BY NUMEROUS ORGANIZATIONS IN COLUMBIA COUNTY, INCLUDING COLUMBUS COMMUNITY HOSPITAL THROUGH PROJECT CLEAN - COMMUNITY LEADERS ELIMINATING THE ABUSE OF NARCOTICS. THIS PROGRAM IS AIMED AT ELIMINATING THE ABUSE OF OPIOIDS. RESOURCES ARE AVAILABLE AT THE PAUQUETTE CENTER IN PORTAGE, WHICH IS THE COUNTY SEAT. AS MORE SPECIFIC DATA BECOMES AVAILABLE REGARDING OPIOID ABUSE SPECIFICALLY, COLUMBUS COMMUNITY HOSPITAL MAY CONSIDER THIS A POTENTIAL INITIATIVE IN THE 2018 CHNA.- AGE ADJUSTED DEATH RATE DUE TO SUICIDE IS A RECOGNIZED ISSUE. AT THIS TIME, COLUMBUS COMMUNITY HOSPITAL DOES NOT HAVE THE STAFF OR RESOURCES TO PROPERLY ADDRESS THIS NEED. COLUMBUS COMMUNITY HOSPITAL IS WORKING WITH SSM HEALTH TO INVESTIGATE THE POSSIBILITY OF TELEHEALTH, SPECIFICALLY TELENEUROLOGY AND/OR TELEPSYCHOLOGY. - HIGH RATES OF UNINTENTIONAL INJURY AND TRAFFIC ACCIDENTS ARE BEING ADDRESSED BY OTHERS, INCLUDING LAW ENFORCEMENT AND STATE LEVEL EXPERTS THROUGH INITIATIVES SUCH AS MANDATORY SEAT BELT LAWS AND SPEED LIMIT ENFORCEMENT. AS A RURAL COMMUNITY, FARM SAFETY CONTINUES TO BE A PRIORITY. THE HOSPITAL SUPPORTS SAFETY EDUCATION THROUGH PARTICIPATION IN ANNUAL EVENTS LIKE SAFETY FUN NIGHT, NATIONAL NIGHT OUT, BIKE SAFETY, CAR SEAT SAFETY CHECKS, ETC.- ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES IS A RECOGNIZED NEED RESULTING IN POOR MENTAL HEALTH STATUS. COLUMBUS COMMUNITY HOSPITAL IS AWARE OF THIS NEED IN THE COUNTY. HOWEVER, AT THIS TIME, CCH DOES NOT HAVE THE STAFF OR RESOURCES TO PROPERLY ADDRESS THIS NEED. RESOURCES ARE AVAILABLE AT THE PAUQUETTE CENTER IN PORTAGE, WHICH IS THE COUNTY SEAT. A MONTHLY NAMI SUPPORT GROUP ALSO MEETS AT THE PORTAGE PUBLIC LIBRARY.- COLORECTAL CANCER IS A RECOGNIZED NEED IN COLUMBIA COUNTY. COLUMBUS COMMUNITY HOSPITAL RECENTLY EXPANDED ITS CANCER NAVIGATION PROGRAM TO INCLUDE COLON AND LUNG CANCER. IT IS RECOGNIZED THAT IT WILL TAKE TIME TO BUILD THIS RESOURCE AS A VIABLE OPPORTUNITY FOR THOSE IN NEED. HOWEVER, AT THIS TIME, COLUMBUS COMMUNITY HOSPITAL DOES NOT HAVE FURTHER RESOURCES TO RESPOND TO THE RECOGNIZED NEED OF PROSTATE CANCER.- THE LACK OF DENTAL CARE IN THE COMMUNITY PROVES TO BE A LARGE ISSUE, BUT THE HOSPITAL CANNOT IMPACT THIS. MANY OF THE FOCUS GROUP PARTICIPANTS MENTIONED A LACK OF DENTISTS. MANY PEOPLE DO NOT RECEIVE THE DENTAL CARE THEY NEED BECAUSE THEY EITHER CANNOT MAKE AN APPOINTMENT, DO NOT HAVE THE TRANSPORTATION TO GET TO AN APPOINTMENT OR THEIR INSURANCE IS NOT ACCEPTED. THE HOSPITAL WILL CONTINUE TO WORK WITH LOCAL DENTISTS WHEN A PATIENT PRESENTS TO THE EMERGENCY DEPARTMENT OR EXPRESSES A NEED.- VIOLENT CRIME IN COLUMBIA COUNTY IS A NEED BEING ADDRESSED BY LOCAL LAW ENFORCEMENT OFFICIALS WITHIN THE HOSPITAL'S COMMUNITY.
COLUMBUS COMMUNITY HOSPITAL, INC.	PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:1. HOMELESS OR RECEIVED CARE FROM A HOMELESS OR FREE CLINIC; 2. PATIENT IS DECEASED WITH NO KNOWN ESTATE;3. ACCOUNTS UNCOLLECTIBLE DUE TO DISCHARGE OF DEBTOR BY BANKRUPTCY;4. ALL DATES OF SERVICE WITHIN 30-DAYS PRIOR TO WHEN A PATIENT HAS BEEN APPROVED FOR MEDICAL ASSISTANCE;5. OUT-OF-STATE MEDICAL ASSISTANCE COVERAGE NOT CONTRACTED WITH CCH OR ARE LISTED AS NO FUNDS AVAILABLE. 6. QUALIFICATION FOR TREATMENT UNDER THE MEMORANDUM OF UNDERSTANDING BETWEEN COLUMBIA COUNTY HEALTH AND HUMAN SERVICES AND CCH
COLUMBUS COMMUNITY HOSPITAL, INC.	PART V, SECTION B, LINE 16J: PROVIDED TO PATIENTS UPON ADMISSION

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 - PRAIRIE RIDGE HEALTH CLINIC
118 W MAPLE AVENUE	BEAVER DAM	WI	53916	PHYSICIAN CLINIC
2 - PRAIRIE RIDGE HEALTH CLINIC
301 W MAIN STREET SUITE A	MARSHALL	WI	53559	PHYSICIAN CLINIC

Supplemental Information Detail SupplementalInformationDetail (16 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 3C:	PATIENTS WHOSE FAMILY INCOME AND FAMILY ASSETS ARE AT OR BELOW 200% OF THE FPG ARE ELIGIBLE TO RECEIVE FREE CARE AND PATIENTS WHOSE FAMILY INCOME AND FAMILY ASSETS ARE ABOVE 200% OF THE FPG BUT NOT MORE THAN 400% OF THE FPG ARE ELIGIBLE TO RECEIVE SERVICES AT AMOUNTS TO GREATER THAN THE AMOUNTS GENERALLY BILLED. IN ADDITION, PATIENTS WHOSE FAMILY INCOME AND ASSET EXCEED 400% OF THE FPG MAYBE BE ELIGIBLE TO RECEIVE DISCOUNTED RATES BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE, AT THE DISCRETION OF CCH.
PART I, LINE 6A:	COLUMBUS COMMUNITY HOSPITAL, INC. PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND FILES IT WITH THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE REPORT IS AVAILABLE TO THE GENERAL PUBLIC ON WHA'S WEBSITE.
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 DEBTS DIVIDED BY GROSS PATIENT SERVICES REVENUES. 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 FOR LINE 7G ON THE FIRST PAGE OF SCHEDULE H OF THE FORM 990 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 ORGANIZATION.)
PART I, LINE 7G:	SUBSIDIZED HEALTH SERVICES AT COLUMBUS COMMUNITY HOSPITAL INC. INCLUDE THE OPERATION OF THE HOSPITAL INPATIENT MEDICAL/SURGICAL NURSING UNIT AND THE INTENSIVE CARE UNIT. THESE DEPARTMENTS ARE OFTEN OPERATED AT MINIMAL STAFFING REQUIREMENTS BUT ARE REQUIRED TO MAINTAIN CONSISTENT STAFFING, WHICH LEADS TO HIGHER COSTS, IN ORDER TO ALLOW FOR EMERGENCY ADMISSIONS TO THE UNIT AND FLUCTUATING PATIENT DEMANDS. THE HOSPITAL ADJUSTS ITS STAFFING BASED ON PATIENT TRENDS AND CURRENT CENSUS LEVELS TO ENSURE THAT LOW COST HEALTHCARE IS BEING PROVIDED, HOWEVER THERE IS A LARGE AMOUNT OF FIXED COSTS IN THESE UNITS AND A MINIMAL LEVEL OF STAFFING MUST BE MAINTAINED IN ORDER TO PROVIDE THESE HIGHER LEVEL OF SERVICES TO THE COMMUNITY. IT IS THE GOAL OF COLUMBUS COMMUNITY HOSPITAL TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY.
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 $ 1,615,429.
PART II, COMMUNITY BUILDING ACTIVITIES:	WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT", THESE EFFORTS CONTINUE TO BE A WORK IN PROGRESS. COLUMBUS COMMUNITY HOSPITAL INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE ORGANIZATION BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT BENEFIT WHICH IS NOT QUANTIFIED. COLUMBUS COMMUNITY HOSPITAL, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE ORGANIZATION PROVIDES LOCAL ACCESS TO MANY SERVICES INCLUDING: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES, SWING BED SERVICES, LABORATORY SERVICES, REHABILITATION SERVICES, SPECIALTY MEDICINE, SPEECH PATHOLOGY, SURGICAL SERVICES, LIFELINE, OCCUPATIONAL HEALTH, AND WOMENS' SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED.
PART III, LINE 2:	THE ORGANIZATION UTILIZES HFMA 15. PLEASE SEE EXPLANATION AT PART III, LINE 4.
PART III, LINE 3:	USING HFMA 15 WOULD NOT ALLOW ANY ADDITIONAL AMOUNT TO BE DEEMED CHARITY CARE.
PART III, LINE 4:	THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL 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 DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES FOR AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE AMOUNTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID BASED ON THE AGING OF THOSE RECEIVABLES. 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 HOSPITAL RECORDS A PROVISION FOR BAD DEBTS ON THE BASIS OF ITS PAST EXPERIENCE AND THE AGING OF THOSE RECEIVABLES. 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 DOUBTFUL ACCOUNTS.THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE ORGANIZATION'S TOTAL OPERATING EXPENSES LESS PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE ORGANIZATION. THE ORGANIZATION ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS 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 ORGANIZATION.
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 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 ANESTHESIA PROFESSIONAL SERVICES, RESPIRATORY THERAPY PHYSICIAN 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 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 COLUMBUS COMMUNITY HOSPITAL 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 YEAR ENDED SEPTEMBER 30, 2018, AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE).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:	UNDER THE ORGANIZATION'S COLLECTION AND CHARITY CARE POLICIES, COLUMBUS COMMUNITY HOSPITAL MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE ORGANIZATION'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.
PART VI, LINE 2:	COLUMBUS COMMUNITY HOSPITAL INC. 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 COLUMBUS COMMUNITY HOSPITAL'S MISSION IN THE COMMUNITY. COLUMBUS COMMUNITY HOSPITAL ALSO REVIEWS STATISTICS IN THE HOSPITAL, NURSING HOME, CLINIC, HOME HEALTH, 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 ORGANIZATION ALSO MEETS WITH LOCAL COMMUNITY MEMBERS AND ITS PHYSICIAN GROUP TO DETERMINE WHICH SERVICES MAY BENEFIT THE COMMUNITY. A FORMAL COMMUNITY NEEDS ASSESSMENT WAS COMPLETED BY SEPTEMBER 2016.
PART VI, LINE 3:	UNINSURED AND UNDER INSURED PATIENTS ARE ASKED TO MEET WITH ONE OF THE ORGANIZATION'S FINANCIAL COUNSELORS EITHER AT THE TIME SERVICE IS PROVIDED OR WHEN THE PATIENT'S BILL IS GENERATED. THE FINANCIAL COUNSELOR EXPLAINS THE VARIOUS PAYMENT OPTIONS AVAILABLE TO THE PATIENT AS WELL AS THE HOSPITAL'S CHARITY CARE PROGRAM AND OFFERS THE CHARITY CARE APPLICATION WHEN APPROPRIATE. IF OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE WISCONSIN MEDICAL ASSISTANCE OR BADGERCARE PROGRAMS, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE.
PART VI, LINE 4:	THE PRIMARY SERVICE AREA FOR COLUMBUS COMMUNITY HOSPITAL INC. ENCOMPASSES ALL PERSONS LIVING WITHIN A 20 TO 30 MILE RADIUS OF THE HOSPITAL. COLUMBUS COMMUNITY HOSPITAL IS THE ONLY HOSPITAL LOCATED IN ITS IMMEDIATE SERVICE AREA. THE HOSPITAL PROVIDES A SIGNIFICANT PORTION OF ITS PATIENT SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAL ASSISTANCE PROGRAMS, ESPECIALLY THOSE BENEFICIARIES WHO ARE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY AND RURAL SURROUNDING AREAS WHO OTHERWISE WOULD HAVE A DIFFICULT TIME TRAVELING TO LARGER FACILITIES AND IN SOME CASES COULD BE MORE THAN 20+ MILES AWAY FROM COLUMBUS COMMUNITY HOSPITAL. IN FISCAL YEAR 2018, THESE MEDICARE AND MEDICAL ASSISTANCE PATIENTS ACCOUNTED FOR OVER 54 PERCENT OF THE GROSS PATIENT SERVICE REVENUE PROVIDED BY THE ORGANIZATION DURING THE YEAR.
PART VI, LINE 5:	CCH HAS AN 11 MEMBER BOARD OF DIRECTORS, 6 OF WHICH ARE COMMUNITY MEMBERS THAT RESIDE IN COLUMBIA COUNTY. CCH ALSO MAINTAINS AN OPEN MEDICAL STAFF. SURPLUS FUNDS ARE USED TO REINVEST IN EQUIPMENT, TECHNOLOGY, AND INFRASTRUCTURE IN ORDER TO ENSURE THAT CCH IS ABLE TO SUPPORT THE PROMOTION OF COMMUNITY HEALTH WELL INTO THE FUTURE.
PART VI, LINE 7, REPORTS FILED WITH STATES	WI

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	Yes (1)	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 (10 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
GARY GALVIN MD
CHIEF OF STAFF (THRU 1/18), DIRECTOR	$329,454	$0	$80,889	$0	$1,290	$0	$10,800	$0	$23,253	$0	$445,686	$0	$0	$0
BRUCE KRAUS MD
DIRECTOR (THRU 1/18)	$171,400	$0	$46,214	$0	$1,905	$0	$8,809	$0	$23,764	$0	$252,092	$0	$0	$0
JOHN D RUSSELL
PRESIDENT & CEO	$324,523	$0	$47,383	$0	$45,785	$0	$10,800	$0	$25,253	$0	$453,744	$0	$0	$0
PHILLIP G ROBERTS
VP OF FINANCE & CFO	$207,070	$0	$23,501	$0	$31,428	$0	$9,282	$0	$22,852	$0	$294,133	$0	$0	$0
JAMIE E HENDRIX
VP OF PATIENT CARE SERVICE	$179,790	$0	$19,812	$0	$24,426	$0	$8,089	$0	$23,834	$0	$255,951	$0	$0	$0
ANN ROUNDY
VP OF EMPLOYEE SERVICES	$167,514	$0	$40,774	$0	$26,065	$0	$10,564	$0	$24,127	$0	$269,044	$0	$0	$0
ROBERT COE
PHYSICIAN	$122,600	$0	$321,640	$0	$1,290	$0	$10,800	$0	$24,169	$0	$480,499	$0	$0	$0
CRAIG HABERMAN
PHYSICIAN	$251,646	$0	$72,634	$0	$58,784	$0	$10,800	$0	$20,330	$0	$414,194	$0	$0	$0
MATTHEW NIESEN
PHYSICIAN	$564,863	$0	$48,542	$0	$55,056	$0	$10,800	$0	$23,253	$0	$702,514	$0	$0	$0
KATHERINE SKAGGS
PHYSICIAN	$189,526	$0	$17,308	$0	$21,695	$0	$0	$0	$17,716	$0	$246,245	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 4A	FormAndLineReferenceDesc
Explanation	CRAIG HABERMAN RECEIVED SEVERANCE PAY AT HIS LAST REGULAR WEEKLY SALARY RATE OF $5,769 PER WEEK, LESS REGULAR AND REQUIRED PAYROLL WITHHOLDINGS, FOR UP TO TWELVE WEEKS, AMOUNTING TO A TOTAL OF $34,615. KATHERINE SKAGGS RECEIVED SEVERANCE PAY AT HER LAST REGULAR WEEKLY SALARY RATE OF $4,327 PER WEEK, LESS REGULAR AND REQUIRED PAYROLL WITHHOLDINGS, FOR UP TO FOUR WEEKS, AMOUNTING TO A TOTAL OF $17,308.	ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY
A	391337855	2010-12-01	$5,500,000	FINANCE THE RENOVATION AND EQUIPPING OF THE HOSPITAL FACILITIES	0	0	0
CITY OF COLUMBUS WISCONSIN
B	396005417	2005-06-06	$2,000,000	FINANCE THE IMPROVEMENT OF THE EXISTING HOSPITAL FACILITY	0	0	0
CITY OF COLUMBUS WISCONSIN
C	396005417	2004-12-14	$10,000,000	FINANCE THE IMPROVEMENT AND EQUIPPING OF THE EXISTING HOSPITAL FACILITY	0	0	0
CITY OF COLUMBUS WISCONSIN
D	396005417	2013-12-12	$8,000,000	FINANCE THE RENOVATION AND EQUIPPING OF THE HOSPITAL FACILITIES	0	0	0

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Total ProceedsTotalProceedsAmt	Capital ExpendituresCapitalExpendituresAmt	Substantial CompletionSubstantialCompletionYr	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt
A	$1,384,017	$5,500,000	$5,500,000	2011	Yes (1)	Yes (1)
B	$959,077	$2,000,000	$1,960,000	2006	Yes (1)	Yes (1)	$40,000
C	$4,676,991	$10,000,000	$9,800,000	2006	Yes (1)	Yes (1)	$200,000
D	$601,457	$8,000,000	$8,000,000	2015	Yes (1)	Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A	Yes (1)	Yes (1)
B	Yes (1)	Yes (1)
C	Yes (1)	Yes (1)
D	Yes (1)	Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCd	Rebate Not Due YetRebateNotDueYetInd	Exception To RebateExceptionToRebateInd	Variable Rate IssueVariableRateIssueInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A	Yes (1)	0	Yes (1)	Yes (1)
B	0	Yes (1)	0	Yes (1)
C	0	0	0	Yes (1)
D	0	0	Yes (1)	Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	Yes (1)
B	Yes (1)
C	Yes (1)
D	Yes (1)

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	CITY OF COLUMBUS WISCONSIN	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	396005417	BondIssuerEIN
Bond Issued	2014-06-25	BondIssuedDt
Issue Price	$2,000,000	IssuePriceAmt
Purpose	FINANCE THE RENOVATION AND EQUIPPING OF THE HOSPITAL FACILITIES	PurposeDesc
Defeased	0	DefeasedInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Pool Financing	0	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Retired	$142,421	RetiredAmt
Total Proceeds	$2,000,000	TotalProceedsAmt
Unspent	$2,000,000	UnspentAmt
Substantial Completion	2016	SubstantialCompletionYr
Current Refunding	0	CurrentRefundingInd
Advance Refunding	0	AdvanceRefundingInd
Final Allocation Made	Yes (1)	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (1)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedPropertyInd
Any Lease Arrangements	0	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	0	MgmtContractBondFincdPropInd
Any Research Agreements	0	AnyResearchAgreementsInd
Private Bus Use By Others	0.00000	PrivateBusUseByOthersPct
Private Bus Concerning UBI	0.00000	PrivateBusConcerningUBIPct
Total Private Business Use	0.00000	TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test	Yes (1)	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	Yes (1)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	0	Form8038TFiledInd
Rebate Not Due Yet	0	RebateNotDueYetInd
Exception To Rebate	0	ExceptionToRebateInd
No Rebate Due	0	NoRebateDueInd
Variable Rate Issue	Yes (1)	VariableRateIssueInd
Hedge Identified In Bks And Rec	0	HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGICInd
Gross Proceeds Invested	0	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	Yes (1)	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	Yes (1)	ProceduresCorrectiveActionInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 7A	SSM HEALTH CARE OF WISCONSIN, INC. APPOINTS THREE DIRECTORS TO THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B	THE FOLLOWING DECISIONS BY THE BOARD OF DIRECTORS REQUIRE PRIOR WRITTEN APPROVAL OF SSM HEALTH CARE OF WISCONSIN, INC.: APPROVAL OF ANY AMENDMENT OR RESTATEMENT OF THE CORPORATION'S RESTATED ARTICLES OF INCORPORATION OR OF THE RESTATED BYLAWS; APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; APPROVAL OF ANY MERGER OR CONSOLIDATION INVOLVING THE CORPORATION AND APPROVAL OF THE DISSOLUTION OF THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11B	THE FORM 990 IS REVIEWED BY EITHER THE SENIOR ACCOUNTANT OR DIRECTOR OF FINANCIAL SERVICES FOR COMPLETION AND ACCURACY AND THEN ALSO BY THE CHIEF FINANCIAL OFFICER. THE BOARD OF DIRECTORS ARE GIVEN THE OPPORTUNITY TO REVIEW THE RETURN BEFORE BEING FILED WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C	THE BOARD OF DIRECTORS CHECKS COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY WHENEVER THERE IS A CHANGE IN PEOPLE GOVERNING ANY PART OF THE HOSPITAL OPERATIONS. EACH DIRECTOR AND OFFICER SHALL, SHOULD A CONFLICT ARISE AT ANY TIME, PROMPTLY DISCLOSE SUCH CONFLICT IN WRITING TO THE BOARD OF DIRECTORS AND THE INTERESTED PERSON DOES NOT VOTE ON THE MATTER.
FORM 990, PART VI, SECTION B, LINE 15	THE BOARD OF DIRECTORS REVIEW MARKET DATA FOR ALL ADMINISTRATION POSITIONS AS WELL AS EVALUATES THE PRESIDENT & CEO. A REVIEW OF THE CRITERIA NECESSARY FOR INCENTIVE COMPENSATION IS ALSO DONE ANNUALLY.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11G	HOSPITAL PROFESSIONAL FEES AND PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 461,270. MANAGEMENT AND GENERAL EXPENSES 118,871. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 580,141. CONTRACTED LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 267,197. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 267,197. MEDICAL IMAGING SERVICES: PROGRAM SERVICE EXPENSES 890,351. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 890,351. OTHER MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 23,528. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,528. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 95,064. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 95,064. AGENCY LABOR: PROGRAM SERVICE EXPENSES 175,179. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 175,179. CONTRACTED LABOR: PROGRAM SERVICE EXPENSES 3,371,245. MANAGEMENT AND GENERAL EXPENSES 197,308. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,568,553. EKG/PFT: PROGRAM SERVICE EXPENSES 42,083. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 42,083. PRESS GANEY: PROGRAM SERVICE EXPENSES 26,337. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 26,337. PATHOLOGY: PROGRAM SERVICE EXPENSES 29,640. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,640. CLEANING SERVICES: PROGRAM SERVICE EXPENSES 51,978. MANAGEMENT AND GENERAL EXPENSES 13,395. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 65,373.
FORM 990, PART XI, LINE 9:	CHANGE IN INTEREST IN ASSETS OF COLUMBUS COMMUNITY HOSPITAL FOUNDATION 130,366.
FORM 990, PART XII, LINE 2C:	THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
COLUMBUS COMMUNITY HOSPITAL FOUNDATION INC
1515 PARK AVE	COLUMBUS	WI	53925	391656161	TO SUPPORT COLUMBUS COMMUNITY HOSPITAL, INC.	WI	501(C)(3)	LINE 12B, II	COLUMBUS COMMUNITY HOSPITAL INC	Yes (1)
VOLUNTEERS OF COLUMBUS COMMUNITY HOSPITAL INC
1515 PARK AVE	COLUMBUS	WI	53925	391707234	TO SUPPORT COLUMBUS COMMUNITY HOSPITAL, INC.	WI	501(C)(3)	LINE 12C, III-FI	COLUMBUS COMMUNITY HOSPITAL INC	0

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	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	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	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	0	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	COLUMBUS COMMUNITY HOSPITAL FOUNDATION INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Transaction Type	C	TransactionTypeTxt
Involved	$59,286	InvolvedAmt
Method Of Amount Determination	FMV	MethodOfAmountDeterminationTxt