SAUK PRAIRIE HEALTHCARE INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- SAUK PRAIRIE HEALTHCARE INC (EIN 39-0872080)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-10
- IRS object ID
- 201703149349303275
- 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 | 2017-11-10T16:10:01-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390872080 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAUK PRAIRIE HEALTHCARE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SAUK | BusinessNameControlTxt |
| Phone | 6086433311 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 260 26TH STREET | AddressLine1Txt |
| City | PRAIRIE DU SAC | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53578 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES DREGNEY | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 6086433311 | PhoneNum |
| Signature | 2017-11-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KOREY BOELTER | PreparerPersonNm |
| PTIN | P00775161 | PTIN |
| Phone | 6123764500 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-10 | IPDt |
| IP Tm | 07:31:28 | IPTm |
| IP Timezone | PS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | F3F329DFBA37A4C14C73FD596159B47BC051605F | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | AB71778D6892C0E42F58020F1D4906ABCC386121 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JAMES DREGNEY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 260 26TH STREET | AddressLine1Txt |
| City | PRAIRIE DU SAC | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53578 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $90,564,822 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SAUKPRAIRIEHEALTHCARE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1956 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | EXTRAORDINARY HEALTHCARE FROM THE HEART - ONE PERSON AT A TIME. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 696 | TotalEmployeeCnt |
| Total Volunteers | 115 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $779,904 | PYContributionsGrantsAmt |
| CY Contributions Grants | $526,816 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $81,105,326 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $82,422,908 | CYProgramServiceRevenueAmt |
| PY Investment Income | $581,211 | PYInvestmentIncomeAmt |
| CY Investment Income | $245,028 | CYInvestmentIncomeAmt |
| PY Other Revenue | $27,628 | PYOtherRevenueAmt |
| CY Other Revenue | -$52,080 | CYOtherRevenueAmt |
| PY Total Revenue | $82,494,069 | PYTotalRevenueAmt |
| CY Total Revenue | $83,142,672 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $146,638 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $170,352 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $45,550,947 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $47,369,069 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $86,668 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $38,328,790 | PYOtherExpensesAmt |
| CY Other Expenses | $37,388,114 | CYOtherExpensesAmt |
| PY Total Expenses | $84,026,375 | PYTotalExpensesAmt |
| CY Total Expenses | $84,927,535 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,532,306 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,784,863 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $150,616,117 | TotalAssetsBOYAmt |
| Total Assets EOY | $147,458,437 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $78,170,526 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $76,031,737 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $72,445,591 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $71,426,700 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | EXTRAORDINARY HEALTHCARE FROM THE HEART - ONE PERSON AT A TIME.VISION: WE WILL SET THE STANDARD FOR COMMUNITY-BASED HEALTHCARE THAT IMPROVES THE HEALTH AND QUALITY OF LIFE OF THE PEOPLE WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $54,894,874 | ExpenseAmt |
| Grant | $170,352 | GrantAmt |
| Revenue | $70,218,571 | RevenueAmt |
| Desc | SAUK PRAIRIE HEALTHCARE ("THE HOSPITAL"), A 36-BED ACUTE CARE GENERAL HOSPITAL, IS A NONPROFIT, NONSTOCK WISCONSIN CORPORATION PROVIDING SERVICES TO SAUK CITY, PRAIRIE DU SAC, AND THE SURROUNDING COMMUNITIES.TOTAL ADMISSIONS FOR 2016 WERE 1,850 WITH PATIENT DAYS OF 4,017. KEY PATIENT SERVICES INCLUDING 332 BIRTHS IN THE NURSERY, 4,984 SUGICAL PROCEDURES, 73,757 REHABILITATION THERAPY SERVICES, 27,648 MEDICAL IMAGING SERVICES, AND 14,022 EMERGENCY ROOM VISITS ARE AMONG MANY OF THE SERVICES PROVIDED TO PATIENTS DURING 2016.THE HOSPITAL FULFILLS ITS MISSION AND VISION BY OFFERING HIGH-QUALITY SERVICES IN RURAL COMMUNITIES, THEREBY ALLOWING OUR PATIENTS TO BE TREATED LOCALLY WITHOUT LENGTHY COMMUTES OR WAITING. THE HOSPITAL HAS GAINED A REGIONAL REPUTATION OF EXCELLENCE IN ORTHOPEDICS, GENERAL SURGERY, SPINE SURGERY, AND GYNECOLOGY SURGERY. THE HOSPITAL TREATED MORE THAN 1,850 INPATIENTS IN 2016, 332 BABIES ENTERED THE WORLD HERE, AND THE HOSPITAL HAD 62,298 OUTPATIENT VISITS. THE HOSPITAL OPERATES FOUR CLINICS IN RURAL AREAS: LODI, SPRING GREEN, PLAIN, AND BLACK EARTH, BRINGING PRIMARY CARE TO THOSE COMMUNITIES. THE CLINICS HAD CLOSE TO 36,650 VISITS IN 2016. AS A CHARITABLE ORGANIZATION, THE HOSPITAL PROVIDED OVER $1.8 MILLION IN FREE CARE TO PAITENTS IN OUR SERVICE AREA IN 2016, IN ADDITION TO SUBSIDIZING SERVICES THAT DO NOT COVER COSTS, FREE HEALTH SCREENINGS, EDUCATION PROGRAMS, AND YOUTH OUTREACH. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $14,693,396 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $12,204,337 | RevenueAmt |
| Desc | THE HOSPITAL ALSO OWNS AND OPERATES PHYSICIAN PRACTICES IN SPRING GREEN, MAZOMANIE (DBA WISCONSIN HEIGHTS CLINIC), PLAIN, AND LODI, WISCONSIN, AS WELL AS OPERATES ORTHOPEDIC AND SURGICAL PHYSICIAN PRACTICES IN PRAIRIE DE SAC, WISCONSIN. TOTAL CLINIC VISITS TO THESE GIVE SITES FOR 2016 WAS 49,669. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $69,588,270 | 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 | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | 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 | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 56 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 696 | 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 | 8 | 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 | JAMES DREGNEY | PersonNm |
| Phone | 6086433311 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 260 26TH STREET | AddressLine1Txt |
| City | PRAIRIE DU SAC | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53578 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| TAMMY ADLER | ||||||||
| PRESIDENT | 5.80 | Yes (X) | Yes (X) | $19,300 | $0 | $0 | ||
| PHILIP KEISER | ||||||||
| VICE PRESIDENT | 2.90 | Yes (X) | Yes (X) | $1,600 | $0 | $0 | ||
| DALE CARLSON | ||||||||
| TREASURER | 3.10 | Yes (X) | Yes (X) | $8,500 | $0 | $0 | ||
| ROXI MAIER | ||||||||
| SECRETARY | 4.00 | Yes (X) | Yes (X) | $9,600 | $0 | $0 | ||
| NEIL BISHOP | ||||||||
| TRUSTEE | 3.10 | Yes (X) | $9,300 | $0 | $0 | |||
| NANCY BREUNIG | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $11,712 | $0 | $0 | |||
| JASON BRICKI | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $400 | $0 | $0 | |||
| RICHARD MARINO | ||||||||
| TRUSTEE | 4.20 | Yes (X) | $8,200 | $0 | $0 | |||
| ALLAN PECKHAM | ||||||||
| TRUSTEE | 3.40 | Yes (X) | $8,900 | $0 | $0 | |||
| TODD SCHAD MD | ||||||||
| TRUSTEE | 1.80 | Yes (X) | $50,758 | $0 | $0 | 4.00 | ||
| TOM SCHWARTZ | ||||||||
| TRUSTEE | 2.90 | Yes (X) | $9,708 | $0 | $0 | |||
| VICKIE WENZEL-SCHLICK | ||||||||
| TRUSTEE | 3.20 | Yes (X) | $7,300 | $0 | $0 | |||
| LARRY SCHROEDER | ||||||||
| CEO | 40.00 | Yes (X) | $389,411 | $0 | $39,783 | |||
| CAROL MAY | ||||||||
| VP FINANCE & OPERATIONS (THRU 06/16) | 40.00 | Yes (X) | $144,297 | $0 | $18,004 | |||
| JAMES DREGNEY | ||||||||
| VP FINANCE & OPERATIONS | 40.00 | Yes (X) | $120,769 | $0 | $11,267 | |||
| DENISE COLE-OUZOUNIAN | ||||||||
| VP PATIENT SERVICES | 40.00 | Yes (X) | $139,671 | $0 | $35,712 | |||
| MATTHEW HERBERT MD | ||||||||
| SURGEON | 40.00 | $877,446 | $0 | $19,574 | Yes (X) | |||
| MICHAEL LAMSON MD | ||||||||
| SURGEON | 40.00 | $941,528 | $0 | $43,157 | Yes (X) | |||
| DAVID MARCU MD | ||||||||
| SURGEON | 40.00 | $866,101 | $0 | $40,607 | Yes (X) | |||
| THEODORE PARINS | ||||||||
| SURGEON | 40.00 | $404,583 | $0 | $40,230 | Yes (X) | |||
| ARNOLD ROSENTHAL MD | ||||||||
| SURGEON | 40.00 | $541,237 | $0 | $43,379 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,570,321 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $291,713 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 64 | 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 |
|---|---|---|---|---|---|
| CENTRAL MINNESOTA DIAGNOSTICS | |||||
| 150 10TH STREET NW | MILACA | MN | 56353 | CT & MRI SERVICE | $1,414,655 |
| SHARED IMAGING | |||||
| PO BOX 88450 | MILWAUKEE | WI | 53288 | ULTRASOUND, CARDIAC ECHO & NUCLEAR MED S | $1,062,257 |
| KRAEMER BORTHERS | |||||
| 925 PARK AVE | PLAIN | WI | 53577 | GENERAL CONTRACTOR | $560,873 |
| MERITER LABORATORIES | |||||
| PO BOX 681166 | CHICAGO | IL | 60695 | LAB TESTING SERVICE | $406,530 |
| RIPPE KEANE MARKETING | |||||
| 5950 SEMINOLE CENTRE COURT SUITE 2 | MADISON | WI | 53711 | MARKETING SERVICE | $290,818 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 12 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $526,816 | RelatedOrganizationsAmt |
| Total Contributions | $526,816 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| HOSPITAL PATIENT REVENUE | 621990 | $67,980,017 | $67,980,017 | |
| CLINIC REVENUE | 621110 | $12,204,337 | $12,204,337 | |
| OTHER HOSPITAL SERVICES | 621990 | $1,966,222 | $1,966,222 | |
| CAFETERIA AND VENDING | 621990 | $272,332 | $272,332 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $82,422,908 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $874,061 | TotalRevenueColumnAmt |
| Exclusion | $874,061 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $116,616 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $168,696 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$52,080 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$52,080 | TotalRevenueColumnAmt |
| Exclusion | -$52,080 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $6,593,977 | SecuritiesAmt |
| Other | $30,444 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,110,187 | SecuritiesAmt |
| Other | $143,267 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$516,210 | SecuritiesAmt |
| Other | -$112,823 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$629,033 | TotalRevenueColumnAmt |
| Exclusion | -$629,033 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $83,142,672 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $80,184,354 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,431,502 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $116,715 | TotalAmt |
| Program Services | $116,715 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,637 | TotalAmt |
| Program Services | $53,637 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,044,192 | TotalAmt |
| Management And General | $1,044,192 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,058,804 | TotalAmt |
| Program Services | $33,335,403 | ProgramServicesAmt |
| Management And General | $3,658,974 | ManagementAndGeneralAmt |
| Fundraising | $64,427 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,500,835 | TotalAmt |
| Program Services | $1,340,719 | ProgramServicesAmt |
| Management And General | $157,525 | ManagementAndGeneralAmt |
| Fundraising | $2,591 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,450,700 | TotalAmt |
| Program Services | $4,843,111 | ProgramServicesAmt |
| Management And General | $598,125 | ManagementAndGeneralAmt |
| Fundraising | $9,464 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,314,538 | TotalAmt |
| Program Services | $2,004,856 | ProgramServicesAmt |
| Management And General | $304,916 | ManagementAndGeneralAmt |
| Fundraising | $4,766 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $179,391 | TotalAmt |
| Program Services | $389 | ProgramServicesAmt |
| Management And General | $179,002 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,377 | TotalAmt |
| Management And General | $51,377 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,789 | TotalAmt |
| Management And General | $11,789 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,937,660 | TotalAmt |
| Program Services | $5,447,785 | ProgramServicesAmt |
| Management And General | $1,489,875 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $697,276 | TotalAmt |
| Program Services | $278,378 | ProgramServicesAmt |
| Management And General | $418,898 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,048,419 | TotalAmt |
| Program Services | $1,418,014 | ProgramServicesAmt |
| Management And General | $625,857 | ManagementAndGeneralAmt |
| Fundraising | $4,548 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $892,806 | TotalAmt |
| Management And General | $892,806 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,251,740 | TotalAmt |
| Program Services | $162,425 | ProgramServicesAmt |
| Management And General | $1,088,443 | ManagementAndGeneralAmt |
| Fundraising | $872 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,034 | TotalAmt |
| Program Services | $32,425 | ProgramServicesAmt |
| Management And General | $13,609 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,652,888 | TotalAmt |
| Program Services | $2,647,742 | ProgramServicesAmt |
| Management And General | $5,146 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,018,577 | TotalAmt |
| Program Services | $4,748,146 | ProgramServicesAmt |
| Management And General | $1,270,431 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $308,099 | TotalAmt |
| Program Services | $139,183 | ProgramServicesAmt |
| Management And General | $168,916 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $11,531,178 | $11,531,178 | |
| REPAIRS & MAINTENANCE | $1,440,428 | $1,031,596 | $408,832 |
| MEDICAID ASSESSMENT TAX | $1,275,597 | $1,275,597 | |
| BAD DEBT | $88,413 | $88,413 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,956,442 | TotalAmt |
| Program Services | $368,155 | ProgramServicesAmt |
| Management And General | $1,588,287 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,927,535 | TotalAmt |
| Program Services | $69,588,270 | ProgramServicesAmt |
| Management And General | $15,252,597 | ManagementAndGeneralAmt |
| Fundraising | $86,668 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,788,332 | BOYAmt |
| EOY | $17,969,046 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,777,589 | BOYAmt |
| EOY | $8,819,409 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,659 | BOYAmt |
| EOY | $140,416 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,156,061 | BOYAmt |
| EOY | $1,179,781 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,015,756 | BOYAmt |
| EOY | $1,277,624 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $130,421,262 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $43,449,295 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $90,566,695 | BOYAmt |
| EOY | $86,971,967 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,090,617 | BOYAmt |
| EOY | $25,972,129 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $250,000 | BOYAmt |
| EOY | $250,000 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $822,671 | BOYAmt |
| EOY | $988,503 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,997,737 | BOYAmt |
| EOY | $3,889,562 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,616,117 | BOYAmt |
| EOY | $147,458,437 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,956,644 | BOYAmt |
| EOY | $9,765,028 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $66,519,294 | BOYAmt |
| EOY | $64,011,352 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $223,170 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,471,418 | BOYAmt |
| EOY | $2,255,357 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $78,170,526 | BOYAmt |
| EOY | $76,031,737 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,528,300 | BOYAmt |
| EOY | $67,298,713 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,404,045 | BOYAmt |
| EOY | $2,527,734 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,513,246 | BOYAmt |
| EOY | $1,600,253 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,445,591 | BOYAmt |
| EOY | $71,426,700 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,616,117 | BOYAmt |
| EOY | $147,458,437 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,784,863 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $639,000 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $126,972 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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 | 0 | 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 |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $11,789 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $11,789 | 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 | PART II-B, LINE 1: SAUK PRAIRIE HEALTHCARE ("THE HOSPITAL) PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING DEVELOPMENT. THE HOSPITAL IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE HOSPITAL PAYS MEMBERSHIP FEES TO THE RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO DOES PROVIDE ANALYSIS ON CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. PART II-B, LINE 1 (D AND G): REPRESENTITIVES FROM THE HOSPITAL ANNUALLY PARTICIPATE IN THE WISCONSIN HOSPITAL ASSOCIATION'S ADVOCACY DAY WHERE THE REPRESENTITIVES ARE GIVEN THE OPPORTUNITY TO GATHER WITH OTHER HEALTHCARE ORGANIZATIONS IN THE STATE OF WISCONSIN AND ALSO MEET WITH STATE GOVERNMENT REPRESENTITIVES WITH THE PURPOSE OF IMPROVING THE DELIVERY OF HEALTHCARE NOT ONLY AT SAUK PRAIRIE HEALTHCARE BUT ALSO COLLECTIVELY IN THE STATE OF WISCONSIN. AS ISSUES OR PROPOSED LEGISLATION ARISE THROUGHOUT THE YEAR, OFFICIALS OF THE HOSPITAL WILL SEND LETTERS OF COMMENT TO LOCAL, STATE, AND FEDERAL GOVERNMENT REPRESENTITIVES TO EITHER SHOW SUPPORT OF PROPOSED CHANGES OR VOICE AN OPINION TO IMPROVE THE OUTCOME OF PROPOSED LEGISLATION OR OTHER CHANGES. THESE ACTIVITIES RESULT IN MINIMAL COST TO THE OPERATION OF THE HOSPITAL. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,688,056 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $155,320 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,843,376 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,654,555 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $33,501 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,688,056 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,495,840 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $158,715 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,654,555 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,329,586 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $166,254 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,495,840 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,196,971 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $132,615 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,329,586 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.86800 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.13200 | 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 | $7,338,643 | OtherCostOrOtherBasisAmt |
| Book Value | $7,338,643 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $64,878,255 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,623,668 | DepreciationAmt |
| Book Value | $49,254,587 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,615,010 | OtherCostOrOtherBasisAmt |
| Depreciation | $236,724 | DepreciationAmt |
| Book Value | $1,378,286 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $56,493,147 | OtherCostOrOtherBasisAmt |
| Depreciation | $27,588,903 | DepreciationAmt |
| Book Value | $28,904,244 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $96,207 | OtherCostOrOtherBasisAmt |
| Book Value | $96,207 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $86,971,967 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFFERED COMPENSATION LIABILITY | $1,986,692 |
| THIRD PARTY SETTLEMENTS | $268,665 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,255,357 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $83,218,424 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $639,000 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$205,128 | OtherRevenueAmt |
| Revenue Not Reported | $433,872 | RevenueNotReportedAmt |
| Revenue Subtotal | $82,784,552 | RevenueSubtotalAmt |
| Other Revenues Not Included | $358,120 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $358,120 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $83,142,672 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $84,891,103 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $168,696 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $168,696 | ExpensesNotReportedAmt |
| Expenses Subtotal | $84,722,407 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $205,128 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $205,128 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $84,927,535 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE SCHNELLER SISTERS FUND SHALL BE HELD AS A SEPARATE PERMANENT ENDOWMENT FUND ON THE BOOKS AND RECORDS OF THE FOUNDATION, THE INCOME FROM WHICH SHALL BE DISTRIBUTED TO SAUK PRAIRIE HEALTHCARE FOR UNRESTRICTED NEEDS. ALL DISTRIBUTIONS FROM THE SCHNELLER SISTERS FUND SHALL BE DESIGNATED AS HAVING BEEN MADE "IN MEMORY OF THE SCHNELLER SISTERS: CECELIA SCHNELLER MUELLER, ADLYNN F. BALFANZ, AND MARY ANN ROSAR." |
| PART X, LINE 2: | IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE HOSPITAL ASSESSES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL HAS NOT RECORDED ANY ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF DECEMBER 31, 2016 OR 2015. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE -88,413. GOOD NEIGHBOR ADJUSTMENTS -116,715. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | CONTRIBUTION FROM RELATED ORGANIZATION 526,816. RENTAL EXPENSES -168,696. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 168,696. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | GOOD NEIGHBOR CLINIC SERVICES PROVIDED 116,715. BAD DEBT EXPENSE 88,413. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $850,175 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $850,175 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01000 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,793,632 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,516,640 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,276,992 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03860 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,643,807 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,516,640 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,127,167 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04860 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $294,698 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $26,189 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $268,509 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00320 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $243,548 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $243,548 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,656,069 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,904,701 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,751,368 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02060 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $177,689 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $177,689 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00210 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,372,004 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,930,890 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,441,114 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02880 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,015,811 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,447,530 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,568,281 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07740 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,595 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,595 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,024 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,024 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,750 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,750 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,715 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,715 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $43,010 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $43,010 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $68,094 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $68,094 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $88,413 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $16,122,699 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $19,359,516 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,236,817 | 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 | SAUK PRAIRIE HEALTHCARE INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 260 26TH STREET | AddressLine1Txt |
| City | PRAIRIE DU SAC | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53578 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SAUKPRAIRIEHEALTHCARE.ORG | WebsiteAddressTxt |
| State License | 122 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAUK PRAIRIE HEALTHCARE 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 |
| Other | Yes (X) | OtherInd |
| 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.SAUKPRAIRIEHEALTHCARE.ORG/ABOUT/COMMUNITY-HEALTH | 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.SAUKPRAIRIEHEALTHCARE.ORG/ABOUT/COMMUNITY-HEALTH | 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 | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://WWW.SAUKPRAIRIEHEALTHCARE.ORG/PATIENTS/BILLING/COMMUNITY-CARE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://WWW.SAUKPRAIRIEHEALTHCARE.ORG/PATIENTS/BILLING/COMMUNITY-CARE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://WWW.SAUKPRAIRIEHEALTHCARE.ORG/PATIENTS/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 |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | 0 | FAPActionsOnNonpaymentInd |
| 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 (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SAUK PRAIRIE HEALTHCARE, INC. | PART V, SECTION B, LINE 3J: INPUT FROM LOCAL PHYSICIANS WITH REGARD TO THE HIGHEST COMMUNITY HEALTH NEEDS WAS ALSO INCLUDED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. |
| SAUK PRAIRIE HEALTHCARE, INC. | PART V, SECTION B, LINE 5: ALONG WITH COLLECTING AND ANALYZING DATA FROM THE SAUK COUNTY HEALTH & WELLNESS COALITION SURVEY AND ONLINE DATA SOURCES, FIVE KEY INFORMANT FOCUS GROUP MEETINGS WERE CONDUCTED WITH STAKEHOLDERS REPRESENTING BROAD INTERESTS OF THE SERVICE AREA. THE GROUPS INCLUDED, BUT WERE NOT LIMITED TO, SCHOOL REPRESENTATIVES, LAW ENFORCEMENT OFFICERS, HEALTHCARE PROVIDERS, EMERGENCY RESPONSE PROFESSIONALS, CLERGY MEMBERS, MUNICIPAL OFFICIALS, AND COMMUNITY GROUP LEADERS. THE QUESTIONS ASKED WERE RELATED TO GENERAL COMMUNITY ISSUES AND CONCERNS, ISSUES IN THE COMMUNITY THAT PROMOTE POOR HEALTH, AND ISSUES RELATED TO HEALTHCARE ACCESS. AT THE MEETINGS, HEALTH CONCERNS WERE IDENTIFIED AND PRIORITIZED.IN ADDITION TO THE KEY INFORMANT MEETINGS FACILITATED BY SPH, MANY OTHER COMMUNITY FORUMS WERE HELD BY MEMBERS OF THE SAUK COUNTY HEALTH & WELLNESS COALITION. ON NOVEMBER 17, 2015, A "CREATING OUR HEALTHY COMMUNITY PLAN" FORUM AND PRIORITY SESSION WAS HELD AT HO-CHUNK CASINO. AT THIS STRATEGY SESSION, APPROXIMATELY 56 COMMUNITY STAKEHOLDERS HELD FOCUSED DISCUSSIONS ABOUT THE TOP HEALTH NEED PRIORITIES AND PROPOSED MOBILIZATION TACTICS TO CONSIDER FOR DEPLOYMENT. THE PARTICIPANTS USED A PRIORITIZATION EXERCISE TO RANK THE HEALTH ISSUES FACING THE AREA. IN TOTAL, SPH CONDUCTED FOCUS GROUPS INVOLVING MORE THAN 50 INDIVIDUALS AND WE ALSO USED COMMUNITY INPUT FROM HUNDREDS OF MEETING PARTICIPANTS PROVIDED BY OUR COLLABORATION COLLEAGUES AT SAUK COUNTY HEALTH DEPARTMENT, ST. CLARE HOSPITAL, AND REEDSBURG AREA MEDICAL CENTER (SEE CHNA APPENDIX FOR A LIST OF PARTICIPANTS AND MEETINGS). |
| SAUK PRAIRIE HEALTHCARE, INC. | PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS: ST. CLARE HOSPITAL (BARABOO, WI) AND REEDSBURG AREA MEDICAL CENTER (REEDSBURG, WI). SAUK PRAIRIE HEALTHCARE, INC. ALSO WORKED WITH THE RICHLAND HOSPITAL (RICHLAND CENTER) AND UPLAND HILLS HEALTH( DODGEVILLE), BUT TO A LESSOR DEGREE THAN ST. CLARE AND REEDSBURG. |
| SAUK PRAIRIE HEALTHCARE, INC. | PART V, SECTION B, LINE 6B: SAUK PRAIRIE HEALTHCARE, INC. WORKED WITH REEDSBURG AREA MEDICAL CENTER (REEDSBURG, WI) AND ST. CLARE HOSPITAL (BARABOO, WI) AND THE SAUK COUNTY DEPARTMENT OF HEALTH TO IDENTIFY AND PRIORITIZE HEALTH NEEDS. THIS GROUP MEETS ON AT LEAST A QUARTERLY BASIS TO CONTINUALLY ASSESS NEEDS AND COORDINATE AND REPORT ON HEALTH INITIATIVE PROGRESS IN EACH MEMBER'S RESPECTIVE SERVICE AREA. |
| SAUK PRAIRIE HEALTHCARE, INC. | PART V, SECTION B, LINE 7D: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS MADE PUBLICLY AVAILABLE IN FEBRUARY 2016 AND IT'S AVAILABILITY WAS ANNOUNCED VIA A COMMUNITY NEWSLETTER TO MORE THAN 20,000 HOUSEHOLDS IN APRIL 2016. THE CHNA WAS INTERNALLY ANNOUNCED TO EMPLOYEES AND MEDICAL STAFF OF THE HOSPITAL ON FEBRUARY 2016. IT WAS INTERNALLY ANNOUNCED TO EMPLOYEES AND MEDICAL STAFF OF THE HOSPITAL. |
| SAUK PRAIRIE HEALTHCARE, INC. | PART V, SECTION B, LINE 11: THE FOLLOWING STEPS ACTIONS WERE TAKEN IN 2016 TO ADDRESS SIGNIFICANT HEALTH NEEDS IDENTIFIED IN PRIOR COMMUNITY HEALTH NEEDS ASSESSMENTS.1. SAUK PRAIRIE HEALTHCARE FOUNDATION ("SPHF") FUNDED FOUR MENTAL HEALTH FIRST AID CLASSES TO TEACH STAFF AND COMMUNITY MEMBERS HOW TO IDENTIFY THE SIGNS OF MENTAL ILLNESS AND THE RESOURCES AVAILABLE FOR HELP. TO DATE MORE THAN 100 INDIVIDUALS HAVE PARTICIPATED.2. TO PREVENT SUICIDE AND SHARE RESOURCES AND EDUCATION TO LOWER THE LIKELIHOOD THAT OUR COMMUNITY WILL LOSE A MEMBER TO SUICIDE, SPH HAD THREE REPRESENTATIVES PARTICIPATE IN HOPE SAUK PRAIRIE. THE FOUNDATION IS CURRENTLY DISCUSSING OPTIONS AROUND SERVING AS FISCAL INTERMEDIARY.3. TO ESTABLISH AND CARRY OUT EMPOWERMENT PROGRAMMING FOR AT-RISK TEENS THROUGHOUT OUR PRIMARY SERVICE AREA:- THE WOMEN'S HEALTH STEERING TEAM ("WHST") PARTNERED WITH TWO ORGANIZATIONS THAT HAVE PROGRAMS DESIGNED TO ADDRESS NEEDS AND ISSUES FACING AT-RISK ADOLESCENT GIRLS. - IN THE SPRING GREEN AREA, RIVER VALLEY MIDDLE SCHOOL HAD 33 GIRLS WHO MET WEEKLY.- IN SAUK PRAIRIE, THE LOCAL SCHOOL DISTRICT PARTNERED WITH RIVER ARTS AND THE PROJECT GIRL PROGRAM TO INTRODUCE GIRLS TO DESIGNING AND CREATING ARTWORK.- SPH AND SPHF PIGGYBACKED ON EACH OF THESE PROGRAMS TO TEACH HEALTHY EATING TECHNIQUES TO THE GIRLS, MANY OF WHOM FACE FOOD INSECURITY AND LACK OF FOOD PREPARATION SKILLS. SPH/SPHF PURCHASED SMOOTHIE BLENDERS AND CREATED MENU BOOKS FOR EACH PARTICIPANT.4. TO CREATE AN ENVIRONMENT OF HEART HEALTH AWARENESS, SPH AND SPH FOUNDATION EACH DONATED $10,000 TO THE SCHOOL DISTRICTS OF RIVER VALLEY (SPRING GREEN), LODI, WISCONSIN HEIGHTS (BLACK EARTH, MAZOMANIE), AND SAUK PRAIRIE (SAUK CITY, PRAIRIE DU SAC, MERRIMAC) TO INITIATE AND EXPAND THE HEART ZONES PROGRAM. WE ALSO DEVELOPED A FUNDRAISING BROCHURE FOR EACH SCHOOL DISTRICT TO ENCOURAGE ADDITIONAL GIVING TO THE PROGRAM. 5. SPH DONATED $1,000 TO HELP PROVIDE A PERMANENT WATER SUPPLY TO A RELOCATED GARDEN IN THE WISCONSIN HEIGHTS COMMUNITY.6. SPH DONATED A LARGE SUPPLY OF KITCHEN RESOURCES, INCLUDING WALK-IN CHILLERS AND VENTILATION UNITS, TO THE SAUK PRAIRIE FOOD PANTRY.7. THROUGH EFFORTS TO EDUCATE STUDENTS ON THE HEALTH BENEFITS OF FRUITS AND VEGETABLES, STUDENTS SHOWED AN INCREASED UNDERSTANDING OF 43.7% IN THE 2015/16 SCHOOL YEAR AND 45.8% IN THE 2016/2017 SCHOOL YEAR.8. SPH DONATED $1,000 TO THE MAZOMANIE SPLASH PAD COALITION TO HELP PHYSICAL ACTIVITY IN THAT COMMUNITY.9. SPH PROVIDED A CLASSROOM PROGRAM FOR THOSE IN THE COMMUNITY WHO WANT ASSISTANCE QUITTING SMOKING. TO DATE, SIX SMOKERS ENROLLED, WITH ONE COMPLETING THE COURSE. |
| SAUK PRAIRIE HEALTHCARE, INC. | PART V, SECTION B, LINE 13B: PATIENTS WHO ARE UNABLE TO COMPLETE AN APPLICATION FORM MAY BE ELIGIBLE FOR COMMUNITY CARE IF OTHER EVIDENCE IS AVAILABLE WHICH MAY INDICATE FINANCIAL HARDSHIP. THIS INFORMATION MAY BE OBTAINED FROM A PATIENT INTERVIEW, CREDIT REPORT, OR OTHER AVAILABLE RECORDS. CONSIDERATION WILL BE GIVEN ON AN INDIVIDUAL BASIS.OTHER PROVISIONS UNDER PRESUMPTIVE ELIGIBILITY:I. DECEASED WITH NO ESTATE - BASED ON THE CONCLUSION THAT THE DECENDANT HAS NO ASSETS, AND THEREFORE NO ABILITY TO PAY. *II. ACCOUNTS UNCOLLECTIBLE DUE TO DISCHARGE OF DEBTOR BY BANKRUPTCY. *III. IF IT HAS BEEN DETERMINED THAT A PATIENT HAS BEEN APPROVED FOR MEDICAL ASSISTANCE, ALL ACCOUNTS CURRENTLY IN THE A/R WITH SPH WILL BE WRITTEN OFF TO COMMUNITY CARE AFTER PAYMENT IS RECEIVED FROM THE INSURANCE. *IV. ANY ACCOUNT RETURNED BY THE COLLECTION AGENCY THAT HAS BEEN DETERMINED TO BE UNCOLLECTIBLE WILL BE CONSIDERED COMMUNITY CARE. *V. QUALIFIED INDIVIDUALS UNDER ANOTHER ORGANIZATION'S SIMILAR COMMUNITY CARE APPLICATION PROCESS.* NO COMMUNITY CARE APPLICATION NEEDS TO BE COMPLETED IN THESE INSTANCES. |
| SAUK PRAIRIE HEALTHCARE, INC. | PART V, SECTION B, LINE 16J: INFORMATION ABOUT THE POLICY IS INCLUDED ON BILLING INVOICES, ON ADMISSION INFORMATION, ON THE WEBSITE, AND IS REFERENCED IN COLLECTION EFFORTS. IT IS ALSO MENTIONED IN COMMUNITY TALKS ON HEALTH INSURANCE. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 6 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - ORTHOPEDIC ASSOCIATES OF SAUK PRAIRIE | ||||
| 250 26TH ST | PRAIRIE DU SAC | WI | 53578 | ORTHOPEDIC CLINIC |
| 2 - LODI MEDICAL CLINIC | ||||
| 160 VALLEY DRIVE | LODI | WI | 53555 | PHYSICIAN CLINIC |
| 3 - RIVER VALLEY MEDICAL CLINIC | ||||
| 436 SUNRISE DRIVE | SPRING GREEN | WI | 53588 | RURAL HEALTH CLINIC |
| 4 - WISCONSIN HEIGHTS CLINIC | ||||
| 506 CROCKER STREET SUITE 3 | MAZOMANIE | WI | 53560 | PHYSICIAN CLINIC |
| 5 - PLAIN MEDICAL CLINIC | ||||
| 825 MAIN STREET | PLAIN | WI | 53577 | RURAL HEALTH CLINIC |
| 6 - SURGICAL ASSOCIATES | ||||
| 250 26TH ST | PRAIRIE DU SAC | WI | 53578 | SURGICAL CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | ELIGIBILITY FOR SAUK PRAIRIE HEALTHCARE'S COMMUNITY CARE (FINANCIAL ASSISTANCE) PROGRAM IS CONSIDERED FOR INDIVIDUALS WHO ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR GOVERNMENTAL HEALTH PLANS, AND WHO ARE UNABLE TO PAY FOR THEIR CARE. ABILITY TO PAY IS DETERMINED BY COMPARING FAMILY INCOME TO FEDERAL POVERTY LEVELS, BUT IT ALSO CONSIDERS THE FAMILY'S ASSETS. DETERMINATIONS ARE BASED UPON AN INDIVIDUAL'S FINANCIAL NEED AND DO NOT TAKE INTO ACCOUNT GENDER, RACE, SOCIAL STATUS, SEXUAL ORIENTATION, OR RELIGIOUS AFFILIATION. INDIVIDUALS MUST RESIDE OR HAVE A PRIMARY CARE PHYSICIAN IN SAUK PRAIRIE HEALTHCARE'S SERVICE AREA TO BE ELIGIBLE. PATIENTS WHO ARE UNABLE TO COMPLETE A COMMUNITY CARE APPLICATION MAY BE ELIGIBLE FOR ASSISTANCE IF OTHER EVIDENCE IS AVAILABLE THAT MAY INDICATE FINANCIAL HARDSHIP. THIS INFORMATION MAY BE OBTAINED FROM A PATIENT INTERVIEW, CREDIT REPORT, OR OTHER AVAILABLE RECORDS. THIS INCLUDES THE FOLLOWING SITUATIONS:1. DECEASED WITH NO ESTATE2. DISCHARGE OF DEBTOR BY BANKRUPTCY3. PATIENT HAS BEEN APPROVED FOR MEDICAL ASSISTANCE4. ACCOUNT IS RETURNED BY THE COLLECTION AGENCY AS UNCOLLECTIBLE5. QUALIFICATION UNDER ANOTHER ORGANIZATION'S SIMILAR FINANCIAL ASSISTANCE APPLICATION PROCESS |
| PART I, LINE 7: | THE COSTING METHODOLOGY USED ON FORM 990 IS PRIMARILY 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 SERVICE REVENUE. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER SUGGESTED COSTING METHODS FOR THE FORM 990. THE COSTING METHOD FOR SUBSIDIZED HEALTH SERVICES IS BASED ON INTERNAL RECORDS ALLOCATIONS WHICH ARE SIMILAR TO A DIRECT COSTING ACCOUNTING SYSTEM FOR THESE SERVICES NOTED AS SUBSIDIZED HEALTH SERVICES. |
| PART I, LINE 7G: | SUBSIDIZED HEALTH SERVICES AT SAUK PRAIRIE HEALTHCARE, INC. INCLUDE THE OPERATION OF SEVERAL HOSPITAL DEPARTMENTS THAT OPERATE AT A LOSS FROM OPERATIONS, BUT ARE CONSIDERED VITAL HOSPITAL AND CLINIC SERVICES SUCH AS THE INTENSIVE CARE UNIT, OUTPATIENT PHYSICIAN CLINICS, INCLUDING INTERNAL MEDICINE (HOSPITAL MEDICINE), AND SEVERAL OTHER DEPARTMENTS. A LARGE PORTION OF THESE SERVICES ARE ACCESSED BY COMMUNITY MEMBERS THROUGH THE HOSPITAL'S EMERGENCY SERVICES DEPARTMENT. IT IS THE GOAL OF SAUK PRAIRIE HEALTHCARE, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THE HOSPITAL'S COMMUNITY BUILDING EFFORTS PROMOTE BOTH THE PHYSICAL AND ECONOMIC HEALTH OF THE COMMUNITIES IT SERVES. FROM AN ECONOMIC PERSPECTIVE, SAUK PRAIRIE HEALTHCARE STAFF CONTRIBUTES HUNDREDS OF HOURS TO CHAMBERS OF COMMERCE ACTIVITIES AND SUPPORT WORKFORCE DEVELOPMENT THROUGH COMMUNITY AND EDUCATIONAL PROGRAMS. THE PHYSICAL HEALTH OF THE COMMUNITY IS SUPPORTED THROUGH THE DEVELOPMENT OF HEALTH-RELATED COALITIONS, PARTICULARLY THE SAUK PRAIRIE WELLNESS MOVEMENT AND THE SAUK COUNTY HEALTH AND WELLNESS COALITION. |
| 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 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 THAT 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 RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE ORGANIZATION HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVEABLE. |
| PART III, LINE 4: | PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY:IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER 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 AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF THEIR PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. |
| PART III, LINE 8: | WHETHER THERE IS SHORTFALL OR A SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PATIENTS, WHO ARE TYPICALLY ELDERLY 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. THE TOTAL MEDICARE REVENUE SHOWN ON SCHEDULE H IS BASED ON THE IRS FORM 990 INSTRUCTIONS AND ONLY INCLUDE THE CHARGES FROM MEDICARE PROGRAM BENEFICIARIES THAT ARE REPORTED ON THE HOSPITAL'S MEDICARE COST REPORT. THE AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT SAUK PRAIRIE HEALTHCARE, INC., PHYSICIAN SERVICES FOR THE INTERNAL MEDICINE (HOSPITALIST) PROGRAM, PHYSICIAN SERVICES PROVIDED TO TWO OF THE FOUR OUTLYING PHYSICIAN CLINICS, CRNA SERVICES PROVIDED TO PATIENTS UNDERGOING ANESTHESIA AT THE HOSPITAL, AND A SIGNIFICANT PORTION OF LAB AND PHYSICAL THERAPY SERVICES WHICH ARE REIMBURSED BY THE MEDICARE PROGRAM UNDER ANOTHER METHODOLOGY. PHYSICIAN COVERAGE OUTPATIENT LAB SERVICES AND OUTPATIENT PHYSICAL THERAPY SERVICES ARE REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COST OF CARING FOR PATIENTS. EMERGENCY 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 SAUK PRAIRIE HEALTHCARE, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHODOLOGY USED ABOVE FOR IRS FORM 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 OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE DIVIDED BY HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENT ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES, WHICH ARE REIMBURSED ON A COST REPORTING METHODOLOGY. INCLUDING THE FEE SCHEDULE ITEMS, SUCH AS PHYSICIAN SERVICES, WOULD PRODUCE A LARGER LOSS OR SHORTFALL ON THESE SERVICES TO BE REPORTED ON THE FORM 990 IN ANY GIVEN YEAR. |
| PART III, LINE 9B: | IT IS THE POLICY OF SAUK PRAIRIE HEALTHCARE, INC. THAT EACH PATIENT RECEIVES CARE REGARDLESS OF THE ABILITY TO PAY. IF DURING THE COLLECTION PROCESS A PATIENT DOES NOT COMPLETE THE NECESSARY PAPERWORK OR RESPOND TO ATTEMPTS BY THE HOSPITAL TO PROVIDE CHARITY SERVICES, THE PATIENT MAY STILL REQUEST CHARITY INFORMAITON AND COMPLETE THE INFORMATION AT ANY TIME DURING THE COLLECTION PROCESS. THE PATIENT WILL BE REFERRED TO THE HOSPITAL'S CHARITY CARE POLICY AND CAN QUALIFY FOR CHARITY CARE, AND HAVE ANY COLLECTION ISSUES REVERSED BY THE ORGANIZATION, IF THEY SHOW A NEED FOR CARE BASED ON THE HOSPITAL'S POLICY. |
| PART VI, LINE 2: | THE HOSPITAL ENGAGES IN THE FOLLOWING ACTIVITIES TO ASSESS THE HEALTHCARE NEEDS OF THE 42,000 RESIDENT THROUGHOUT ITS 700 SQUARE MILE PRIMARY SERVICE AREA: ANALYZE HEALTH STATUS INFORMATION, EPIDEMIOLOGICAL DATA, AND HOSPITAL DISCHARGE DATA FURNISHED BY THE STATE OF WISCONSIN AND SAUK COUNTY TO IDENTIFY ISSUES AND TRENDS; MEET PERIODICALLY WITH THE COUNTY HEALTH DEPARTMENT AND TWO OTHER NEARBY HOSPITALS TO ASSESS HIGH PRIORITY HEALTH NEEDS AND COORDINATE ACTION; PARTICIPATE IN AND HELP COORDINATE COUNTY-WIDE INPUT SESSIONS WITH THE COUNTY HEALTH DEPARTMENT; LEAD AND PARTICIPATE IN COMMUNITY WELLNESS GROUPS AND INITIATIVES THROUGHOUT THE SERVICE AREA; CONDUCT "COMMUNITY HEALTH NEED" FOCUS GROUPS CONSISTING OF COMMUNITY LEADERS AND RANDOMLY SELECTED RESIDENTS; ANALYZE THE POPULATION-BASED NEED FOR MEDICAL PROVIDERS BY SPECIALTY. THIS INFORMATION IS ASSESSED AND MODIFIED BY MEMBERS OF THE HOSPITAL MEDICAL STAFF; LEADER PARTICIPATION AND LEADERSHIP IN CIVIC AND COMMUNITY SERVICE ORGANIZATIONS; ACTIVELY ENGAGE HOSPITAL BOARD MEMBERS IN COMMUNITY HEALTH IMPROVEMENT INITIATIVES AND PROVIDE THE BOARD WITH MONTHLY UPDATES REGARDING COMMUNITY HEALTH ACTIVITIES. |
| PART VI, LINE 3: | 1. AT THE TIME OF REGISTRATION, A REGISTRATION SPECIALIST WILL INQUIRE IF THERE IS HEALTH INSURANCE. IF NOT, THEY WILL BE ADVISED OF THE HOSPITAL'S COMMUNITY CARE PROGRAM IF THEY RESIDE WITHIN OUR SERVICE AREA. THOSE WHO HAVE A SAUK PRAIRIE BASED PHYSICIAN WILL ALSO BE CONSIDERED FOR ELIGIBILITY. COMMUNITY CARE INFORMATION IS ALSO POSTED ON THE HOSPITAL WEBSITE AND BILLS STATE THAT IF THE PATIENT IS HAVING DIFFICULTY PAYING THEY SHOULD CONTACT A HOSPITAL REPRESENTATIVE, AS THEY MAY BE ELIGIBLE FOR FREE OR REDUCED FEES. 2. ANY PATIENT REQUESTING ADDITIONAL INFORMATION ABOUT THE COMMUNITY CARE PROGRAM WILL BE REFERRED TO THE PATIENT ACCOUNTS SPECIALIST, WHO WILL EXPLAIN THE PROGRAM AND ITS ELIGIBLITY CRITERIA. WHEN APPLICABLE, ALL GOVERNMENT ASSISTANCE PROGRAMS SUCH AS MEDICAID, BADGER CARE, AND CRIME VICTIMS MUST BE EXHAUSTED BEFORE APPLYING FOR COMMUNITY CARE (EXCEPTION: THE GOVERNMENT ASSISTANCE PROGRAM APPLICATION MAY BE WAIVED BASED ON RELIGIOUS BELIEFS). COMMUNITY CARE IS NOT AVAILABLE FOR ELECTIVE PROCEDURES. PERSONS RESIDED IN THE SAUK PRAIRIE HEALTHCARE, INC.'S PRIMARY SERVICE AREA WILL BE CONSIDERED FOR ELIGIBLITY DETERMINATION. IN THE CASE OF EMERGENCY SERVICES, COMMUNITY CARE MAY BE EXTENDED TO THOSE RESIDING OUTSIDE OF THE PRIMARY SERVICE AREA. 3. THE INFORMATION IS ALSO POSTED ON OUR WEBSITE UNDER "PREPARING FOR YOUR STAY." IF AT ANY TIME PRIOR TO, DURING, OR AFTER THE SERVICES ARE PROVIDED THE PATIENT EXPRESSED CONCERNS ABOUT PAYMENT, THE COMMUNITY CARE PROGRAM IS EXPLAINED. INFORMATION IS ALSO PRINTED ON PATIENT STATEMENTS AND DISCUSSED WITH THE PATIENT DURING THE BILLING PROCESS. |
| PART VI, LINE 4: | THE HOSPITAL'S PRIMARY SERVICE AREA ENCOMPASSES A 700 SQUARE MILE REGION IN RURAL SOUTH CENTRAL WISCONSIN, INCLUDING SAUK, SOUTHERN COLUMBIA, NORTHWEST DANE, NORTHERN IOWA AND EASTERN RICHLAND COUNTIES. THE HOSPITAL IS LOCATED IN SAUK PRAIRIE (COMMON NAME FOR THE NEIGHBORING MUNICIPALITIES OF SAUK CITY AND PRAIRIE DU SAC) AND THE CLINICS ARE LOCATED IN FOUR TOWNS SURROUNDING SAUK PRAIRIE (MAZOMANIE, SPRING GREEN, PLAIN, AND LODI). NO OTHER HOSPITALS ARE LOCATED WITHIN THE PRIMARY SERVICE AREA, HOWEVER, EIGHT INPATIENT HOSPITALS (INCLUDING 5 RURAL AND 3 TERTIARY FACILITIES) ARE LOCATED WITHIN A 30 MILE RADIUS OF SAUK PRAIRIE HEALTHCARE, INC.DEMOGRAPHIC ANALYSIS INDICATES A 5-YEAR GROWTH RATE OF 2.5% COMPARED TO THE STATE OF WISCONSIN'S RATE OF 1.9%. AGE GROUPS THAT WILL GROW AT A CONSIDERABLY FASTER RATE THAN THE STATE INCLUDE 0-17 YEAR OLDS (1.9%), 25-34 (15.2%), AND 65+ (16.6%). HEALTH ISSUES AFFECTING THESE AGE SEGMENTS INCLUDE PRENATAL SCREENING, TEEN PREGNANCY, LACK OF ACCESS TO HEALTHCARE, AND MEDICAL ISSUES ASSOCIATED WITH AGING. THE AREA HAS LITTLE RACIAL AND ETHNIC DIVERSITY, ALTHOUGH THE NUMBER OF HISPANIC RESIDENTS HAS INCREASED CONSIDERABLY SINCE 2000. BY 2018, THIS POPULATION SEGMENT WILL REPRESENT 5.1% OF THE TOTAL POPULATION. SPECIFIC HEALTH-RELATED ISSUES CONFRONTING THIS POPULATION INCLUDE DIABETES, ACCESS TO CARE, AND LANGUAGE BARRIERS.AVERAGE HOUSEHOLD INCOME OF SERVICE AREA RESIDENTS IS 10% HIGHER THAN THE STATE AVERAGE. THIS DIFFERENCE IS DUE IN LARGE PART BECAUSE OF THE RELATIVELY STRONG JOB MARKET IN MADISON, WHICH ATTRACTS COMMUTERS FROM THE SERVICE AREA. THROUGHOUT THE SERVICE AREA, HOWEVER, AGRICULTURE AND TOURISM REPRESENT A CONSIDERABLE NUMBER OF LOW-PAYING JOBS, TYPICALLY WITHOUT HEALTH BENEFITS.A PORTION OF THE HOSPITAL PRIMARY SERVICE AREA IS DESIGNATED AS A MEDICALLY UNDERSERVED AREA/POPULATION. THIS AREA IS LOCATED IN THE TOWN OF ARENA (MCD 02575). SAUK COUNTY IS ALSO DESIGNATED AS A HEALTH MANPOWER SHORTAGE AREA FOR PSYCHIATRY. |
| PART VI, LINE 5: | SAUK PRAIRIE HEALTHCARE, INC. IS AN INDEPENDENT COMMUNITY HOSPITAL GOVERNED BY AN 11-MEMBER BOARD OF DIRECTORS WHO RESIDE WITHIN THE PRIMARY SERVICE AREA. THE BOARD IS ELECTED BY THE 120 MEMBER COMMUNITY HOSPITAL ASSOCIATION. AN INDEPENDENT HOSPITAL IS A CRUCIAL PART OF THE HOSPITAL'S VISION, BECAUSE IT KEEPS CONTROL AT THE LOCAL LEVEL, NOT IN A CORPORATE HEADQUARTERS LOCATED ELSEWHERE. LOCAL CONTROL ALLOWS THE HOSPITAL TO MAKE DECISIONS THAT ARE BEST FOR THE LOCAL COMMUNITIES. THE SAUK PRAIRIE HEALTHCARE, INC. MEDICAL STAFF PRIVILEGES QUALIFIED PHYSICIANS IN ITS COMMUNITIES. THE VAST MAJORITY OF THE ACTIVE MEDICAL STAFF PRACTICE SOLELY AT THE SAUK PRAIRE HEALTHCARE HOSPITAL OR ASSOCIATED CLINICS.THE HOSPITAL STRATEGIC PLAN SPECIFICALLY ADDRESSES OUR DESIRE TO "IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE AND THE ORGANIZATION'S EFFORTS TO ASSESS THE NEEDS OF THE COMMUNITY AND ADDRESS THOSE NEEDS. SAUK PRAIRIE HEALTHCARE, INC. PROMOTES COMMUNITY HEALTH THROUGH A BROAD ARRAY OF APPROACHES. THE FOLLOWING LIST DESCRIBES SPECIFIC PROGRAMS AND ACTIVITIES THAT CONTRIBUTE TO IMPROVING THE HEALTH OF THE COMMUNITY AND ENHANCING THE PROVISION OF MEDICAL CARE: TRAINING MEDICAL STUDENTS, NURSING STUDENTS, AND OTHER HEALTH PROFESSIONS; CONTRIBUTE TIME AND FINANCIAL RESOURCES IN THE DEVELPOMENT OF A DENTAL CLINIC, COLLABORATIVE WITH OTHER INDIVIDUALS AND ORGANIZATIONS IN THE COMMUNITY, TO PROVIDE DENTAL SERVICES TO UNINSURED AND UNDERINSURED MEMBERS OF THE COMMUNITIES SERVED WHO WOULD OTHERWISE NOT HAVE ACCESS OR THE ABILITY TO ACCESS THESE SERVICES ON A REGULAR BASIS; ORGANIZE AND/OR PARTICIPATE IN HEALTH FAIRS; OFFER CPR/FIRST AID CLASSES; ISSUE EDUCATIONAL NEWS RELEASES; CONDUCT COMMUNITY-BASED CLINICAL SCREENINGS (HEARING AID CHECKS, BLOOD PRESSURE, AND CHOLESTERAL SCREENING); PROVIDE SERVICES FOR THE GOOD NEIGHBOR CLINIC OF SAUK PRAIRIE, INC. (LOCAL FREE CLINIC); MEDICATION TAKE BACK DAY; DISCOUNTED EQUIPMENT AND SUPPLIES; ADVANCED DIRECTIVES COUNSELING; BLOOD DRIVES; BREASTFEEDING EDUCATION; CANCER EDUCATION; CLINICS FOR UNDERINSURED/LAB & MEDICATION COSTS; COMMUNITY GARDEN; COMMUNITY HEALTH IMPROVEMENT ADVOCACY; DIABETES EDUCATION; FAMILY/PARENTING/SIBLING EDUCATION; IMMUNIZATIONS/PERTUSSIS; MOBILE MEALS; PRESCRIPTION DRUG COLLECTION; SCHOOL-BASED HEALTH EDUCATION PROGRAMS; SCREENING/HEARING; SELF-HELP/CARDIAC REHAB; SELF-HELP/FITNESS AND EXERCISE; SELF-HELP/NUTRITION AND WEIGHT MANAGEMENT; SELF-HELP/SPORTS INJURY PREVENTION; SHARPS COLLECTION; SUPPORT GROUPS-BEREAVEMENT/GRIEF; SUPPORT GROUPS-BREASTFEEDING; SUPPORT GROUP-DIABETES; SUPPORT GROUPS-NEW MOM; SUPPORT GROUPS-SLEEP APNEA; TRANSPORTATION TOCKENS (BUS, CAB FARE); SUBSIDIZED THE SALE OF A VACANT CLINIC BUILDING IN LODI, WISCONSIN. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE GOOD NEIGHBOR CLINIC OF SAUK PRAIRIE INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1906 NORTH ST | AddressLine1Txt |
| City | PRAIRIE DU SAC | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53578 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 391963290 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Non Cash Assistance | $116,715 | NonCashAssistanceAmt |
| Valuation Method Used | COST | ValuationMethodUsedDesc |
| Non Cash Assistance | MEDICAL SERVICES AND SUPPLIES | NonCashAssistanceDesc |
| Purpose Of Grant | TO PROVIDE MEDICAL ASSISTANCE TO THOSE WHO NORMALLY COULD NOT AFFORD IT. | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | TUITION REIMBURSMENT | GrantTypeTxt |
| Recipient | 20 | RecipientCnt |
| Cash Grant | $53,637 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | TO SUPPORT THE NEEDS OF LOW-INCOME COMMUNITY MEMBERS, SAUK PRAIRIE HEALTHCARE PROVIDES SPACE IN OUR OLD HOSPITAL TO GOOD NEIGHBOR CLINIC TO SERVE THOSE INDIVIDUALS. ANY PRODUCTS GIVEN TO GOOD NEIGHBOR CLINIC ARE HAND-DELIVERED. THE SHARED SPACE ENABLES SAUK PRAIRIE HEALTHCARE TO SEE HOW THE SUPPLIES ARE BEING USED. SAUK PRAIRIE HEALTHCARE ("SPH") ALSO PROVIDES FINANCIAL ASSISTANCE TO EMPLOYEES OF SPH TO ADVANCE THEIR KNOWLEDGE, SKILLS AND ABILITIES THROUGH POST-SECONDARY EDUCATION. APPLICATION FOR TUITION REIMBURSEMENT MUST BE MADE AT LEAST TWO WEEKS PRIOR TO THE COURSE STARTING DATE. THE APPLICATION MATERIALS MUST INCLUDE A COPY OF THE CLASS OR CURRICULUM DESCRIPTION BEING SUBMITTED FOR APPROVAL AND THE COST PER COURSE OR PER CREDIT. THE TUITION REIMBURSEMENT REQUEST FORM MUST BE COMPLETED AND SIGNED BY THE EMPLOYEE, DEPARTMENT DIRECTOR, AND VICE PRESIDENT PRIOR TO THE FIRST DATE OF CLASS. WITHIN 60 DAYS OF COMPLETION OF THE COURSE(S), THE EMPLOYEE MUST SUBMIT RECEIPTS FOR TUITION PAID BY THE EMPLOYEE AND PROOF OF SATISFACTORY COMPLETION TO THE HUMAN RESOURCES DEPARTMENT. UPON VERIFICATION OF ALL INFORMATION, HUMAN RESOURCES WILL ARRANGE FOR A REIMBURSEMENT CHECK TO BE ISSUED TO THE EMPLOYEE. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LARRY SCHROEDER | ||||||||||||||
| CEO | $352,400 | $0 | $21,875 | $0 | $15,136 | $0 | $13,250 | $0 | $26,533 | $0 | $429,194 | $0 | $0 | $0 |
| CAROL MAY | ||||||||||||||
| VP FINANCE & OPERATIONS (THRU 06/16) | $112,407 | $0 | $22,500 | $0 | $9,390 | $0 | $6,823 | $0 | $11,181 | $0 | $162,301 | $0 | $0 | $0 |
| DENISE COLE-OUZOUNIAN | ||||||||||||||
| VP PATIENT SERVICES | $131,923 | $0 | $7,500 | $0 | $248 | $0 | $7,345 | $0 | $28,367 | $0 | $175,383 | $0 | $0 | $0 |
| MATTHEW HERBERT MD | ||||||||||||||
| SURGEON | $537,015 | $0 | $339,711 | $0 | $720 | $0 | $13,250 | $0 | $6,324 | $0 | $897,020 | $0 | $0 | $0 |
| MICHAEL LAMSON MD | ||||||||||||||
| SURGEON | $524,456 | $0 | $416,352 | $0 | $720 | $0 | $13,250 | $0 | $29,907 | $0 | $984,685 | $0 | $0 | $0 |
| DAVID MARCU MD | ||||||||||||||
| SURGEON | $541,007 | $0 | $324,662 | $0 | $432 | $0 | $13,250 | $0 | $27,357 | $0 | $906,708 | $0 | $0 | $0 |
| THEODORE PARINS | ||||||||||||||
| SURGEON | $324,461 | $0 | $79,735 | $0 | $387 | $0 | $13,250 | $0 | $26,980 | $0 | $444,813 | $0 | $0 | $0 |
| ARNOLD ROSENTHAL MD | ||||||||||||||
| SURGEON | $432,738 | $0 | $105,331 | $0 | $3,168 | $0 | $13,250 | $0 | $30,129 | $0 | $584,616 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 1A | FormAndLineReferenceDesc |
| Explanation | THE BOARD HAS APPROVED A POLICY TO COMPENSATE THE CEO FOR THE TRAVEL OF HIS/HER SPOUSE FOR HOSPITAL RELATED BUSINESS ACTIVITY. THE CEO WILL BE COMPENSATED FOR REASONABLE TRAVEL EXPENSE INCURRED BY HIS/HER SPOUSE. BOARD APPROVAL NEEDS TO BE RECEIVED PRIOR TO MAKING THE TRAVEL ARRANGEMENTS. THE COST OF ANY SUCH TRAVEL REIMBURSMENTS ARE ADDED TO THE CEO'S W-2 FOR TAX REPORTING PURPOSES. DURING 2016, THE CEO RECEIVED $356 OF TRAVEL REIMBURSMENTS FROM THE HOSPITAL, WHICH WAS INCLUDED IN TAXABLE WAGES ON HIS W-2 AND IS INCLUDED ON SCHEDULE J. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY | ||||||||
| A | 391337855 | 97710B6V9 | 2013-02-19 | $38,000,000 | CONSTRUCTION OF NEW HOSPITAL | 0 | 0 | 0 |
| WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY | ||||||||
| B | 391337855 | 2013-02-19 | $30,000,000 | CONSTRUCTION OF NEW HOSPITAL | 0 | 0 | 0 | |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | In Reserve FundInReserveFundAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | RetiredRetiredAmt |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $38,000,000 | $3,384,826 | $562,253 | $34,053,525 | 2014 | 0 | 0 | Yes (1) | Yes (1) | |
| B | $30,000,000 | $1,987,633 | $542,647 | $27,469,720 | 2014 | 0 | 0 | Yes (1) | Yes (1) | $2,993,222 |
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 | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 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 | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | Yes (1) | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE ORGANIZATION HAS AN EXECUTIVE COMMITTEE COMPRISED OF THE CURRENT AND PAST BOARD PRESIDENTS, CURRENT BOARD VICE PRESIDENT, AND CURRENT BOARD TREASURER & SECRETARY. THE EXECUTIVE COMMITTEE, AT ITS SOLE DISCRETION, IS EMPOWERED TO EXERCISE THE POWERS OF THE FULL BOARD WITH RESPECT TO ANY MATTER THAT SHOULD NOT BE POSTPONED UNTIL THE NEXT MEETING OF THE BOARD OF DIRECTORS. THE COMMITTEE SHALL: -ACT ON BEHALF OF THE BOARD OF DIRECTORS WHEN NECESSARY -ACT AS A RESOURCE FOR THE CEO ON EMERGING, CONFIDENTIAL, AND SENSITIVE MATTERS -CONDUCT THE CEO'S ANNUAL PERFORMANCE EVALUATION -NEGOTIATE AND RECOMMEND THE CEO'S COMPENSATION PACKAGE -NEGOTIATE THE CEO'S EMPLOYMENT CONTRACT -REGULARLY REPORT ITS ACTIONS TO THE BOARD OF DIRECTORS |
| FORM 990, PART VI, SECTION A, LINE 6 | ANNUAL MEMBERSHIP WILL BE CONFERRED FOR ONE YEAR UPON PERSONS CONTRIBUTING THE SUM OF TEN DOLLARS TO THE CORPORATION AND/OR THE SAUK PRAIRIE HEALTHCARE FOUNDATION. LIFE MEMBERSHIP WILL BE CONFERRED UPON PERSONS CONTRIBUTING THE SUM OF ONE HUNDRED DOLLARS TO THE CORPORATION AND/OR SAUK PRAIRIE HEALTHCARE FOUNDATION. TWO LIFE MEMBERSHIPS WILL BE CONFERRED UPON TWO PERSONS CONTRIBUTING THE SUM OF TWO HUNDRED DOLLARS OR MORE TO THE CORPORATION AND/OR SAUK PRAIRIE HEALTHCARE FOUNDATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD OF DIRECTORS SHALL BE ELECTED BY THE MEMBERS AT THE ANNUAL MEETING OF THE MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | AN ANNUAL AND LIFE MEMBERSHIP SHALL BE ENTITLED TO ONE VOTE AT THE ANNUAL MEETING OR AT ANY SPECIAL MEETINGS OF THE MEMBERSHIP. THOSE WITH LIFE MEMBERSHIPS MAY ALSO HOLD OFFICE AS A DIRECTOR OF THE CORPORATION OR SERVE ON A COMMITTEE. MEMBERS MAY VOTE ON ELECTIONS OF BOARD MEMBERS, CHANGES TO THE BYLAWS, AND OTHER BUSINESS ALLOWED BY LAW. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED IN DETAIL BY THE DIRECTOR OF FINANCE, THE CFO, AND A DISCUSSION IS HELD WITH THE CEO FOR ANY NEW OR UNUSUAL ITEMS. UPON APPROVAL, THE BOARD OF DIRECTORS RECEIVES AN ELECTRONIC COPY OF THE FORM 990 PRIOR TO SUBMISSION WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | SINCE SAUK PRAIRIE HEALTHCARE IS A PART OF A SMALL COMMUNITY, CONFLICTS ARE GENERALLY KNOWN, IF NOT DISCLOSED THROUGH THE ANNUAL PROCESS CONDUCTED BY HUMAN RESOURCES. THE ANNUAL PROCESS INCLUDES ALL DIRECTOR LEVEL EMPLOYEES AND ABOVE OF THE HOSPITAL. THE BOARD OF DIRECTORS HAS A CONFLICT OF INTEREST POLICY AND MUST ANNUALLY SIGN A DISCLOSURE FROM STATING ANY POTENTIAL CONFLICTS OF INTEREST. THE BOARD PRESIDENT THEN DISCLOSES ANY CONFLICTS OF INTEREST TO THE FULL BOARD OF DIRECTORS. CONFLICT OF INTEREST STATEMENTS COMPLETED BY BOARD MEMBERS ARE REVIEWED BY THE BOARD PRESIDENT AND EMPLOYEE'S CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY STAFF LEADERSHIP AND/OR ADMINISTRATION. THESE INDIVIDUALS ARE CHARGED WITH THE RESPONSIBILITY OF ENSURING THAT BUSINESS IS CONDUCTED IN A MANNER THAT ADHERES TO THE HOSPITAL'S FORMALLY APPROVED CONFLICT OF INTEREST POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE BOARD OF DIRECTORS HAS ESTABLISHED POLICY BG-8 TO ESTABLISH ITS COMPENSATION PHILOSOPHY WITH RESPECT TO EXECUTIVE COMPENSATION AND TO DEFINE PRACTICES ASSOCIATED IN ACCORDANCE WITH IRC 4958. HOSPITAL EXECUTIVE SALARY IS SET ANNUALLY USING COMPARABILITY DATA FROM OUTSIDE CONSULTANTS AND THIRD-PARTY SURVEY DATA. THE EXECUTIVE COMMITTEE IS RESPONSIBLE FOR SETTING SALARY FOR THE CEO BASED ON THE CEO'S JOB PERFORMANCE. THE COMMITTEE RELIES UPON COMPARABILITY DATA DEVELOPED BY OUTSIDE CONSULTANTS TO SUPPORT ITS DECISION MAKING PROCESS AND TO ENSURE COMPETITIVE SALARY LEVELS. THE BOARD REVIEWS BG-8 ANNUALLY AT THE GOVERNANCE COMMITTEE. COMPENSATION FOR OTHER KEY EMPLOYEES IS ESTABLISHED BY APPLICATION OF THE HOSPITAL'S COMPENSATION PHILOSOPHY, WHEREIN RATES OF PAY ARE COMPARED TO MARKET RATES OBTAINED THROUGH PARTICIPATION IN WAGE AND BENEFIT SURVEYS. PAY RANGES ARE OBTAINED FROM SURVEYS OF SIMILARLY SITUATED HOSPITALS LOCATED WITHIN THE STATE OF WISCONSIN IN TERMS OF SIZE AND REVENUE CATEGORY. THE HOSPITAL ADOPTED A "MEET THE MARKET" APPROACH TO COMPENSATION FOR POSITIONS AT THESE LEVELS. THIS MEANS THAT SAUK PRAIRIE HEALTHCARE, INC. TARGETS THE MIDPOINT OF THE PAY RANGE ASSOCIATED WITH EACH POSITION. THE CEO APPROVES COMPENSATION FOR ALL OTHER OFFICERS AND KEY EMPLOYEES BASED ON THE CRITERIA ABOVE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ABBREVIATED FINANCIAL STATEMENTS ARE A PART OF THE HOSPITAL'S ANNUAL REPORT PRESENTED TO THE PUBLIC AT THE ANNUAL MEETING AND POSTED ON THE HOSPITAL'S WEBSITE. THE ABBREVIATED FINANCIAL STATEMENTS ARE ALSO MADE PUBLICLY AVAILABLE THROUGH THE WISCONSIN HOSPITAL ASSOCIATION. THE HOSPITAL'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | NET ASSETS RELEASED FROM RESTRICTION 443,092. NET ASSETS RELEASED FROM RESTRICTION OF FOUNDATION -526,816. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 210,696. |
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 | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| SAUK PRAIRIE HEALTHCARE FOUNDATION LTD | ||||||||||
| 80 FIRST STREET | PRAIRIE DU SAC | WI | 53578 | 930841113 | FUNDRAISING | WI | 501(C)(3) | LINE 10 | N/A | 0 |
| FRIENDS OF SAUK PRAIRIE HEALTHCARE | ||||||||||
| 260 26TH STREET | PRAIRIE DU SAC | WI | 53578 | 391453754 | VOLUNTEERING | WI | 501(C)(3) | LINE 12C, III-FI | N/A | 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 | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | 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 |