MEMORIAL HOSPITAL INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL HOSPITAL INC (EIN 39-0806828)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-14
- IRS object ID
- 201633199349310093
- Schema version
- 2015v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-14T16:20:04-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wipfli LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3703 Oakwood Hills Pkwy | AddressLine1Txt |
| City | Eau Claire | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390806828 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MEMO | BusinessNameControlTxt |
| Phone | 7157433101 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 216 SUNSET PLACE | AddressLine1Txt |
| City | NEILLSVILLE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54456 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Ryan Neville | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7157433101 | PhoneNum |
| Signature | 2016-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DONNA NELSON CPA | PreparerPersonNm |
| PTIN | P00968978 | PTIN |
| Phone | 7158323407 | PhoneNum |
| Preparation | 2016-11-14 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Ryan Neville | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 216 SUNSET PLACE | AddressLine1Txt |
| City | NEILLSVILLE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54456 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $26,952,609 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MEMORIALMEDCENTER.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1954 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | MEMORIAL HOSPITAL, INC.'S MISSION IS TO PROVIDE THE COMMUNITIES WE SERVE THE BEST EXPERIENCE IN HEALTH CARE, EDUCATION, AND PREVENTION SUPPORTED BY OUR PILLARS OF PEOPLE, SERVICE, QUALITY AND SAFETY, FINANCE, COMMUNITY, AND GROWTH...ONE PATIENT AT A TIME. MEMORIAL HOSPITAL, INC. PROVIDES SERVICES THROUGH ITS 25-BED CRITICAL ACCESS HOSPITAL, ASSISTED LIVING, AS WELL AS 3 RURAL HEALTH CLINICS LOCATED IN NEILLSVILLE, LOYAL, AND GREENWOOD, WISCONSIN. TO FULFILL COMMUNITY NEEDS, MEMORIAL HOSPITAL, INC. FACILITATES EDUCATIONAL SEMINARS AND SUPPORT GROUPS LED BY MEDICAL AND PROFESSIONAL STAFF AT GREATLY REDUCED-RATES; PROVIDES FREE HEALTH SCREENINGS AT GIVEN TIMES THROUGHOUT THE YEAR; STAFF BOOTHS AT COMMUNITY EVENTS; SERVES AS AN EDUCATION SITE FOR STUDENTS IN HIGH SCHOOL, TECHNICAL COLLEGE, AND UNIVERSITIES; AS WELL AS OTHER NEEDS AS DETERMINED. MEMORIAL HOSPITAL, INC. ALSO ADMINISTERS A CHARITY CARE PROGRAM HELPING TO ENSURE AFFORDABLE ACCESS TO HEALTH CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 256 | TotalEmployeeCnt |
| Total Volunteers | 78 | TotalVolunteersCnt |
| Total Gross UBI | $434,593 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$194,364 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $142,543 | PYContributionsGrantsAmt |
| CY Contributions Grants | $110,899 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $24,174,112 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $26,414,056 | CYProgramServiceRevenueAmt |
| PY Investment Income | $87,046 | PYInvestmentIncomeAmt |
| CY Investment Income | -$71,782 | CYInvestmentIncomeAmt |
| PY Other Revenue | $464,289 | PYOtherRevenueAmt |
| CY Other Revenue | $404,455 | CYOtherRevenueAmt |
| PY Total Revenue | $24,867,990 | PYTotalRevenueAmt |
| CY Total Revenue | $26,857,628 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $15,109,918 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $16,419,504 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,423,636 | PYOtherExpensesAmt |
| CY Other Expenses | $10,103,725 | CYOtherExpensesAmt |
| PY Total Expenses | $25,533,554 | PYTotalExpensesAmt |
| CY Total Expenses | $26,523,229 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$665,564 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $334,399 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,247,440 | TotalAssetsBOYAmt |
| Total Assets EOY | $15,651,312 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,841,327 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,910,800 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,406,113 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,740,512 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE THE COMMUNITIES WE SERVE THE BEST EXPERIENCE IN HEALTH CARE, EDUCATION, AND PREVENTION, SUPPORTED BY OUR PILLARS OF PEOPLE, SERVICE, QUALITY AND SAFETY, FINANCE, COMMUNITY, AND GROWTH...ONE PATIENT AT A TIME. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $14,632,376 | ExpenseAmt |
| Revenue | $22,185,303 | RevenueAmt |
| Desc | MEMORIAL HOSPITAL, INC. (THE "HOSPITAL"), A 25-BED RURAL HOSPITAL, IS A NONPROFIT, NONSTOCK WISCONSIN CORPORATION PROVIDING SERVICES TO NEILLSVILLE, WISCONSIN, AND THE SURROUNDING COMMUNITIES. HOSPITAL INPATIENT SERVICES IN 2015 INCLUDED 727 ACUTE CARE PATIENT DAYS, 187 OBSERVATION DAYS, AND 530 SWING BED PATIENT DAYS.EMERGENCY ROOM VISITS TOTALED 530, URGENT CARE VISITS TOTALED 2,727, AND SURGERIES AND PROCEDURES TOTALED 848 IN 2015.OTHER HOSPITAL SERVICES PROVIDED IN 2015 INCLUDED BUT WERE NOT LIMITED TO: PRIMARY CARE, ORTHOPEDIC AND GENERAL SURGERY CLINIC AND PROCEDURES, ATHLETIC TRAINING, DIETARY, PAIN MANAGEMENT, PHARMACY, PHYSICAL THERAPY, RADIOLOGY, LABORATORY, CARDIAC REHABILITATION, RESPIRATORY THERAPY, OCCUPATIONAL THERAPY, AND DIABETIC EDUCATION. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,290,671 | ExpenseAmt |
| Revenue | $3,665,445 | RevenueAmt |
| Desc | Memorial Hospital, Inc. also owns and operates three clinics located in Neillsville, Loyal, and Greenwood, Wisconsin. Total clinic visits for 2015 was 23,403. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $747,461 | ExpenseAmt |
| Revenue | $381,281 | RevenueAmt |
| Desc | The assisted living facility is an alternative for seniors who can no longer live safely in their own home, yet do not need 24-hour medical supervision. Sunset Gardens is a housing and health care alternative, combining independence with personal care, in a warm, dignified, home-like atmosphere. Sunset gardens has 11 private rooms and 2 double rooms, for a couple or siblings. Meals, snacks, housekeeping, laundry, cable television, and maintenance services are provided. Social and recreational programs and a chapel are also provided. Health care services include a registered nurse on-site or on-call 24-hours per day, medication management, and personal care services provided by certified nursing assistants (such as assistance with bathing, dressing, and grooming). THE ASSISTED LIVING PROVIDED approximately 4,535 resident days during 2015. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $21,670,508 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| 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 | Yes (1) | 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 | 43 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 256 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Kelly Silbernagel | PersonNm |
| Phone | 7157433101 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 216 SUNSET PLACE | AddressLine1Txt |
| City | neillsville | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54456 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| ROBERT BARTH | ||||||||
| CHAIRMAN | 2.00 | 0.50 | Yes (X) | Yes (X) | $275 | $0 | $0 | |
| RICK SZYMANSKI | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $325 | $0 | $0 | |||
| Kevin Grap | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $200 | $0 | $0 | ||
| TREVOR WUETHRICH | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $250 | $0 | $0 | |||
| MARY KAY MILLS | ||||||||
| Board MEMBER | 1.00 | 0.50 | Yes (X) | $325 | $0 | $0 | ||
| JAMES CHADWICK | ||||||||
| Board MEMBER | 1.00 | Yes (X) | $325 | $0 | $0 | |||
| GARY WEIRAUCH | ||||||||
| Board MEMBER | 1.00 | Yes (X) | $300 | $0 | $0 | |||
| RUSSELL RATSCH | ||||||||
| VICE CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $275 | $0 | $0 | ||
| BARBARA PETKOVSEK | ||||||||
| Board MEMBER | 1.00 | Yes (X) | $225 | $0 | $0 | |||
| DR DAVID CARLSON | ||||||||
| CHief Medical Officer | 33.00 | Yes (X) | $791,331 | $0 | $21,027 | |||
| DR SHARON HAYWARD | ||||||||
| PHYSICIAN | 33.00 | Yes (X) | $493,102 | $0 | $31,149 | |||
| ROGER SNEATH | ||||||||
| INTERIM CFO | 40.00 | Yes (X) | $93,229 | $0 | $0 | |||
| RYAN NEVILLE | ||||||||
| PRESIDENT & CEO | 40.00 | 0.50 | Yes (X) | $228,495 | $0 | $32,220 | ||
| Kelly Silbernagel | ||||||||
| CFO | 40.00 | Yes (X) | $96,537 | $0 | $25,518 | |||
| DR MARIA CRUZ-APOLINARIO | ||||||||
| PHYSICIAN | 33.00 | $667,780 | $0 | $29,379 | Yes (X) | |||
| DR Timothy Meyer | ||||||||
| PHYSICIAN | 33.00 | 0.50 | $432,191 | $0 | $13,317 | Yes (X) | ||
| DR AMY SCHNEIDER DE CORTEZ | ||||||||
| PHYSICIAN | 33.00 | $300,270 | $0 | $24,519 | Yes (X) | |||
| Dr James Stanga | ||||||||
| PHYSICIAN | 33.00 | $297,038 | $0 | $25,254 | Yes (X) | |||
| Dr Kenneth Weimer | ||||||||
| PhYSICIAN | 33.00 | $289,776 | $0 | $31,815 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,692,249 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $234,198 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 19 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| EMCARE INC | |||||
| 8032 COLLECTION CENTER DRIVE | CHICAGO | IL | 60693 | ER Medical Services | $571,465 |
| Wi ANETHESIA SERVICE LLC | |||||
| W5844 ROLLING HILL DRIVE | NEILLSVILLE | WI | 54456 | ANETHESIA SERVICES | $457,291 |
| OS Inc | |||||
| W237N2920 Woodgate Suite 100 | Pewaukee | WI | 53072 | Patient Financial Services | $403,000 |
| EvidentCPSI Inc | |||||
| PO Box 850309 | Mobile | AL | 36685 | ELECTRONIC Health Records Software | $332,388 |
| Emile W Salvo MD SC | |||||
| 17312 Interlude Rd | Tomah | WI | 54660 | ER Medical Services | $255,726 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $76,851 | RelatedOrganizationsAmt |
| Government Grants | $9,178 | GovernmentGrantsAmt |
| All Other Contributions | $24,870 | AllOtherContributionsAmt |
| Total Contributions | $110,899 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Hospital Revenue | 621110 | $22,215,441 | $22,185,303 | $30,138 |
| Clinic Revenue | 621110 | $3,665,445 | $3,665,445 | |
| ASSISTED LIVING Revenue | 623000 | $381,281 | $381,281 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $151,889 | TotalRevenueColumnAmt |
| Exclusion | $151,889 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $26,414,056 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,940 | TotalRevenueColumnAmt |
| Exclusion | $9,940 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $13,259 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $94,981 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$81,722 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$81,722 | TotalRevenueColumnAmt |
| Exclusion | -$81,722 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DIET,MAINT,HSKG,LNDRY | Desc |
| Business | 812900 | BusinessCd |
| Total Revenue Column | $404,455 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $404,455 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $404,455 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,857,628 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $26,232,029 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $434,593 | UnrelatedBusinessRevenueAmt |
| Exclusion | $80,107 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,815,108 | TotalAmt |
| Program Services | $1,336,609 | ProgramServicesAmt |
| Management And General | $478,499 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,616,970 | TotalAmt |
| Program Services | $8,884,588 | ProgramServicesAmt |
| Management And General | $1,732,382 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $304,443 | TotalAmt |
| Program Services | $254,767 | ProgramServicesAmt |
| Management And General | $49,676 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,968,968 | TotalAmt |
| Program Services | $2,502,113 | ProgramServicesAmt |
| Management And General | $466,855 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $714,015 | TotalAmt |
| Program Services | $593,742 | ProgramServicesAmt |
| Management And General | $120,273 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,326 | TotalAmt |
| Management And General | $24,326 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,431 | TotalAmt |
| Management And General | $60,431 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,501,412 | TotalAmt |
| Program Services | $2,701,113 | ProgramServicesAmt |
| Management And General | $800,299 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,118 | TotalAmt |
| Management And General | $75,118 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $818,562 | TotalAmt |
| Program Services | $625,215 | ProgramServicesAmt |
| Management And General | $193,347 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,838 | TotalAmt |
| Management And General | $40,838 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $498,398 | TotalAmt |
| Program Services | $323,607 | ProgramServicesAmt |
| Management And General | $174,791 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,095 | TotalAmt |
| Program Services | $37,866 | ProgramServicesAmt |
| Management And General | $29,229 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,081 | TotalAmt |
| Program Services | $34,411 | ProgramServicesAmt |
| Management And General | $19,670 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,253,508 | TotalAmt |
| Program Services | $813,895 | ProgramServicesAmt |
| Management And General | $439,613 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $179,849 | TotalAmt |
| Program Services | $102,965 | ProgramServicesAmt |
| Management And General | $76,884 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $2,103,435 | $2,103,435 | |
| Equipment Rental & Main | $679,486 | $608,996 | $70,490 |
| BAD DEBT | $674,199 | $674,199 | |
| ADMIN HOSPITAL TAX EXPE | $72,987 | $72,987 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,523,229 | TotalAmt |
| Program Services | $21,670,508 | ProgramServicesAmt |
| Management And General | $4,852,721 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $388,985 | BOYAmt |
| EOY | $1,089,525 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,856,313 | BOYAmt |
| EOY | $1,936,379 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,961,357 | BOYAmt |
| EOY | $3,129,727 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $652,732 | BOYAmt |
| EOY | $667,823 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $209,613 | BOYAmt |
| EOY | $184,043 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $17,642,028 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $11,547,371 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,448,078 | BOYAmt |
| EOY | $6,094,657 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,730,362 | BOYAmt |
| EOY | $2,549,158 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,247,440 | BOYAmt |
| EOY | $15,651,312 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,234,967 | BOYAmt |
| EOY | $3,157,681 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,436,609 | BOYAmt |
| EOY | $1,661,963 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,169,751 | BOYAmt |
| EOY | $1,091,156 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,841,327 | BOYAmt |
| EOY | $5,910,800 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,406,113 | BOYAmt |
| EOY | $9,740,512 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,406,113 | BOYAmt |
| EOY | $9,740,512 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,247,440 | BOYAmt |
| EOY | $15,651,312 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $334,399 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 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 |
| Other Activities | $6,390 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $6,390 | 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 | Memorial Hospital, Inc. pays annual association membership dues to the Wisconsin Hospital Association (WHA) and American Hospital Association (AHA). These dues are primarily for access to educational materials and staff training and development. The WHA and AHA have notified Memorial Hospital, Inc. that $1,173 (WHA) and $1,654 (AHA) of the annual dues were used in conjunction with lobbying activities with the goal of improving the overall health care environment. Memorial Hospital, Inc. is also a member of the Rural Wisconsin Health Cooperative (RWHC). Each year, Memorial Hospital, Inc. pays membership fees to the RWHC. The RWHC provides support services for a number of its member hospitals throughout the State of Wisconsin. Some of the many services provided to member hospitals include providing assistance to Organizations in finding grant funding for new programs, legal services, reimbursement review services, accounting assistance, contracting for therapist and emergency room physician coverage, and administrative consulting services. As a part of these services, the RWHC also does provide analysis on current health care issues in an effort to promote better health care for hospitals in rural communities throughout Wisconsin. One of these efforts also includes some lobbying on the part of the member organizations. The RWHC determined that $3,563 of the fees paid in 2015 related to lobbying activities with the goal of improving the health care environment in the state of Wisconsin. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,713 | OtherCostOrOtherBasisAmt |
| Book Value | $15,713 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,854,267 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,060,185 | DepreciationAmt |
| Book Value | $3,794,082 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,512,784 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,250,214 | DepreciationAmt |
| Book Value | $2,262,570 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $259,264 | OtherCostOrOtherBasisAmt |
| Depreciation | $236,972 | DepreciationAmt |
| Book Value | $22,292 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,094,657 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Investment in Central MN Diagnostic, Inc. | $329,026 |
| Deferred compensation plan assets | $1,099,899 |
| amounts receivable from third-party reimbursement programs | $504,000 |
| Other Receivables | $616,233 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,549,158 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFERRED COMPENSATION LIABILITY | Desc |
| Amt | $1,091,156 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,091,156 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 49.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| 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 | $68,240 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $68,240 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00260 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,710,763 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,189,704 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $521,059 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01960 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,779,003 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,189,704 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $589,299 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02220 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $53,945 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,125 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $49,820 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $228,752 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $228,752 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00860 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,473,110 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,236,841 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,236,269 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.19740 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $682 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $682 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,724 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,724 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,762,213 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,240,966 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,521,247 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.20810 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,541,216 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,430,670 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,110,546 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.23030 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,472 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,472 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $256 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $256 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,728 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,728 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $409,818 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $163,927 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $4,606,601 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,705,939 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$99,338 | 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 | Memorial Hospital Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 216 Sunset Place | AddressLine1Txt |
| City | Neillsville | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54456 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.memorialmedcenter.org | WebsiteAddressTxt |
| State License | 1026 | 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 | Memorial Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.memorialmedcenter.org | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | http:/memorialmedcenter.org/wp-content/uploads/2016/07community-health-need | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 49.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| 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.memorialmedcenter.org | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.memorialmedcenter.org | FAPAppAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Memorial Hospital, Inc. | Part V, Section B, Line 5: Representatives from Memorial Hospital, Inc. and Ministry Our Lady of Victory Hospital partnered with the Clark County Public Health Department to establish the "Health Care Partnership for Clark County." In addition to the founding organizations, other participating members represent a variety of Clark County based organizations. The Partnership was awarded a grant to pilot community assessment tools that brought special public health expertise and knowledge to the process. |
| Memorial Hospital, Inc. | Part V, Section B, Line 6a: The CHNA was conducted in joint effort with Ministry Our Lady of Victory Hospital (Stanley, Wisconsin). |
| Memorial Hospital, Inc. | Part V, Section B, Line 6b: THE CHNA WAS CONDUCTED IN JOINT EFFORT WITH THE CLARK COUNTY PUBLIC HEALTH DEPARTMENT. |
| Memorial Hospital, Inc. | Part V, Section B, Line 11: THE FOLLOWING ITEMS WERE ITEMS IDENTIFIED IN THE CHNA FOR MEMORIAL HOSPITAL, INC. (THE "HOSPITAL") AND ARE BEING ADDRESSED AS FOLLOWS: CLARK COUNTY WISCONSIN, THROUGH ITS 2013-2015 COMMUNITY NEEDS ASSESSMENT IDENTIFIED THE FOLLOWING LOCAL HEALTH PRIORITIES- HEALTHY LIFESTYLE CHOICES TO INCLUDE PHYSICAL ACTIVITY AND HEALTHY EATING AND ACCESS TO INCLUDE MENTAL HEALTH/TRANSPORTATION AND PREVENTATIVE HEALTH SCREENINGS. MEMORIAL MEDICAL CENTER (MMC) CONTINUES TO ALIGN NOT ONLY ITS COMMUNITY VOLUNTEERISM BUT ALSO THE CURRENT STRATEGIC PLAN ACCORDING TO THE CLARK COUNTY COMMUNITY NEEDS. THE 4 KEY COMPONENTS OF MMC STRATEGIC PLAN ARE ACCESS TO CARE, COMMUNITY PARTNERSHIP, PROGRAMS DEVELOPED AND FINANCIAL STABILITY. CLARK COUNTY IDENTIFIED NEEDS AS FOLLOWS: 1) HEALTHY LIFESTYLE CHOICES-EMPHASIS ON PHYSICAL ACTIVITY AND HEALTHY EATINGA) MMC IS AN INFLUENTIAL LEADER IN THE COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) WHICH IN 2015 IDENTIFIED HEALTH PRIORITIES THROUGH THE COMMUNITY HEALTH IMPROVEMENT PROCESS.B) MMC ACTIVELY ATTENDED AND SUPPORTED THE CLARK COUNTY EAT RIGHT BE FIT TASK FORCE INITIATIVES, SUPPORTING THE MISSION "PROMOTING HEALTHY LIFESTYLES BY EATING RIGHT AND BEING FIT"C) MMC ACTIVELY ATTENDED AND SUPPORTED THE CLARK COUNTY HEALTH COMMUNITY PARTNER GROUP TO ASSIST IN OVERSEEING ACTION PLANS OF THE PUBLIC HEALTH INITIATIVES.D) MMC APPLIED AND WAS ACCEPTED TO BECOME AN ACCOUNTABLE CARE ORGANIZATION. THE MODEL OF DELIVERY FOCUSES ON POPULATION HEALTH MANAGEMENT FOR THE NEXT 3 YEARS.E) MMC CONTINUES TO PROVIDE AN ATHLETIC TRAINER TO NEILLSVILLE HIGH SCHOOL FOR ALL REQUESTED ACTIVITIES.F) MMC COMMUNITY EDUCATION INCLUDED- SCHOOL BASED EDUCATION, DIABETES EDUCATION, BABYSITTING CLASSES, COMMUNITY HEALTH FAIRS AND FITNESS EDUCATION.2) ACCESS TO CARE- EMPHASIS ON MENTAL/HEALTH, TRANSPORTATION AND PREVENTATIVE SCREENINGSA) MMC IMPROVED OVERALL ACCESS TO CARE BY EXPANDING OUTPATIENT CLINIC APPOINTMENTS TO 7 PM 5 DAYS A WEEK AND CONTINUED 24-HOUR URGENT CARE.B) MMC TRAINED A STAFF MEMBER TO BE A CERTIFIED NAVIGATOR FOR THE HEALTHCARE MARKET EXCHANGE. MMC ADVERTISED AND IMPLEMENTED COMMUNITY SIGN UP SESSIONS.C) MMC CONTINUES EFFORT TO RECRUIT A FULL TIME MENTAL HEALTH PROVIDERD) DUE TO PHYSICIAN COVERAGE LEAVING CLARK COUNTY, MMC PROVIDED MEDICAL COVERAGE FOR THE OAKBROOK NURSING HOME IN THORP, WI. THIS INCLUDES 24/7 COVERAGE AND MEDICAL VISITS 1-2 TIMES PER WEEK. THIS NURSING HOME IS A 55-BED FACILITY IN NORTHERN RURAL WISCONSIN.E) MMC ACTIVELY ATTENDED AND SUPPORTED THE CLARK COUNTY MENTAL HEALTH TASK FORCE INITIATIVES OF IDENTIFIED MODELS OF CARE DELIVERY FOR CLARK COUNTY RESIDENTS.F) THROUGH 2015 MMC CONTRACTED WITH CENTERPOINT COUNSELING TO PROVIDE PSYCHIATRIC CONSULTS TO SUPPORT OUR MMC PROVIDERS WITH APPROPRIATELY TREATING PRIMARY CARE PATIENTS WITH MENTAL HEALTH NEEDS THAT ARE UNABLE TO SEE A PSYCHIATRIST. G) MMC CONTINUES TO WORK WITH 3 AREA HEALTH SYSTEMS TO PROVIDE SPACE-EQUIPMENT AND STAFF FOR SPECIALISTS TO DELIVER CARE IN CLARK COUNTY.H) MMC CONTINUES TO INCREASE MEDICAL TRAINING HOURS AT FACILITY TO EXPAND APPROPRIATE CARE AND RECRUIT TO CLARK COUNTY.I) MMC COMMUNITY EDUCATION INCLUDED- STRESS MANAGEMENT, CAR SEAT TRAINING, CARDIAC REHAB TRAINING TO PREVENT ADDITIONAL CARDIAC DISEASES, MENTAL HEALTH SUPPORT GROUP, CONTINUED COMMUNITY BLOOD PRESSURE AND SPORTS SCREENINGS. THERE WERE ITEMS IDENTIFIED IN THE CHNA WHICH WERE NOT ADDRESSED BY MEMORIAL HOSPITAL, INC.; HOWEVER, ALL ITEMS WERE CONSDERED IF A NEED WAS BROUGHT TO THE ATTENTION OF THE GROUP DURING THE INFORMATION GATHERING PHASE OF THE CHNA PROCESS. SEVERAL OF THE ITEMS WHICH WERE NOT ADDRESSED PRIMARILY WERE NOT ADDRESSED DUE TO THE FINANCIAL CONSTRANT OF PROVIDING A NEW SERVICE FOR A LIMITED POPULATION OF PEOPLE WITHIN THE PRIMARY SERVICE AREA OR AT THE PRESENT TIME IT WAS DETERMINED THAT A PARTNER ORGANIZATION MAY BE NEEDED TO MAKE A NEW HEALTH SERVICE A FINANCIALLY VIABLE OPTION IN THE LOCAL COMMUNITY. |
| Memorial Hospital, Inc. | Part V, Section B, Line 16i: A letter describing the hospital's financial assistance policy is sent to patients for every service provided where they are registered as a private pay patient. A letter is also sent to patients again when no payment has been received after two statements. |
| Memorial Hospital, Inc. | Part V, Section B, Line 22d: Maximum amounts that can be charged to individuals are as follows:Patients whose income is 49% or less of the Federal poverty guidelines receive free care.Patients whose income is below 200% of the Federal poverty guidelines receive the lowest negotiated commercial rate.Patients whose income is below 300% of the Federal poverty guidelines receive a 30% discount from gross charges or a 10% discount from insurance adjusted balance. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - MEMORIAL MEDICAL CENTER | ||||
| 216 SUNSET PLACE | NEILLSVILLE | WI | 54456 | PROVIDER-BASED RURAL HEALTH CLINIC |
| 2 - Sunset GARDENS | ||||
| 216 SUNSET PLACE | NEILLSVILLE | WI | 54456 | AssisTED LIVING FACILITY |
| 3 - LOYAL CLINIC - MEMORIAL MEDICAL CENTER | ||||
| 502 EAST ELM STREET | LOYAL | WI | 54446 | PROVIDER-BASED RURAL HEALTH CLINIC |
| 4 - GREENWOOD FAMILY MEDICAL CENTER | ||||
| 201 SOUTH MAIN | GREENWOOD | WI | 54437 | PROVIDER-BASED RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | Memorial Hospital, Inc. GENERALLY USES 49% OF FEDERAL POVERTY GUIDELINES FOR offering care free of charge and a sliding scale going up to 300% offering care at reduced charges. IT SHOULD also BE NOTED THAT Memorial Hospital, Inc., AS A PART OF ITS COMMUNITY CARE policy, WILL ALSO CONSIDER AN ADMINISTRATIVE REVIEW OF OTHER OUTSTANDING BALANCES OF AN INDIVIDUAL. The hospital will determine on an individual basis if additional discounts can be provided to patients. A patient may have a significant or long-term need of medical bills that may require additional community support to help a patient through a difficult time. |
| Part I, Line 6a: | Memorial Hospital, Inc. prepares a community benefit report annually and files it with the Wisconsin Hospital Association (WHA). The report is available to the general public on the WHA's website. |
| Part I, Line 7: | THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES, excluding THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. This cost-to-charge ratio is applied against various revenue and expense categories to compute the estimated community benefit expense under IRS suggested costing methods for the Form 990. |
| Part I, Line 7g: | The cost of subsidized health services is based on cost allocations from the Medicare cost Report. Allowable costs are assigned directly to departments throughout the year and then the cost report uses the allocation methodology to assign all other costs to calculate service line costs. Subsidized health services include the operation of three family practice clinics, hospital inpatient unit, and emergency room. It is the goal of Memorial Hospital, Inc. to provide these services to the community regardless of a patient's ability to pay. |
| Part II, Community Building Activities: | COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITY that the hospital SERVEs. THROUGH COLLABORATION WITH LOCAL ORGANIZATIONS, the hospital provides information to THE COMMUNITY REGARDING VARIOUS ISSUES THAT AFFECT HEALTH SUCH AS babysitting classes, serving on public health boards, working with disaster preparedness, CPR classes, diabetic support groups, prescription assistance, stress management, preventative services, and others. |
| Part III, Line 4: | Patient Receivables and Credit Policy: In evaluating the collectability of patient accounts receivable, the Hospital analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for uncollectible accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for uncollectible accounts. Specifically, for receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for uncollectible accounts and a provision for bad debts for expected uncollectible deductible and copayments on accounts for which the third-party payor has not yet paid, or for payors and patients who are known to be having financial difficulties that make the realization of amounts due unlikely. For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a provision for bad debts in the period of service on the basis of their past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for uncollectible accounts. The audited financial statements do not include a separate footnote regarding bad debt expense. |
| Part III, Line 8: | Memorial Hospital, Inc. is designated a critical access hospital and as such a portion of its revenues are paid under a cost reimbursement system. Based on the instructions, the total medicare revenue shown on this form 990 includes only a portion of the gross medicare revenue that is actually received by the hospital from the medicare program. The amounts listed for Medicare do not include physician and mid-level practitioner services for the coverage of the emergency department or anesthesia services at the hospital. Physician coverage is reimbursed primarily on a fee schedule reimbursement methodology at rates that are often below the cost of providing care to patients. Emergency and anesthesia services provided to Medicare patients are vital to the well-being of the community and therefore these costs and shortfalls should also be considered as an additional benefit that the hospital provides to the community and surrounding area of Neillsville, Wisconsin. The costing method used above for IRS 990 compliance reporting is also based on an overall average cost-to-charge ratio and does not consider medicare non-allowable expenses as it is based on total hospital patient service revenue (ignoring contractual adjustments on fee schedule reimbursed items and non-allowable medicare expenses as noted above) divided by total operating expenses less the provision for bad debt. This ratio is then multiplied by the total Medicare services which are reimbursed on a cost methodology excluding the fee schedule items like physician and mid-level practitioner services which the hospital would show a large loss on these services.Whether there is a shortfall or surplus from services provided to Medicare beneficiaries, the recipients are typically elderly and/or disabled members of the community and are an underserved population who experience issues with access to healthcare services. Without tax-exempt hospitals providing medicare patient services, the centers for medicare and medicaid (CMS) would bear the burden of directly providing services to the elderly and disabled members of the community. |
| Part III, Line 9b: | Under the hospital's charity care policy, Memorial Hospital, Inc., makes every attempt to identify and promote charity care to patients. Included in the hospital's policy it is noted that patients may qualify for charity care either prior to admission or following discharge. UNINSURED PATIENTS ARE GIVEN THE OPPORTUNITY TO FILL OUT A Charity Care APPLICATION AT THE TIME OF ADMISSION AND ALL patientS ARE asked to fill out a charity care application DURING THE COLLECTION PROCESS prior to sending aNY ACCOUNTS TO A collection agency. If the paperwork is not received, the account is handled through the normal collection process. |
| Part VI, Line 2: | THE HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES AND AREAS IT SERVES BY REVIEWING LOCAL DEMOGRAPHICS AND TRENDS IN PATIENT SERVICE UTILIZATION TO DETERMINE WHICH SERVICES COULD AND SHOULD BE MADE AVAILABLE TO THE COMMUNITY IN A COST-EFFECTIVE MANNER. THE HOSPITAL RECENTLY COLLABORATED WITH ANOTHER AREA HOSPITAL TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE CHNA FOCUSED ON DETERMINING THE KEY HEALTH CARE PRIORITIES IN THE COMMUNITY. THE HOSPITAL ALSO SEEKS ONGOING INPUT FROM LOCAL COMMUNITY MEMBERS AND STAFF MEMBERS TO DETERMINE WHICH SERVICES MAY BENEFIT THE COMMUNITY. |
| Part VI, Line 3: | All patients who register withOUT INSURANCE are sent a private pay letter notifying them to contact a financial services representative at the hospital if they need assistance in paying their bill. The letter also highlights the charity care program and gives the website where the application can be found. The financial services representative then discusses the options available to the patient. |
| Part VI, Line 4: | THE HOSPITAL FOCUSES ON SERVING THE HEALTH NEEDS OF CLARK COUNTY WHICH HAS A POPULATION OF 35,000. THE HOSPITAL SERVES IN A COMMUNITY WHICH RANK'S IN THE THIRD LOWEST IN THE STATE OF WISCONSIN FOR PER CAPITA MONEY INCOME INCLUDING 15% OF THE POPULATION BELOW THE FEDERAL POVERTY LEVEL AND 20% OF ADULTS AND 13% OF CHILDREN ARE UNINSURED. IT IS ESTIMATED THAT APPROXIMATELY 30% OF THE COUNTY'S POPULATION IS AMISH/MENNONITE. ROUGHLY 92% OF THE POPULATION LIVES IN A RURAL AREA COMPARED TO THE STATE AVERAGE OF 30% WHICH IS SIGNIFICANT DUE TO CLARK COUNTY'S TRANSPORTATION SYSTEM BEING UNDERDEVELOPED. |
| Part VI, Line 5: | While there is growing agreement in the United States about what constitutes a non-profit hospital's community benefit, this is a work in progress. Our hospital provides charity care and other community benefits as defined by the IRS. But in addition, we believe that we provide a critically important community benefit which is not quantified. Our hospital, like most rural hospitals, was created and is maintained in order to provide care locally. Beyond inpatient hospitalizations, we provide local access to many health services: Diagnostics, Emergency Services & Urgent Care, Infusion Services, Laboratory Services, Occupational Health, Rehabilitation Services, Specialty Medicine, Sleep Center, Speech and Audiology, Surgical Services, and Womens Health Services. |
| Part VI, Line 7, Reports Filed With States | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR DAVID CARLSON | ||||||||||||||
| CHief Medical Officer | $568,606 | $0 | $222,725 | $0 | $0 | $0 | $4,500 | $0 | $16,527 | $0 | $812,358 | $0 | $0 | $0 |
| DR SHARON HAYWARD | ||||||||||||||
| PHYSICIAN | $463,102 | $0 | $30,000 | $0 | $0 | $0 | $4,500 | $0 | $26,649 | $0 | $524,251 | $0 | $0 | $0 |
| RYAN NEVILLE | ||||||||||||||
| PRESIDENT & CEO | $228,495 | $0 | $0 | $0 | $0 | $0 | $4,500 | $0 | $27,720 | $0 | $260,715 | $0 | $0 | $0 |
| DR MARIA CRUZ-APOLINARIO | ||||||||||||||
| PHYSICIAN | $253,524 | $0 | $262,798 | $0 | $151,458 | $0 | $4,500 | $0 | $24,879 | $0 | $697,159 | $0 | $0 | $0 |
| DR Timothy Meyer | ||||||||||||||
| PHYSICIAN | $312,828 | $0 | $55,960 | $0 | $63,403 | $0 | $4,500 | $0 | $8,817 | $0 | $445,508 | $0 | $0 | $0 |
| DR AMY SCHNEIDER DE CORTEZ | ||||||||||||||
| PHYSICIAN | $179,737 | $0 | $120,533 | $0 | $0 | $0 | $4,500 | $0 | $20,019 | $0 | $324,789 | $0 | $0 | $0 |
| Dr James Stanga | ||||||||||||||
| PHYSICIAN | $296,573 | $0 | $465 | $0 | $0 | $0 | $4,500 | $0 | $20,754 | $0 | $322,292 | $0 | $0 | $0 |
| Dr Kenneth Weimer | ||||||||||||||
| PhYSICIAN | $249,918 | $0 | $39,858 | $0 | $0 | $0 | $4,500 | $0 | $27,315 | $0 | $321,591 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 4b | MEMORIAL HOSPITAL, INC. OFFERS AN EXECUTIVE 457(F) RETIREMENT PLAN, ESTABLISHED IN 2006, IN WHICH THE EMPLOYER MAY MAKE DISCRETIONARY CREDITS TO THE DEFERRED COMPENSATION ACCOUNT OF THE PARTICIPANTS. THE AMOUNT CONTRIBUTED TO THE PARTICIPANTS IS DETERMINED ON AN ANNUAL BASIS BY THE EMPLOYER. |
| Part I, Line 5 | During 2015, the following physicians received compensation that was partly based on the gross charges recognized for their professional services: Dr. Timothy Meyer $55,960; Dr. Grace Cruz-Apolinario $262,798; Dr. David Carlson $222,725; Dr. Sharon Hayward $30,000; and Dr. Amy Schneider De Cortez $120,533. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (7 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Chelsea Barth | |||
| Daughter of Robert Barth, Board Chairman | $45,886 | Employment compensation FOR RN SERVICES | 0 |
| Jamie Barth | |||
| Daughter-in-law of Robert Barth, Board Chairman | $47,995 | Employment Compensation FOR RESPIRATORY THERAPY | 0 |
| Thomas Silbernagel | |||
| FAMILY MEMBER OF OFFICER, KELLY SILBERNAGEL | $457,292 | OWNER OF COMPANY PROVIDING 24/7 CRNA COVEAGE | 0 |
| Linda Ormond | |||
| Sister of Board Member, BarbARA Petkovsek | $38,379 | Employment Compensation FOR PATIENT BENEFIT SPECIALIST | 0 |
| Tara Ormond | |||
| NIECE OF BOARD MEMBERS, BARBARA PETKOVSEK AND ROBERT BARTH | $52,792 | Employment Compensation FOR RN SERVICES | 0 |
| Jennifer Larson | |||
| Daughter of Dr. David Carlson, Highest Compensated Employee | $47,444 | Employment Compensation FOR PHYSICIAN ASSISTANT SERVICES | 0 |
| Kevin Grap | |||
| OFFICER OF COMPANY, Kevin Grap | $10,220 | RADIO ADVERTISING | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11 | THE CHIEF FINANCIAL OFFICER DETAIL REVIEWS THE FORM 990 PRIOR TO SUBMISSION. ALSO, BEFORE THE RETURN WAS FILED, A DRAFT COPY WAS MADE AVAILABLE TO THE BOARD OF DIRECTORS FOR REVIEW AND COMMENTS. |
| Form 990, Part VI, Section B, line 12c | Memorial Hospital, Inc. relies on the annual disclosure of key individuals to the board of directors and monitors purchases and abstentions from necessary votes throughout the year. All managers and medical staff are required to disclose and follow the conflict of interest policy. |
| Form 990, Part VI, Section B, line 15 | A COMMITTEE OF THE BOARD OF DIRECTORS HAS BEEN DESIGNATED TO REVIEW ALL EXECUTIVE PAY CHANGES. MARKET DATA IS PROVIDED TO THE COMMITTEE IN THEIR EVALUATION OF PAY CHANGES. COMPARABILITY DATA WAS USED AND THE RESULTS OF ANY EXECUTIVE PAY CHANGES WERE DOCUMENTED. NO ONE WITH A CONFLICT OF INTEREST WAS INCLUDED IN THE DECISION MAKING OF EXECUTIVE COMPENSATION. |
| Form 990, Part VI, Section C, line 19 | ALL DOCUMENTS ARE AVAILABLE UPON REQUEST. DOCUMENTS ARE ALSO DISCUSSED AT COMMUNITY MEETINGS AND EMPLOYEE FORUMS. |
| Form 990, Part VII, Line 1A, Explanation for Hours worked: | Some officers and board members also provided service to Country View, Inc., a related organization. These hours are reflected in Line 2 of Column B. |
| Form 990, Part IX, line 11g | Contracted Laboratory Services: Program service expenses 140,685. Management and general expenses 0. Fundraising expenses 0. Total expenses 140,685. contracted emergency room physicians: Program service expenses 928,800. Management and general expenses 0. Fundraising expenses 0. Total expenses 928,800. contracted anesthesia services: Program service expenses 482,392. Management and general expenses 0. Fundraising expenses 0. Total expenses 482,392. contracted radiology services: Program service expenses 604,932. Management and general expenses 0. Fundraising expenses 0. Total expenses 604,932. other contracted services: Program service expenses 544,304. Management and general expenses 0. Fundraising expenses 0. Total expenses 544,304. contracted administrative services: Program service expenses 0. Management and general expenses 800,299. Fundraising expenses 0. Total expenses 800,299. |
| Form 990, Part XII, Line 2C: | The Board of Directors is responsible for the selection of an independent auditor and management oversees the audit process. This process did not change in 2015. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| COUNTRY VIEW INC | ||||||||||
| 216 SUNSET PLACE | NEILLSVILLE | WI | 54456 | 391411586 | HUD HOUSING | WI | 501(C)(3) | Line 9 | Memorial Hospital Inc | Yes (1) |
| The Foundation of Memorial Hospital Inc | ||||||||||
| 216 SUNSET PLACE | NeILLSVILLE | WI | 54456 | 383800811 | Fundraising | WI | 501(C)(3) | Line 7 | Memorial Hospital Inc | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Foundation of Memorial Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $76,851 | InvolvedAmt |
| Method Of Amount Determination | Cost | MethodOfAmountDeterminationTxt |