AMERY REGIONAL MEDICAL CENTER INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- AMERY REGIONAL MEDICAL CENTER INC (EIN 39-0908320)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-14
- IRS object ID
- 201723189349304137
- 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 C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-14T11:02:28-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 135665207 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4200 WELLS FARGO CTR 90 S 7TH | AddressLine1Txt |
| Address Line2 | STREET | AddressLine2Txt |
| 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 | 390908320 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMERY REGIONAL MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | AMER | BusinessNameControlTxt |
| Phone | 7152688000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8170 33RD AVENUE SOUTH PO BOX 1309 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554401309 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DEBRA RUDQUIST | PersonNm |
| Person Title | PRESIDENT & CEO | PersonTitleTxt |
| Phone | 7152688000 | PhoneNum |
| Signature | 2017-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MONROE JORDAN GIERL | PreparerPersonNm |
| PTIN | P01413237 | PTIN |
| Phone | 6123055000 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 198.174.110.146 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-14 | IPDt |
| IP Tm | 11:02:04 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 1A39D2BAC3E977A191A219CBBAAA8778AA2E0A5D | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 282CC43464B9830A349574F670F0BA37F913502D | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DEBRA RUDQUIST | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8170 33RD AVENUE SOUTH PO BOX 1309 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554401309 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $58,046,183 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.AMERYMEDICALCENTER.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1954 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | SEE PART III, LINE 1 - ORGANIZATION'S MISSION" | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 484 | TotalEmployeeCnt |
| Total Volunteers | 28 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $51,974 | PYContributionsGrantsAmt |
| CY Contributions Grants | $298,279 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $54,193,515 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $57,300,642 | CYProgramServiceRevenueAmt |
| PY Investment Income | $132,342 | PYInvestmentIncomeAmt |
| CY Investment Income | $69,771 | CYInvestmentIncomeAmt |
| PY Other Revenue | $820,256 | PYOtherRevenueAmt |
| CY Other Revenue | $170,590 | CYOtherRevenueAmt |
| PY Total Revenue | $55,198,087 | PYTotalRevenueAmt |
| CY Total Revenue | $57,839,282 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $40,315 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $71,766 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $33,444,138 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $36,447,344 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $19,194,327 | PYOtherExpensesAmt |
| CY Other Expenses | $19,614,652 | CYOtherExpensesAmt |
| PY Total Expenses | $52,678,780 | PYTotalExpensesAmt |
| CY Total Expenses | $56,133,762 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,519,307 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,705,520 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $63,067,420 | TotalAssetsBOYAmt |
| Total Assets EOY | $58,452,023 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $40,523,350 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $34,202,433 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $22,544,070 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $24,249,590 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | AMERY REGIONAL MEDICAL CENTER IS COMMITTED TO PROVIDEACCESSIBLE, COMPREHENSIVE, QUALITY HEALTHCARE AND TO PROMOTE THEHEALTH AND WELLNESS OF ITS COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $49,610,571 | ExpenseAmt |
| Grant | $71,766 | GrantAmt |
| Revenue | $57,300,642 | RevenueAmt |
| Desc | SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS | Desc |
| Total Program Service Expenses | $49,610,571 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | 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 | 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 | 0 | 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 | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 484 | 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 | 5 | 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 | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JASON LUHRS - CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7152688000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 265 GRIFFIN STREET EAST | AddressLine1Txt |
| City | AMERY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| DAN DRAXLER | |||||||||
| DIRECTOR | 1.00 | 0.25 | Yes (X) | $1,200 | $0 | $0 | |||
| HEIDI ERSPAMER | |||||||||
| DIRECTOR & SECRETARY | 1.00 | 0.25 | Yes (X) | $1,200 | $0 | $0 | |||
| JAMES A LEADHOLM JR | |||||||||
| DIRECTOR & VICE CHAIR | 1.00 | 0.25 | Yes (X) | $1,200 | $0 | $0 | |||
| DANIEL LIEN | |||||||||
| DIRECTOR & CHAIR | 1.00 | 0.25 | Yes (X) | $1,200 | $0 | $0 | |||
| RANAE NYGAARD | |||||||||
| DIRECTOR | 0.25 | 0.25 | Yes (X) | $1,200 | $0 | $0 | |||
| DAVID RASMUSSEN | |||||||||
| DIRECTOR | 0.25 | 0.25 | Yes (X) | $1,200 | $0 | $0 | |||
| KATHRYN WALKER | |||||||||
| DIRECTOR | 0.25 | 0.25 | Yes (X) | $1,100 | $0 | $0 | |||
| ROSS R BULLARD | |||||||||
| DIRECTOR & TREASURER | 1.00 | 47.00 | Yes (X) | $0 | $210,942 | $57,881 | |||
| DYLAN COE MD | |||||||||
| DIRECTOR | 0.25 | 35.75 | Yes (X) | $0 | $241,620 | $70,987 | |||
| MARTIN E RICHARDS MD | |||||||||
| DIRECTOR | 0.25 | 44.75 | Yes (X) | $0 | $450,110 | $50,937 | |||
| ANN SEAGREN MD | |||||||||
| DIRECTOR | 0.25 | 49.75 | Yes (X) | $0 | $280,265 | $70,511 | |||
| TED WEGLEITNER | |||||||||
| DIRECTOR | 0.25 | 44.75 | Yes (X) | $0 | $521,283 | $106,696 | |||
| MARYANN SCOGLIO CANP | |||||||||
| DIRECTOR | 0.25 | 39.75 | Yes (X) | $0 | $205,568 | $42,110 | |||
| JASON J LUHRS | |||||||||
| CFO | 0.50 | 49.50 | $0 | $204,194 | $60,376 | Yes (X) | |||
| SANDRA M REED | |||||||||
| VP - AMBULATORY CARE | 60.00 | $154,249 | $0 | $35,786 | Yes (X) | ||||
| DEBRA RUDQUIST | |||||||||
| CHIEF EXECUTIVE OFFICER | 55.00 | $0 | $313,468 | $73,944 | Yes (X) | ||||
| JOYCE R SCHAEFER | |||||||||
| VP-PATIENT CARE | 50.00 | $163,810 | $0 | $35,900 | Yes (X) | ||||
| PATRICK SURA MD | |||||||||
| CHIEF MEDICAL OFFICER | 1.00 | 70.00 | $0 | $617,152 | $53,359 | Yes (X) | |||
| MARK A TRYGGESTAD | |||||||||
| DIRECTOR OF PHARMACY | 48.00 | $166,960 | $0 | $16,831 | Yes (X) | ||||
| MARK T MOIOFFER | |||||||||
| PHARMACIST | 40.00 | $126,027 | $0 | $34,622 | Yes (X) | ||||
| FREDERICK KOSMACH | |||||||||
| PHYSICIAN ASSISTANT | 44.00 | $127,189 | $0 | $32,194 | Yes (X) | ||||
| VICKI D ZIGLINSKI | |||||||||
| DIRECTOR-PATIENT FINANCIAL | 48.00 | $106,152 | $0 | $32,664 | Yes (X) | ||||
| ANTHONY GOULD | |||||||||
| DIRECTOR - REHAB SERVICES | 40.00 | $107,276 | $0 | $32,805 | Yes (X) | ||||
| JOANNE L JACKSON | |||||||||
| FORMER HR, PR AND MKTG DIRECTOR | 50.00 | $136,297 | $0 | $22,943 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,096,260 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,044,602 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $830,546 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 14 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | 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 ANESTHESIA INC | |||||
| PO BOX 118 | NEW RICHMOND | WI | 54017 | NURSE ANESTHITISTS | $889,704 |
| HEALOGICS WOUND CARE | |||||
| 28525 NETWORK PLACE | CHICAGO | IL | 60673 | WOUND HEALING MANAGEMENT | $458,496 |
| NXC IMAGING | |||||
| 2118 4TH AVE S | MINNEAPOLIS | MN | 554042642 | PROFESSIONAL SERVICES | $375,689 |
| SHARED MEDICAL TECHNOLOGY INC | |||||
| 202 W NEWTON ST | RICE LAKE | WI | 54868 | PROFESSIONAL SERVICES | $327,637 |
| COMPHEALTH INC | |||||
| PO BOX 972651 | DALLAS | TX | 753972651 | PROFESSIONAL SERVICES | $310,598 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 19 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $237,405 | GovernmentGrantsAmt |
| All Other Contributions | $60,874 | AllOtherContributionsAmt |
| Total Contributions | $298,279 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE | 621110 | $56,458,445 | $56,458,445 |
| OTHER OPERATING | 900099 | $421,985 | $421,985 |
| SUBSIDIARY REVENUE | 900099 | $256,866 | $256,866 |
| FITNESS CENTER | 624110 | $163,346 | $163,346 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $57,300,642 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $153,829 | TotalRevenueColumnAmt |
| Exclusion | $153,829 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $75,046 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $118,087 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$43,041 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$43,041 | TotalRevenueColumnAmt |
| Exclusion | -$43,041 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $4,756 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $88,814 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$84,058 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$84,058 | TotalRevenueColumnAmt |
| Exclusion | -$84,058 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA AND OTHER | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $213,631 | TotalRevenueColumnAmt |
| Exclusion | $213,631 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $213,631 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $57,839,282 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $57,300,642 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $240,361 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,766 | TotalAmt |
| Program Services | $71,766 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $398,045 | TotalAmt |
| Management And General | $398,045 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,460,651 | TotalAmt |
| Program Services | $27,914,877 | ProgramServicesAmt |
| Management And General | $2,545,774 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $439,062 | TotalAmt |
| Program Services | $368,284 | ProgramServicesAmt |
| Management And General | $70,778 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,750,285 | TotalAmt |
| Program Services | $3,145,729 | ProgramServicesAmt |
| Management And General | $604,556 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,399,301 | TotalAmt |
| Program Services | $1,173,730 | ProgramServicesAmt |
| Management And General | $225,571 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,898 | TotalAmt |
| Management And General | $9,898 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $110 | TotalAmt |
| Program Services | $110 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,466,109 | TotalAmt |
| Program Services | $2,877,300 | ProgramServicesAmt |
| Management And General | $588,809 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $356,476 | TotalAmt |
| Program Services | $16,931 | ProgramServicesAmt |
| Management And General | $339,545 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $469,928 | TotalAmt |
| Program Services | $286,193 | ProgramServicesAmt |
| Management And General | $183,735 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $301,528 | TotalAmt |
| Program Services | $263,214 | ProgramServicesAmt |
| Management And General | $38,314 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $731,701 | TotalAmt |
| Program Services | $730,361 | ProgramServicesAmt |
| Management And General | $1,340 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,558 | TotalAmt |
| Program Services | $64,424 | ProgramServicesAmt |
| Management And General | $40,134 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,190 | TotalAmt |
| Program Services | $4,494 | ProgramServicesAmt |
| Management And General | $8,696 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $981,536 | TotalAmt |
| Program Services | $981,536 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,124,421 | TotalAmt |
| Program Services | $2,946,844 | ProgramServicesAmt |
| Management And General | $177,577 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $134,174 | TotalAmt |
| Management And General | $134,174 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DRUG EXPENSE | $3,518,009 | $3,518,009 | |
| MEDICAL SUPPLY & EQUIP. | $2,561,608 | $2,558,360 | $3,248 |
| EQUIP. RENT & REPAIR | $1,514,072 | $958,738 | $555,334 |
| OTHER EXPENSE | $1,502,450 | $1,178,800 | $323,650 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $824,884 | TotalAmt |
| Program Services | $550,871 | ProgramServicesAmt |
| Management And General | $274,013 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,133,762 | TotalAmt |
| Program Services | $49,610,571 | ProgramServicesAmt |
| Management And General | $6,523,191 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,750 | BOYAmt |
| EOY | $5,570 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,661,151 | BOYAmt |
| EOY | $15,837,030 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,878,269 | BOYAmt |
| EOY | $5,615,195 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $702,782 | BOYAmt |
| EOY | $685,849 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $468,782 | BOYAmt |
| EOY | $51,785 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $56,311,773 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $31,320,800 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,055,373 | BOYAmt |
| EOY | $24,990,973 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,405,752 | BOYAmt |
| EOY | $8,552,008 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,893,561 | BOYAmt |
| EOY | $2,713,613 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,067,420 | BOYAmt |
| EOY | $58,452,023 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,196,904 | BOYAmt |
| EOY | $7,470,083 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,326,446 | BOYAmt |
| EOY | $26,732,350 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,523,350 | BOYAmt |
| EOY | $34,202,433 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,544,070 | BOYAmt |
| EOY | $24,249,590 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,544,070 | BOYAmt |
| EOY | $24,249,590 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,067,420 | BOYAmt |
| EOY | $58,452,023 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,705,520 | ReconcilationRevenueExpnssAmt |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Total Lobbying Expenditures | $0 | 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 | AMERY REGIONAL MEDICAL CENTER, INC. PAYS FOR CERTAIN CORPORATE AND EMPLOYEE PROFESSIONAL ASSOCIATION MEMBERSHIPS. A PORTION OF SUCH MEMBERSHIP DUES POTENTIALLY COULD BE USED BY THE PROFESSIONAL ASSOCIATIONS FOR LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,072,735 | OtherCostOrOtherBasisAmt |
| Book Value | $1,072,735 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $26,487,689 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,482,260 | DepreciationAmt |
| Book Value | $14,005,429 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,501,069 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,959,487 | DepreciationAmt |
| Book Value | $7,541,582 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,250,280 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,879,053 | DepreciationAmt |
| Book Value | $2,371,227 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $24,990,973 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | AMERY REGIONAL MEDICAL CENTER, INC. IS INCLUDED IN THE HEALTHPARTNERS, INC. (HP) CONSOLIDATED AUDITED FINANCIAL STATEMENT. HP'S ACCOUNTING POLICY PROVIDES THAT A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. HP RECORDED NO LIABILITIES AT DECEMBER 31, 2016 OR 2015 FOR UNRECOGNIZED TAX BENEFITS. | ExplanationTxt |
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 |
| Percent200 | Yes (X) | Percent200Ind |
| 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 | $458,944 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $458,944 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00820 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,956,826 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,615,528 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,341,298 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04170 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,415,770 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,615,528 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,800,242 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04990 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 24 | ActivitiesOrProgramsCnt |
| Persons Served | 4184 | PersonsServedCnt |
| Total Community Benefit Expns | $369,915 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,649 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $354,266 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00630 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 7 | ActivitiesOrProgramsCnt |
| Persons Served | 252 | PersonsServedCnt |
| Total Community Benefit Expns | $30,922 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $30,922 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 11 | ActivitiesOrProgramsCnt |
| Persons Served | 621 | PersonsServedCnt |
| Total Community Benefit Expns | $114,152 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $114,152 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 42 | ActivitiesOrProgramsCnt |
| Persons Served | 5057 | PersonsServedCnt |
| Total Community Benefit Expns | $514,989 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,649 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $499,340 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00890 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 42 | ActivitiesOrProgramsCnt |
| Persons Served | 5057 | PersonsServedCnt |
| Total Community Benefit Expns | $7,930,759 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,631,177 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,299,582 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05880 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,137,485 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $790,642 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $19,567,810 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $19,846,479 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$278,669 | 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 | AMERY REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 265 GRIFFIN STREET EAST | AddressLine1Txt |
| City | AMERY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.AMERYMEDICALCENTER.ORG | WebsiteAddressTxt |
| State License | CAH CERT LICENSE 1010 | 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 | AMERY REGIONAL MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.AMERYMEDICALCENTER.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.AMERYMEDICALCENTER.ORG/COMMUNITY_HEALTH_NEEDS_ASSESSMENT.ASPX | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| 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 | WWW.AMERYMEDICALCENTER.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.AMERYMEDICALCENTER.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.AMERYMEDICALCENTER.ORG | 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 |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| AMERY REGIONAL MEDICAL CENTER, INC. | PART V, SECTION B, LINE 5: AS A PART OF COUNTY-WIDE ASSESSMENTS, SURVEYS AND LISTENING SESSIONS INCLUDED:1. STATE, LOCAL, TRIBAL, OR REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENT(OR EQUIVALENT DEPARTMENT OR AGENCY) WITH KNOWLEDGE, INFORMATION, OREXPERTISE RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY (THE POLK COUNTY 2020 COMMUNITY HEALTH IMPROVEMENT PLAN, CONDUCTED IN COLLABORATION WITH THE POLK COUNTY HEALTH DEPARTMENT).2. MEMBERS OF MEDICALLY UNDERSERVED, LOW ]INCOME, AND MINORITYPOPULATIONS IN THE COMMUNITY, OR INDIVIDUALS OR ORGANIZATIONS SERVING ORREPRESENTING THE INTERESTS OF SUCH POPULATIONS (COMMUNITY SURVEYS). |
| AMERY REGIONAL MEDICAL CENTER, INC. | PART V, SECTION B, LINE 6A: OTHER HOSPITAL FACILITIES INCLUDED IN THE 2015 HEALTHPARTNERS CHNA WERE:- HUDSON HOSPITAL, HUDSON, WI.- WESTFIELDS HOSPITAL, NEW RICHMOND, WI.- LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, STILLWATER, MN.- PARK NICOLLET METHODIST HOSPITAL, ST. LOUIS PARK, MN- REGIONS HOSPITAL, ST. PAUL, MN |
| AMERY REGIONAL MEDICAL CENTER, INC. | PART V, SECTION B, LINE 11: THE 2015 HEALTHPARTNERS CHNA CONDUCTED RESULTED IN THE FOLLOWING PRIORITIES:PRIORITY 1: INCREASE ACCESS TO MENTAL HEALTHPRIORITY 2: PROMOTE POSITIVE BEHAVIORS TO REDUCE OBESITY (NUTRITION / PHYSICAL ACTIVITY)PRIORITY 3: INCREASE ACCESS TO PRIMARY AND PREVENTIVE CAREPRIORITY 4: IMPROVE SERVICE INTEGRATIONPRIORITY 5: PROMOTE CHANGE IN UNHEALTHY LIFESTYLES (TOBACCO / ALCOHOL / SUBSTANCE ABUSE)A FULL REPORT OF ARMC'S 2015 CHNA AND ANNUAL IMPLEMENTATION PLAN UPDATE IS POSTED ON ARMC'S WEBPAGE AT WWW.AMERYMEDICALCENTER.ORG/COMMUNITY_HEALTH_NEEDS_ASSESSMENT.ASPX |
| 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 - ARMC REHAB SERVICES | ||||
| 220 N KELLER AVENUE | AMERY | WI | 54001 | REHABILITATION |
| 2 - LUCK MEDICAL CLINIC | ||||
| 137 FIRST AVENUE | LUCK | WI | 54853 | RURAL HEALTH CLINIC |
| 3 - TURTLE LAKE MEDICAL CLINIC | ||||
| 550 MARTIN AVENUE | TURTLE LAKE | WI | 54889 | RURAL HEALTH CLINIC |
| 4 - CLEAR LAKE CLINIC | ||||
| 357 THIRD AVENUE | CLEAR LAKE | WI | 54005 | RURAL HEALTH CLINIC |
| 5 - LUCK PT & FITNESS | ||||
| 2547 STATE ROAD 35 SUITE 5 | LUCK | WI | 54853 | PHYSICAL THERAPY |
| 6 - AMERY REGIONAL MEDICAL CENTER WEST | ||||
| 230 DERONDA STREET | AMERY | WI | 54001 | 10 BED INPATIENT DPU OF AMERY |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART III, LINE 2: | AMERY REGIONAL MEDICAL CENTER (ARMC) USES A COST TO CHARGE METHODOLOGY. |
| PART III, LINE 3: | ARMC USES THE COST TO CHARGE METHODOLOGY TO DETERMINE AMOUNT REPORTED AS BAD DEBT. ARMC BELIEVES THAT MANY OF THE ACCOUNTS IN BAD DEBT WOULD HAVE QUALIFIED FOR CHARITY IF THE GUARANTORS WOULD HAVE COMPLETED THE FINANCIAL ASSISTANCE PAPERWORK. ARMC IS PROVIDING SERVICES TO INDIVIDUALS/FAMILIES IN ITS SERVICE AREA THAT ARE UNABLE/UNWILLING TO PAY FOR THESE SERVICES. THIS IS COMPARABLE TO PROVIDING CHARITY CARE WHICH ARMC ALSO INCLUDES AS A COMMUNITY BENEFIT. |
| PART III, LINE 4: | ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CHARITY CARE: THE FINANCIAL STATEMENTS DO NOT HAVE A SEPARATE BAD DEBT FOOTNOTE. THE FOLLOWING IS PART OF ARMC'S PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY:ACCOUNTS RECEIVABLE ARE REDUCED BY AN ANNUAL ALLOWANCE FOR DOUBTFUL ACCOUNTS OR CHARITY CARE, BASED ON ESTABLISHED GUIDELINES FOR IDENTIFYING UNCOLLECTIBLE PATIENT ACCOUNTS AND CLASSIFYING THESE ACCOUNTS AS EITHER DOUBTFUL ACCOUNTS OR CHARITY. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, ARMC'S MANAGEMENT PERIODICALLY ASSESSES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CHARITY CARE BY TAKING INTO CONSIDERATION BY PAYER CATEGORY, THE EXPECTED NET COLLECTIONS, ACCOUNTS RECEIVABLE AGING, HISTORICAL COLLECTIONS EXPERIENCE, ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THE PRIMARY SOURCE OF THE ALLOWANCE FOR CHARITY CARE IS CHARGES FOR UNINSURED PATIENTS. PATIENTS WHO ARE INSURED ARE ASSESSED SEPARATELY FOR COLLECTABILITY FROM UNINSURED PATIENTS. THE RESULTS OF THESE ASSESSMENTS ARE USED TO ESTABLISH THE NET REALIZABLE VALUE OF PATIENT ACCOUNTS RECEIVABLE AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CHARITY CARE. ARMC PROVIDED MEDICAL CARE WITHOUT CHARGE OR A REDUCED COST TO PATIENTS WHO WERE DETERMINED TO BE UNABLE TO PAY (CHARITY CARE) OF $790,642 AND $695,683 FOR THE YEARS ENDED 12/31/16 AND 12/31/15 RESPECTIVELY, AND PROVIDED MEDICAL CARE TO PATIENTS WHO WERE DETERMINED TO BE ABLE, BUT UNWILLING TO PAY (DOUBTFUL ACCOUNTS) OF $1,137,485 AND $1,896,101 FOR THE YEARS ENDED 12/31/16 AND 12/31/15 RESPECTIVELY. ACCORDINGLY, ARMC DOES NOT SEPARATE ALLOWANCE ACCOUNTS FOR DOUBTFUL ACCOUNTS AND CHARITY CARE. |
| PART III, LINE 8: | THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO AS REQUIRED BY MEDICARE. THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE ARMC IS INCURRING THE COST OF PROVIDING SERVICES TO MEDICARE PATIENTS AND NOT GETTING PAID COMPLETELY BY MEDICARE FOR THE COST OF PROVIDING THESE SERVICES. |
| PART III, LINE 9B: | ARMC IS COMMITTED TO MEETING THE HEALTHCARE NEEDS OF THE COMMUNITY. AS PART OF THIS MISSION, ARMC ADMINISTERS A FINANCIAL ASSISTANCE PROGRAM TO HELP PATIENTS WHO NEED MEDICAL CARE BUT HAVE DIFFICULTY WITH RELATED MEDICAL EXPENSES. IN ARMC FACILITIES, NON-ELECTIVE PROFESSIONAL MEDICAL SERVICES WILL BE PROVIDED WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY AND FINANCIAL ASSISTANCE WILL BE MADE AVAILABLE. PROGRAM ELIGIBILITY IS BASED ON INCOME, ASSETS, LIABILITIES, AND FAMILY SIZE UTILIZING A SLIDING DISCOUNT BASED ON THE LATEST HEALTH AND HUMAN/SERVICES (HHS) FEDERAL POVERTY GUIDELINES. PATIENTS IN NEED OF FINANCIAL ASSISTANCE ARE SENT AN APPLICATION AND FOLLOWED UP IN COORDINATION WITH THE HEALTH BENEFITS COUNSELOR. ARMC BELIEVES THAT MANY OF THE ACCOUNTS IN BAD DEBT WOULD HAVE QUALIFIED FOR CHARITY CARE IF THE GUARANTORS WOULD HAVE COMPLETED THE FINANCIAL ASSISTANCE PAPERWORK. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
| PART VI, LINE 2 | IN 2015, A COMPREHENSIVE, SIX-STEP COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") COLLABORATION WAS CONDUCTED FOR HEALTHPARTNERS AND ITS HOSPITALS (REGIONS HOSPITAL, LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, HUDSON HOSPITAL, WESTFIELDS HOSPITAL, ARMC, AND PARK NICOLLET METHODIST HOSPITAL) BY COMMUNITY HOSPITAL CONSULTING TO DETERMINE THE GREATEST HEALTH NEEDS IN THE COMMUNITIES THEY SERVE. THESE HOSPITALS SERVE SIMILAR COMMUNITIES AND HAVE OVERLAPPING STUDY AREAS. THE STUDY AREA IS DEFINED AS DAKOTA, HENNEPIN, RAMSEY, SCOTT, AND WASHINGTON COUNTIES IN MINNESOTA AND POLK AND ST. CROIX COUNTIES IN WISCONSIN. ARMC'S SPECIFIC STUDY AREA IS DEFINED AS:- POLK COUNTYDATA ELEMENTS REGARDING ALL SEVEN COUNTIES IN THE STUDY AREA WERE INCLUDED IN THE REPORT FOR COMPARISON, AND WERE ALSO PROVIDED AS AN OPPORTUNITY FOR THE HOSPITALS TO WORK TOGETHER TO MEET THE NEEDS IDENTIFIED IN THE OVERLAPPING COUNTIES.- DEMOGRAPHICS: CHC CONSULTING ANALYZED THE MOST CURRENT DEMOGRAPHICS OF RESIDENTS IN POLK COUNTY, INCLUDING: OVERALL POPULATION, POPULATION BY RACE AND ETHNICITY, MEDIAN AGE, MEDIAN HOUSEHOLD INCOME, POVERTY LEVELS, FOOD INSECURITY, AND EDUCATIONAL ATTAINMENT.- HEALTH DATA COLLECTION: ARMC PARTICIPATED IN A COUNTY-WIDE INITIATIVE TO ANALYZE THE HEALTH OF RESIDENTS IN THE COMMUNITY, THE POLK COUNTY 2020 COMMUNITY HEALTH IMPROVEMENT PLAN VERSION 2014-2016.- COMMUNITY INPUT: AS A PART OF THE COUNTY-WIDE ASSESSMENT, SURVEYS WERE CONDUCTED TO GATHER INPUT FROM COMMUNITY RESIDENTS. IN ADDITION, ARMC CONDUCTED A COMMUNITY CONVERSATION ON AUGUST 20, 2015 TO GAIN INSIGHT SURROUNDING SIGNIFICANT HEALTH NEEDS.FINAL PRIORITIZED NEEDS - MENTAL AND BEHAVIORAL HEALTH - ACCESS AND AFFORDABILITY - CHRONIC DISEASE AND ILLNESS PREVENTION - EQUITABLE CAREA FULL REPORT OF ARMC'S CHNA AND IMPLEMENTATION PLAN IS POSTED ON ARMC'S WEBPAGE AT HTTP://WWW.AMERYMEDICALCENTER.ORG/COMMUNITY_HEALTH_NEEDS_ASSESSMENT.ASPX. |
| PART VI, LINE 3 | ARMC'S PATIENT FINANCIAL SERVICES DEPARTMENT WORKS WITH EACH PATIENT REGARDING ACCOUNT BALANCES LEFT TO PATIENT RESPONSIBILITY. PATIENTS THAT ARE NOT ALREADY ON GOVERNMENT ASSISTANCE OR HAVE LIMITED ASSISTANCE, ARE REFERRED TO ARMC'S HEALTH BENEFITS COUNSELOR, WHO WORKS WITH THEM TO EVALUATE ASSISTANCE OPTIONS AND ASSISTS IN GETTING APPLICATIONS OR CONTACTS WITH THE APPROPRIATE PROGRAMS. IF ADDITIONAL ASSISTANCE IS NEEDED, THE COUNSELOR WILL WORK WITH THE PATIENT TO APPLY FOR FINANCIAL ASSISTANCE WITH ARMC AND HELPS THEM THROUGH THE PROCESS. THE FINANCIAL ASSISTANCE PROGRAM AND APPLICATION ARE LOCATED ON THE ARMC'S INTERNET SITE TO ALLOW PATIENTS DIRECT ACCESS TO THIS INFORMATION. |
| PART VI, LINE 4 | ARMC SERVICE AREA INCLUDES FIFTEEN DIFFERENT ZIP CODES IN NORTHWEST WISCONSIN THAT PRIMARILY REPRESENT POLK COUNTY. IT INCLUDES THREE RURAL HEALTH CLINICS IN LUCK, TURTLE LAKE, & CLEAR LAKE WHICH ARE ALL MEDICALLY UNDERSERVED AREAS. THE ARMC COMMUNITY IS ALSO CONSIDERED A MENTAL HEALTH MEDICALLY UNDERSERVED AREA. THE WOUND CENTER & INPATIENT PSYCH SERVICE DRAWS PATIENTS FROM OUTSIDE ARMC'S NORMAL SERVICE AREA. |
| PART VI, LINE 5 | TEN OF ARMC'S THIRTEEN BOARD MEMBERS LIVE IN ARMC'S SERVICE AREA. ARMC HAS AN OPEN MEDICAL STAFF WHICH INCLUDES PROVIDERS FROM THE COMMUNITY, AND OTHER COMMUNITIES AS WELL AS THE TWIN CITIES. ANY SURPLUS FUNDS GENERATED ARE USED TO PURCHASE EQUIPMENT, BUILD NEW FACILITIES, AND EXPAND SERVICES AVAILABLE IN ARMC'S COMMUNITY. |
| PART VI, LINE 6 | HEALTHPARTNERS AND ARMC HAVE HAD A LONG-STANDING RELATIONSHIP, WITH HEALTHPARTNERS EMPLOYING AND SOURCING PHYSICIANS AND MID-LEVEL PRACTITIONERS TO ARMC FOR ARMC'S PRIMARY CARE CLINICS. AS OF 2014, ARMC BECAME PART OF THE HEALTHPARTNERS FAMILY OF MISSION-DRIVEN NON-PROFIT ORGANIZATIONS. AS PART OF THE HEALTHPARTNERS FAMILY, ARMC USES HEALTHPARTNERS' INTEGRATED ELECTRONIC HEALTH RECORD SYSTEM, PARTICIPATES IN COORDINATED CHNA PROCESSES AND IMPLEMENTATION STRATEGIES, ACCESSES CENTRALIZED SUPPORT SERVICES IN FINANCE, LEGAL, IS&T, AND QUALITY. THE FOUR HEALTHPARTNERS HOSPITALS IN THE ST. CROIX VALLEY - STILLWATER MN AND HUDSON, NEW RICHMOND, AND AMERY WI - WORK TOGETHER TO ESTABLISH ACCESSIBLE AND COORDINATED SPECIALTY SERVICES IN THE VALLEY FOR THE BENEFIT OF VALLEY RESIDENTS. EXAMPLES OF THESE SERVICES INCLUDE RADIATION THERAPY ON THE NEW RICHMOND CAMPUS, BREAST DIAGNOSTICS ON THE STILLWATER CAMPUS, AND GERIATRIC BEHAVIORAL HEALTH SERVICES ON THE ARMC CAMPUS. HEALTHPARTNERS INCLUDES INSURANCE AND HMO (HEALTH MAINTENANCE ORGANIZATION) ENTITIES THAT PROVIDE CARE COORDINATION, DISEASE MANAGEMENT, ON-LINE CARE FOR BASIC CONDITIONS, A 24 HOUR/7 DAY PER WEEK NURSE LINE, AND OTHER SERVICES THAT ENHANCE CARE FOR MEMBERS, PATIENTS AND THE COMMUNITY. |
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 | AMERICAN CANCER SOCIETY | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 WILLIAMS STREE NW | AddressLine1Txt |
| City | ATLANTA | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30303 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 131788491 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $5,000 | CashGrantAmt |
| Purpose Of Grant | PROGRAM SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | AMERY REGIONAL MEDICAL CENTER, INC. (ARMC) MANAGEMENT STAFF REVIEW THE MISSION AND PURPOSE OF POTENTIAL GRANTEE ORGANIZATIONS TO ASSURE CONSISTENCY WITH ARMC'S MISSION AND PURPOSE. AMOUNTS SUBSEQUENTLY GRANTED ARE SUBJECT TO ARMC'S FORMAL SPENDING APPROVAL AND DOCUMENTATION PROCESS BASED ON AMOUNT OF THE EXPENDITURE. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (15 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROSS R BULLARD | ||||||||||||||
| DIRECTOR & TREASURER | $0 | $179,063 | $0 | $27,125 | $0 | $4,754 | $0 | $31,170 | $0 | $26,711 | $0 | $268,823 | $0 | $0 |
| DYLAN COE MD | ||||||||||||||
| DIRECTOR | $0 | $182,442 | $0 | $0 | $0 | $59,178 | $0 | $53,766 | $0 | $17,221 | $0 | $312,607 | $0 | $0 |
| MARTIN E RICHARDS MD | ||||||||||||||
| DIRECTOR | $0 | $361,661 | $0 | $0 | $0 | $88,449 | $0 | $19,875 | $0 | $31,062 | $0 | $501,047 | $0 | $0 |
| ANN SEAGREN MD | ||||||||||||||
| DIRECTOR | $0 | $187,054 | $0 | $0 | $0 | $93,211 | $0 | $41,321 | $0 | $29,190 | $0 | $350,776 | $0 | $0 |
| TED WEGLEITNER | ||||||||||||||
| DIRECTOR | $0 | $380,178 | $0 | $130,432 | $0 | $10,673 | $0 | $74,602 | $0 | $32,094 | $0 | $627,979 | $0 | $6,196 |
| MARYANN SCOGLIO CANP | ||||||||||||||
| DIRECTOR | $0 | $148,942 | $0 | $0 | $0 | $56,626 | $0 | $15,775 | $0 | $26,335 | $0 | $247,678 | $0 | $0 |
| JASON J LUHRS | ||||||||||||||
| CFO | $0 | $167,211 | $0 | $30,978 | $0 | $6,005 | $0 | $34,077 | $0 | $26,299 | $0 | $264,570 | $0 | $0 |
| SANDRA M REED | ||||||||||||||
| VP - AMBULATORY CARE | $127,827 | $0 | $20,268 | $0 | $6,154 | $0 | $4,807 | $0 | $30,979 | $0 | $190,035 | $0 | $0 | $0 |
| DEBRA RUDQUIST | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $0 | $245,042 | $0 | $59,123 | $0 | $9,303 | $0 | $45,760 | $0 | $28,184 | $0 | $387,412 | $0 | $0 |
| JOYCE R SCHAEFER | ||||||||||||||
| VP-PATIENT CARE | $140,413 | $0 | $22,138 | $0 | $1,259 | $0 | $5,229 | $0 | $30,671 | $0 | $199,710 | $0 | $0 | $0 |
| PATRICK SURA MD | ||||||||||||||
| CHIEF MEDICAL OFFICER | $0 | $385,457 | $0 | $4,375 | $0 | $227,320 | $0 | $19,875 | $0 | $33,484 | $0 | $670,511 | $0 | $0 |
| MARK A TRYGGESTAD | ||||||||||||||
| DIRECTOR OF PHARMACY | $162,981 | $0 | $0 | $0 | $3,979 | $0 | $4,832 | $0 | $11,999 | $0 | $183,791 | $0 | $0 | $0 |
| MARK T MOIOFFER | ||||||||||||||
| PHARMACIST | $124,081 | $0 | $0 | $0 | $1,946 | $0 | $4,101 | $0 | $30,521 | $0 | $160,649 | $0 | $0 | $0 |
| FREDERICK KOSMACH | ||||||||||||||
| PHYSICIAN ASSISTANT | $126,800 | $0 | $0 | $0 | $389 | $0 | $3,715 | $0 | $28,479 | $0 | $159,383 | $0 | $0 | $0 |
| JOANNE L JACKSON | ||||||||||||||
| FORMER HR, PR AND MKTG DIRECTOR | $122,388 | $0 | $9,350 | $0 | $4,559 | $0 | $4,138 | $0 | $18,805 | $0 | $159,240 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 4B | DEFERRED COMPENSATION IN COLUMN C OF SCHEDULE J, PART II INCLUDES AMOUNTS FROM A NONQUALIFIED 457(F) PLAN FOR THE FOLLOWING DIRECTOR: TED WEGLEITNER $36,015 |
| PART II | COLUMN (F) INCLUDES AMOUNTS PAID TO PARTICIPANTS IN THE CURRENT YEAR, WHICH WERE PREVIOUSLY REPORTED IN COLUMN (C) OF PRIOR YEARS' 990'S, AS RETIREMENT AND DEFERRED COMPENSATION, FOR THE FOLLOWING DIRECTORS, OFFICERS AND FORMER OFFICER: TED WEGLEITNER $ 6,196 ANY ANALYSIS OF EARNINGS FOR THE CURRENT YEAR, FOR THESE PARTICIPANTS OF THE PLAN, SHOULD EXCLUDE THE AMOUNT IN COLUMN F AS PART OF THE ANALYSIS SINCE THOSE EARNINGS WERE ALREADY REPORTED IN COLUMN (C) OF PREVIOUS YEARS' 990'S. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| VILLAGE OF LUCK WISCONSIN | |||||||
| A | 396006307 | 2011-04-28 | $8,500,000 | REFINANCE EXISTING DEBT | 0 | 0 | 0 |
| CITY OF AMERY WISCONSIN | |||||||
| B | 396005378 | 2011-04-13 | $8,500,000 | REFINANCE EXISTING DEBT | 0 | 0 | 0 |
| VILLAGE OF CLEAR LAKE WISCONSIN | |||||||
| C | 396006238 | 2011-03-29 | $8,500,000 | REFINANCE EXISTING DEBT | 0 | 0 | 0 |
| TOWN OF BLACK BROOK POLK COUNTY WISCONSIN | |||||||
| D | 391169876 | 2011-05-13 | $6,150,000 | REFINANCE EXISTING DEBT | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|
| A | $2,487,044 | $8,500,000 | $170,000 | $8,330,000 | 2007 | Yes (1) | 0 | Yes (1) | Yes (1) |
| B | $2,487,044 | $8,500,000 | $170,000 | $8,330,000 | 2007 | Yes (1) | 0 | Yes (1) | Yes (1) |
| C | $2,487,044 | $8,500,000 | $170,000 | $8,330,000 | 2007 | Yes (1) | 0 | Yes (1) | Yes (1) |
| D | $1,803,259 | $6,150,000 | $123,000 | $6,027,000 | 2007 | Yes (1) | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00110 | 0.00110 | Yes (1) | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0.00110 | 0.00110 | Yes (1) | 0 | 0 |
| C | 0 | 0 | 0 | 0 | 0.00110 | 0.00110 | Yes (1) | 0 | 0 |
| D | 0 | 0 | 0 | 0 | 0.00110 | 0.00110 | Yes (1) | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 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 | Yes (1) | 0 | 0 | 0 | 0 |
| B | 0 | Yes (1) | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 |
| C | 0 | Yes (1) | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 |
| D | 0 | Yes (1) | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
| C | 0 |
| D | 0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, SCHEDULE K, PART IV, LINE 2A THRU 2C | FormAndLineReferenceDesc |
| Explanation | REBATE CALCULATION IS NOT DUE BUT EVERY 5 YEARS. THERE IS NO REBATE CACLULATION DUE FOR ANY BONDS LISTED IN SCHEDULE K, PART I. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TOWN OF LINCOLN POLK COUNTY WISCONSIN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 391406159 | BondIssuerEIN |
| Bond Issued | 2011-05-31 | BondIssuedDt |
| Issue Price | $6,150,000 | IssuePriceAmt |
| Purpose | REFINANCE EXISTING DEBT | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,803,259 | RetiredAmt |
| Total Proceeds | $6,150,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $123,000 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $1,709,792 | CapitalExpendituresAmt |
| Other Spent Proceeds | $4,317,208 | OtherSpentProceedsAmt |
| Substantial Completion | 2007 | SubstantialCompletionYr |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00110 | PrivateBusUseByOthersPct |
| Total Private Business Use | 0.00110 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | Yes (1) | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4A - EXEMPT PURPOSE AND ACHIEVEMENTS | CORPORATE STRUCTURE, PURPOSE, GOVERNANCE AMERY REGIONAL MEDICAL CENTER (ARMC), A STATE LICENSED 25-BED, LEVEL IV CRITICAL ACCESS HOSPITAL (CAH), IS A WISCONSIN NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3) AND IS PART OF THE FAMILY OF HEALTHPARTNERS ORGANIZATIONS "HEALTHPARTNERS". FOUNDED IN 1957, HEALTHPARTNERS IS AN INTEGRATED SYSTEM OF HEALTH CARE DELIVERY AND HEALTH CARE FINANCING ORGANIZATIONS, AND IS ONE OF THE LARGEST CONSUMER-GOVERNED ORGANIZATIONS IN THE COUNTRY. HEALTHPARTNERS' MISSION IS TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS AND COMMUNITY. HEALTHPARTNERS SEEKS TO TRANSFORM HEALTHCARE THROUGH A RELENTLESS FOCUS ON THE TRIPLE AIM - PROVIDING EXCEPTIONAL EXPERIENCE FOR THE INDIVIDUAL, IMPROVING THE HEALTH OF THE POPULATION, AND MAINTAINING AFFORDABILITY. HEALTHPARTNERS INCLUDES AN ARRAY OF TAX-EXEMPT AND TAXABLE ORGANIZATIONS WITH HEALTH CARE ACTIVITIES PRIMARILY OPERATING IN MINNESOTA AND WESTERN WISCONSIN. HEALTHPARTNERS PROVIDES A FULL-RANGE OF HEALTH CARE DELIVERY AND HEALTH PLAN SERVICES INCLUDING INSURANCE, PATIENT CARE, ADMINISTRATION AND HEALTH AND WELL-BEING PROGRAMS. HEALTHPARTNERS HEALTH PLANS SERVE MORE THAN 1.6 MILLION MEDICAL AND DENTAL MEMBERS NATIONWIDE. HEALTHPARTNERS MEDICAL CARE SYSTEM INCLUDES MORE THAN 1,700 PHYSICIANS AND DENTISTS, SIX OWNED HOSPITALS WITH OVER 1,000 ACUTE CARE BEDS, OVER 100 OWNED AND LEASED PRIMARY AND SPECIALTY CARE MEDICAL FACILITIES AND 24 DENTAL FACILITIES WITH PRACTICES IN MINNESOTA AND WESTERN WISCONSIN. HEALTHPARTNERS ALSO CONTRACTS WITH OTHER PRIMARY AND SPECIALTY MEDICAL FACILITIES AND DENTAL FACILITIES, PHYSICIAN GROUPS, HOSPITALS AND RELATED HEALTHCARE PROVIDERS LOCATED PRIMARILY IN MINNESOTA AND WESTERN WISCONSIN. HEALTHPARTNERS ALSO PROVIDES MEDICAL EDUCATION AND TRAINING TO MEDICAL PROFESSIONALS AND CONDUCTS RESEARCH AND FUND RAISING ACTIVITIES THAT SUPPORT THE HEALTH CARE DELIVERY SYSTEM. A COMPLETE LISTING OF ALL ORGANIZATIONS WITHIN THE HEALTHPARTNERS FAMILY, AND THE RELATIONSHIP BETWEEN THEM, CAN BE FOUND ON SCHEDULE R WITHIN THIS 990 RETURN. DETAILED INFORMATION ABOUT THE COMMUNITY BENEFIT ACTIVITIES AND ACCOMPLISHMENTS OF EACH TAX-EXEMPT ORGANIZATION CAN BE FOUND IN THE INDIVIDUAL FORM 990 RETURN FOR THAT ORGANIZATION. HEALTHPARTNERS IS DRIVING CHANGE THAT HELPS OUR MEMBERS AND PATIENTS LIVE HEALTHIER LIVES. HEALTHPARTNERS COLLABORATE WITH OTHER PLANS, CARE PROVIDERS AND OTHER COMMUNITY AND BUSINESS ORGANIZATIONS IN THE REGION AND THROUGHOUT THE NATION TO INCREASE ACCESS, CREATE AND SHARE QUALITY MEASURES AND INITIATIVES, PARTICIPATE IN DEVELOPMENT OF PUBLIC POLICY, AND COLLABORATE IN IMPROVEMENTS THAT SUPPORT THE TRIPLE AIM. AMONG HEALTHPARTNERS' SIGNATURE INITIATIVES CONTINUING IN 2016 ARE TOTAL COST OF CARE MEASUREMENTS (DEVELOPMENT OF A NATIONALLY RECOGNIZED METRIC, ENDORSED BY THE NATIONAL QUALITY FORUM, ENABLING MEASUREMENT AND INCENTIVES BASED ON COORDINATION AND EVIDENCE-BASED PRACTICES), MENTAL HEALTH (REDUCING STIGMA, AND ASSURING ACCESS TO HIGH QUALITY CARE IN THE MOST APPROPRIATE SETTINGS), CHILDREN'S HEALTH (IMPROVING CHILD HEALTH BY PROMOTING EARLY BRAIN DEVELOPMENT, PROVIDING FAMILY CENTERED CARE, AND STRENGTHENING COMMUNITIES), AND SUSTAINABILITY (ENERGY EFFICIENCY, WASTE REDUCTION, AND RESOURCE MANAGEMENT). HEALTHPARTNERS, INC. (HPI) IS THE PARENT ENTITY OF HEALTHPARTNERS AND IS A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(4). HPI IS THE SOLE CORPORATE MEMBER OF HPI-RAMSEY, A MINNESOTA NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, HPI-RAMSEY IS THE SOLE CORPORATE MEMBER OF REGIONS HOSPITAL, REGIONS HOSPITAL FOUNDATION, CAPITOL VIEW TRANSITIONAL CARE CENTER, STILLWATER HEALTH SYSTEM (LAKEVIEW HEALTH), RAMSEY INTEGRATED HEALTH SERVICES AND RH-WISCONSIN, INC., ALL OF WHICH ARE NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). RH-WISCONSIN AND GROUP HEALTH PLAN, INC. (GHI) ARE CORPORATE MEMBERS OF ARMC. GHI IS A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, ARMC IS THE SOLE CORPORATE MEMBER OF THE AMERY REGIONAL MEDICAL CENTER FOUNDATION (FOUNDATION) A WISCONSIN NON-STOCK CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). BENEFIT TO THE COMMUNITY: 1. COMMUNITY HEALTH IMPROVEMENT SERVICES: $ 251,008 COMMUNITY HEALTH EDUCATION - ARMC HELPS EDUCATE THE LOCAL COMMUNITIES IN REGARDS TO HEALTH ISSUES BY PROVIDING THE FOLLOWING TYPES OF COMMUNITY EDUCATION: CPR/BLS CLASSES, MONTHLY DIABETES SUPPORT GROUP REACHING 120 INDIVIDUALS, EXPECTANT PARENTS/PRE-NATAL AND BREASTFEEDING CLASSES REACHING OVER 40 PARENTS, 11 HEALTH FAIRS REACHING APPROXIMATELY 1450 INDIVIDUALS WITH FOCUS ON HEART HEALTH, STROKE PREVENTION, WOUND HEALING, DIABETES EDUCATION, AND NUTRITION, ONE BIKE SAFETY RODEO WITH EMPHASIS ON INJURY PREVENTION THROUGH HELMET FITTINGS AND GIVEAWAYS, 7 CAR SEAT SAFETY CHECKS, DRIVERS EDUCATION BY EMT/AMBULANCE TO HIGH SCHOOL STUDENTS ON TOPICS SUCH AS DISTRACTED DRIVING, SEATBELT USE, DRINKING AND DRIVING, GARDENING CLASS, 16 MENTAL HEALTH FOCUSED COMMUNITY EDUCATION CLASSES WITH A REACH OF OVER 570 INDIVIDUALS, WOUND HEALING CLINICAL TRAINING PROVIDED TO SURROUNDING HEALTHCARE FACILITIES, AND 18 LOCAL NEWS RADIO SPOTS OVER THE COURSE OF 2016 THAT FEATURED NUTRITION AND WOUND HEALING TOPICS. FOR THE FIRST TIME IN 2016, ARMC OFFERED AT LEAST ONE FREE COMMUNITY EDUCATION CLASS EVERY MONTH. REGISTERED DIETITIANS ALSO STARTED OFFERING TWO DIFFERENT MEDICAL NUTRITION THERAPY CLASSES WITH A FOCUS ON HEALTHY WEIGHT AND DIABETES PREVENTION. ARMC PROVIDES EDUCATION AT OUR SCHOOLS BY HOLDING A 3RD GRADE HEALTH FAIR REACHING 225 STUDENTS FROM AMERY, CLEAR LAKE, CLAYTON, AND TURTLE LAKE. POWERUP, A COMMUNITY-WIDE INITIATIVE TO MAKE IT EASY, FUN AND POPULAR TO EAT BETTER AND BE ACTIVE SO YOUTH CAN REACH THEIR FULL POTENTIAL MADE ITS DEBUT IN THE AMERY AREA WITH GREAT SUCCESS. SOME EXAMPLES INCLUDE: ALL 732 STUDENTS FROM LIEN ELEMENTARY AND AMERY INTERMEDIATE COMPLETED THEIR FIRST SCHOOL CHALLENGE, WHICH ENCOURAGES KIDS TO "TRY FOR 5" FRUITS AND VEGETABLES EVERY DAY. THEIR PARTICIPATION RAISED A COMBINED TOTAL OF $1848 POWERUP BUCKS WHICH WAS USED TO PURCHASED WELLNESS EQUIPMENT. A TOTAL OF FOUR FREE COOKING CLASSES FOR KIDS EXCEEDED CAPACITY WITH 10+ KIDS AT EACH CLASS. NINE OPEN GYMS WERE HELD DURING THE WINTER MONTHS TO GIVE FAMILIES A SPACE TO BE ACTIVE REGARDLESS OF THE WEATHER. A FREE FAMILY 2K RUN/WALK HAD OVER 120 PARTICIPANTS. COMMUNITY-BASED CLINICAL SERVICES - $ 2,960 ARMC PROVIDED 7 FLU SHOT CLINICS AT SURROUNDING AREA BUSINESSES, IMMUNIZING APPROXIMATELY 100 INDIVIDUALS. BEHAVIORAL HEALTH SCREENED 20 TEENS FOR DEPRESSION, SUICIDAL THOUGHTS AND STRESSORS IN GENERAL AT THE AMERY AND CLAYTON HIGH SCHOOL. HEALTH CARE SUPPORT SERVICES - $ 148,371 SOCIAL WORKER, HEALTH BENEFIT COUNSELORS, AND PATIENT FINANCIAL SERVICES REPRESENTATIVES PROVIDE HEALTH CARE SUPPORT SERVICES TO INDIVIDUALS ON A ONE-ON-ONE BASIS. THESE STAFF MEMBERS HELP EDUCATE AND ASSIST INDIVIDUALS WITH ADVANCE DIRECTIVE SUPPORT, INFORMATION AND REFERRAL SERVICES, ENROLLMENT ASSISTANCE IN GOVERNMENT PROGRAMS, FINDING OTHER SOURCES OF PAYMENT, AND ACCESSING SERVICES BEYOND MEDICAL CARE. ARMC SPENT $ 89,891 IN STAFF TIME TO ASSIST PATIENTS IN ENROLLING IN PUBLIC MEDICAL PROGRAMS, FREE DRUG PROGRAMS, AND REFER INDIVIDUALS TO COMMUNITY SERVICES/PUBLIC HEALTH ASSISTANCE. ARMC OPERATES A VAN TRANSPORTATION SERVICE FOR ITS RURAL PATIENT POPULATION. PATIENTS WHO ARE UNABLE TO ARRANGE THEIR OWN TRANSPORTATION TO ARMC FOR CARE AND TREATMENT MAY SCHEDULE A TRANSPORT. PERSONS WHO USE THE SERVICE ARE ASKED TO PAY $2.00 PER RIDE. OVER 1,300 PATIENTS USED THIS SERVICE IN 2016, WITH REVENUE OF $2537 AND OPERATING COST OF $ 58,480. SOCIAL & ENVIRONMENTAL IMPROVEMENT ACTIVITIES DUE TO THE HEALTH PROFESSIONAL SHORTAGE AREA IN THE ARMC SERVICE AREA, NUMEROUS RESOURCES WERE INVESTED IN PHYSICIAN AND ADVANCED PRACTICE PROVIDER RECRUITMENT, TOTALING AT LEAST $ 24,500. ARMC WELCOMED FOUR, NEW ADVANCED PRACTICE PROVIDERS, A SECOND PSYCHIATRIST, A PSYCHIATRY NURSE PRACTITIONER AND TWO NEW FAMILY MEDICINE PHYSICIANS. ARMC PARTNERED WITH THE CITY OF AMERY TO OFFER ADDITIONAL GARDENING PLOTS AT THE COMMUNITY GARDEN LOCATED ON ARMC GROUNDS. A TOTAL OF 12 RAISED GARDEN BEDS WERE PLANTED AND HARVESTED IN 2016. A GARDEN SHED WAS BUILT BY AMERY HIGH SCHOOL STUDENTS AS PART OF THE BUILDING TRADES CLASS, WITH CONTRIBUTIONS FROM LAMBERTS LUMBER, AMERY HIGH SCHOOL, AND AMERY HEALTH & WELLNESS FOUNDATION. |
| FORM 990, PART III, LINE 4A | GARDEN TOOLS WERE DONATED BY AMERY TRUVALUE HARDWARE AND HUNGRY TURTLE INSTITUTE. AMERY EMS PARTICIPATES IN COUNTY-WIDE AND REGIONAL EMERGENCY PREPAREDNESS PLANNING ACTIVITIES TO PLAN FOR LARGE SCALE EVENTS THAT WOULD QUICKLY OVERCOME LOCAL RESOURCES. 2. HEALTH PROFESSIONAL EDUCATION: $ 30,822 STUDENTS IN NURSING, PHYSICIAN ASSISTANT PROGRAMS, PHYSICAL THERAPY, RADIOLOGIC TECHNOLOGY, MEDICAL RECORDS, MEDICAL ASSISTANT, LAB TECHNICIAN, NURSE PRACTITIONERS, AND MEDICAL ADMINISTRATIVE ASSISTANTS, STUDY AT ARMC. ARMC ALSO HAS AN AGREEMENT WITH UNIVERSITY OF MINNESOTA-DULUTH FOR FIRST YEAR AND SECOND YEAR MEDICAL STUDENT ROTATIONS. IN ADDITION, ARMC ACTIVELY COLLABORATES WITH THE WISCONSIN INDIANHEAD TECHNICAL COLLEGE (WITC) TO HELP EDUCATE AND TRAIN YOUNG NURSES. FOR THE YEAR 2016, ARMC PROVIDED CLINICAL TRAINING FOR 96 NURSES, 2 MED STUDENTS, 1 PHLEBOTOMY STUDENT, 1 DIAGNOSTIC TECHNICIAN STUDENT, 4 PHARMACY STUDENTS, AND 2 MEDICAL ASSISTANTS. QUARTERLY CONTINUING MEDICAL EDUCATION THROUGH WOUND HEALING WERE OFFERED BOTH LOCALLY AND VIA WEB MEETING FORMAT TO ALL PROVIDER TYPES TO EDUCATE ON ISSUES SPECIFIC TO CHRONIC WOUNDS. EACH YEAR ARMC AND THE FOUNDATION PROVIDE SEVEN $1,000 SCHOLARSHIPS TO LOCAL HIGH SCHOOL SENIORS PURSUING A CAREER IN A HEALTH-RELATED FIELD. ARMC'S SHARE OF THE COST WAS $3,500. 3. SUBSIDIZED HEALTH SERVICES: NONE 4. FINANCIAL CONTRIBUTIONS: $ 187,976 CASH DONATIONS - ARMC HELPED VARIOUS NON-PROFIT ORGANIZATIONS, COMMUNITY GROUPS, AND SCHOOL PROGRAMS THROUGH CASH DONATIONS TOTALING $ 25,411. IN-KIND DONATIONS - IN-KIND SERVICES DONATED INCLUDED STAFF HOURS SPENT IN SUPPORT OF LOCAL COMMUNITY BOARDS OR COMMITTEE WORK SUCH AS: VALLEY BEHAVIORAL HEALTH STEERING COMMITTEE, DEMENTIA FRIENDLY COMMUNITIES COALITION, NORTHWESTERN WISCONSIN HEALTHCARE COALITION, POLK COUNTY INFECTION PREVENTION COORDINATORS MEETING, INJURY PREVENTION COMMITTEE, REGIONAL TRAUMA ADVISORY COMMITTEE, UNITED WAY OF ST. CROIX VALLEY, MENTAL HEALTH TASK FORCE OF POLK COUNTY, POLK COUNTY COMMUNITY HEALTH IMPROVEMENT PLANNING GROUP, AND THE POLK COUNTY OBESITY PREVENTION GROUP. ARMC ATHLETIC TRAINERS ARE IN BOTH AMERY AND LUCK SCHOOL DISTRICTS, PROVIDING OVER 2000 HOURS OF ATHLETIC TRAINING AND SUPPORT FOR A MINIMAL FEE TOTALING $ 13,112, WITH THE BENEFIT OF DONATED SERVICES TOTALING $ 73,824. ARMC HOSTED TWO BLOOD DRIVES COLLECTING A TOTAL OF 56 UNITS OF BLOOD FROM 62 INDIVIDUALS IN SUPPORT OF THE AMERICAN RED CROSS. ARMC PROVIDES MEETING SPACE FOR NON-PROFIT AND COMMUNITY GROUPS WITH A HEALTH FOCUS SUCH AS THE AMERICAN RED CROSS, BABY & ME, PRENATAL & BREASTFEEDING SUPPORT, DAVITA KIDNEY SMART, AND WITC NURSING PROGRAM TOTALING $ 5,042. IN ORDER TO HELP COMBAT POVERTY, ARMC PROVIDES THE LOCAL FOOD SHELF, AMERY AREA FOOD SHELF, WITH FREE RENT, HEAT AND SHELVING FOR FOOD ITEMS. IN 2016, A TOTAL OF $ 74,892 WAS PROVIDED TO THIS LOCAL PROGRAM. 5. COMMUNITY BUILDING ACTIVITIES: $ 14,263 PHYSICAL IMPROVEMENTS AND HOUSING - ARMC HAS A REPRESENTATIVE ON THE AMERY WALKABILITY COMMITTEE DEFINING AND IMPROVING WALKING SPACES AND BIKE PATH DEVELOPMENT. ECONOMIC DEVELOPMENT - ARMC HAS A REPRESENTATIVE ON THE AMERY ECONOMIC DEVELOPMENT BOARD WHICH MEETS MONTHLY TO WORK ON ECONOMIC DEVELOPMENT AND THE CREATION OF JOBS IN THE AMERY AREA THROUGH PROCESSES INCLUDING HOTEL STUDY, INDUSTRIAL PARKS, AND HOUSING STUDY. COMMUNITY SUPPORT - ARMC COORDINATED THE PURCHASE, INSTALLATION, AND REGISTRATION OF A "FREE LITTLE LIBRARY" LOCATED ON THE ARMC CAMPUS. FREE LITTLE LIBRARY IS A "TAKE A BOOK, LEAVE A BOOK" PERMANENT INSTALLATION AND IS AVAILABLE TO ALL COMMUNITY MEMBERS. THE MISSION OF FREE LITTLE LIBRARY IS TO PROMOTE LITERACY AND THE LOVE OF READING BY BUILDING FREE BOOK EXCHANGES WORLDWIDE AND TO BUILD A SENSE OF COMMUNITY AS WE SHARE SKILLS, CREATIVITY AND WISDOM ACROSS GENERATIONS. ARMC PROVIDES MEETING SPACE FOR NON-PROFIT AND COMMUNITY GROUPS WITHOUT A HEALTH FOCUS SUCH AS THE GIRL SCOUTS AND POLK COUNTY EXTENSION TOTALING $ 185. ENVIRONMENTAL IMPROVEMENTS - ARMC HAS A REPRESENTATIVE ATTEND THE ANNUAL CLEANMED CONFERENCE WHICH IS A NATIONAL ENVIRONMENTAL CONFERENCE FOR LEADERS IN HEALTH CARE SUSTAINABILITY. ARMC CONTINUES TO BE A SUSTAINABILITY CHAMPION AND HOSTS AN ELECTRONICS RECYCLING EVENT, RECYCLING 6,600 POUNDS FROM OUR AREA COMMUNITIES. WORKFORCE DEVELOPMENT - ARMC HAS REPRESENTATIVES SERVE ON THE WITC MEDICAL ASSISTANT ADVISORY COMMITTEE, WITC ADVISORY COUNCIL, AND WITC HEALTH INFORMATION TECHNOLOGY ADVISORY COMMITTEE. A MOCK INTERVIEW DAY AT WITC WAS ATTENDED BY 2 ARMC STAFF INTENDED FOR STUDENTS CURRENTLY ENROLLED IN THE NURSING, MEDICAL ASSISTANT AND MEDICAL ADMINISTRATIVE SPECIALIST PROGRAMS. THIS INCLUDED PRACTICE INTERVIEW QUESTIONS AND RESUME REVIEW. 6. COMMUNITY BENEFIT OPERATIONS: $ 29,033 IN 2016 EXTENSIVE STAFF TRAINING WAS CONDUCTED ON THE TOPIC OF COMMUNITY BENEFIT AND ACCURATELY CAPTURING OUR COMMUNITY BENEFIT ACTIVITIES. ALL DEPARTMENTS WERE REPRESENTED AND WE CONTINUE TO WORK TOWARD ACCURATE AND COMPLETE REPORTING THROUGH THE USE OF CBISA, A WEB-BASED REPORTING PROGRAM. ARMC HAD A REPRESENTATIVE ATTEND THE WISCONSIN HEALTH ASSOCIATION POPULATION HEALTH SUMMIT WHICH HAD NATIONAL EXPERTS SPEAK ON AREAS OF COMPLIANCE, CHNA PROCESS, AND BEST PRACTICES, HELPING TO CREATE HEALTHY COMMUNITIES IN WISCONSIN. 7. ORGANIZATION AWARDS AND ACHIEVEMENTS PRACTICE GREENHEALTH PARTNER FOR CHANGE - WISCONSIN SUSTAINABLE BUSINESS COUNCIL GREEN PROFESSIONAL AWARD - WISCONSIN SUSTAINABLE BUSINESS COUNCIL THE CENTERS FOR MEDICARE SERVICES FIVE-STAR QUALITY RATING - ARMC ACHIEVED FOUR OUT OF FIVE STARS, WHICH MEANS WE ARE AMONG THE ELITE AS ONLY 20 PERCENT OF U.S. HOSPITALS ACHIEVED THIS RATING AND ONLY 2.2 ACHIEVED FIVE STARS. |
| FORM 990, PART VI, SECTION A, LINE 6 | RH WISCONSIN, INC. IS THE CLASS A MEMBER AND GHI IS THE CLASS B MEMBER OF ARMC. |
| FORM 990, PART VI, SECTION A, LINE 7A | ARMC'S BOARD OF DIRECTORS IS COMPRISED OF NOT MORE THAN 13 PERSONS APPOINTED AS FOLLOWS: - 7 COMMUNITY REPRESENTATIVES APPOINTED BY THE CLASS A MEMBER (RH-WISCONSIN), FROM RECOMMENDATIONS BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. - 3 REPRESENTATIVES APPOINTED BY THE CLASS B MEMBER (GHI). - 3 HEALTH CARE PROVIDERS NOMINATED BY THE PHYSICIAN GROUP STAFFING ARMC'S PRIMARY CARE CLINIC, AND APPOINTED BY THE CLASS B MEMBER (GHI). - THE PRESIDENT AND CHIEF MEDICAL OFFICER OF ARMC SIT IN EX-OFFICIO CAPACITIES, WITHOUT THE RIGHT TO VOTE. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE CLASS A AND CLASS B MEMBERS (RH WISCONSIN, INC. AND GHI RESPECTIVELY) BOTH MUST APPROVE THE DECISIONS OF THE BOARD OF DIRECTORS AS FOLLOWS: - AMENDMENT OF ARTICLES OR BYLAWS IMPACTING MEMBERSHIP - RESIGNATION OF A MEMBER - DISSOLUTION - ANY CHANGE IN THE FUNDAMENTAL NATURE OR PURPOSE - MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION - DISPOSITION OF SUBSTANTIALLY ALL ASSETS. ONLY THE CLASS A MEMBER MUST APPROVE THE DECISIONS OF THE BOARD OF DIRECTORS AS FOLLOWS: - AMENDMENT OF ARTICLES OR BYLAWS NOT IMPACTING MEMBERSHIP - ANNUAL OPERATING AND CAPITAL BUDGETS AND STRATEGIC PLANS - ESTABLISHMENT OF NEW ENTITIES OR SIGNIFICANT RELATIONSHIPS WITH OTHER ENTITIES - UNBUDGETED EXPENDITURES IN EXCESS OF AMOUNTS ESTABLISHED BY THE MEMBER - GUARANTEEING THE DEBT OF ANY OTHER PERSON OR ENTITY - A LOAN OR OTHER INDEBTEDNESS IN EXCESS OF AMOUNTS ESTABLISHED BY THE MEMBER - TRANSFER OF ASSETS TO ANOTHER ENTITY - APPOINTMENT OF THE PRESIDENT AND THE BOARD CHAIR. |
| FORM 990, PART VI, SECTION B, LINE 11B | ARMC'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF ARMC. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF ARMC, GHI'S INTERNAL LEGAL DEPARTMENT AND ARMC'S OUTSIDE INDEPENDENT ACCOUNTANTS. EACH ONE OF THOSE AREAS HAS AN OPPORTUNITY TO REVIEW, ASK QUESTIONS AND MAKE COMMENTS BACK TO THE TAX DEPARTMENT OF GHI BEFORE THE FORM 990 IS COMPLETED AND PRESENTED TO THE GOVERNING BODY OF ARMC. ARMC MAKES AVAILABLE TO THE GOVERNING BODY (BOARD OF DIRECTORS) A COPY OF THE 990 FOR REVIEW AND COMMENT PRIOR TO THE FILING OF THE 990 RETURN. THIS COPY IS PROVIDED IN A PRE-MEETING PACKET, AND IS AN AGENDA ITEM AT A MEETING OF THE FULL BOARD OF DIRECTORS. THIS PROCESS IS NOTED AND DOCUMENTED IN THE WRITTEN MINUTES OF THE MEETING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ARMC BOARD OF DIRECTORS MONITORS POTENTIAL CONFLICTS OF INTEREST OF ITS BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES, BY MAINTAINING A CONFLICT OF INTEREST POLICY. ANNUALLY, UNDER THE POLICY, ALL BOARD MEMBERS, PRINCIPAL OFFICERS, MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS AND KEY EMPLOYEES ARE PROVIDED WITH A COPY OF THE POLICY AND REQUESTED TO COMPLETE A QUESTIONNAIRE IDENTIFYING ANY POTENTIAL CONFLICTS OF INTERESTS. A REPORT OF THESE POTENTIAL CONFLICTS IS SHARED WITH THE CHAIR AND THE CEO. BOARD AGENDAS AND EXECUTIVE DECISIONS ARE DOCUMENTED IN RELATION TO THIS POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15 | ARMC'S CEO AND ITS OFFICERS ARE EMPLOYED BY REGIONS HOSPITAL (REGIONS) OR BY GROUP HEALTH PLAN, INC. (GHI), BOTH OF WHICH ARE RELATED ORGANIZATIONS, OR BY ARMC. GHI, REGIONS, AND ARMC HAVE AN ANNUAL PROCESS TO REVIEW THE MARKET COMPARABILITY OF THE TOTAL COMPENSATION OF ARMC'S CEO AND OTHER OFFICERS. EVERY THREE YEARS, THE INDEPENDENT COMPENSATION COMMITTEE OF THE GHI BOARD OF DIRECTORS (THE "COMMITTEE"), RETAINS AN EXTERNAL COMPENSATION EXPERT TO CONDUCT AN EXTENSIVE MARKET COMPARABILITY REVIEW FOR ALL OFFICERS OF THE ORGANIZATION. THE REVIEW INCLUDES ALL COMPONENTS OF TOTAL COMPENSATION: BASE SALARY, ANNUAL INCENTIVES, BENEFITS AND PERQUISITES. THE MARKET SURVEY RESULTS ARE PRESENTED TO, REVIEWED BY AND APPROVED BY THE APPROPRIATE COMMITTEE. BASED ON THIS DATA, EITHER THE EXECUTIVE COMMITTEE OF REGIONS, THE COMPENSATION COMMITTEE OF GHI OR THE ARMC EXECUTIVE COMMITTEE (THE "COMMITTEES") DETERMINE MINIMUM AND MAXIMUM TOTAL COMPENSATION RANGES FOR EACH EMPLOYED OFFICER. IN INTERIM YEARS, GHI'S HUMAN RESOURCES STAFF, UNDER THE COMMITTEES' DIRECTION, UPDATES CHANGES IN THE SALARY STRUCTURE BASED ON THE SAME INDEPENDENT STUDIES PERFORMED BY THE COMPENSATION CONSULTANT FOR THE COMMITTEE. FOR CERTAIN POSITIONS FULL INDEPENDENT REVIEWS ARE PERFORMED TO SET SALARY RANGES BASED ON THE COMPETITIVE MARKET DATA SPECIFIC TO THOSE POSITIONS. THE COMMITTEES REVIEW AND APPROVE EACH YEAR'S COMPENSATION RESULTS. IN ALL CASES, THE COMMITTEES' MEMBERS COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY TO ASSURE THE COMMITTEES MEMBERS' INDEPENDENCE AND THIS IS UPDATED AT ANY MEETING AT WHICH DECISIONS ARE BEING MADE. STAFF (OTHER THAN THE SECRETARY TO THE BOARD) IS NOT IN THE ROOM DURING DELIBERATIONS OR VOTE INCLUDING EXECUTIVE SESSIONS, AND CONTEMPORANEOUS MINUTES ARE KEPT. WITH ARMC'S BOARD OF DIRECTORS INPUT, THE ST CROIX VALLEY EXECUTIVE LEADER CONDUCTS THE ANNUAL PERFORMANCE REVIEW AND, WITH ARMC'S BOARD APPROVAL, DETERMINES THE COMPENSATION OF THE ARMC CEO. THE ARMC BOARD HAS DELEGATED TO THE CEO THE ACCOUNTABILITY TO CONDUCT ANNUAL PERFORMANCE REVIEWS AND DETERMINE THE COMPENSATION OF ALL ARMC-EMPLOYED OFFICERS WITHIN THE COMPENSATION RANGES DETERMINED BY THE COMMITTEE. ANY EXCEPTIONS TO COMPENSATION IN EXCESS OF THE APPROVED RANGES ARE APPROVED BY THE ARMC EXECUTIVE COMMITTEE. TOTAL COMPENSATION IS APPROPRIATELY DOCUMENTED ON THE FORM 990 AND ON THE EMPLOYEE'S W-2. |
| FORM 990, PART VI, SECTION C, LINE 18 | ARMC 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM ARMC OR HEALTHPARTNERS, INC. |
| FORM 990, PART VI, SECTION C, LINE 19 | ARMC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| 990, PART VII, SEC A, LN 1A, COL (B) - RELATED ORGANIZATION AVERAGE HOURS | DIRECTORS AND OFFICERS OF ARMC ARE EMPLOYED AND COMPENSATED BY GHI, INC., REGIONS HOSPITAL OR ARMC. REPORTED AVERAGE HOURS WORKED ARE BASED ON THEIR TOTAL COMPENSATION FROM ALL RELATED ORGANIZATIONS. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (26 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| HEALTHPARTNERS INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411693838 | HYBRID STAFF MODEL/NETWORK MODEL HEALTH MAINTENANCE ORGANIZATION | MN | 501(C)(4) | N/A | 0 | ||
| HPI - RAMSEY | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411793333 | CORPORATE PLANNING AND OVERSIGHT | MN | 501(C)(3) | 0 | 509(A)(3) TYPE I | HEALTHPARTNERS INC | |
| GROUP HEALTH PLAN INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 410797853 | STAFF MODEL HEALTH MAINTENANCE ORGANIZATION | MN | 501(C)(3) | 0 | 170(B)(1) (A)(III) | HEALTHPARTNERS INC | |
| HEALTHPARTNERS INSTITUTE | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411670163 | HEALTHCARE EDUCATION & RESEARCH | MN | 501(C)(3) | 0 | 509(A)(3) TYPE I | HEALTHPARTNERS INC | |
| CAPITOL VIEW TRANSITIONAL CARE CENTER | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 412011453 | POST HOSPITALIZATION PATIENT CARE | MN | 501(C)(3) | 0 | 170(B)(1) (A)(III) | HPI - RAMSEY | |
| REGIONS HOSPITAL | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 410956618 | HOSPITAL | MN | 501(C)(3) | 0 | 170(B)(1) (A)(III) | HPI - RAMSEY | |
| REGIONS HOSPITAL FOUNDATION | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411888902 | PROVIDE SUPPORT TO HOSPITAL AND TO IMPROVE COMMUNITY HEALTH | MN | 501(C)(3) | 0 | 170(B)(1) (A)(VI) | HPI - RAMSEY | |
| RHSC INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411891928 | HEALTHCARE STAFFING | MN | 501(C)(3) | 0 | 509(A)(3) TYPE II | HEALTHPARTNERS INC | |
| RH-WISCONSIN | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 202287016 | CORPORATE PLANNING AND OVERSIGHT | WI | 501(C)(3) | 0 | 509(A)(3) TYPE I | HPI - RAMSEY | |
| PHYSICIANS NECK AND BACK CLINICS | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 270684883 | SPECIALTY PATIENT CARE | MN | 501(C)(3) | 0 | 509(A)(3) TYPE II | GROUP HEALTH PLAN INC | |
| HUDSON HOSPITAL INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 390804125 | HOSPITAL | WI | 501(C)(3) | 0 | 170(B)(1) (A)(III) | RH-WISCONSIN | |
| HUDSON HOSPITAL FOUNDATION INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 391279567 | PROVIDE SUPPORT TO HOSPITAL AND TO IMPROVE COMMUNITY HEALTH | WI | 501(C)(3) | 0 | 170(B)(1) (A)(VI) | HUDSON HOSPITAL INC | |
| LAKEVIEW MEMORIAL HOSPITAL FOUNDATION | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411386635 | PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT | MN | 501(C)(3) | 0 | 509(A)(3) TYPE II | STILLWATER HEALTH SYSTEM | |
| LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 410811697 | HOSPITAL | MN | 501(C)(3) | 0 | 170(B)(1) (A)(III) | STILLWATER HEALTH SYSTEM | |
| STILLWATER MEDICAL GROUP | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 830379473 | PHYSICIANS GROUP | MN | 501(C)(3) | 0 | 509(A)(3) TYPE I | STILLWATER HEALTH SYSTEM | |
| STILLWATER HEALTH SYSTEM | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 300221189 | CORPORATE PLANNING AND OVERSIGHT | MN | 501(C)(3) | 0 | 509(A)(3) TYPE II | HPI - RAMSEY | |
| WESTFIELDS HOSPITAL INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 390808442 | HOSPITAL | WI | 501(C)(3) | 0 | 170(B)(1) (A)(III) | RH-WISCONSIN | |
| WESTFIELDS HOSPITAL FOUNDATION INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 391770913 | PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT | WI | 501(C)(3) | 0 | 509(A)(3) TYPE I | WESTFIELDS HOSPITAL INC | |
| RAMSEY INTEGRATED HEALTH SERVICES | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411503090 | IN-HOME PATIENT CARE | MN | 501(C)(3) | 0 | 509(A)(2) | HPI - RAMSEY | |
| PARK NICOLLET HEALTH SERVICES | |||||||||||
| 6500 EXCELSIOR BLVD | ST LOUIS PARK | MN | 55426 | 363465840 | CORPORATE PLANNING AND OVERSIGHT | MN | 501(C)(3) | 0 | 509(A)(2) | HEALTHPARTNERS INC | |
| PARK NICOLLET FOUNDATION | |||||||||||
| 6500 EXCELSIOR BLVD | ST LOUIS PARK | MN | 55426 | 237346465 | GRANTS TO SERVE THE COMMUNITY | MN | 501(C)(3) | 0 | 170(B)(1) (A)(VI) | PARK NICOLLET HEALTH SERVICES | |
| PARK NICOLLET METHODIST HOSPITAL | |||||||||||
| 6500 EXCELSIOR BLVD | ST LOUIS PARK | MN | 55426 | 410132080 | HOSPITAL | MN | 501(C)(3) | 0 | 170(B)(1) (A)(III) | PARK NICOLLET HEALTH SERVICES | |
| PARK NICOLLET HEALTH CARE PRODUCTS | |||||||||||
| 6500 EXCELSIOR BLVD | ST LOUIS PARK | MN | 55426 | 010638901 | HEALTHCARE PRODUCTS | MN | 501(C)(3) | 0 | 509(A)(3) TYPE I | PARK NICOLLET HEALTH SERVICES | |
| PARK NICOLLET CLINIC | |||||||||||
| 6500 EXCELSIOR BLVD | ST LOUIS PARK | MN | 55426 | 410834920 | HEALTHCARE | MN | 501(C)(3) | 0 | 170(B)(1) (A)(III) | PARK NICOLLET HEALTH SERVICES | |
| PNMC HOLDINGS | |||||||||||
| 6500 EXCELSIOR BLVD | ST LOUIS PARK | MN | 55426 | 411741792 | HEALTHCARE REAL ESTATE | MN | 501(C)(3) | 0 | 509(A)(3) TYPE I | PARK NICOLLET CLINIC | |
| AMERY REGIONAL MEDICAL CENTER FOUNDATION INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 391726539 | PROVIDE SUPPORT TO HOSPITAL AND TO IMPROVE COMMUNITY HEALTH | WI | 501(C)(3) | Yes (1) | 170(B)(1) (A)(VI) | AMERY REGIONAL MEDICAL CENTER INC | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMERY REGIONAL MEDICAL CENTER PHARMACY LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 265 GRIFFIN STREET E | AddressLine1Txt |
| City | AMERY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391979705 | EIN |
| Primary Activities | PHARMACEUTICAL | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMERY REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Share Of Total Income | -$82,791 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $128,062 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.50000 | OwnershipPct |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| HEALTHPARTNERS ADMINISTRATORS INC | |||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411629390 | THIRD PARTY ADMINISTRATOR | MN | HEALTHPARTNERS INC | C | 0 |
| HEALTHPARTNERS ASSOCIATES INC | |||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 522365151 | MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT | MN | HEALTHPARTNERS ADMINISTRATORS INC | C | 0 |
| HEALTHPARTNERS SERVICES INC | |||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411683568 | MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT | MN | HEALTHPARTNERS ADMINISTRATORS INC | C | 0 |
| HEALTHPARTNERS INSURANCE COMPANY | |||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411683523 | MEDICAL AND DENTAL INSURANCE | MN | HEALTHPARTNERS ADMINISTRATORS INC | C | 0 |
| DENTAL SPECIALTIES INC | |||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 451297583 | PROFESSIONAL DENTAL SERVICES | MN | HEALTHPARTNERS ADMINISTRATORS INC | C | 0 |
| HEALTHPARTNERS CENTRAL MINNESOTA CLINICS INC | |||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411236798 | MEDICAL CLINIC STAFFING | MN | HEALTHPARTNERS ADMINISTRATORS INC | C | 0 |
| PARK NICOLLET ENTERPRISES | |||||||||
| 6500 EXCELSIOR BLVD | ST LOUIS PARK | MN | 55426 | 411656735 | REAL ESTATE FOR RELATED ORGANIZATIONS | MN | PARK NICOLLET HEALTH SERVICES | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | 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 | 0 | 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 |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEALTHPARTNERS INC - CLAIMSHEALTHCARE SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | L | TransactionTypeTxt |
| Involved | $225,221 | InvolvedAmt |