ST CROIX REGIONAL MEDICAL CENTER: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- ST CROIX REGIONAL MEDICAL CENTER (EIN 39-0890676)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-15
- IRS object ID
- 201831359349304278
- Schema version
- 2016v3.0
- 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 I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-05-15T10:33:14-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wipfli LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3703 Oakwood Hills Pkwy | AddressLine1Txt |
| City | Eau Claire | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390890676 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Croix Regional Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STCR | BusinessNameControlTxt |
| Phone | 7154830556 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Sally Bajak | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7154830556 | PhoneNum |
| Signature | 2018-05-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | HOLLY POKRANDT CPA | PreparerPersonNm |
| PTIN | P00449155 | PTIN |
| Phone | 7158323407 | PhoneNum |
| Preparation | 2018-05-14 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Dave Dobosenski | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $99,433,910 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.scrmc.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1954 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | To provide quality healthcare services to all residents of the service area. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 741 | TotalEmployeeCnt |
| Total Volunteers | 150 | TotalVolunteersCnt |
| Total Gross UBI | $1,468,131 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$252,252 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $127,257 | PYContributionsGrantsAmt |
| CY Contributions Grants | $102,598 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $96,341,956 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $97,845,725 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$124,934 | PYInvestmentIncomeAmt |
| CY Investment Income | $26,315 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,931,234 | PYOtherRevenueAmt |
| CY Other Revenue | $1,433,681 | CYOtherRevenueAmt |
| PY Total Revenue | $99,275,513 | PYTotalRevenueAmt |
| CY Total Revenue | $99,408,319 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $10,744 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $17,111 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $33,681,157 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $41,714,600 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $53,533,691 | PYOtherExpensesAmt |
| CY Other Expenses | $51,616,203 | CYOtherExpensesAmt |
| PY Total Expenses | $87,225,592 | PYTotalExpensesAmt |
| CY Total Expenses | $93,347,914 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $12,049,921 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $6,060,405 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $69,017,853 | TotalAssetsBOYAmt |
| Total Assets EOY | $76,821,979 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,200,883 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $17,944,604 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $52,816,970 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $58,877,375 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | The mission of SCRMC is to provide the highest quality, accessible, integrated, cost effective care for individuals and families served. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $60,417,690 | ExpenseAmt |
| Grant | $17,111 | GrantAmt |
| Revenue | $64,858,224 | RevenueAmt |
| Desc | Outpatient services - surgical, laboratory, basic, and advanced radiology procedures. During Fiscal Year 2017, there were 9,784 emergency room visits recorded, and 1,714 outpatient surgeries. Inpatient services - obstetric, medical-surgical, intensive care, and short stay inpatient care. During Fiscal Year 2017, there were 279 births, 1,490 inpatient admissions, and a total of 4,955 inpatient days for an average length of 3.33 days. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $15,236,910 | ExpenseAmt |
| Revenue | $22,316,522 | RevenueAmt |
| Desc | St. Croix Regional Medical Center operates four provider based clinics and one free standing clinic. Together, the clinics strive to meet the healthcare needs of patients and families who live and work in the communities they serve. A total of 115,994 clinic visits occured in fiscal year 2017. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,830,267 | ExpenseAmt |
| Revenue | $4,249,062 | RevenueAmt |
| Desc | Contract pharmacy - St. Croix Regional Medical Center became eligible to participate in the 340B drug pricing program, which is managed by the health resources and services administration (HRSA) office of pharmacy affairs (OPA), resulting in the realization of a contract pharmacy service. Participation in the 340B drug pricing program results in significant savings, estimated to be 20-50%, on the cost of pharmaceuticals for use by outpatients of the facility. Through this program, St. Croix Regional Medical Center is able to reach more eligible patients and provide more comprehensive services. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $7,022,117 | ExpenseAmt |
| Revenue | $4,603,815 | RevenueAmt |
| Desc | St. Croix Valley Regional Pharmacies provide local pharmacy care to the service area of St. Croix Regional Medical Center. St. Croix Valley Pharmacies is the sole member of the following community pharmacies: Unity Pharmacy located in the Unity Clinic building near Balsam, WI, Frederic Pharmacy located in the Frederic Clinic Building in Frederic, WI, and, St. Croix Falls Pharmacy located in the St. Croix Falls Clinic Building in St. Croix Falls, WI. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $7,022,117 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $4,603,815 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $85,506,984 | 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 | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | 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 | Yes (1) | 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 | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 66 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 741 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | 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 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SALLY BAJAK | PersonNm |
| Phone | 7154830556 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Kristine Fuge | |||||||
| Chair | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Patrick McDonough MD | |||||||
| Vice-Chair | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Michael Buchite | |||||||
| Treasurer | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| April Wallace PsyD | |||||||
| Secretary | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Steve Tesch | |||||||
| Trustee | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Allison Karun MD | |||||||
| Trustee | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Danielle Redburn MD | |||||||
| Trustee | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Sarah Cormell | |||||||
| Trustee | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Dana Frey | |||||||
| Trustee | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Dave Dobosenski | |||||||
| CEO | 40.00 | Yes (X) | $319,653 | $0 | $51,985 | ||
| Sally Bajak | |||||||
| CFO | 40.00 | Yes (X) | $149,253 | $0 | $36,701 | ||
| Gurdesh Bedi | |||||||
| Physician | 40.00 | $808,710 | $0 | $15,300 | Yes (X) | ||
| Claudio Nunes | |||||||
| Physician | 40.00 | $400,590 | $0 | $55,128 | Yes (X) | ||
| Muhammad Khan | |||||||
| Physician | 40.00 | $345,804 | $0 | $44,962 | Yes (X) | ||
| Pradeep Wardhan | |||||||
| Physician | 40.00 | $278,299 | $0 | $23,257 | Yes (X) | ||
| William Schultz | |||||||
| Physician | 40.00 | $291,875 | $0 | $25,940 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,594,184 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $253,273 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 34 | 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 |
|---|---|---|---|---|---|
| River Valley Medical Center | |||||
| 208 South Adams Street | St Croix Falls | WI | 54024 | Physician Services | $8,843,673 |
| Voyageur Radiology LLC | |||||
| 9975 Dellwood Road | Stillwater | MN | 55082 | Radiology Services | $1,193,704 |
| St Croix Valley Anesthesia | |||||
| PO Box 45 | Osceola | WI | 54024 | CRNA Services | $1,115,669 |
| Regions Hospital | |||||
| PO Box 64059 | St Paul | MN | 55164 | Physician Services | $1,021,802 |
| CMDI | |||||
| PO Box 158 | Milaca | MN | 56353 | RAdiology Services | $946,618 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 15 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $102,598 | AllOtherContributionsAmt |
| Total Contributions | $102,598 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Patient Services | 624100 | $87,174,746 | $87,174,746 | |
| Contract Pharmacy | 624100 | $4,249,062 | $4,249,062 | |
| Frederic Pharmacy | 624100 | $2,614,064 | $1,838,114 | $775,950 |
| SCR Pharmacy | 624100 | $2,084,874 | $1,783,084 | $301,790 |
| Unity Pharmacy | 624100 | $1,373,008 | $982,617 | $390,391 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $349,971 | TotalRevenueColumnAmt |
| Exclusion | $349,971 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $97,845,725 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,251 | TotalRevenueColumnAmt |
| Exclusion | $39,251 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $69,361 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $9,155 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $60,206 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $60,206 | TotalRevenueColumnAmt |
| Exclusion | $60,206 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $3,500 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $16,436 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$12,936 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$12,936 | TotalRevenueColumnAmt |
| Exclusion | -$12,936 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| Miscellaneous | 900099 | $1,026,168 | $1,026,168 |
| Joint Venture Revenue | 900099 | $177,107 | $177,107 |
| EHR Payments | 900099 | $170,200 | $170,200 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,373,475 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $99,408,319 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $96,027,623 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $1,468,131 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,809,967 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,111 | TotalAmt |
| Program Services | $17,111 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $613,867 | TotalAmt |
| Management And General | $613,867 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,398,339 | TotalAmt |
| Program Services | $29,429,587 | ProgramServicesAmt |
| Management And General | $3,968,752 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,442,637 | TotalAmt |
| Program Services | $1,271,207 | ProgramServicesAmt |
| Management And General | $171,430 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,928,674 | TotalAmt |
| Program Services | $3,461,826 | ProgramServicesAmt |
| Management And General | $466,848 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,331,083 | TotalAmt |
| Program Services | $2,021,115 | ProgramServicesAmt |
| Management And General | $309,968 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,528 | TotalAmt |
| Management And General | $131,528 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,226 | TotalAmt |
| Management And General | $72,226 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,000 | TotalAmt |
| Management And General | $3,000 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,704,218 | TotalAmt |
| Program Services | $17,420,984 | ProgramServicesAmt |
| Management And General | $1,283,234 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $330,189 | TotalAmt |
| Program Services | $143,615 | ProgramServicesAmt |
| Management And General | $186,574 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $710,848 | TotalAmt |
| Program Services | $393,597 | ProgramServicesAmt |
| Management And General | $317,251 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,505,586 | TotalAmt |
| Program Services | $1,380,129 | ProgramServicesAmt |
| Management And General | $125,457 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,940,454 | TotalAmt |
| Program Services | $1,847,299 | ProgramServicesAmt |
| Management And General | $93,155 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $174,256 | TotalAmt |
| Program Services | $126,286 | ProgramServicesAmt |
| Management And General | $47,970 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $296,394 | TotalAmt |
| Program Services | $260,516 | ProgramServicesAmt |
| Management And General | $35,878 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,829 | TotalAmt |
| Program Services | $157,949 | ProgramServicesAmt |
| Management And General | $9,880 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,450,290 | TotalAmt |
| Program Services | $3,450,290 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $237,964 | TotalAmt |
| Program Services | $234,052 | ProgramServicesAmt |
| Management And General | $3,912 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Medical Supplies | $20,852,284 | $20,852,284 |
| Provision for Bad Debts | $2,944,835 | $2,944,835 |
| MN Care & ACA Taxes | $49,673 | $49,673 |
| Equipment Rental | $44,629 | $44,629 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,347,914 | TotalAmt |
| Program Services | $85,506,984 | ProgramServicesAmt |
| Management And General | $7,840,930 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,726,092 | BOYAmt |
| EOY | $21,153,955 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $515,988 | BOYAmt |
| EOY | $372,844 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,855,947 | BOYAmt |
| EOY | $14,155,480 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,589 | BOYAmt |
| EOY | $40,035 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,635,121 | BOYAmt |
| EOY | $3,038,662 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $633,444 | BOYAmt |
| EOY | $496,199 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $62,598,077 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $31,992,401 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,430,881 | BOYAmt |
| EOY | $30,605,676 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,023,771 | BOYAmt |
| EOY | $4,779,386 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,477,331 | BOYAmt |
| EOY | $1,604,742 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $623,689 | BOYAmt |
| EOY | $575,000 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $69,017,853 | BOYAmt |
| EOY | $76,821,979 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,372,223 | BOYAmt |
| EOY | $11,642,443 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,175,606 | BOYAmt |
| EOY | $2,715,233 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $247,000 | BOYAmt |
| EOY | $209,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,406,054 | BOYAmt |
| EOY | $3,377,928 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,200,883 | BOYAmt |
| EOY | $17,944,604 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,816,970 | BOYAmt |
| EOY | $58,877,375 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,816,970 | BOYAmt |
| EOY | $58,877,375 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $69,017,853 | BOYAmt |
| EOY | $76,821,979 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $6,060,405 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | 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
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 | Yes (1) | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | Yes (1) | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (1) | DirectContactLegislatorsInd |
| Direct Contact Legislators | $3,000 | DirectContactLegislatorsAmt |
| Rallies Demonstrations | Yes (1) | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $3,000 | 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 | We have hired Strategic Healthcare to assist us in discussing Critical Access Hospital (CAH) designation for 10 mile hospitals. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,502,879 | OtherCostOrOtherBasisAmt |
| Book Value | $1,502,879 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $36,426,088 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,553,306 | DepreciationAmt |
| Book Value | $18,872,782 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,462,075 | OtherCostOrOtherBasisAmt |
| Depreciation | $962,100 | DepreciationAmt |
| Book Value | $499,975 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,474,884 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,476,995 | DepreciationAmt |
| Book Value | $6,997,889 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,732,151 | OtherCostOrOtherBasisAmt |
| Book Value | $2,732,151 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $30,605,676 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Asset Retirement Obligation | $219,938 |
| Payable to third-party reimbursement programs | $180,000 |
| Deferred Compensation Plan | $2,977,990 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,377,928 | TotalLiabilityAmt |
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 |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 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 | $463,029 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $463,029 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00500 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,425,272 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,586,297 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,838,975 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04110 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,888,301 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,586,297 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,302,004 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04610 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,888,301 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,586,297 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,302,004 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04610 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,484,703 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $742,352 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $26,120,954 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $26,161,666 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$40,712 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Croix Regional Medical Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 State Street | AddressLine1Txt |
| City | St Croix Falls | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.scrmc.org | WebsiteAddressTxt |
| State License | 1043240922 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Croix Regional Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | 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 | www.scrmc.org | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | www.healthypolkcounty.com | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://scrmc.org/contact/insurance/financial-assistance/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://scrmc.org/contact/insurance/financial-assistance/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://scrmc.org/contact/insurance/financial-assistance/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| St. Croix Regional Medical Center | Part V, Section B, Line 5: In the collection of data for the community health needs assessment, the Medical Center utilized health and lifestyle community surveys. A county wide survey of the health of Polk County residents was made available to the public to participate. This survey was made available at all of the local medical centers and the health department as well as advertised in the local newspapers and posted on all four of the Partner's organization's websites. Once the data was collected from the surveys, four community forums were sponsored in Balsam Lake, St. Croix Falls, Amery and Osceola. The community members in attendance offered input and suggestions on the health focus areas. In addition, a partner meeting was held targeting key organizations as well as local health-related coalitions. At each of these venues, attendees had the opportunity to provide input on the 10 health focus areas as well as vote for their top five. On April 12, 2016, a partner meeting convened and participated in a process focusing on review and discussion of compiled data on the current health status of Polk County citizens, as well as voting results from the community forums. During this meeting, this group completed a paper survey to cast their votes to determine the top four health focus areas for Polk County, WI. The collaborative group of the Polk County Health Department, the three medical centers and many other community organizations engages community members and works collectively with partners to improve the health of the community through assessment, prioritization, effective planning, collaborative implementation and evaluation. |
| St. Croix Regional Medical Center | Part V, Section B, Line 6a: The Medical Center worked in collobration with the Polk County Health Department, Amery Hospital and Clinic and Osceola Medical Center with the ultimate goal to identify priority health issues and to develop strategies to address the community's health needs. |
| St. Croix Regional Medical Center | Part V, Section B, Line 6b: As stated above, The medical center worked in collobration with the Polk County Health Department for their community health needs assessment. |
| St. Croix Regional Medical Center | Part V, Section B, Line 11: The community members in attendance offered input and suggestions on the health focus areas. At each of these venues, attendees had the opportunity to provide input on the top health focus areas. The final top health focus areas selected were:1. Mental Health2. Substance abuse3. Access to care4. Obesity After reviewing the data and mapping existing resources, SCRMC developed an implementation strategy. The SCRMC governing board approved the implementation strategy on October 25, 2016. The above needs were prioritized based on size, severity, available data, and the hospital's ability to have an impact. In order to address priority needs, SCRMC will engage key community partners in implementing strategies across the service area. These strategies include modifying policies, providing support, enhancing acces, changing consequenses and incentives, providing information, and enhancing skills. SCRMC works collaboratively with Osceola Medical Center, Amery Medical Center, the Polk County Health Department, and other other community members to determine the four most significant health needs of the community. SCRMC would also like to contribute efforts to other community health needs identified in the community health needs assessment. 1. Nutrition - Nutrition now falls under obesity. Because obesity was ranked as one of the most important health needs, nutrition will be addressed indirectly through many of the strategies and activities aimed at reducing obesity. 2. Physicial Activity - Physical activity now falls under obesity. Because obesity was ranked as one more the most important health needs, physical activity will be addressed indirectly through many of the strategies and activities aimed at reducing obesity. 3. Reproductive and sexual health: Though not voted as one of the top signifcant health needs of Polk County, SCRMC is commited to playing an active role in reporductive and sexual health. SCRMC is currently working toward re-designing patient education materials to better suit patient understanding. If a patient is deemed sexually active and is between the age of 16-24, all primary care providers screen the patient for Chlamydia nad gonorrhea. For all teen primary care cistis, "teen health" information is included in the after visit summary for the patient. During a patient visit primary care, counseling is offered for any issue in reporductive and sexual health. SCRMC acknowledges the wide range of signficant health issues that emerged from the CHNA process and determined that it could effectively focus on only those health needs which it deemed most pressing, under-addressed, and within its ability to influence. SCRMC will not take new or additonal actions on the following health needs at this time: 1. Unintentional injury: Because substance abuse was ranked as on of the most important health needs, unintentional injury will be addressed indirectly through many of the strategies and activites aimed at reducing substance abuse. 2. Dental health services and oral health: Many of the key stakeholders reported access to affordable dental care as a need among the low-income and medically underserved populations. SCRMC providers promote the positive health benefits of good oral health at patient visits and allow dental service promotion at suitable SCRMC sponsored community and employee events throughout the year. Due to limited resources and space, SCRMC is unable, at this time, to address this matter. |
| St. Croix Regional Medical Center | Part V, Section B, Line 13h: SCRMC may presumptively determine eligibility of patients based on external sources and databases without a FAP-application. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Frederic Clinic | ||||
| 107 Oak Street E | Frederic | WI | 54837 | Provider based clinic |
| 2 - Ingalls Clinic | ||||
| 7456 Main Street | Webster | WI | 54893 | Provider based clinic |
| 3 - Unity Clinic | ||||
| 1482 190th Ave | Balsam Lake | WI | 54024 | Provider based clinic |
| 4 - St Croix Falls Clinic | ||||
| 235 State Street | St Croix Falls | WI | 54024 | Provider based clinic |
| 5 - Lindstrom Clinic | ||||
| 12375 Lindstrom Lane | Lindstrom | MN | 55045 | Free Standing Clinic |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | St. Croix Regional Medical Center, through its patient advocates, evaluates each applicant's situation in accordance with criteria established annually by the board of directors. The criteria includes:(1) Individual or family income(2) Family Size(3) Other sources of payment for services. Qualification is based on asset levels established by medical assistance, family size, and income levels based on 100% of the federal poverty guidelines as published annualy by the federal government. In addition to the above listed eligibility requirements dependent upon income, SCRMC may also presumtively determine eligibility for financial assistance. Portions of or the entire financial application process may be waived for certain patients/guarantors who presumptively qualify for financial assistance and are subsequently verified based on SCRMC policies and procedures. Examples may include patients/guarantors who are homeless, deceased without an estate, bankruptcy, food stamps and/or patients/guarantors who qualify by external available data sources such as credit agencies or social economic status of qualifying for financial assistance. |
| Part I, Line 6a: | St. Croix Regional Medical Center participates in an annual community benefit report produced by the Wisconsin Hospital Association. |
| Part I, Line 7: | The costing methodology used on From 990 is based on a cost-to-charge ratio which is developed based on the hospital's total operating expenses less the provsision for bad debt divided by gross patient service revenue. This cost-to-charge ratio is applied against various revenue and expense categories to compute the estimated community benefit expense under IRS suggested costing methods for the Form 990. |
| Part III, Line 2: | The costing methodology used on Form 990 is based on a cost-to-charge ratio, which is developed based on the hospital's total operating expenses excluding the provision for bad debt, divided by gross patient service revenue. This cost-to-charge ratio is applied against the total charges that are written off during the year to estimate the cost of care of patients who have accounts that are deemed to be bad debts to the hospital. The hospital also recognizes that it also provides a discount to self-pay or uninsured patients. These amounts are excluded from gross patient service revenue on the financial statements and are not included in the ratio as described above and approved by the IRS for use on Form 990. If considered, these additional write-off amounts to uninsured accounts would also increase the estimated bad debt expense amount associated with these uncollectible accounts to the hospital. |
| Part III, Line 3: | MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY REPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE hospital HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. |
| Part III, Line 4: | See the "Patient Receivables and Credit Policy" Section in Note 1 to the financial statements for information about the calculation of bad debts. |
| Part III, Line 8: | The Medical Center provides care to individuals where government departments determine the amount of reimbursement of service regardless of the cost to provide the service. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES GROSS MEDICARE REVENUE BUT DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE ALSO DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS RADIOLOGIST, RESPIRATORY THERAPY, URGENT CARE, OR ANESTHESIA PROFESSIONAL SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT the hospital PROVIDES TO THE COMMUNITY AND SURROUNDING AREA. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTH CARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. |
| Part III, Line 9b: | The following procedures are Section 8 in SCRMC's billing and collection policy included on their website and describe the policy and procedures used for patients that may qualify for financial assistance. St. Croix Regional Medical Center will make reasonable efforts to patient/guarantors that financial assistance is available, where to get the information, how to apply, and assistance available with applying. St. Croix Regional Medical Center will allow and process a financial assistance application up to 240 days after the patient/guarantor's first billing statement after a date of service. St. Croix Regional Medical Center will take steps to notify patient/guarantor about our financial assistance policy and will not take extraordinary collection actions before 120 days from patient/guarantor's first billing statement after a date of service. If a financial assistance application is received during the application period, St. Croix Reginal Medical Center will suspend any extraordinary collection actions to obtain payment, make an eligibilty determination as to whether the patient/guarantor is eligible for financial assistance and notify the patient/guarantor in writing. If eligible, the final notification period will be reset for another 30 day period. If a patient/guarantor does not apply for financial assistance under the financial assistance policy by the last day of the final notification period, and the patient/guarantor has received the 30 day notice described in final notification period, then St. Croix Regional Medical Center may initiate extraordinary collection actions. If a patient/guarantor has applied for financial assistance under the financial assistance policy in the last six months, and it was determined that the patient/guarantor is not eligible for financial assistance under the financial assistance policy, then SCRMC may initiate extraordinary collection actions. If an incomplete financial assistance application under the financial assistance policy is received prior to the final notice, then extraoridnary collection actions will be suspended and patient/guarantor will be provided a written notice that describes additional information required under the financial assistance policy. If additional information requested is not provided, then the final notification period will be reset. |
| Part VI, Line 2: | Overall marketplace demorgraphics and competitive analysis is conducted on a regular basis. When demand for new servivce lines is intensified, they are added slowly until demand capcacity reach critical levels. |
| Part VI, Line 3: | All patients have access to written materials and pamphlets at or near the point of registration. In addition, patients have access to patient advocates with full knowledge of resources available. |
| Part VI, Line 4: | SCRMC servces a geographic area of approximately 300 square miles in western Wisconsin that includes the towns of St. Croix Falls, Balsam Lake, Luck, Milltown, Frederic, and Grantsburg in Wisconsin and Taylor Falls and Lindstrom in Eastern Minnesota. |
| Part VI, Line 7, Reports Filed With States | WI |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Tuition Reimbursement | GrantTypeTxt |
| Recipient | 7 | RecipientCnt |
| Cash Grant | $17,111 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
| Non Cash Assistance | Tuition Reimbursement | NonCashAssistanceDesc |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | The organization's procedures include substantiation of expenses, grades, transcripts and receipts, as well as follow up with community organizations and leaders. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dave Dobosenski | ||||||||||||||
| CEO | $284,369 | $0 | $0 | $0 | $35,284 | $0 | $15,300 | $0 | $36,685 | $0 | $371,638 | $0 | $0 | $0 |
| Sally Bajak | ||||||||||||||
| CFO | $149,037 | $0 | $0 | $0 | $216 | $0 | $9,741 | $0 | $26,960 | $0 | $185,954 | $0 | $0 | $0 |
| Gurdesh Bedi | ||||||||||||||
| Physician | $800,000 | $0 | $7,000 | $0 | $1,710 | $0 | $15,300 | $0 | $0 | $0 | $824,010 | $0 | $0 | $0 |
| Claudio Nunes | ||||||||||||||
| Physician | $393,290 | $0 | $7,000 | $0 | $300 | $0 | $15,300 | $0 | $39,828 | $0 | $455,718 | $0 | $0 | $0 |
| Muhammad Khan | ||||||||||||||
| Physician | $338,534 | $0 | $7,000 | $0 | $270 | $0 | $15,162 | $0 | $29,800 | $0 | $390,766 | $0 | $0 | $0 |
| Pradeep Wardhan | ||||||||||||||
| Physician | $275,535 | $0 | $2,625 | $0 | $139 | $0 | $0 | $0 | $23,257 | $0 | $301,556 | $0 | $0 | $0 |
| William Schultz | ||||||||||||||
| Physician | $287,307 | $0 | $4,190 | $0 | $378 | $0 | $0 | $0 | $25,940 | $0 | $317,815 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 4b | Contributions to a 457(F) supplemental Non-qualified Retirement Plan: Dave Dobosenski - $40,617 |
| Schedule J, Line 6a | Annual employer contributions to the 457(f) plan are conditioned upon attaining certain pre-set goals and are contingent on approval by the board of directors. The award is based on two components - longevity and performance. Performance is based on meeting 3 goals - net revenue, net margin and net assets. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| Polk County | |||||||
| A | 396005730 | 2006-05-11 | $13,000,000 | Refund Series 2000 Bonds, Facility Construction and Equipment Purchases | 0 | 0 | 0 |
| Polk County | |||||||
| B | 396005730 | 2006-12-27 | $3,683,432 | Facility Construction | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|
| A | $11,131,979 | $13,000,000 | $13,000,000 | 2008 | 0 | 0 | Yes (1) | Yes (1) |
| B | $2,822,079 | $3,683,432 | $3,683,432 | 2008 | 0 | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 2 | SCRMC contracted with Midwest Spine to offer enhanced spine surgical services during fiscal year 2017. |
| Form 990, Part VI, Section A, line 6 | St. Croix Regional Medical Center has two classes of members - sponsoring members and physician electors. Individuals and corporations may become sponsoring members through donations of a specified amount to the medical center. Individuals may become physician electors by providing services at St. Croix Regional Medical Center through specified employment conditions. |
| Form 990, Part VI, Section A, line 7a | Physician electors vote in the election of four physician trustees. Sponsoring members vote in the election of five community trustees. |
| Form 990, Part VI, Section A, line 7b | The members vote on the auditors employed to audit the books of the Medical Center and to prepare an annual report. An Ops council, consisting of five individuals appointed by River Valley Medical Center, a related organization, has signficant oversight of authority at the Medical Center. The Ops council's authority includes, but is not limited to, review and approval of all policies and procedures as they relate to medical operations and recommendation of the annual capital and operating budgest to the finance committee of the board of directors. |
| Form 990, Part VI, Section B, line 11b | THE FORM 990 WENT THROUGH THE FOLLOWING REVIEW PROCESS BEFORE FILING WITH THE IRS: A DETAILED REVIEW WAS CONDUCTED BY THE ORGANIZATION'S CFO, UPON APPROVAL, THE FORM 990 WAS THEN FILED ELECTRONICALLY. A COPY OF THE FILED FORM 990 WAS PROVIDED FOR REVIEW AND APPROVAL TO THE ORGANIZATION'S BOARD OF DIRECTORS AT THE NEXT BOARD OF DIRECTORS MEETING. |
| Form 990, Part VI, Section B, line 12c | Board membership is contingent upon annual disclosure of potential and actual conflicts of interest. The determination is made at the board level and all board members must certify annually. If a board member has a conflict, they refrain from voting or participating in discussions concerning the topic. |
| Form 990, Part VI, Section B, line 15a | CEO - annual performance and salary review is conducted by the board of directors using such outside information as deemend necessary. Reviews are conducted each June. The process last included review and approval by independent persons, comparability data and contemporaneous substantiation. Other officers - The human resource department conducts outside research to determine reasonable compensation. The CEO then determines the compensation of these individuals. Reviews are conducted each June. |
| Form 990, Part VI, Section C, line 19 | The Medical Center's governing documents, conflict of interest policy and financial statements are not made available to the public. |
| Form 990, Part IX, line 11g | Physician Fees: Program service expenses 12,079,764. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,079,764. Purchased Services: Program service expenses 3,885,342. Management and general expenses 846,570. Fundraising expenses 0. Total expenses 4,731,912. Therapits & Other Phy Fees: Program service expenses 113,111. Management and general expenses 0. Fundraising expenses 0. Total expenses 113,111. Independent Contractors: Program service expenses 1,045,105. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,045,105. Consulting Services: Program service expenses 297,662. Management and general expenses 436,664. Fundraising expenses 0. Total expenses 734,326. |
| Part XII, Line 2C, Selection of Independent Accountant: | The BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE BOARD OF DIRECTORS MEETS WITH INDEPENDENT ACCOUNTANT FOLLOWING THE AUDIT EACH YEAR TO REVIEW THE FINANCIAL STATEMENTS. MEMBERS OF THE BOARD OF DIRECTORS ALSO HAVE THE CONTACT INFORMATION OF THE INDEPENDENT ACCOUNTANT AND ARE ENCOURAGED TO CONTACT THE ACCOUNTANTS DURING THE YEAR WHEN QUESTIONS ARISE. THERE HAS BEEN NO CHANGE TO THESE PROCEDURES DURING THE PAST YEAR. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| Unity Pharmacy LLC | |||||||||
| 1504 190th Avenue Suite 100 | Balsam Lake | WI | 54810 | 454471131 | Pharmaceuticals | WI | $1,367,995 | $411,583 | SCV Pharmacies |
| Frederic Pharmacy LLC | |||||||||
| 201 Oak Street West | Frederic | WI | 54837 | 464469897 | Pharmaceuticals | WI | $2,567,539 | $1,137,936 | SCV Pharmacies |
| St Croix Valley Pharmacy LLC | |||||||||
| 235 State Street | St Croix Falls | WI | 54024 | 464463191 | Pharmaceuticals | WI | $2 | $8,418 | St Croix Regional Medical Center |
| St Croix Falls Pharmacy LLC | |||||||||
| 216 South Adams Street | St Croix Falls | WI | 54024 | 464487348 | Pharmaceuticals | WI | $2,019,044 | $405,684 | SCV Pharmacies |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| St Croix Valley Emergency Medical Services Inc | |||||||||||
| 235 East State Street | St Croix Falls | WI | 54024 | 452872803 | To lease, maintain, and operate an emergency ambulance service | WI | 501(c)(3) | Line 9 | St Croix Regional Medical Center | Yes (1) | |
| Cancer Center of Western Wisconsin | |||||||||||
| 501 Hosiptal Road | New Richmond | WI | 54017 | 273238660 | To provide care to cancer patients | WI | 501(c)(3) | Line 12a, I | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |