ST CROIX REGIONAL MEDICAL CENTER: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- ST CROIX REGIONAL MEDICAL CENTER (EIN 39-0890676)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-15
- IRS object ID
- 201721359349302567
- Schema version
- 2015v3.0
- 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 | 2017-05-15T09:29:59-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | 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 | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390890676 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CROIX REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STCR | BusinessNameControlTxt |
| Phone | 7154830556 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SALLY BAJAK | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7154830556 | PhoneNum |
| Signature | 2017-05-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KACIE MCEWEN | PreparerPersonNm |
| PTIN | P01599614 | PTIN |
| Phone | 6123764500 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVE DOBOSENSKI | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $99,364,246 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SCRMC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1954 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY HEALTHCARE SERVICES TO ALL RESIDENTS OF THE SERVICE AREA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 701 | TotalEmployeeCnt |
| Total Volunteers | 141 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $140,309 | PYContributionsGrantsAmt |
| CY Contributions Grants | $127,257 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $86,067,301 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $96,341,956 | CYProgramServiceRevenueAmt |
| PY Investment Income | $22,905 | PYInvestmentIncomeAmt |
| CY Investment Income | -$124,934 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,608,057 | PYOtherRevenueAmt |
| CY Other Revenue | $2,931,234 | CYOtherRevenueAmt |
| PY Total Revenue | $87,838,572 | PYTotalRevenueAmt |
| CY Total Revenue | $99,275,513 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $8,947 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $10,744 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $29,953,548 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $33,681,157 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $48,730,724 | PYOtherExpensesAmt |
| CY Other Expenses | $53,533,691 | CYOtherExpensesAmt |
| PY Total Expenses | $78,693,219 | PYTotalExpensesAmt |
| CY Total Expenses | $87,225,592 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $9,145,353 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $12,049,921 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $62,943,736 | TotalAssetsBOYAmt |
| Total Assets EOY | $69,017,853 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $22,175,837 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $16,200,883 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $40,767,899 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $52,816,970 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF SCRMC IS TO PROVIDE THE HIGHEST QUALITY, ACCESSIBLE, INTEGRATED, COST EFFECTIVE CARE FOR INDIVIDUALS AND FAMILIES SERVED. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $50,630,560 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $61,095,116 | RevenueAmt |
| Desc | OUTPATIENT SERVICES - SURGICAL, LABORATORY, BASIC, AND ADVANCED RADIOLOGY PROCEDURES. DURING FISCAL YEAR 2016, THERE WERE 9,216 EMERGENCY ROOM VISITS RECORDED, 1,740 OUTPATIENT SURGERIES, AND 245,088 LAB TESTS COMPLETED. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $20,569,874 | ExpenseAmt |
| Grant | $10,744 | GrantAmt |
| Revenue | $24,821,350 | RevenueAmt |
| Desc | INPATIENT SERVICES - OBSTETRIC, MEDICAL-SURGICAL, INTENSIVE CARE, AND SHORT STAY INPATIENT CARE. DURING FISCAL YEAR 2016, THERE WERE 268 BIRTHS, 1,563 INPATIENT ADMISSIONS, AND A TOTAL OF 5,017 INPATIENT DAYS FOR AN AVERAGE LENGTH OF STAY OF 3.21 DAYS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,915,806 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $4,725,143 | RevenueAmt |
| Desc | CONTRACT PHARMACY - ST. CROIX REGIONAL MEDICAL CENTER BECAME ELIGIBLE TO PARTICIPATE IN THE 340B DRUG PRICING PROGRAM, WHICH IS MANAGED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OFFICE OF PHARMACY AFFAIRS (OPA), RESULTING IN THE REALIZATION OF A CONTRACT PHARMACY SERVICE. PARTICIPATION IN THE 340B DRUG PRICING PROGRAM RESULTS IN SIGNIFICANT SAVINGS, ESTIMATED TO BE 20-50%, ON THE COST OF PHARMACEUTICALS FOR USE BY OUTPATIENTS OF THE FACILITY. THROUGH THIS PROGRAM, ST. CROIX REGIONAL MEDICAL CENTER IS ABLE TO REACH MORE ELIGIBLE PATIENTS AND PROVIDE MORE COMPREHENSIVE SERVICES. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,723,975 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $5,700,347 | RevenueAmt |
| Desc | ST. CROIX VALLEY PHARMACIES PROVIDE LOCAL PHARMACY CARE TO THE SERVICE AREA OF ST. CROIX REGIONAL MEDICAL CENTER. ST. CROIX VALLEY PHARMACIES IS THE SOLE MEMBER OF THE FOLLOWING COMMUNITY PHARMACIES: UNITY PHARMACY LOCATED IN THE UNITY CLINIC BUILDING NEAR BALSAM, WI, FREDERIC PHARMACY LOCATED IN THE FREDERIC CLINIC BUILDING IN FREDERIC, WI, AND ST. CROIX FALLS PHARMACY LOCATED IN THE ST. CROIX FALLS CLINIC BUILDING IN ST. CROIX FALLS, WI. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $4,723,975 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $5,700,347 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $79,840,215 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 76 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 701 | 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Own Website | Yes (X) | OwnWebsiteInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SALLY BAJAK | PersonNm |
| Phone | 7154830556 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| HARLEN HEGDAL | |||||||
| CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KRISTINE FUGE | |||||||
| VICE CHAIR | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MICHAEL BUCHITE | |||||||
| TREASURER | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOSEPH RUEGEMER MD | |||||||
| SECRETARY/CONTRACTED RVMC PHYSICIAN | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SARAH CORMELL | |||||||
| TRUSTEE/CONTRACTED RVMC PHYSICIAN | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| ALLISON KARUN MD | |||||||
| TRUSTEE/CONTRACTED RVMC PHYSICIAN | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| PATRICK MCDONOUGH MD | |||||||
| TRUSTEE/CONTRACTED RVMC PHYSICIAN | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| DANIELLE REDBURN MD | |||||||
| TRUSTEE/CONTRACTED RVMC PHYSICIAN | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| STEVE TESCH | |||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM SCHULTZ MD TRUSTEE | |||||||
| CONTRACTED RVMC PHYSICIAN THRU 12/15 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| DAVE DOBOSENSKI | |||||||
| CEO | 40.00 | Yes (X) | $523,560 | $0 | $43,064 | ||
| JOHN TREMBLE | |||||||
| CFO & VP | 40.00 | Yes (X) | $226,999 | $0 | $14,324 | ||
| GURDESH BEDI | |||||||
| PHYSICIAN OF SCRMC | 40.00 | $775,787 | $0 | $16,326 | Yes (X) | ||
| STEPHEN DENNIS | |||||||
| PHYSICIAN OF SCRMC | 40.00 | $271,645 | $0 | $40,717 | Yes (X) | ||
| MUHAMMAD KHAN | |||||||
| PHYSICIAN OF SCRMC | 40.00 | $297,937 | $0 | $34,445 | Yes (X) | ||
| CLAUDIO NUNES | |||||||
| PHYSICIAN OF SCRMC | 40.00 | $364,384 | $0 | $56,731 | Yes (X) | ||
| MINGZHU XU | |||||||
| PHYSICIAN OF SCRMC | 40.00 | $271,449 | $0 | $41,592 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,731,761 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $247,199 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 31 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| RIVER VALLEY MEDICAL CENTER | |||||
| 208 SOUTH ADAMS STREET | ST CROIX FALLS | WI | 54024 | PHYSICIAN SERVICES | $8,995,987 |
| VOYAGEUR RADIOLOGY LLC | |||||
| 9975 DELLWOOD ROAD | STILLWATER | MN | 55082 | RADIOLOGY SERVICES | $1,042,539 |
| ALLINA HEALTH SYSTEM | |||||
| PO BOX 9383 | MINNEAPOLIS | MN | 55440 | EMR SUPPORT SERVICES | $1,042,499 |
| ST CROIX VALLEY ANESTHESIA | |||||
| PO BOX 45 | OSCEOLA | WI | 54024 | CRNA SERVICES | $1,008,933 |
| CMDI | |||||
| PO BOX 158 | MILACA | MN | 56353 | RADIOLOGY SERVICES | $899,809 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 15 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $127,257 | AllOtherContributionsAmt |
| Total Contributions | $127,257 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES | 624100 | $85,583,921 | $85,583,921 |
| CONTRACT PHARMACY | 624100 | $4,725,143 | $4,725,143 |
| FREDERIC PHARMACY | 624100 | $2,581,804 | $2,581,804 |
| SCF PHARMACY | 624100 | $1,744,828 | $1,744,828 |
| UNITY PHARMACY | 624100 | $1,373,699 | $1,373,699 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $332,561 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $16 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $332,545 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $96,341,956 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$89,010 | TotalRevenueColumnAmt |
| Exclusion | -$89,010 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $84,023 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $7,447 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $76,576 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $76,576 | TotalRevenueColumnAmt |
| Exclusion | $76,576 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $35,924 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$35,924 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$35,924 | TotalRevenueColumnAmt |
| Exclusion | -$35,924 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $73,079 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $45,362 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $27,717 | TotalRevenueColumnAmt |
| Exclusion | $27,717 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| EHR PAYMENT | 900099 | $1,618,389 | $1,618,389 |
| MISCELLANEOUS | 900099 | $934,272 | $934,272 |
| JOINT VENTURE REVENUE | 900099 | $274,280 | $274,280 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,826,941 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $99,275,513 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $96,009,411 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,138,845 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,744 | TotalAmt |
| Program Services | $10,744 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $474,498 | TotalAmt |
| Management And General | $474,498 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,412,663 | TotalAmt |
| Program Services | $25,533,564 | ProgramServicesAmt |
| Management And General | $3,879,099 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,276,330 | TotalAmt |
| Program Services | $1,108,001 | ProgramServicesAmt |
| Management And General | $168,329 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $457,364 | TotalAmt |
| Program Services | $397,044 | ProgramServicesAmt |
| Management And General | $60,320 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,060,302 | TotalAmt |
| Program Services | $1,788,578 | ProgramServicesAmt |
| Management And General | $271,724 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $194,551 | TotalAmt |
| Management And General | $194,551 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,984 | TotalAmt |
| Management And General | $44,984 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,250 | TotalAmt |
| Management And General | $5,250 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,442,155 | TotalAmt |
| Program Services | $17,627,731 | ProgramServicesAmt |
| Management And General | $814,424 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,506 | TotalAmt |
| Program Services | $28,281 | ProgramServicesAmt |
| Management And General | $145,225 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $366,175 | TotalAmt |
| Program Services | $215,963 | ProgramServicesAmt |
| Management And General | $150,212 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $760,432 | TotalAmt |
| Program Services | $694,274 | ProgramServicesAmt |
| Management And General | $66,158 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,096,352 | TotalAmt |
| Program Services | $1,913,969 | ProgramServicesAmt |
| Management And General | $182,383 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,976 | TotalAmt |
| Program Services | $88,738 | ProgramServicesAmt |
| Management And General | $23,238 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $326,489 | TotalAmt |
| Program Services | $285,146 | ProgramServicesAmt |
| Management And General | $41,343 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $250,190 | TotalAmt |
| Program Services | $228,423 | ProgramServicesAmt |
| Management And General | $21,767 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,496,453 | TotalAmt |
| Program Services | $3,192,262 | ProgramServicesAmt |
| Management And General | $304,191 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$18,336 | TotalAmt |
| Program Services | -$21,334 | ProgramServicesAmt |
| Management And General | $2,998 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $19,017,328 | $18,941,048 | $76,280 |
| OTHER EXPENSES | $4,311,556 | $3,905,151 | $406,405 |
| BAD DEBTS | $3,471,555 | $3,471,555 | |
| COLLECTIONS | $182,117 | $182,117 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $300,958 | TotalAmt |
| Program Services | $248,960 | ProgramServicesAmt |
| Management And General | $51,998 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $87,225,592 | TotalAmt |
| Program Services | $79,840,215 | ProgramServicesAmt |
| Management And General | $7,385,377 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,649,812 | BOYAmt |
| EOY | $15,726,092 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $831,879 | BOYAmt |
| EOY | $515,988 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,238,342 | BOYAmt |
| EOY | $15,855,947 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $139,704 | BOYAmt |
| EOY | $75,589 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,323,996 | BOYAmt |
| EOY | $2,635,121 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $504,897 | BOYAmt |
| EOY | $633,444 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $60,255,007 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $31,824,126 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,357,977 | BOYAmt |
| EOY | $28,430,881 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,725,886 | BOYAmt |
| EOY | $3,023,771 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,335,156 | BOYAmt |
| EOY | $1,477,331 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $715,237 | BOYAmt |
| EOY | $623,689 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $120,850 | BOYAmt |
| EOY | $20,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,943,736 | BOYAmt |
| EOY | $69,017,853 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,987,967 | BOYAmt |
| EOY | $9,372,223 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,400,536 | BOYAmt |
| EOY | $4,175,606 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $375,000 | BOYAmt |
| EOY | $247,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,412,334 | BOYAmt |
| EOY | $2,406,054 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,175,837 | BOYAmt |
| EOY | $16,200,883 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,767,899 | BOYAmt |
| EOY | $52,816,970 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,767,899 | BOYAmt |
| EOY | $52,816,970 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,943,736 | BOYAmt |
| EOY | $69,017,853 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $12,049,921 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$850 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | Yes (1) | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | Yes (1) | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (1) | DirectContactLegislatorsInd |
| Direct Contact Legislators | $5,250 | DirectContactLegislatorsAmt |
| Rallies Demonstrations | Yes (1) | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $5,250 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | WE HAVE HIRED STRATEGIC HEALTHCARE TO ASSIST US IN DISCUSSING CAH DESIGNATION FOR 10 MILE HOSPITALS. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $3,697 | BeginningBalanceAmt |
| Additions During Year | $0 | AdditionsDuringYearAmt |
| Distributions During Year | $3,697 | DistributionsDuringYearAmt |
| Ending Balance | $0 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,235,979 | OtherCostOrOtherBasisAmt |
| Book Value | $1,235,979 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $34,931,073 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,937,657 | DepreciationAmt |
| Book Value | $18,993,416 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,462,075 | OtherCostOrOtherBasisAmt |
| Depreciation | $846,309 | DepreciationAmt |
| Book Value | $615,766 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,531,202 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,040,160 | DepreciationAmt |
| Book Value | $6,491,042 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,094,678 | OtherCostOrOtherBasisAmt |
| Book Value | $1,094,678 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $28,430,881 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED COMPENSATION PLAN | $1,077,563 |
| ASSET RETIREMENT OBLIGATION | $236,491 |
| THIRD PARTY PAYOR | $1,092,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,406,054 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $95,740,483 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$3,445,958 | OtherRevenueAmt |
| Revenue Not Reported | -$3,445,958 | RevenueNotReportedAmt |
| Revenue Subtotal | $99,186,441 | RevenueSubtotalAmt |
| Other Revenues Not Included | $89,072 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $89,072 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $99,275,513 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $83,847,796 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $93,759 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $93,759 | ExpensesNotReportedAmt |
| Expenses Subtotal | $83,754,037 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $3,471,555 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $3,471,555 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $87,225,592 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, LINE 1B: | ST. CROIX REGIONAL MEDICAL CENTER IS AN AGENT FOR A CHECKING ACCOUNT THAT HOUSES FUNDS FOR THE WEST CENTER REGIONAL TRAUMA ADVISORY COUNCIL. THE MONIES ARE USED TO FUND TRAUMA TRAINING FOR THOSE PARTICIPATING HOSPITALS WITHIN THE COUNCIL. |
| PART X, LINE 2: | THE MEDICAL CENTER IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE MEDICAL CENTER IS ALSO EXEMPT FROM STATE INCOME TAXES. THE MEDICAL CENTER'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE MEDICAL CENTER IS NOT AWARE OF ANY ADDITIONAL ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES THAN ARE CURRENTLY FILED IN THE TAX RETURN. THE MEDICAL CENTER IS THE SOLE CORPORATE MEMBER OF SCV PHARMACIES. SCV PHARMACIES IS TREATED AS A 501(C)(3) FOR FEDERAL TAX PURPOSES AS IT COMES UNDER THE MEDICAL CENTER'S TAX-EXEMPT STATUS. SCV PHARMACIES IS THE SOLE MEMBER OF FREDERIC, UNITY, AND SCF PHARMACY, SO ALL OF THESE ENTITIES ARE ALSO TREATED AS A 501(C)(3) FOR FEDERAL TAX PURPOSES UNDER THE MEDICAL CENTER'S TAX-EXEMPT STATUS. SCV EMS IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. SCV EMS IS ALSO EXEMPT FROM STATE INCOME TAXES. SCV EMS'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. SCV EMS IS NOT AWARE OF ANY ADDITIONAL ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES THAN ARE CURRENTLY FILED IN THE TAX RETURN. THE MEDICAL CENTER FOLLOWS GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE MEDICAL CENTER FOLLOWS THE ACCOUNTING STANDARD FOR INCOME TAXES FOR EVALUATING UNCERTAIN TAX POSITIONS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PROVISION FOR UNCOLLECTIBLE ACCOUNTS -3,471,555. INCOME STATEMENT ELIMINATIONS 25,597. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | INVESTMENT INCOME -89,010. LOSS ON SALE OF ASSETS -35,924. COST OF GOODS SOLD -45,362. OTHER INCOME 282,168. INCOME STATEMENT ELIMINATIONS -22,800. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | COST OF GOODS SOLD 45,362. INCOME STATEMENT ELIMINATIONS 48,397. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT 3,471,555. |
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 |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $527,081 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $527,081 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00630 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,783,876 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,014,011 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,769,865 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02110 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,310,957 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,014,011 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,296,946 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02740 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $92,691 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $92,691 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $92,691 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $92,691 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,403,648 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,014,011 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,389,637 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02850 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 46 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $10,287 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,287 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 47 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $10,287 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,287 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,329,799 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,745,402 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $23,662,733 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $24,131,411 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$468,678 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CROIX REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SCRMC.ORG | WebsiteAddressTxt |
| State License | 1043240922 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CROIX REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| 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 | HTTP://SCRMC.ORG/WP-CONTENT/UPLOADS/2015/08/CHA-2016.PDF | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | HTTP://HEALTHYPOLKCOUNTY.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://SCRMC.ORG/WP-CONTENT/UPLOADS/2016/03/FAP-POLICY-AND-APPENDIX.PDF | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://SCRMC.ORG/WP-CONTENT/UPLOADS/2016/03/FINANCIAL-ASSISTANCE-APPLICATIO | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://SCRMC.ORG/WP-CONTENT/UPLOADS/2016/03/PLAIN-LANGUGAE-SUMMARY-FINAL.PD | 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 5: IN THE COLLECTION OF DATA FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE MEDICAL CENTER UTILIZED HEALTH AND LIFESTYLE COMMUNITY SURVEYS. A COUNTY WIDE SURVEY OF THE HEALTH OF POLK COUNTY RESIDENTS WAS MADE AVAILABLE TO THE PUBLIC TO PARTICIPATE. THIS SURVEY WAS MADE AVAILABLE AT ALL OF THE LOCAL MEDICAL CENTERS AND THE HEALTH DEPARTMENT AS WELL AS ADVERTISED IN THE LOCAL NEWSPAPERS AND POSTED ON ALL FOUR OF THE PARTNER'S ORGANIZATION'S WEBSITES. ONCE THE DATA WAS COLLECTED FROM THE SURVEYS, FOUR COMMUNITY FORUMS WERE SPONSORED IN BALSAM LAKE, ST. CROIX FALLS, AMERY AND OSCEOLA. THE COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE HEALTH FOCUS AREAS. IN ADDITION, A PARTNER MEETING WAS HELD TARGETING KEY ORGANIZATIONS AS WELL AS LOCAL HEALTH-RELATED COALITIONS. AT EACH OF THESE VENUES, ATTENDEES HAD THE OPPORTUNITY TO PROVIDE INPUT ON THE 10 HEALTH FOCUS AREAS AS WELL AS VOTE FOR THEIR TOP FIVE. ON APRIL, 12, 2016, A PARTNER MEETING CONVENED AND PARTICIPATED IN A PROCESS FOCUSING ON REVIEW AND DISCUSSION OF COMPILED DATA ON THE CURRENT HEALTH STATUS OF POLK COUNTY CITIZENS, AS WELL AS VOTING RESULTS FROM THE COMMUNITY FORUMS. DURING THIS MEETING, THIS GROUP COMPLETED A PAPER SURVEY TO CAST THEIR VOTES TO DETERMINE THE TOP FOUR HEALTH FOCUS AREAS FOR POLK COUNTY, WI. THE COLLABORATIVE GROUP OF THE POLK COUNTY HEALTH DEPARTMENT, THE THREE MEDICAL CENTERS AND MANY OTHER COMMUNITY ORGANIZATIONS ENGAGES COMMUNITY MEMBERS AND WORKS COLLECTIVELY WITH PARTNERS TO IMPROVE THE HEALTH OF THE COMMUNITY THROUGH ASSESSMENT, PRIORITIZATION, EFFECTIVE PLANNING, COLLABORATIVE IMPLEMENTATION AND EVALUATION. |
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 6A: THE MEDICAL CENTER WORKED IN COLLOBORATION WITH THE POLK COUNTY HEALTH DEPARTMENT, AMERY HOSPITAL AND CLINIC AND OSCEOLA MEDICAL CENTER WITH THE ULTIMATE GOAL TO IDENTIFY PRIORITY HEALTH ISSUES AND TO DEVELOP STRATEGIES TO ADDRESS THE COMMUNITY'S HEALTH NEEDS. |
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 6B: AS STATED ABOVE, SCRMC WORKED IN COLLABORATION WITH THE POLK COUNTY HEALTH DEPARTMENT FOR THEIR COMMUNITY HEALTH NEEDS ASSESSMENT. |
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 11: THE COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE HEALTH FOCUS AREAS. AT EACH OF THESE VENUES, ATTENDEES HAD THE OPPORTUNITY TO PROVIDE INPUT ON THE TOP HEALTH FOCUS AREAS. THE FINAL TOP HEALTH FOCUS AREAS SELECTED WERE 1) MENTAL HEALTH 2) SUBSTANCE ABUSE 3) ACCESS TO CARE AND 4) OBESITY. AFTER REVIEWING THE DATA, AND MAPPING EXISTING RESOURCES, SCRMC DEVELOPED AN IMPLEMENTATION STRATEGY. THE SCRMC GOVERNING BOARD APPROVED THE IMPLEMENTATION STRATEGY ON OCTOBER 25TH, 2016. THE ABOVE NEEDS WERE PRIORITIZED BASED ON SIZE, SEVERITY, AVAILABLE DATA, AND THE HOSPITAL'S ABILITY TO HAVE AN IMPACT. IN ORDER TO ADDRESS PRIORITY NEEDS, SCRMC WILL ENGAGE KEY COMMUNITY PARTNERS IN IMPLEMENTING STRATEGIES ACROSS THE SERVICE AREA. THESE STRATEGIES INCLUDE MODIFYING POLICES, PROVIDING SUPPORT, ENHANCING ACCESS, CHANGING CONSEQUENCES AND INCENTIVES, PROVIDING INFORMATION, AND ENHANCING SKILLS. SCRMC WORKS COLLABORATIVELY WITH OSCEOLA MEDICAL CENTER, AMERY MEDICAL CENTER, THE POLK COUNTY HEALTH DEPARTMENT, AND OTHER COMMUNITY MEMBERS TO DETERMINE THE FOUR MOST SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. SCRMC WOULD ALSO LIKE TO CONTRIBUTE EFFORTS TO OTHER COMMUNITY HEALTH NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. - NUTRITION - NUTRITION NOW FALLS UNDER OBESITY. BECAUSE OBESITY WAS RANKED AS ONE OF THE MOST IMPORTANT HEALTH NEEDS, NUTRITION WILL BE ADDRESSED INDIRECTLY THROUGH MANY OF THE STRATEGIES AND ACTIVITIES AIMED AT REDUCING OBESITY. - PHYSICAL ACTIVITY - PHYSICAL ACTIVITY NOW FALLS UNDER OBESITY. BECAUSE OBESITY WAS RANKED AS ONE OF THE MOST IMPORTANT HEALTH NEEDS, PHYSICAL ACTIVITY WILL BE ADDRESSED INDIRECTLY THROUGH MANY OF THE STRATEGIES AND ACTIVITIES AIMED AT REDUCING OBESITY. - REPRODUCTIVE AND SEXUAL HEALTH - THOUGH NOT VOTED AS ONE OF THE TOP SIGNIFICANT HEALTH NEEDS OF POLK COUNTY, SCRMC IS COMMITTED TO PLAYING AN ACTIVE ROLE IN REPRODUCTIVE AND SEXUAL HEALTH. SCRMC IS, CURRENTLY, WORKING TOWARD RE-DESIGNING PATIENT EDUCATION MATERIALS TO BETTER SUIT PATIENT UNDERSTANDING. IF A PATIENT IS DEEMED SEXUALLY ACTIVE AND IS BETWEEN THE AGE OF 16-24, ALL PRIMARY CARE PROVIDERS SCREEN THE PATIENT FOR CHLAMYDIA AND GONORRHEA. FOR ALL TEEN PRIMARY CARE VISITS, "TEEN HEALTH" INFORMATION IS INCLUDED IN THE AFTER VISIT SUMMARY FOR THE PATIENT. DURING A PATIENT VISIT IN PRIMARY CARE, COUNSELING IS OFFERED FOR ANY ISSUE IN REPRODUCTIVE AND SEXUAL HEALTH.SCRMC ACKNOWLEDGES THE WIDE RANGE OF SIGNIFICANT HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS, AND DETERMINED THAT IT COULD EFFECTIVELY FOCUS ON ONLY THOSE HEALTH NEEDS WHICH IT DEEMED MOST PRESSING, UNDER-ADDRESSED, AND WITHIN ITS ABILITY TO INFLUENCE. SCRMC WILL NOT TAKE NEW OR ADDITIONAL ACTIONS ON THE FOLLOWING HEALTH NEEDS AT THIS TIME: - UNINTENTIONAL INJURY - BECAUSE SUBSTANCE ABUSE WAS RANKED AS ONE OF THE MOST IMPORTANT HEALTH NEEDS, UNINTENTIONAL INJURY WILL BE ADDRESSED INDIRECTLY THROUGH MANY OF THE STRATEGIES AND ACTIVITIES AIMED AT REDUCING SUBSTANCE ABUSE. - DENTAL HEALTH SERVICES AND ORAL HEALTH -MANY OF THE KEY STAKEHOLDERS REPORTED ACCESS TO AFFORDABLE DENTAL CARE AS A NEED AMONG THE LOW-INCOME AND MEDICALLY UNDERSERVED POPULATIONS. SCRMC PROVIDERS PROMOTE THE POSITIVE HEALTH BENEFITS OF GOOD ORAL HEALTH AT PATIENT VISITS AND ALLOW DENTAL SERVICE PROMOTION AT SUITABLE SCRMC SPONSORED COMMUNITY AND EMPLOYEE EVENTS THROUGHOUT THE YEAR. DUE TO LIMITED RESOURCES AND SPACE, SCRMC IS UNABLE, AT THIS TIME, TO ADDRESS THE MATTER FURTHER. |
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 13H: SCRMC MAY PRESUMPTIVELY DETERMINE ELIGIBILITY OF PATIENTS BASED ON EXTERNAL SOURCES AND DATABASES WITHOUT A FAP-APPLICATION. |
| ST. CROIX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 22D: A PATIENT ELIGIBILE FOR FINANCIAL ASSISTANCE WILL NOT BE CHARGED MORE THAN AMOUNTS GENERALLY BILLED (AGB) BY ST. CROIX REGIONAL MEDICAL CENTER FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. CURRENTLY THE MEDICAL CENTER DETERMINES AGB BY MULTIPLYING GROSS CHARGES FOR ANY EMERGENCY OR OTHER MEDICALLY NECESSARY CARE PROVIDED TO A PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE BY AN AGB PERCENTAGE OF 46.7%, WHICH IS A 53.3% DISCOUNT. THE MEDICAL CENTER CALCULATED THIS PERCENTAGE BY DIVIDING THE SUM OF ALL ITS CLAIMS FOR MEDICALLY NECESSARY CARE ALLOWED BY HEALTH INSURERS DURING A PRIOR 12 MONTH PERIOD BY THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - FREDERIC CLINIC | ||||
| 107 OAK STREET E | FREDERIC | WI | 54837 | PROVIDER BASED CLINIC |
| 2 - INGALLS CLINIC | ||||
| 7456 MAIN STREET | WEBSTER | WI | 54893 | PROVIDER BASED CLINIC |
| 3 - UNITY CLINIC | ||||
| 1482 190TH AVE | BALSAM LAKE | WI | 54024 | PROVIDER BASED CLINIC |
| 4 - ST CROIX FALLS CLINIC | ||||
| 235 STATE STREET | ST CROIX FALLS | WI | 54024 | PROVIDER BASED CLINIC |
| 5 - LINDSTROM CLINIC | ||||
| 12375 LINDSTROM LANE | LINDSTROM | MN | 55045 | FREE STANDING CLINIC |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | ST. CROIX REGIONAL MEDICAL CENTER, THROUGH ITS PATIENT ADVOCATES, EVALUATES EACH APPLICANT'S SITUATION IN ACCORDANCE WITH CRITERIA ESTABLISHED ANNUALLY BY THE BOARD OF DIRECTORS. THE CRITERIA INCLUDES: (1) INDIVIDUAL OR FAMILY INCOME (2) FAMILY SIZE (3) OTHER SOURCES OF PAYMENT FOR SERVICES. QUALIFICATION IS BASED ON ASSET LEVELS ESTABLISHED BY MEDICAL ASSISTANCE, FAMILY SIZE, AND INCOME LEVELS BASED ON 100% OF FEDERAL POVERTY GUIDELINES AS PUBLISHED ANNUALLY BY THE FEDERAL GOVERNMENT. IN ADDITION TO THE ABOVE LISTED ELIGIBILY REQUIREMENTS DEPENDENT UPON INCOME, SCRMC MAY ALSO PRESUMTIVELY DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. PORTIONS OF OR THE ENTIRE FINANCIAL APPLICATION PROCESS MAY BE WAIVED FOR CERTAIN PATIENTS/GUARANTORS WHO PRESUMPTIVELY QUALIFY FOR FINANCIAL ASSISTANCE AND ARE SUBSEQUENTLY VERIFIED BASED ON SCRMC POLICIES AND PROCEDURES. EXAMPLES MAY INCLUDE PATIENTS/GUARANTORS WHO ARE HOMELESS, DECEASED WITHOUT AN ESTATE, BANKRUPTY, FOOD STAMPS AND/OR PATIENTS/GUARANTORS WHO QUALIFY BY EXTERNAL AVAILABLE DATA SOURCES SUCH AS CREDIT AGENCIES OR SOCIAL ECEONOMIC STATUS OF QUALIFYING FOR FINANCIAL ASSISTANCE. |
| PART I, LINE 6A: | ST. CROIX REGIONAL MEDICAL CENTER PARTICIPATES IN AN ANNUAL COMMUNITY BENEFIT REPORT PRODUCED BY THE WISCONSIN HOSPITAL ASSOCIATION. |
| PART I, LINE 7: | THE AMOUNTS INCLUDED IN PART I, LINE 7 WERE DERIVED USING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2 OF THE IRS SCHEDULE H INSTRUCTIONS. |
| PART I, LN 7 COL(F): | BAD DEBT EXPENSES OF $3,329,799 WERE SUBTRACTED FROM TOTAL EXPENSES IN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THE ORGANIZATION PROVIDES DIRECT SUPPORT TO OVER 47 COMMUNITY ACTIVITIES, PROVIDES OVER 19,000 HOURS OF VOLUNTEER TIME IN INDIRECT PATIENT CARE ACTIVITIES, AND OVER 400 HOURS OF EDUCATION FOR HEALTHCARE PROFESSIONALS. |
| PART III, LINE 2: | PATIENTS ARE NOT REQUIRED TO PROVIDE COLLATERAL FOR SERVICES RENDERED. PAYMENT FOR SERVICES IS REQUIRED UPON RECEIPT OF AN INVOICE, AFTER PAYMENT OF INSURANCE, IF ANY. SELF-PAY ACCOUNTS ARE ANALYZED FOR COLLECTIBILITY BASED ON THE MONTHS PAST DUE AND PAYMENT HISTORY. AN ALLOWANCE IS ESTIMATED FOR THESE ACCOUNTS BASED ON THE HISTORICAL EXPERIENCE OF THE MEDICAL CENTER. ACCOUNTS THAT ARE DETERMINED TO BE UNCOLLECTIBLE ARE SENT TO A COLLECTION AGENCY AND WRITTEN OFF AT THAT TIME. |
| PART III, LINE 3: | THE AMOUNT OF BAD DEBT EXPENSE ESTIMATED BY THE ORGANIZATION TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE ON PART III, LINE 3 WAS DERIVED BY TAKING THE COST TO CHARGE RATIO AGAINST TOTAL BAD DEBT EXPENSES INCLUDED IN LINE 2. |
| PART III, LINE 4: | SEE THE "PATIENT ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS" SECTION IN NOTE 1 (PAGE 10) TO THE FINANCIAL STATEMENTS FOR INFORMATION ABOUT THE CALCULATION OF BAD DEBTS. |
| PART III, LINE 8: | THE MEDICAL CENTER PROVIDES MEDICAL CARE TO INDIVIDUALS WHERE GOVERNMENT DEPARTMENTS DETERMINE THE AMOUNT OF REIMBURSEMENT OF SERVICE REGARDLESS OF THE COST TO PROVIDE THE SERVICE. AMOUNTS REIMBURSED BY GOVERNMENT PAYORS ARE ESTIMATED TO BE LESS THAN THE COSTS TO PROVIDE THE SERVICES AS FOLLOWS:MEDICAID- WISCONSIN $2,523,000 CHAMPUS AND VA $62,500MEDICARE - PHYSICIAN $4,222,800MEDICARE ADVANTAGE $4,888,200ALL GOVERNMENT PAYORS $7,696,500TOTAL CHARITY CARE, UNCOMPENSATED CARE AND UNDER COMPENSATED CARE BY GOVERNMENT PAYORS WAS $4,640,055 THIS REPRESENTS 7.1% OF NET OPERATING REVENUES OF THE MEDICAL CENTER.THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6 WERE DERIVED USING THE FILED 2016 MEDICARE COST REPORT. |
| PART III, LINE 9B: | THE FOLLOWING PROCEDURES ARE SECTION 8 IN SCRMC'S BILLING AND COLLECTION POLICY INCLUDED ON THEIR WEBSITE AND DESCRIBES THE POLICY AND PROCEDURES USED FOR PATIENTS THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE. ST. CROIX REGIONAL MEDICAL CENTER WILL MAKE REASONABLE EFFORTS TO PATIENT/GUARANTORS THAT FINANCIAL ASSISTANCE IS AVAILABLE, WHERE TO GET THE INFORMATION, HOW TO APPLY, AND ASSISTANCE AVAILABLE WITH APPLYING. ST. CROIX REGIONAL MEDICAL WILL ALLOW AND PROCESS A FINANCIAL ASSISTANCE APPLICATION UP TO 240 DAYS AFTER THE PATIENT/GUARANTOR'S FIRST BILLING STATEMENT AFTER A DATE OF SERVICE. ST. CROIX REGIONAL MEDICAL CENTER WILL TAKE STEPS TO NOTIFY PATIENT/GUARANTOR ABOUT OUR FINANCIAL ASSISTANCE POLICY AND WILL NOT TAKE EXTRAORDINARY COLLECTION ACTIONS BEFORE 120 DAYS FROM PATIENT/GUARANTOR'S FIRST BILLING STATEMENT AFTER A DATE OF SERVICE.IF A FINANCIAL ASSISTANCE APPLICATION IS RECEIVED DURING THE APPLICATION PERIOD, ST. CROIX REGIONAL MEDICAL CENTER WILL SUSPEND ANY EXTRAORDINARY COLLECTION ACTIONS TO OBTAIN PAYMENT, MAKE AN ELIGIBILITY DETERMINATION AS TO WHETHER THE PATIENT/GUARANTOR IS ELIGIBLE FOR FINANCIAL ASSISTANCE AND NOTIFY THE PATIENT/GUARANTOR IN WRITING. IF ELIGIBLE, THE FINAL NOTIFICATION PERIOD WILL BE RE-SET FOR ANOTHER 30 DAY PERIOD. IF A PATIENT/GUARANTOR DOES NOT APPLY FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY BY THE LAST DAY OF THE FINAL NOTIFICATION PERIOD, AND THE PATIENT/GUARANTOR HAS RECEIVED THE 30 DAY NOTICE DESCRIBED IN FINAL NOTIFICATION PERIOD, THEN ST. CROIX REGIONAL MEDICAL CENTER MAY INITIATE EXTRAORDINARY COLLECTION ACTIONS. IF A PATIENT/GUARANTOR HAS APPLIED FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY IN THE LAST SIX MONTHS, AND IT WAS DETERMINED THAT THE PATIENT/GUARANTOR IS NOT ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY, THEN SCRMC MAY INITIATE EXTRAORDINARY COLLECTION ACTIONS.IF AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION UNDER THE FINANCIAL ASSISTANCE POLICY IS RECEIVED PRIOR TO THE FINAL NOTICE, THEN EXTRAORDINARY COLLECTION ACTIONS WILL BE SUSPENDED AND PATIENT/GUARANTOR WILL BE PROVIDED A WRITTEN NOTICE THAT DESCRIBES ADDITIONAL INFORMATION REQUIRED UNDER THE FINANCIAL ASSISTANCE POLICY. IF ADDITIONAL INFORMATION REQUESTED IS NOT PROVIDED, THEN THE FINAL NOTIFICATION PERIOD WILL BE RE-SET. |
| PART VI, LINE 2: | OVERALL MARKETPLACE DEMOGRAPHICS AND COMPETITIVE ANALYSIS IS CONDUCTED ON A REGULAR BASIS. WHEN DEMAND FOR NEW SERVICE LINES IS INTENSIFIED, THEY ARE ADDED SLOWLY UNTIL DEMAND CAPACITY REACH CRITICAL LEVELS. |
| PART VI, LINE 3: | ALL PATIENTS HAVE ACCESS TO WRITTEN MATERIALS AND PAMPHLETS AT OR NEAR THE POINT OF REGISTRATION. IN ADDITION, PATENTS HAVE ACCESS TO PATIENT ADVOCATES WITH FULL KNOWLEDGE OF RESOURSES AVAILABLE. |
| PART VI, LINE 4: | THE ORGANIZATION SERVES A GEOGRAPHIC AREA OF APPROXIMATELY 300 SQUARE MILES IN WESTERN WISCONSIN THAT INCLUDES THE TOWNS OF ST CROIX FALLS, BALSAM LAKE, LUCK, MILLTOWN, FREDERIC, AND GRANTSBURG IN WISCONSIN AND TAYLORS FALLS AND LINDSTROM IN EASTERN MINNESOTA. |
| PART VI, LINE 6: | THE CENTER IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | TUITION REIMBURSEMENT | GrantTypeTxt |
| Recipient | 10 | RecipientCnt |
| Cash Grant | $10,744 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION'S PROCEDURES INCLUDE SUBSTANTIATION OF EXPENSES, GRADES, TRANSCRIPTS AND RECEIPTS, AS WELL AS FOLLOW UP WITH COMMUNITY ORGANIZATIONS AND LEADERS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVE DOBOSENSKI | ||||||||||||||
| CEO | $481,060 | $0 | $42,500 | $0 | $0 | $0 | $15,300 | $0 | $27,764 | $0 | $566,624 | $0 | $0 | $0 |
| JOHN TREMBLE | ||||||||||||||
| CFO & VP | $220,559 | $0 | $5,000 | $0 | $1,440 | $0 | $11,442 | $0 | $2,882 | $0 | $241,323 | $0 | $0 | $0 |
| GURDESH BEDI | ||||||||||||||
| PHYSICIAN OF SCRMC | $773,347 | $0 | $1,000 | $0 | $1,440 | $0 | $15,300 | $0 | $1,026 | $0 | $792,113 | $0 | $0 | $0 |
| STEPHEN DENNIS | ||||||||||||||
| PHYSICIAN OF SCRMC | $271,645 | $0 | $0 | $0 | $0 | $0 | $15,300 | $0 | $25,417 | $0 | $312,362 | $0 | $0 | $0 |
| MUHAMMAD KHAN | ||||||||||||||
| PHYSICIAN OF SCRMC | $297,937 | $0 | $0 | $0 | $0 | $0 | $3,231 | $0 | $31,214 | $0 | $332,382 | $0 | $0 | $0 |
| CLAUDIO NUNES | ||||||||||||||
| PHYSICIAN OF SCRMC | $364,384 | $0 | $0 | $0 | $0 | $0 | $15,300 | $0 | $41,431 | $0 | $421,115 | $0 | $0 | $0 |
| MINGZHU XU | ||||||||||||||
| PHYSICIAN OF SCRMC | $270,449 | $0 | $1,000 | $0 | $0 | $0 | $15,300 | $0 | $26,292 | $0 | $313,041 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 4B | CONTRIBUTIONS TO A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: JOHN TREMBLE - $23,394 DAVE DOBOSENSKI - $34,917 |
| PART I, LINE 6 | ANNUAL EMPLOYER CONTRIBUTIONS TO THE 457F PLAN ARE CONDITIONED UPON ATTAINING CERTAIN PRE-SET GOALS AND ARE CONTINGENT ON APPROVAL BY THE BOARD OF DIRECTORS. THE AWARD IS BASED ON TWO COMPONENTS - LONGEVITY AND PERFORMANCE. PERFORMANCE IS BASED ON MEETING 3 GOALS - NET REVENUE, NET MARGIN AND NET ASSETS. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| POLK COUNTY | |||||||
| A | 396005730 | 2006-05-11 | $13,000,000 | REFUND SERIES 2000 BONDS, FACILITY CONSTRUCTION AND EQUIPMENT PURCHASES | 0 | 0 | 0 |
| POLK COUNTY | |||||||
| B | 396005730 | 2006-12-27 | $3,683,432 | FACILITY CONSTRUCTION | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|
| A | $10,046,012 | $13,000,000 | $13,000,000 | 2008 | 0 | 0 | Yes (1) | Yes (1) |
| B | $2,461,814 | $3,683,432 | $3,683,432 | 2008 | 0 | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | ST. CROIX REGIONAL MEDICAL CENTER HAS AN EXECUTIVE COMMITTEE WITH BROAD AUTHORITY TO ACT ON BEHALF OF ITS BOARD OF TRUSTEES. THE EXECUTIVE COMMITTEE INCLUDES THE CHAIR, VICE CHAIR, SECRETARY, TREASURER AND ONE OTHER TRUSTEE FROM THE BOARD OF TRUSTEES. THE EXECUTIVE COMMITTEE HAS POWER TO TRANSACT ALL REGULAR BUSINESS OF THE ORGANIZATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD OF TRUSTEES, SUBJECT TO ANY PERIOD LIMITATION IMPOSED BY THE BOARD OF TRUSTEES AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF TRUSTEES. |
| FORM 990, PART VI, SECTION A, LINE 6 | ST. CROIX REGIONAL MEDICAL CENTER HAS TWO CLASSES OF MEMBERS - SPONSORING MEMBERS AND PHYSICIAN ELECTORS. INDIVIDUALS AND CORPORATIONS MAY BECOME SPONSORING MEMBERS THROUGH DONATIONS OF A SPECIFIED AMOUNT TO THE MEDICAL CENTER. INDIVIDUALS MAY BECOME PHYSICIAN ELECTORS BY PROVIDING SERVICES AT ST. CROIX REGIONAL MEDICAL CENTER THROUGH SPECIFIED EMPLOYMENT CONDITIONS. |
| FORM 990, PART VI, SECTION A, LINE 7A | PHYSICIAN ELECTORS VOTE IN THE ELECTION OF FOUR PHYSICIAN TRUSTEES. SPONSORING MEMBERS VOTE IN THE ELECTION OF FIVE COMMUNITY TRUSTEES. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBERS VOTE ON THE AUDITORS EMPLOYED TO AUDIT THE BOOKS OF THE MEDICAL CENTER AND TO PREPARE AN ANNUAL REPORT. AN OPS COUNCIL, CONSISTING OF FIVE INDIVIDUALS APPOINTED BY RIVER VALLEY MEDICAL CENTER, A RELATED ORGANIZATION, HAS SIGNIFICANT OVERSIGHT AUTHORITY AT THE MEDICAL CENTER. THE OPS COUNCIL'S AUTHORITY INCLUDES, BUT IS NOT LIMITED TO, REVIEW AND APPROVE OF ALL POLICIES AND PROCEDURES AS THEY RELATE TO MEDICAL OPERATIONS AND RECOMMENDATION OF THE ANNUAL CAPITAL AND OPERATING BUDGETS TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WENT THROUGH THE FOLLOWING REVIEW PROCESS BEFORE FILING WITH THE IRS: A DETAILED REVIEW WAS CONDUCTED BY THE ORGANIZATION'S INTERIM CFO, UPON APPROVAL, THE FORM 990 WAS THEN ELECTRONICALLY PROVIDED FOR REVIEW AND APPROVAL TO THE ORGANIZATION'S BOARD OF DIRECTORS IN MAY, 2017. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERSHIP IS CONTINGENT UPON ANNUAL DISCOSURE OF POTENTIAL AND ACTUAL CONFLICTS OF INTEREST. THE DERTERMINATION IS MADE AT THE BOARD LEVEL AND ALL BOARD MEMBERS MUST CERTIFY ANNUALLY. IF A BOARD MEMBER HAS A CONFLICT, THEY REFRAIN FROM VOTING OR PARTICIPATING IN DISCUSSIONS CONCERNING THAT TOPIC. |
| FORM 990, PART VI, SECTION B, LINE 15A | CEO - ANNUAL PERFORMANCE AND SALARY REVIEW IS CONDUCTED BY THE BOARD OF DIRECTORS USING SUCH OUTSIDE INFORMATION AS DEEMED NECESSARY. REVIEWS ARE CONDUCTED EACH JUNE. THE PROCESS LAST INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2016. OTHER OFFICERS - THE HUMAN RESOURCE DEPARTMENT CONDUCTS OUTSIDE RESEARCH TO DETERMINE REASONABLE COMPENSATION. THE CEO THEN DETERMINES THE COMPENSATION OF THESE INDIVIDUALS. REVIEWS ARE CONDUCTED EACH JUNE. THIS PROCESS LAST OCCURED IN FISCAL YEAR 2016. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE MEDICAL CENTER'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 11,927,629. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,927,629. THERAPIST & OTHER PHYS FEES: PROGRAM SERVICE EXPENSES 63,885. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 63,885. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,933,154. MANAGEMENT AND GENERAL EXPENSES 294,468. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,227,622. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 576,764. MANAGEMENT AND GENERAL EXPENSES 532,509. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,109,273. INDEPENDENT CONTRACTORS: PROGRAM SERVICE EXPENSES 1,126,299. MANAGEMENT AND GENERAL EXPENSES -12,553. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,113,746. |
| SCHEDULE L, PART IV AND SCHEDULE R, PART V, LINE 1O | ST. CROIX REGIONAL MEDICAL CENTER REIMBURSES RIVER VALLEY MEDICAL CENTER (RVMC), FOR PHYSICIAN SERVICES PROVIDED BY EMPLOYEES OF RVMC. ALL PAYMENTS ARE "GROSS", MEANING THAT THEY INCLUDE UNIDENTIFIED AMOUNTS FOR BENEFITS AND MALPRACTICE INSURANCE, AS WELL AS W-2 COMPENSATION. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| UNITY PHARMACY LLC | |||||||||
| 1504 190TH AVENUE SUITE 100 | BALSAM LAKE | WI | 54810 | 454471131 | PHARMACEUTICALS | WI | $1,373,748 | $431,197 | SCV PHARMACIES |
| FREDERIC PHARMACY LLC | |||||||||
| 201 OAK STREET WEST | FREDERIC | WI | 54837 | 464469897 | PHARMACEUTICALS | WI | $2,581,804 | $1,021,291 | SCV PHARMACIES |
| ST CROIX VALLEY PHARMACY LLC | |||||||||
| 235 STATE STREET | ST CROIX FALLS | WI | 54024 | 464463191 | PHARMACEUTICALS | WI | $17 | $9,267 | ST CROIX REGIONAL MEDICAL CENTER |
| ST CROIX FALLS PHARMACY LLC | |||||||||
| 216 SOUTH ADAMS STREET | ST CROIX FALLS | WI | 54024 | 464487348 | PHARMACEUTICALS | WI | $1,744,878 | $375,684 | SCV PHARMACIES |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ST CROIX VALLEY EMERGENCY MEDICAL SERVICES INC | |||||||||||
| 235 EAST STATE STREET | ST CROIX FALLS | WI | 54024 | 452872803 | TO LEASE, MAINTAIN, AND OPERATE AN EMERGENCY AMBULANCE SERVICE. | WI | 501(C)(3) | LINE 9 | ST CROIX REGIONAL MEDICAL CENTER | Yes (1) | |
| CANCER CENTER OF WESTERN WISCONSIN | |||||||||||
| 501 HOSPITAL ROAD | NEW RICHMOND | WI | 54017 | 273238660 | TO PROVIDE CARE TO CANCER PATIENTS. | WI | 501(C)(3) | LINE 11A, I | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |