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SAUK PRAIRIE HEALTHCARE INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
SAUK PRAIRIE HEALTHCARE INC (EIN 39-0872080)
Tax period
2013-01-01 to 2013-12-31
Filed
2014-08-11
IRS object ID
201402239349301290
Schema version
2013v3.0
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 ReturnHeader

FieldValueIRS element (for citing)
Return2014-08-11T13:13:17-05:00ReturnTs
Tax Period End2013-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN390758449PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line13703 OAKWOOD HILLS PARKWAYAddressLine1
CityEAU CLAIRECity
StateWIState
ZIP Code54701ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN390872080EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SAUK PRAIRIE MEMORIAL HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlSAUKBusinessNameControlTxt
Phone6086433311PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1260 26TH STREETAddressLine1
CityPRAIRIE DU SACCity
StateWIState
ZIP Code53578ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonCAROL J MAYPersonNm
Person TitleCFOPersonTitleTxt
Phone6086433311PhoneNum
Signature2014-08-04SignatureDt
Discuss With Paid Preparer0DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonHOLLY POKRANDT CPAPreparerPersonNm
PTINP00449155PTIN
Phone7158323407PhoneNum
Preparation2014-08-04PreparationDt
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeYes (X)AddressChangeInd

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1SAUK PRAIRIE HEALTHCAREBusinessNameLine1
FieldValueIRS element (for citing)
Principal OfficerCAROL J MAYPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1260 26TH STREETAddressLine1
CityPRAIRIE DU SACCity
StateWIState
ZIP Code53578ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$88,887,503GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.SAUKPRAIRIEHEALTHCARE.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1956FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionEXTRAORDINARY HEALTHCARE FROM THE HEART - ONE PERSON AT A TIME.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent2VotingMembersIndependentCnt
Total Employee603TotalEmployeeCnt
Total Volunteers111TotalVolunteersCnt
Total Gross UBI$14,703TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$22,510NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$4,584,045PYContributionsGrantsAmt
CY Contributions Grants$1,167,810CYContributionsGrantsAmt
PY Program Service Revenue$62,255,934PYProgramServiceRevenueAmt
CY Program Service Revenue$67,796,747CYProgramServiceRevenueAmt
PY Investment Income$1,422,042PYInvestmentIncomeAmt
CY Investment Income$718,436CYInvestmentIncomeAmt
PY Other Revenue-$207,536PYOtherRevenueAmt
CY Other Revenue-$141,455CYOtherRevenueAmt
PY Total Revenue$68,054,485PYTotalRevenueAmt
CY Total Revenue$69,541,538CYTotalRevenueAmt
PY Grants And Similar Paid$90,792PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$104,235CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$33,100,731PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$38,287,233CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$110,979CYTotalFundraisingExpenseAmt
PY Other Expenses$25,618,608PYOtherExpensesAmt
CY Other Expenses$27,869,686CYOtherExpensesAmt
PY Total Expenses$58,810,131PYTotalExpensesAmt
CY Total Expenses$66,261,154CYTotalExpensesAmt
PY Revenues Less Expenses$9,244,354PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$3,280,384CYRevenuesLessExpensesAmt
Total Assets BOY$84,288,271TotalAssetsBOYAmt
Total Assets EOY$159,225,299TotalAssetsEOYAmt
Total Liabilities BOY$11,106,633TotalLiabilitiesBOYAmt
Total Liabilities EOY$83,039,101TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$73,181,638NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$76,186,198NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionMISSION: EXTRAORDINARY HEALTHCARE FROM THE HEART - ONE PERSON AT A TIME.VISION: WE WILL SET THE STANDARD FOR COMMUNITY-BASED HEALTHCARE THAT IMPROVES THE HEALTH AND QUALITY OF LIFE OF THE PEOPLE WE SERVE.SEE CONTINUATION OF MISSION AND VISION INFORMATION UNDER STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS PART 4C.MissionDesc
Significant New Program SrvcYes (1)SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$45,274,320ExpenseAmt
Grant$104,235GrantAmt
Revenue$59,261,653RevenueAmt
DescSAUK PRAIRIE MEMORIAL HOSPITAL, INC. (THE "HOSPITAL"), A 36-BED ACUTE CARE GENERAL HOSPITAL, IS A NONPROFIT, NONSTOCK WISCONSIN CORPORATION PROVIDING SERVICES TO SAUK CITY, PRAIRIE DU SAC, AND THE SURROUNDING COMMUNITIES.TOTAL ADMISSIONS FOR 2013 WERE 1,697 WITH PATIENT DAYS OF 4,022. KEY PATIENT SERVICES INCLUDING 258 BIRTHS IN THE NURSERY, 5,344 SURGICAL PROCEDURES, 58,516 REHABILITATION THERAPY SERVICES, 24,638 MEDICAL IMAGING SERVICES, AND 12,987 EMERGENCY ROOM VISITS ARE AMONG MANY OF THE SERVICES PROVIDED TO PATIENTS DURING 2013.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$10,539,781ExpenseAmt
Revenue$8,520,391RevenueAmt
DescTHE HOSPITAL ALSO OWNS AND OPERATES PHYSICIAN PRACTICES IN SPRING GREEN, BLACK EARTH, PLAIN, AND LODI, WISCONSIN. TOTAL CLINIC VISITS TO THESE FOUR SITES FOR 2013 WAS 32,905.DURING 2013, THE HOSPITAL ASSUMED THE CLINICAL PRACTICE OPERATIONS OF ORTHOPEDIC ASSOCIATES OF SAUK PRAIRIE AND SURGICAL ASSOCIATES, WHICH WERE PREVIOUSLY OPERATED BY UNRELATED PHYSICIAN ORGANIZATIONS. THE CLINICAL PRACTICES' ARE LOCATED IN SPACE WITHIN THE HOSPITAL FACILITY. TOTAL ORTHOPEDIC VISITS FROM APRIL-DECEMBER 2013 WERE 8,332. TOTAL SURGICAL ASSOCIATES' VISTS FROM JULY-DECEMBER 2013 WERE 824.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
DescTHE HOSPITAL FULFILLS ITS MISSION AND VISION BY OFFERING HIGH-QUALITY SERVICES IN RURAL COMMUNITIES, THEREBY ALLOWING OUR PATIENTS TO BE TREATED LOCALLY WITHOUT LENGTHY COMMUTES OR WAITING. THE HOSPITAL HAS GAINED A REGIONAL REPUTATION OF EXCELLENCE IN ORTHOPEDICS, GENERAL SURGERY, SPINE SURGERY, AND GYNECOLOGIC SURGERY. THE HOSPITAL TREATED MORE THAN 1,100 INPATIENTS IN 2013, 258 BABIES ENTERED THE WORLD HERE, AND THE HOSPITAL HAD 54,900 OUTPATIENT VISITS. THE HOSPITAL OPERATES FOUR CLINICS IN RURAL AREAS: LODI, SPRING GREEN, PLAIN, AND BLACK EARTH, BRINGING PRIMARY CARE TO THOSE COMMUNITIES. THE CLINICS HAD CLOSE TO 33,000 VISITS IN 2013. AS A CHARITABLE ORGANIZATION, THE HOSPITAL PROVIDED OVER $2.7 MILLION IN FREE CARE TO PATIENTS IN OUR SERVICE AREA IN 2013, IN ADDITION TO SUBSIDIZING SERVICES THAT DO NOT COVER COSTS, FREE HEALTH SCREENINGS, EDUCATIONAL PROGRAMS, AND YOUTH OUTREACH.AS THE LARGEST EMPLOYER IN THE COMMUNITY, THE HOSPITAL HAS A POSITIVE ECONOMIC IMPACT ON ITS COMMUNITIES. IT DIRECTLY AND INDIRECTLY CREATES 1,044 JOBS AND ITS IMPACT ON THE LOCAL ECONOMY IS OVER $100 MILLION ANNUALLY.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$55,814,101TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document33IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee603EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member2IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CAROL J MAYBusinessNameLine1
FieldValueIRS element (for citing)
Phone6086433311PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1260 26TH STREETAddressLine1
CityPRAIRIE DU SACCity
StateWIState
ZIP Code53578ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
NANCY BREUNIG
TRUSTEE3.90Yes (X)$15,840$0$0
NEIL BISHOP
TRUSTEE3.00Yes (X)$11,440$0$0
RICHARD MARINO
TRUSTEE4.00Yes (X)$17,400$0$0
PHILLIP KEISER
TRUSTEE2.40Yes (X)$10,400$0$0
ROXI MAIER
TRUSTEE2.80Yes (X)$10,900$0$0
VICKIE WENZEL
TRUSTEE2.40Yes (X)$9,800$0$0
TODD SCHAD MD
TRUSTEEE0.60Yes (X)$12,205$0$0
TOM SCHWARZ
PRESIDENT4.50Yes (X)$19,125$0$0Yes (X)
TAMMY ADLER
VICE PRESIDENT3.90Yes (X)$16,300$0$0Yes (X)
DALE CARLSON
TREASURER2.70Yes (X)$11,900$0$0Yes (X)
ALLAN PECKHAM
SECRETARY3.90Yes (X)$16,700$0$0Yes (X)
LARRY SCHROEDER
CEO50.00$336,810$0$24,473Yes (X)
CAROL MAY
VP, FINANCE & OPERATIONS50.00$183,459$0$16,824Yes (X)
ROBERTA BOS
VP, HUMAN RESOURCES50.00$136,586$0$13,814Yes (X)
KENNETH CARLSON
VP, PLANNING & BUSINESS DE50.00$159,889$0$13,398Yes (X)
CARLA PECK
VP, QUALITY & COMPLIANCE50.00$122,716$0$17,790Yes (X)
MARGARET SHEEKS
VP, PATIENT SERVICES50.00$143,115$0$16,643Yes (X)
MICHAEL LAMSON MD
SURGEON40.00$497,902$0$19,958Yes (X)
DAVID MARCU MD
SURGEON40.00$462,698$0$20,539Yes (X)
MATTHEW HEBERT MD
SURGEON40.00$463,802$0$17,480Yes (X)
WILLIAM BODEMER MD
SURGEON40.00$439,661$0$16,820Yes (X)
ARNOLD ROSENTHAL MD
SURGEON40.00$429,875$0$24,331Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$3,528,523TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$202,070TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K57IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
KRAEMER BROTHERS LLC
PO BOX 219PLAINWI53577CONSTRUCTION SERVICES$1,522,381
SHARED IMAGING SERVICES
PO BOX 45686MADISONWI53744NUCLEAR MED, ECHO, ULTRASOUND SERVICES$831,334
KB DISTRIBUTION CO
PO BOX 219PLAINWI53577CONSTRUCTION SERVICES$791,682
KAHLER SLATER INC
111 W WISCONSIN AVEMILWAUKEEWI53203ARCHITECTURAL SERVICES$623,728
SHARED MEDICAL SERVICES
PO BOX 330COTTAGE GROVEWI53527MRI SERVICES$465,270
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K13CntrctRcvdGreaterThan100KCnt
Related Organizations$1,152,779RelatedOrganizationsAmt
Government Grants$15,031GovernmentGrantsAmt
Total Contributions$1,167,810TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
HOSPITAL PATIENT REVENUE621990$56,254,334$56,254,334
CLINIC REVENUE621110$9,085,218$9,085,218
OTHER HOSPITAL SERVICES621990$2,246,649$2,231,946$14,703
CAFETERIA AND VENDING621990$210,546$210,546
FieldValueIRS element (for citing)
Total Program Service Revenue$67,796,747TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$352,615TotalRevenueColumnAmt
Exclusion$352,615ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$169,096RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$310,551RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real-$141,455RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column-$141,455TotalRevenueColumnAmt
Exclusion-$141,455ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$19,401,235SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$18,969,346SecuritiesAmt
Other$66,068OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$431,889SecuritiesAmt
Other-$66,068OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$365,821TotalRevenueColumnAmt
Exclusion$365,821ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$69,541,538TotalRevenueColumnAmt
Related Or Exempt Func Income$67,782,044RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$14,703UnrelatedBusinessRevenueAmt
Exclusion$576,981ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$104,235TotalAmt
Program Services$104,235ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,337,527TotalAmt
Management And General$1,337,527ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$30,034,589TotalAmt
Program Services$26,113,572ProgramServicesAmt
Management And General$3,836,574ManagementAndGeneralAmt
Fundraising$84,443FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,206,418TotalAmt
Program Services$1,048,920ProgramServicesAmt
Management And General$154,106ManagementAndGeneralAmt
Fundraising$3,392FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$3,838,443TotalAmt
Program Services$3,337,334ProgramServicesAmt
Management And General$490,317ManagementAndGeneralAmt
Fundraising$10,792FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,870,256TotalAmt
Program Services$1,581,012ProgramServicesAmt
Management And General$283,481ManagementAndGeneralAmt
Fundraising$5,763FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$48,900TotalAmt
Management And General$48,900ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$289,549TotalAmt
Management And General$289,549ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,398,504TotalAmt
Program Services$1,398,857ProgramServicesAmt
Management And General$999,647ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$511,571TotalAmt
Program Services$364,510ProgramServicesAmt
Management And General$147,061ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$144,244TotalAmt
Program Services$115,815ProgramServicesAmt
Management And General$28,429ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$265,144TotalAmt
Management And General$265,144ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,037,770TotalAmt
Program Services$979,330ProgramServicesAmt
Management And General$56,842ManagementAndGeneralAmt
Fundraising$1,598FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$54,349TotalAmt
Program Services$37,237ProgramServicesAmt
Management And General$17,112ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$163,148TotalAmt
Program Services$122,527ProgramServicesAmt
Management And General$40,621ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$3,987,635TotalAmt
Program Services$3,987,635ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,502,633TotalAmt
Program Services$159,383ProgramServicesAmt
Management And General$1,343,250ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
SUPPLIES$16,912,644$16,165,371$742,282$4,991
REPAIRS & MAINTENANCE$418,399$418,027$372
OTHER EXPENSES$358,715$103,855$254,860
BAD DEBT EXPENSE$87,032$87,032

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total-$310,551TotalAmt
Program Services-$310,551ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$66,261,154TotalAmt
Program Services$55,814,101ProgramServicesAmt
Management And General$10,336,074ManagementAndGeneralAmt
Fundraising$110,979FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$83,605BOYAmt
EOY$0EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$10,117,751BOYAmt
EOY$28,357,637EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$7,090,553BOYAmt
EOY$8,364,640EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,021,571BOYAmt
EOY$1,047,122EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,109,941BOYAmt
EOY$1,332,549EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$119,186,469LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$31,806,605LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$44,005,164BOYAmt
EOY$87,379,864EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$17,061,165BOYAmt
EOY$24,794,493EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$367,117BOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$3,431,404BOYAmt
EOY$7,948,994EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$84,288,271BOYAmt
EOY$159,225,299EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$9,139,801BOYAmt
EOY$12,995,540EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
EOY$68,000,000EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$990,495BOYAmt
EOY$722,397EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$976,337BOYAmt
EOY$1,321,164EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$11,106,633BOYAmt
EOY$83,039,101EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$67,575,074BOYAmt
EOY$70,452,458EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$4,419,653BOYAmt
EOY$4,458,677EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,186,911BOYAmt
EOY$1,275,063EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$73,181,638BOYAmt
EOY$76,186,198EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$84,288,271BOYAmt
EOY$159,225,299EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$3,280,384ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$403,000NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$127,176OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings MembersYes (1)MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact LegislatorsYes (1)DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$10,232OtherActivitiesAmt
Total Lobbying Expenditures$10,232TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART II-B, LINE 1:SAUK PRAIRIE MEMORIAL HOSPITAL, INC. (THE "HOSPITAL") PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE AHA AND WHA HAVE NOTIFIED THE HOSPITAL THAT APPROXIMATELY $7,719 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. THE HOSPITAL IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE HOSPITAL PAYS MEMBERSHIP FEES TO THE RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO DOES PROVIDE ANALYSIS ON CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGH WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. THE RWHC DETERMINED THAT APPROXIMATELY $2,513 OF THE FEES PAID BY THE HOSPITAL IN 2013 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTHCARE ENVIRONMENT IN THE STATE OF WISCONSIN.
PART II-B, LINE 1 (D AND G):REPRESENTATIVES FROM SAUK PRAIRIE MEMORIAL HOSPITAL, INC. ANNUALLY PARTICIPATE IN THE WISCONSIN HOSPITAL ASSOCIATION'S ADVOCACY DAY WHERE THE REPRESENTATIVES ARE GIVEN THE OPPORTUNITY TO GATHER WITH OTHER HEALTHCARE ORGANIZATIONS IN THE STATE OF WISCONSIN AND ALSO MEET WITH STATE GOVERNMENT REPRESENTATIVES WITH THE PURPOSE OF IMPROVING THE DELIVERY OF HEALTHCARE NOT ONLY AT SAUK PRAIRIE MEMORIAL HOSPITAL, INC. BUT ALSO COLLECTIVELY IN THE STATE OF WISCONSIN. AS ISSUES OR PROPOSED LEGISLATION ARISE THROUGHOUT THE YEAR, OFFICIALS OF SAUK PRAIRIE MEMORIAL HOSPITAL, INC. WILL SEND LETTERS OF COMMENT TO LOCAL, STATE, AND FEDERAL GOVERNMENT REPRESENTATIVES TO EITHER SHOW SUPPORT OF PROPOSED CHANGES OR VOICE AN OPINION TO IMPROVE THE OUTCOME OF PROPOSED LEGISLATION OR OTHER CHANGES. THESE ACTIVITIES RESULT IN MINIMAL COST TO THE OPERATION OF SAUK PRAIRIE MEMORIAL HOSPITAL, INC.

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,329,586BeginningYearBalanceAmt
Investment Earnings Or Losses$166,254InvestmentEarningsOrLossesAmt
End Year Balance$1,495,840EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,196,971BeginningYearBalanceAmt
Investment Earnings Or Losses$132,615InvestmentEarningsOrLossesAmt
End Year Balance$1,329,586EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,147,396BeginningYearBalanceAmt
Investment Earnings Or Losses$49,575InvestmentEarningsOrLossesAmt
End Year Balance$1,196,971EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Contributions$1,084,880ContributionsAmt
Investment Earnings Or Losses$92,516InvestmentEarningsOrLossesAmt
Grants Or Scholarships$30,000GrantsOrScholarshipsAmt
End Year Balance$1,147,396EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.00000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.85240PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.14760TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (1)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (1)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,474,554OtherCostOrOtherBasisAmt
Book Value$7,474,554BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$19,473,625OtherCostOrOtherBasisAmt
Depreciation$13,342,618DepreciationAmt
Book Value$6,131,007BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$28,206,222OtherCostOrOtherBasisAmt
Depreciation$18,463,987DepreciationAmt
Book Value$9,742,235BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$64,032,068OtherCostOrOtherBasisAmt
Book Value$64,032,068BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$87,379,864TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDEFERRED COMPENSATION PLAN LIABILITYDesc
Amt$1,321,164Amt
FieldValueIRS element (for citing)
Total Liability$1,321,164TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$68,207,822TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$403,000NetUnrealizedGainsInvstAmt
Other Revenue$310,551OtherRevenueAmt
Revenue Not Reported-$92,449RevenueNotReportedAmt
Revenue Subtotal$68,300,271RevenueSubtotalAmt
Other Revenues Not Included$1,241,267OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$1,241,267RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$69,541,538TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$66,380,438TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$310,551OtherExpensesIncludedAmt
Expenses Not Reported$310,551ExpensesNotReportedAmt
Expenses Subtotal$66,069,887ExpensesSubtotalAmt
Other Expenses Not Included$191,267OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$191,267ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$66,261,154TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, LINE 4:THE SCHNELLER SISTERS FUND SHALL BE HELD AS A SEPARATE PERMANENT ENDOWMENT FUND ON THE BOOKS AND RECORDS OF THE FOUNDATION, THE INCOME FROM WHICH SHALL BE DISTRIBUTED TO SAUK PRAIRIE MEMORIAL HOSPITAL, INC. FOR UNRESTRICTED NEEDS. ALL DISTRIBUTIONS FROM THE SCHNELLER SISTERS FUND SHALL BE DESIGNATED AS HAVING BEEN MADE "IN MEMORY OF THE SCHNELLER SISTERS: CECELIA SCHNELLER MUELLER, ADLYNN F. BALFANZ, AND MARY ANN ROSAR."
PART X, LINE 2:THE HOSPITAL IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. THE HOSPITAL IS ALSO ENGAGED, TO A LIMITED EXTENT, IN CERTAIN ACTIVITIES SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME (UBI). UBI IS NOT SIGNIFICANT. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE HOSPITAL ASSESSES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OR THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL RECORDED NO ASSETS OR LIABILITIES FOR UNRECOGNIZED TAX BENEFITS FROM UNCERTAIN TAX POSITIONS IN 2013 OR 2012. FEDERAL TAX RETURNS FOR YEARS 2010 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE.
PART XI, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES NET AGAINST RENTAL INCOME 310,551.
PART XI, LINE 4B - OTHER ADJUSTMENTS:GOOD NEIGHBOR CLINIC SERVICES PROVIDED 104,235. CONTRIBUTIONS FROM RELATED ORGANIZATION 1,050,000. BAD DEBT EXPENSE 87,032.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES NET AGAINST RENTAL INCOME 310,551.
PART XII, LINE 4B - OTHER ADJUSTMENTS:GOOD NEIGHBOR CLINIC SERVICES PROVIDED 104,235. BAD DEBT EXPENSE 87,032.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (1)ExpensesExceedBudgetInd
Unable To Provide Care0UnableToProvideCareInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,201,344TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,201,344NetCommunityBenefitExpnsAmt
Total Expense0.01820TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,171,923TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,471,315DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,700,608NetCommunityBenefitExpnsAmt
Total Expense0.02570TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,373,267TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,471,315DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,901,952NetCommunityBenefitExpnsAmt
Total Expense0.04390TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$482,395TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$139,721DirectOffsettingRevenueAmt
Net Community Benefit Expns$342,674NetCommunityBenefitExpnsAmt
Total Expense0.00520TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$105,135TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$105,135NetCommunityBenefitExpnsAmt
Total Expense0.00160TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$12,405,983TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$8,272,493DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,133,490NetCommunityBenefitExpnsAmt
Total Expense0.06250TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$233,586TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$233,586NetCommunityBenefitExpnsAmt
Total Expense0.00350TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$13,227,099TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$8,412,214DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,814,885NetCommunityBenefitExpnsAmt
Total Expense0.07280TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$18,600,366TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,883,529DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,716,837NetCommunityBenefitExpnsAmt
Total Expense0.11670TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$19,616TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$19,616NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$10,178TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$10,178NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$12,019TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$12,019NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$624TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$624NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$11,108TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$11,108NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$53,545TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$53,545NetCommunityBenefitExpnsAmt
Total Expense0.00090TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReportedInd
Bad Debt Expense$39,458BadDebtExpenseAmt
Bad Debt Expense Attributable$19,729BadDebtExpenseAttributableAmt
Reimbursed By Medicare$13,050,617ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$17,215,038CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$4,164,421MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SAUK PRAIRIE MEMORIAL HOSPITAL INCBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1260 26TH STREETAddressLine1
CityPRAIRIE DU SACCity
StateWIState
ZIP Code53578ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1SAUK PRAIRIE MEMORIAL HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Facility1FacilityNum
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
OtherYes (X)OtherInd
CHNA Conducted12CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.SAUKPRAIRIEHEALTHCARE.ORG/ABOUT/COMMUOwnWebsiteURLTxt
Rpt Available Upon RequestYes (X)RptAvailableUponRequestInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Adopt Implementation StrategyYes (X)AdoptImplementationStrategyInd
Exec Implementation StrategyYes (X)ExecImplementationStrategyInd
Develop Community Wide PlanYes (X)DevelopCommunityWidePlanInd
Exec Community Wide PlanYes (X)ExecCommunityWidePlanInd
Include Operational PlanYes (X)IncludeOperationalPlanInd
Adopt BudgetYes (X)AdoptBudgetInd
Prioritize Health NeedsYes (X)PrioritizeHealthNeedsInd
Prioritize ServicesYes (X)PrioritizeServicesInd
Other Needs AddressedYes (X)OtherNeedsAddressedInd
All Needs Addressed0AllNeedsAddressedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Used Deter Elig Free CareYes (1)FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care100.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt CareYes (1)FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care400.000000000000FPGFamilyIncmLmtDscntCarePct
Explained BasisYes (1)ExplainedBasisInd
Income LevelYes (X)IncomeLevelInd
Asset LevelYes (X)AssetLevelInd
Medical IndigencyYes (X)MedicalIndigencyInd
Insurance StatusYes (X)InsuranceStatusInd
Uninsured DiscountYes (X)UninsuredDiscountInd
Medicaid MedicareYes (X)MedicaidMedicareInd
State RegulationYes (X)StateRegulationInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
Posted On WebsiteYes (X)PostedOnWebsiteInd
Attached To InvoiceYes (X)AttachedToInvoiceInd
Posted In Emergency RoomYes (X)PostedInEmergencyRoomInd
Posted In Admission OfficeYes (X)PostedInAdmissionOfficeInd
Provided On AdmissionYes (X)ProvidedOnAdmissionInd
Available On RequestYes (X)AvailableOnRequestInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit Report To Credit AgencyYes (X)PermitReportToCreditAgencyInd
Permit LawsuitYes (X)PermitLawsuitInd
Collection ActivitiesYes (1)CollectionActivitiesInd
Reporting To Credit AgencyYes (X)ReportingToCreditAgencyInd
LawsuitYes (X)LawsuitInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SAUK PRAIRIE MEMORIAL HOSPITAL, INC.PART V, SECTION B, LINE 1J: INPUT FROM LOCAL PHYSICIANS WITH REGARD TO THE HIGHEST COMMUNITY HEALTH NEEDS WAS ALSO INCLUDED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT.
SAUK PRAIRIE MEMORIAL HOSPITAL, INC.PART V, SECTION B, LINE 3: IN FEBRUARY AND MARCH 2011, A MORE FORMALIZED PROCESS WAS COMPLETED TO UPDATE THE 2010 PRELIMINARY COMMUNITY HEALTH NEEDS ASSESSMENT. THE HOSPITAL HIRED MATOUSEK AND ASSOCIATES, A MARKETING RESEARCH AND CONSULTING FIRM LOCATED IN GREEN BAY, WISCONSIN, TO CONDUCT FOCUS GROUPS WITH MORE THAN 150 RESIDENTS FROM THROUGHOUT THE SERVICE AREA TO IDENTIFY UNMET NEEDS OF KEY COMMUNITIES WE SERVE. A TOTAL OF 14 FOCUS GROUPS WERE HELD IN FIVE COMMUNITIES WITH RESIDENTS INVOLVED WITH SAUK COUNTY HOSPITALS, SCHOOLS AND LAW ENFORCEMENT, MENTAL HEALTH, ENVIRONMENTAL HEALTH, BUSINESS, PUBLIC HEALTH, BOARD OF HEALTH MEMBERS, DISABILITY AND AGING ADVOCATES, ABUSE ADVOCATES, LONG TERM CARE PROVIDERS AND RANDOMLY SELECTED WOMEN. EACH FACILITATED SESSION RESULTED IN A LIST OF PRIORITIZED HEALTH NEEDS AND ISSUES. IN ADDITION TO THE FOCUS GROUPS, A COMMUNITY LISTENING SESSION WAS CONDUCTED IN SPANISH WITH EIGHT RESIDENTS OF THE BLUFFVIEW NEIGHBORHOOD LOCATED ACROSS FROM THE FORMER BADGER ORDINANCE PLANT ON HIGHWAY 12. MANY RESIDENTS OF THE BLUFFVIEW NEIGHBORHOOD ARE CONSIDERED LOW-INCOME AND MANY ARE ETHNICALLY HISPANIC. FINALLY, ADDITIONAL INPUT WAS PROVIDED BY MEMBERS OF THE HOSPITAL'S LEADERSHIP TEAM. MEMBERS OF THE LEADERSHIP TEAM ARE ACTIVELY ENGAGED IN COMMUNITY ORGANIZATIONS INCLUDING THE GOOD NEIGHBOR CLINIC BOARD (LOCAL FREE CLINIC), DEVELOPMENT OF A DENTAL CLINIC FOR LOW-INCOME INDIVIDUALS, SAFETY COALITION, AND VARIOUS COMMUNITY ORGANIZATIONS. IN THAT CAPACITY, THE LEADERSHIP TEAM DISCUSSES COMMUNITY HEALTH ISSUES WITH AREA COMMUNITY MEMBERS. THE HOSPITAL IS ALSO REPRESENTED BY 11 COMMUNITY MEMBERS ON ITS BOARD OF DIRECTORS WHO SERVE AS THE COMMUNITY "EARS" OF THE HOSPITAL. INDIVIDUAL INTERVIEWS WERE ALSO CONDUCTED WITH HOSPITAL BOARD MEMBERS AS PART OF THE DATA GATHERING PROCESS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT.
SAUK PRAIRIE MEMORIAL HOSPITAL, INC.PART V, SECTION B, LINE 4: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS: - ST. CLARE HOSPITAL (BARABOO, WI)- REEDSBURG AREA MEDICAL CENTER (REEDSBURG, WI)
SAUK PRAIRIE MEMORIAL HOSPITAL, INC.PART V, SECTION B, LINE 5D: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS MADE PUBLICLY AVAILABLE IN MARCH 2013. THIS WAS ANNOUNCED VIA A COMMUNITY NEWSLETTER TO MORE THAN 20,000 HOUSEHOLDS, AND IT WAS INTERNALLY ANNOUNCED TO EMPLOYEES AND MEDICAL STAFF OF THE HOSPITAL. THE CHNA HAS ALSO BEEN PRESENTED AT VARIOUS COMMUNITY SERVICE ORGANIZATION MEETINGS.
SAUK PRAIRIE MEMORIAL HOSPITAL, INC.PART V, SECTION B, LINE 6I: THE PRIMARY OBJECTIVE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IS TO "DECREASE OBESITY AND INCREASE PHYSICAL ACTIVITY."IN THE PAST YEAR, THE HOSPITAL HAS ENGAGED IN FOUR ACTIVITIES TO ADDRESS THE REDUCTION OF OBESITY AND INCREASING PHYSICAL ACTIVITY. THESE INCLUDE: 1) "KIDS COUNT" OBESITY REDUCTION PROJECT: IN COLLABORATION WITH THE SAUK PRAIRIE SCHOOL DISTRICT, THE HOSPITAL HAS DEVELOPED A 5-YEAR PROJECT TARGETED TOWARD 3RD GRADERS TO INCREASE CLASSROOM ACTIVITY, IMPROVE NUTRITION, AND INCREASE PHYSICAL ACTIVITIES. THIS PROJECT HAS NOW EXPANDED TO INCLUDE THE INCOMING 3RD GRADE CLASS AND NEW 4TH GRADERS (LAST YEAR'S 3RD GRADERS).2) WISCONSIN HEIGHTS COMMUNITY GARDEN: THE HOSPITAL ORGANIZED LOCAL VOLUNTEERS IN THE WISCONSIN HEIGHTS SCHOOL DISTRICT TO CREATE A 2-ACRE COMMUNITY GARDEN IN AN EFFORT TO IMPROVE ACCESS TO NUTRITIONAL FOOD AND TO RAISE AWARENESS ABOUT THE VALUE OF HEALTHY EATING HABITS. THE INITIAL TARGET NUMBER OF GARDENERS WAS SET AT 10. THIS GOAL WAS FAR EXCEEDED AS THE GARDEN ATTRACTED 30 PARTICIPANTS.3) SAUK PRAIRIE WELLNESS MOVEMENT: THIS GROUP WAS ORIGINALLY FORMED AS THE SAUK PRAIRIE OBESITY REDUCTION COLLABORATION BY PRAIRIE CLINIC, S.C., A LOCAL PRIMARY CARE CLINIC. THE GROUP'S ORIGINAL MISSION TO "WORK TOGETHER AS A COMMUNITY TO CHAMPION THE REDUCTION OF OBESITY IN OUR COMMUNITY" REMAINS INTACT. SINCE THE GROUP'S ORIGINAL MEETING IN OCTOBER 2010, THE GROUP HAS GROWN IN NUMBER OF PARTICIPANTS, CREATED A NEW IDENTITY AS THE WELLNESS MOVEMENT, PARTICIPATED IN A HEALTH NEEDS ASSESSMENT, AND DETERMINED ITS FIRST TWO INITIATIVES, THE KIDS COUNT INITIATIVE (DESCRIBED ABOVE) AND WELLNESS IN THE WORKPLACE. 4) GETTING BETTER PROGRAM: THIS PROGRAM FOCUSES ON MORBIDLY OBESE/CHRONICALLY SYMPTOMATIC ADULTS WHO INDICATE A DESIRE TO CHANGE THEIR CURRENT STATE OF HEALTH. CLINICAL AND BEHAVIORAL DATA OF THE 24 STUDY PARTICIPANTS INDICATES A SIGNIFICANT CHANGE IN BODY MASS INDEX, HGA1C LEVELS, AND A WILLINGNESS TO MAINTAIN CHANGES IN EXERCISE AND DIETARY HABITS.
SAUK PRAIRIE MEMORIAL HOSPITAL, INC.PART V, SECTION B, LINE 7: AS WITH ALL HEALTHCARE ORGANIZATIONS, ADEQUATE RESOURCES ARE NOT AVAILABLE TO ADDRESS EVERY UNMET HEALTH NEED IN THE COMMUNITIES THE HOSPITAL SERVES. THERE IS NO LIMIT TO THE NUMBER OF ISSUES TO WHICH A HEALTHCARE INSTITUTION COULD DEVOTE RESOURCES. TIME, PEOPLE, AND MONEY OFTEN ARE LIMITING FACTORS FOR WHY THE HOSPITAL CANNOT MEET EVERY UNMET NEED OF THE COMMUNITY. HOWEVER, SAUK PRAIRIE MEMORIAL HOSPITAL, INC. WILL FOCUS ON A FEW HIGH PRIORITY PROJECTS AND MAKE EVERY EFFORT TO AVOID DUPLICATION AND ENCOURAGE COLLABORATION AND COORDINATION WITH OTHER ORGANIZATIONS AND COMMUNITY GROUPS. AS SAUK PRAIRIE MEMORIAL HOSPITAL, INC. ASSESSED UNMET HEALTH NEEDS AND DETERMINED ITS PRIORITIES, THE HOSPITAL ALSO EVALUATED THOSE ISSUES THAT WERE BEING ADDRESSED BY OTHERS. SAUK PRAIRIE MEMORIAL HOSPITAL, INC.'S PHILOSOPHICAL POSITION REGARDING THE HEALTH OF THE COMMUNITY IS TO FOCUS ON FEWER, RATHER THAN MANY, INITIATIVES SO THAT THOSE WE WORK ON HAVE A HIGHER CHANCE OF SUCCESS.
SAUK PRAIRIE MEMORIAL HOSPITAL, INC.PART V, SECTION B, LINE 14G: INFORMATION ABOUT THE POLICY IS INCLUDED ON BILLING INVOICES, ON ADMISSION INFORMATION, ON THE WEBSITE, AND IS REFERENCED IN COLLECTION EFFORTS. IT IS ALSO MENTIONED IN COMMUNITY TALKS OF HEALTH INSURANCE.
SAUK PRAIRIE MEMORIAL HOSPITAL, INC.PART V, SECTION B, LINE 17E: THE HOSPITAL ATTEMPTS TO CONTACT THE PATIENT TO SEE IF THEY QUALIFY FOR COMMUNITY CARE. IF THE HOSPITAL CANNOT CONTACT THE PATIENT OR IF THE PATIENT HAS OTHER ACCOUNTS IN BAD DEBT, THE ACCOUNTS GO INTO THE HOSPITAL'S NORMAL COLLECTION PROCESS.
SAUK PRAIRIE MEMORIAL HOSPITAL, INC.PART V, SECTION B, LINE 20D: THE HOSPITAL FOLLOWS ITS NORMAL PROCEDURES FOR COLLECTION OF THESE ACCOUNTS, INCLUDING DISCOUNTS BASED ON INCOME/ASSET LEVELS, PROMPT PAYMENT, OR MEDICAL INDIGENCE. THE AVERAGE DISCOUNT OF THE THREE LARGEST MANAGED CARE CONTRACTS IS USED TO CALCULATE THE MAXIMUM RATE CHARGED TO FAP ELIGIBLE PATIENTS.
SAUK PRAIRIE MEMORIAL HOSPITAL, INC.PART V, SECTION B, LINE 22: PATIENTS WITHOUT INSURANCE AND NOT ELIGIBLE FOR FINANCIAL ASSISTANCE ARE GIVEN OPPORTUNITIES FOR DISCOUNTS UNDER INTERNAL PROGRAMS. IF PATIENTS DO NOT AVAIL THEMSELVES OF SUCH OPPORTUNITIES, THEY MAY BE CHARGED THE GROSS CHARGE.
FieldValueIRS element (for citing)
Facility6FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeFacilityFacilityTxt
ORTHOPEDIC ASSOCIATES OF SAUK PRAIRIE
80 FIRST STREETPRAIRIE DU SACWI53578ORTHOPEDIC CLINIC
LODI MEDICAL CLINIC
160 VALLEY DRIVELODIWI53555PHYSICIAN CLINIC
RIVER VALLEY MEDICAL CLINIC
436 SUNRISE DRIVESPRING GREENWI53588RURAL HEALTH CLINIC
BLACK EARTH MEDICAL CLINIC
1529 STATE STREET ABLACK EARTHWI53515PHYSICIAN CLINIC
PLAIN MEDICAL CLINIC
825 MAIN STREETPLAINWI53577RURAL HEALTH CLINIC
SURGICAL ASSOCIATES
80 FIRST STREETPRAIRIE DU SACWI53578SURGICAL CLINIC

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 7:THE COSTING METHODOLOGY USED ON FORM 990 IS PRIMARILY BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICES REVENUES. 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. THE COSTING METHOD FOR SUBSIDIZED HEALTH SERVICES IS BASED ON INTERNAL RECORDS AND ALLOCATIONS WHICH ARE SIMILAR TO A DIRECT COSTING ACCOUNTING SYSTEM FOR THESE SERVICES NOTED AS SUBSIDIZED HEALTH SERVICES.
PART I, LINE 7G:SUBSIDIZED HEALTH SERVICES AT SAUK PRAIRIE MEMORIAL HOSPITAL, INC. INCLUDE THE OPERATION OF SEVERAL HOSPITAL DEPARTMENTS THAT OPERATE AT A LOSS FROM OPERATIONS, BUT ARE CONSIDERED VITAL HOSPITAL AND CLINIC SERVICES SUCH AS THE INTENSIVE CARE UNIT, OUTPATIENT PHYSICIAN CLINICS, INCLUDING INTERNAL MEDICINE, AND SEVERAL OTHER DEPARTMENTS. A LARGE PORTION OF THESE SERVICES ARE ACCESSED BY COMMUNITY MEMBERS THROUGH THE HOSPITAL'S EMERGENCY SERVICES DEPARTMENT. IT IS THE GOAL OF SAUK PRAIRIE MEMORIAL HOSPITAL, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY.
PART I, LN 7 COL(F):MANY TIMES PATIENTS ARE UNABLE TO COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE HOSPITAL PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE.
PART II, COMMUNITY BUILDING ACTIVITIES:THE HOSPITAL'S COMMUNITY BUILDING EFFORTS PROMOTE BOTH THE PHYSICAL AND ECONOMIC HEALTH OF THE COMMUNITIES IT SERVES. FROM AN ECONOMIC PERSPECTIVE, SAUK PRAIRIE MEMORIAL HOSPITAL, INC. STAFF CONTRIBUTES HUNDREDS OF HOURS TO CHAMBERS OF COMMERCE ACTIVITIES AND SUPPORT WORKFORCE DEVELOPMENT THROUGH COMMUNITY AND EDUCATIONAL PROGRAMS. THE PHYSICAL HEALTH OF THE COMMUNITY IS SUPPORTED THROUGH THE DEVELOPMENT OF HEALTH-RELATED COALITIONS, PARTICULARLY THE SAUK PRAIRIE WELLNESS MOVEMENT.
PART III, LINE 2:THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL.
PART III, LINE 4:MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY REPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE ORGANIZATION HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE.
PART III, LINE 8:WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PATIENTS, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.THE TOTAL MEDICARE REVENUE SHOWN ON SCHEDULE H IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY THE CHARGES FROM MEDICARE PROGRAM BENEFICIARIES THAT ARE REPORTED ON THE HOSPITAL'S MEDICARE COST REPORT. THE AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT SAUK PRAIRIE MEMORIAL HOSPITAL, INC., PHYSICIAN SERVICES FOR THE INTERNAL MEDICINE (HOSPITALIST) PROGRAM, PHYSICIAN SERVICES PROVIDED AT TWO OF THE FOUR OUTLYING PHYSICIAN CLINICS, CRNA SERVICES PROVIDED TO PATIENTS UNDERGOING ANESTHESIA AT THE HOSPITAL, AND A SIGNIFICANT PORTION OF LAB AND PHYSICAL THERAPY SERVICES WHICH ARE REIMBURSED BY THE MEDICARE PROGRAM UNDER ANOTHER METHODOLOGY. PHYSICIAN COVERAGE OUTPATIENT LAB SERVICES AND OUTPATIENT PHYSICAL THERAPY SERVICES ARE REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT SAUK PRAIRIE MEMORIAL HOSPITAL, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. 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 OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE DIVIDED BY HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES, WHICH ARE REIMBURSED ON A COST REPORTING METHODOLOGY. INCLUDING THE FEE SCHEDULE ITEMS, SUCH AS PHYSICIAN SERVICES, WOULD PRODUCE A LARGER LOSS OR SHORTFALL ON THESE SERVICES TO BE REPORTED ON THE FORM 990 IN ANY GIVEN YEAR.
PART III, LINE 9B:IT IS THE POLICY OF SAUK PRAIRIE MEMORIAL HOSPITAL, INC. THAT EACH PATIENT RECEIVES CARE REGARDLESS OF THE ABILITY TO PAY. IF DURING THE COLLECTION PROCESS A PATIENT DOES NOT COMPLETE THE NECESSARY PAPERWORK OR RESPOND TO ATTEMPTS BY THE HOSPITAL TO PROVIDE CHARITY SERVICES, THE PATIENT MAY STILL REQUEST CHARITY INFORMATION AND COMPLETE THE INFORMATION AT ANY TIME DURING THE COLLECTION PROCESS. THE PATIENT WILL BE REFERRED TO THE HOSPITAL'S CHARITY CARE POLICY AND CAN QUALIFY FOR CHARITY CARE, AND HAVE ANY COLLECTION ISSUES REVERSED BY THE ORGANIZATION, IF THEY SHOW A NEED FOR THE CARE BASED ON THE HOSPITAL'S POLICY.
PART VI, LINE 2:THE HOSPITAL ENGAGES IN THE FOLLOWING ACTIVITIES TO ASSESS THE HEALTHCARE NEEDS OF THE 42,000 RESIDENTS THROUGHOUT ITS 700 SQUARE MILE PRIMARY SERVICE AREA: - ANALYZE HEALTH STATUS INFORMATION, EPIDEMIOLOGICAL DATA, AND HOSPITAL DISCHARGE DATA FURNISHED BY THE STATE OF WISCONSIN AND SAUK COUNTY TO IDENTIFY ISSUES AND TRENDS.- MEET PERIODICALLY WITH THE COUNTY HEALTH DEPARTMENT AND TWO OTHER NEARBY HOSPITALS TO ASSESS HIGH PRIORITY HEALTH NEEDS AND COORDINATE ACTION.- PARTICIPATE IN AND HELP COORDINATE COUNTY-WIDE INPUT SESSIONS WITH THE COUNTY HEALTH DEPARTMENT.- LEAD AND PARTICIPATE IN COMMUNITY WELLNESS GROUPS AND INITIATIVES THROUGHOUT THE SERVICE AREA.- CONDUCT "COMMUNITY HEALTH NEED" FOCUS GROUPS CONSISTING OF COMMUNITY LEADERS AND RANDOMLY SELECTED RESIDENTS. - ANALYZE THE POPULATION-BASED NEED FOR MEDICAL PROVIDERS BY SPECIALTY. THIS INFORMATION IS ASSESSED AND MODIFIED BY MEMBERS OF THE HOSPITAL MEDICAL STAFF.- LEADER PARTICIPATION AND LEADERSHIP IN CIVIC AND COMMUNITY SERVICE ORGANIZATIONS.- ACTIVELY ENGAGE HOSPITAL BOARD MEMBERS IN COMMUNITY HEALTH IMPROVEMENT INITIATIVES AND PROVIDE THE BOARD WITH MONTHLY UPDATES REGARDING COMMUNITY HEALTH ACTIVITIES.
PART VI, LINE 3:1. AT THE TIME OF REGISTRATION, A REGISTRATION SPECIALIST WILL INQUIRE IF THERE IS HEALTH INSURANCE. IF NOT, THEY WILL BE ADVISED OF THE HOSPITAL'S COMMUNITY CARE PROGRAM IF THEY RESIDE WITHIN OUR SERVICE AREA. THOSE WHO HAVE A SAUK PRAIRIE BASED PHYSICIAN WILL ALSO BE CONSIDERED FOR ELIGIBILITY. COMMUNITY CARE INFORMATION IS ALSO POSTED ON THE HOSPITAL WEBSITE AND BILLS STATE THAT IF THE PATIENT IS HAVING DIFFICULTY PAYING THEY SHOULD CONTACT A HOSPITAL REPRESENTATIVE, AS THEY MAY BE ELIGIBLE FOR FREE OR REDUCED FEES.2. ANY PATIENT REQUESTING ADDITIONAL INFORMATION ABOUT THE COMMUNITY CARE PROGRAM WILL BE REFERRED TO THE PATIENT ACCOUNTS SPECIALIST, WHO WILL EXPLAIN THE PROGRAM AND ITS ELIGIBILITY CRITERIA. WHEN APPLICABLE, ALL GOVERNMENT ASSISTANCE PROGRAMS SUCH AS MEDICAID, BADGER CARE, AND CRIME VICTIMS MUST BE EXHAUSTED BEFORE APPLYING FOR COMMUNITY CARE (EXCEPTION: THE GOVERNMENT PROGRAM APPLICATION MAY BE WAIVED BASED ON RELIGIOUS BELIEFS). COMMUNITY CARE IS NOT AVAILABLE FOR ELECTIVE PROCEDURES. PERSONS RESIDING IN THE SAUK PRAIRIE MEMORIAL HOSPITAL, INC.'S PRIMARY SERVICE AREA WILL BE CONSIDERED FOR ELIGIBILITY DETERMINATION. IN THE CASE OF EMERGENCY SERVICES, COMMUNITY CARE MAY BE EXTENDED TO THOSE RESIDING OUTSIDE OF THE PRIMARY SERVICE AREA.3. THE INFORMATION IS ALSO POSTED ON OUR WEBSITE UNDER "PREPARING FOR YOUR STAY." IF AT ANY TIME PRIOR TO, DURING, OR AFTER THE SERVICES ARE PROVIDED THE PATIENT EXPRESSED CONCERNS ABOUT PAYMENT, THE COMMUNITY CARE PROGRAM IS EXPLAINED. INFORMATION IS ALSO PRINTED ON PATIENT STATEMENTS AND DISCUSSED WITH THE PATIENT DURING THE BILLING PROCESS.
PART VI, LINE 4:THE HOSPITAL'S PRIMARY SERVICE AREA ENCOMPASSES A 700 SQUARE MILE REGION IN RURAL SOUTH CENTRAL WISCONSIN, INCLUDING SAUK, SOUTHERN COLUMBIA, NORTHWEST DANE, NORTHERN IOWA AND EASTERN RICHLAND COUNTIES. THE HOSPITAL IS LOCATED IN SAUK PRAIRIE (COMMON NAME FOR THE NEIGHBORING MUNICIPALITIES OF SAUK CITY AND PRAIRIE DU SAC) AND THE CLINICS ARE LOCATED IN FOUR TOWNS SURROUNDING SAUK PRAIRIE (BLACK EARTH, SPRING GREEN, PLAIN, AND LODI). NO OTHER HOSPITALS ARE LOCATED WITHIN THE PRIMARY SERVICE AREA, HOWEVER, EIGHT INPATIENT HOSPITALS (INCLUDING 5 RURAL AND 3 TERTIARY FACILITIES) ARE LOCATED WITHIN A 30 MILE RADIUS OF SAUK PRAIRIE MEMORIAL HOSPITAL, INC.DEMOGRAPHIC ANALYSIS INDICATES A 5-YEAR GROWTH RATE OF 2.5% COMPARED TO THE STATE OF WISCONSIN'S RATE OF 1.9%. AGE GROUPS THAT WILL GROW AT A CONSIDERABLY FASTER RATE THAN THE STATE INCLUDE 0-17 YEAR OLDS (1.9%), 25-34 (15.2%), AND 65+ (16.6%). HEALTH ISSUES AFFECTING THESE AGE SEGMENTS INCLUDE PRENATAL SCREENING, TEEN PREGNANCY, LACK OF ACCESS TO HEALTHCARE, AND MEDICAL ISSUES ASSOCIATED WITH AGING.THE AREA HAS LITTLE RACIAL AND ETHNIC DIVERSITY, ALTHOUGH THE NUMBER OF HISPANIC RESIDENTS HAS INCREASED CONSIDERABLY SINCE 2000. BY 2018, THIS POPULATION SEGMENT WILL REPRESENT 5.1% OF THE TOTAL POPULATION. SPECIFIC HEALTH-RELATED ISSUES CONFRONTING THIS POPULATION INCLUDE DIABETES, ACCESS TO CARE, AND LANGUAGE BARRIERS.AVERAGE HOUSEHOLD INCOME OF SERVICE AREA RESIDENTS IS 10% HIGHER THAN THE STATE AVERAGE. THIS DIFFERENCE IS DUE IN LARGE PART BECAUSE OF THE RELATIVELY STRONG JOB MARKET IN MADISON, WHICH ATTRACTS COMMUTERS FROM THE SERVICE AREA. THROUGHOUT THE SERVICE AREA, HOWEVER, AGRICULTURE AND TOURISM REPRESENT A CONSIDERABLE NUMBER OF LOW-PAYING JOBS, TYPICALLY WITHOUT HEALTH BENEFITS.A PORTION OF THE HOSPITAL PRIMARY SERVICE AREA IS DESIGNATED AS A MEDICALLY UNDERSERVED AREA/POPULATION. THIS AREA IS LOCATED IN THE TOWN OF ARENA (MCD 02575).
PART VI, LINE 5:SAUK PRIARIE MEMORIAL HOSPITAL, INC. IS AN INDEPENDENT COMMUNITY HOSPITAL GOVERNED BY AN 11-MEMBER BOARD OF DIRECTORS WHO RESIDE WITHIN THE PRIMARY SERVICE AREA. THE BOARD IS ELECTED BY THE 1,200 MEMBER COMMUNITY HOSPITAL ASSOCIATION. AN INDEPENDENT HOSPITAL IS A CRUCIAL PART OF THE HOSPITAL'S VISION, BECAUSE IT KEEPS CONTROL AT THE LOCAL LEVEL, NOT IN A CORPORATE HEADQUARTERS LOCATED ELSEWHERE. LOCAL CONTROL ALLOWS THE HOSPITAL TO MAKE DECISIONS THAT ARE BEST FOR THE LOCAL COMMUNITIES.THE SAUK PRAIRIE MEMORIAL HOSPITAL, INC. MEDICAL STAFF PRIVILEGES QUALIFIED PHYSICIANS IN ITS COMMUNITIES. THE VAST MAJORITY OF THE ACTIVE MEDICAL STAFF PRACTICE SOLELY AT THE SAUK PRAIRIE MEMORIAL HOSPITAL, INC. OR ASSOCIATED CLINICS. THE HOSPITAL STRATEGIC PLAN SPECIFICALLY ADDRESSES OUR DESIRE TO "IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE" AND THE ORGANIZATION'S EFFORTS TO ASSESS THE NEEDS OF THE COMMUNITY AND ADDRESS THOSE NEEDS. SAUK PRAIRIE MEMORIAL HOSPITAL, INC. PROMOTES COMMUNITY HEALTH THROUGH A BROAD ARRAY OF APPROACHES. THE FOLLOWING LIST DESCRIBES SPECIFIC PROGRAMS AND ACTIVITIES THAT CONTRIBUTE TO IMPROVING THE HEALTH OF THE COMMUNITY AND ENHANCING THE PROVISION OF MEDICAL CARE:- TRAINING MEDICAL STUDENTS, NURSING STUDENTS, AND OTHER HEALTH PROFESSIONS- CONTRIBUTE TIME AND FINANCIAL RESOURCES IN THE DEVELOPMENT OF A DENTAL CLINIC, COLLABORATIVE WITH OTHER INDIVIDUALS AND ORGANIZATIONS IN THE COMMUNITY, TO PROVIDE DENTAL SERVICES TO UNINSURED AND UNDERINSURED MEMBERS OF THE COMMUNITIES SERVED WHO WOULD OTHERWISE NOT HAVE ACCESS OR THE ABILITY TO ACCESS THESE SERVICES ON A REGULAR BASIS- ORGANIZE AND/OR PARTICIPATE IN FREE COMMUNITY HEALTH EDUCATION EVENTS AND SEMINARS- ORGANIZE AND/OR PARTICIPATE IN HEALTH FAIRS- OFFER CPR/FIRST AID CLASSES- ISSUE EDUCATIONAL NEWS RELEASES- CONDUCT COMMUNITY-BASED CLINICAL SCREENINGS (HEARING AID CHECKS, BLOOD PRESSURE AND CHOLESTEROL SCREENING)- PROVIDE SERVICES FOR THE GOOD NEIGHBOR CLINIC OF SAUK PRAIRIE, INC. (LOCAL FREE CLINIC)- MEDICATION TAKE BACK DAY- DISCOUNTED EQUIPMENT AND SUPPLIES- ADVANCED DIRECTIVES COUNSELING- BLOOD DRIVES- BREASTFEEDING EDUCATION- CANCER EDUCATION- CLINICS FOR UNDERINSURED/LAB & MEDICATION COSTS- COMMUNITY GARDEN- COMMUNITY HEALTH IMPROVEMENT ADVOCACY- DIABETES EDUCATION- FAMILTY/PARENTING/SIBLING EDUCATION- IMMUNIZATIONS/PERTUSSIS- MOBILE MEALS- PRESCRIPTION DRUG COLLECTION- SCHOOL-BASED HEALTH EDUCATION PROGRAMS- SCREENING/HEARING- SELF-HELP/CARDIAC REHAB- SELF-HELP/FITNESS AND EXERCISE- SELF-HELP/NUTRITION AND WEIGHT MANAGEMENT- SELF-HELP/SPORTS INJURY PREVENTION- SHARPS COLLECTION- SUPPORT GROUPS-BEREAVEMENT/GRIEF- SUPPORT GROUPS-BREASTFEEDING- SUPPORT GROUPS-DIABETES- SUPPORT GROUPS-NEW MOM- SUPPORT GROUPS-SLEEP APNEA- TRANSPORTATION TOKENS (BUS, CAB FARE)
PART VI, LINE 7, REPORTS FILED WITH STATESWI

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1THE GOOD NEIGHBOR CLINIC OF SAUK PRAIRIE INCBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line11906 NORTH STAddressLine1
CityPRAIRIE DU SACCity
StateWIState
ZIP Code53578ZIPCode
FieldValueIRS element (for citing)
Recipient EIN391963290RecipientEIN
IRC Section501(C)3IRCSectionDesc
Cash Grant$0CashGrantAmt
Non Cash Assistance$104,235NonCashAssistanceAmt
Valuation Method UsedCOSTValuationMethodUsedDesc
Non Cash AssistanceMEDICAL SERVICES AND SUPPLIESNonCashAssistanceDesc
Purpose Of GrantTO PROVIDE MEDICAL ASSISTANCE TO THOSE WHO NORMALLY COULD NOT AFFORD ITPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationSAUK PRAIRIE MEMORIAL HOSPITAL, INC. FOLLOWS THE FOLLOWING PROCESS TO PROVIDE ADDITIONAL SUPPLIES TO THE GOOD NEIGHBOR CLINIC ("GNC"): - GNC STAFF REQUESTS PRODUCT FROM MATERIALS STAFF. - IF TOTAL VALUE EXCEEDS $100, MATERIALS STAFF PROVIDES LIST OF PRODUCTS AND ASSOCIATED COSTS (WITHOUT MARK UPS) IN AN E-MAIL TO CFO AND COPY OF EMAIL TO FINANCE & MATERIALS DIRECTORS. - CFO WILL RESPOND BACK TO THE E-MAIL (VIA REPLY TO ALL) INDICATING WHETHER THE REQUEST SHOULD BE BILLABLE OR A CHARITABLE CONTRIBUTION. - MATERIALS STAFF PULLS CENTRAL STORES PRODUCTS AND FORWARDS TO GNC. - IF REQUIRED, PURCHASE ORDER WILL BE CUT FOR NON-STOCK PRODUCTS. - FINANCE USES THE REPLY TO ALL FROM CFO AS INFORMATION REQUIRED FOR BILLING GNC FOR THE PRODUCTS IF REQUIRED. - FINANCE CAN FIND GENERAL LEDGER BREAKDOWNS FOR PRODUCTS VIA A GENERAL LEDGER DISTRIBUTION REPORT FOR GOOD NEIGHBOR CLINIC AS REQUIRED. IF THE REQUEST IS UNDER $100, THE REQUESTS WILL BE PROCESSED THROUGH AND WILL BE CONSIDERED A CHARITABLE CONTRIBUTION. SAUK PRAIRIE MEMORIAL HOSPITAL, INC. ALSO PROVIDES A SIGNIFICANT AMOUNT OF MEDICAL SERVICES TO PATIENTS OF THE GOOD NEIGHBOR CLINIC. THE HOSPITAL RELIES UPON THE INCOME REQUIREMENTS SCREENING PROCESS BY THE GOOD NEIGHBOR CLINIC TO REFER PATIENTS IN NEED OF FREE CARE FOR SERVICES.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsYes (X)TravelForCompanionsInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
LARRY SCHROEDER
CEO$303,060$0$31,000$0$2,750$0$12,750$0$11,723$0$361,283$0$0$0
CAROL MAY
VP, FINANCE & OPERATIONS$171,894$0$10,575$0$990$0$9,243$0$7,581$0$200,283$0$0$0
ROBERTA BOS
VP, HUMAN RESOURCES$127,292$0$9,150$0$144$0$6,947$0$6,867$0$150,400$0$0$0
KENNETH CARLSON
VP, PLANNING & BUSINESS DE$148,833$0$10,791$0$265$0$8,042$0$5,356$0$173,287$0$0$0
MARGARET SHEEKS
VP, PATIENT SERVICES$127,504$0$9,405$0$6,206$0$6,916$0$9,727$0$159,758$0$0$0
MICHAEL LAMSON MD
SURGEON$373,489$0$124,062$0$351$0$12,750$0$7,208$0$517,860$0$0$0
DAVID MARCU MD
SURGEON$383,990$0$78,427$0$281$0$12,750$0$7,789$0$483,237$0$0$0
MATTHEW HEBERT MD
SURGEON$373,548$0$89,903$0$351$0$12,750$0$4,730$0$481,282$0$0$0
WILLIAM BODEMER MD
SURGEON$384,356$0$54,989$0$316$0$12,750$0$4,070$0$456,481$0$0$0
ARNOLD ROSENTHAL MD
SURGEON$339,694$0$87,866$0$2,315$0$12,750$0$11,581$0$454,206$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 1AFormAndLineReferenceDesc
ExplanationTHE BOARD HAS APPROVED A POLICY TO COMPENSATE THE CEO FOR THE TRAVEL OF HIS/HER SPOUSE FOR HOSPITAL RELATED BUSINESS ACTIVITY. THE CEO WILL BE COMPENSATED FOR REASONABLE TRAVEL EXPENSES INCURRED BY HIS/HER SPOUSE. BOARD APPROVAL NEEDS TO BE RECEIVED PRIOR TO MAKING THE TRAVEL ARRANGEMENTS. THE COST OF ANY SUCH TRAVEL REIMBURSEMENTS ARE ADDED TO THE CEO'S W-2 FOR TAX REPORTING PURPOSES. DURING 2013, THE CEO RECEIVED $404 OF TRAVEL REIMBURSEMENTS FROM THE HOSPITAL, WHICH WAS INCLUDED IN TAXABLE WAGES ON HIS W-2 AND IS INCLUDED ON SCHEDULE J.ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY
A39133785597710B6V92013-01-19$38,000,000CONSTRUCTION OF NEW HOSPITAL000
WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY
B3913378552013-01-19$30,000,000CONSTRUCTION OF NEW HOSPITAL000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCdTotal ProceedsTotalProceedsAmtIn Reserve FundInReserveFundAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCapital ExpendituresCapitalExpendituresAmtUnspentUnspentAmtCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintInd
A$38,000,000$3,384,222$562,253$25,843,493$8,210,03200Yes (1)Yes (1)
B$30,000,000$1,987,633$542,647$24,269,832$7,175,15400Yes (1)Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A0000000
B0000000

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A0Yes (1)0000000
B0Yes (1)00Yes (1)0000

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
A0
B0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 2DURING 2013, THE HOSPITAL ASSUMED THE CLINICAL PRACTICE OPERATIONS OF ORTHOPEDIC ASSOCIATES OF SAUK PRAIRIE AND SURGICAL ASSOCIATES, WHICH WERE PREVIOUSLY OWNED BY UNRELATED PHYSICIAN ORGANIZATIONS. THE PRACTICES' ARE LOCATED IN SPACE WITHIN THE HOSPITAL FACILITY. SEE ADDTIONAL INFORMATION IN PART III, LINE 4B.
FORM 990, PART VI, SECTION A, LINE 6ANNUAL MEMBERSHIP WILL BE CONFERRED FOR ONE YEAR UPON PERSONS CONTRIBUTING THE SUM OF TEN DOLLARS TO THE CORPORATION AND/OR THE SAUK PRAIRIE MEMORIAL HOSPITAL FOUNDATION. LIFE MEMBERSHIP WILL BE CONFERRED UPON PERSONS CONTRIBUTING THE SUM OF ONE HUNDRED DOLLARS TO THE CORPORATION AND/OR SAUK PRAIRIE MEMORIAL HOSPITAL FOUNDATION. TWO LIFE MEMBERSHIPS WILL BE CONFERRED UPON TWO PERSONS CONTRIBUTING THE SUM OF TWO HUNDRED DOLLARS OR MORE TO THE CORPORATION AND/OR SAUK PRAIRIE MEMORIAL HOSPITAL FOUNDATION.
FORM 990, PART VI, SECTION A, LINE 7AAN ANNUAL AND LIFE MEMBERSHIP SHALL BE ENTITLED TO ONE VOTE AT THE ANNUAL MEETING OR AT ANY SPECIAL MEETINGS OF THE MEMBERSHIP. THOSE WITH LIFE MEMBERSHIPS MAY ALSO HOLD OFFICE AS A DIRECTOR OF THE CORPORATION OR SERVE ON A COMMITTEE. MEMBERS MAY VOTE ON ELECTIONS OF BOARD MEMBERS, CHANGES TO THE BYLAWS, AND OTHER BUSINESS ALLOWED BY LAW.
FORM 990, PART VI, SECTION B, LINE 11THE BOARD OF DIRECTORS REVIEWS THE 990 AT ITS MONTHLY MEETING PRIOR TO SUBMISSION. IN THE EVENT MEETING AND DUE DATES ARE SUCH THAT THIS IS NOT POSSIBLE, THE BOARD WILL REVIEW AT THE FIRST MEETING AFTER SUBMISSION.
FORM 990, PART VI, SECTION B, LINE 12CSINCE SAUK PRAIRIE MEMORIAL HOSPITAL, INC. IS A PART OF A SMALL COMMUNITY, CONFLICTS ARE GENERALLY KNOWN, IF NOT DISCLOSED THROUGH THE ANNUAL PROCESS CONDUCTED BY HUMAN RESOURCES. THE ANNUAL PROCESS INCLUDES ALL DIRECTOR LEVEL EMPLOYEES AND ABOVE OF THE HOSPITAL. THE BOARD OF DIRECTORS HAS A CONFLICT OF INTEREST POLICY AND MUST ANNUALLY SIGN A DISCLOSURE FORM STATING ANY POTENTIAL CONFLICTS OF INTEREST. THE BOARD PRESIDENT THEN DISCLOSES ANY CONFLICTS TO THE FULL BOARD OF DIRECTORS. CONFLICT OF INTEREST STATEMENTS COMPLETED BY BOARD MEMBERS ARE REVIEWED BY THE BOARD PRESIDENT AND EMPLOYEE'S CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY STAFF LEADERSHIP AND/OR ADMINISTRATION. THESE INDIVIDUALS ARE CHARGED WITH THE RESPONSIBILITY OF ENSURING THAT BUSINESS IS CONDUCTED IN A MANNER THAT ADHERES TO THE HOSPITAL'S FORMALLY APPROVED CONFLICT OF INTEREST POLICY.
FORM 990, PART VI, SECTION B, LINE 15THE BOARD OF DIRECTORS HAS ESTABLISHED POLICY BG-8 TO ESTABLISH ITS COMPENSATION PHILOSOPHY WITH RESPECT TO EXECUTIVE COMPENSATION AND TO DEFINE PRACTICES ASSOCIATED IN ACCORDANCE WITH IRC 4958. HOSPITAL EXECUTIVE SALARY IS SET ANNUALLY USING COMPARABILITY DATA FROM OUTSIDE CONSULTANTS AND THIRD-PARTY SURVEY DATA. THE EXECUTIVE COMMITTEE IS RESPONSIBLE FOR SETTING SALARY FOR THE CEO BASED ON THE CEO'S JOB PERFORMANCE. THE COMMITTEE RELIES UPON COMPARABILITY DATA DEVELOPED BY OUTSIDE CONSULTANTS TO SUPPORT ITS DECISION MAKING PROCESS AND TO ENSURE COMPETITIVE SALARY LEVELS. THE BOARD REVIEWS BG-8 ANNUALLY AT THE GOVERNANCE COMMITTEE. COMPENSATION FOR OTHER KEY EMPLOYEES IS ESTABLISHED BY APPLICATION OF THE HOSPITAL'S COMPENSATION PHILOSOPHY, WHEREIN RATES OF PAY ARE COMPARED TO MARKET RATES OBTAINED THROUGH PARTICIPATION IN WAGE AND BENEFIT SURVEYS. PAY RANGES ARE OBTAINED FROM SURVEYS OF SIMILARLY SITUATED HOSPITALS LOCATED WITHIN THE STATE OF WISCONSIN IN TERMS OF SIZE AND REVENUE CATEGORY. THE HOSPITAL ADOPTED A "MEET THE MARKET" APPROACH TO COMPENSATION FOR POSITIONS AT THESE LEVELS. THIS MEANS THAT SAUK PRAIRIE MEMORIAL HOSPITAL, INC. TARGETS THE MIDPOINT OF THE PAY RANGE ASSOCIATED WITH EACH POSITION.
FORM 990, PART VI, SECTION C, LINE 19THE ABBREVIATED FINANCIAL STATEMENTS ARE A PART OF THE HOSPITAL'S ANNUAL REPORT PRESENTED TO THE PUBLIC AT THE ANNUAL MEETING AND POSTED ON THE HOSPITAL'S WEBSITE. THE ABBREVIATED FINANCIAL STATEMENTS ARE ALSO MADE PUBLICLY AVAILABLE THROUGH THE WISCONSIN HOSPITAL ASSOCIATION. THE HOSPITAL'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 1,279,955. NET ASSETS RELEASED FROM RESTRICTONS FROM FOUNDATION -1,152,779.
FORM 990, PART XII, LINE 2C, SELECTION OF INDEPENDENT ACCOUNTANT:THE HOSPITAL ANSWERED "YES" TO QUESTION 2C UNDER PART XII OF THE 990, INDICATING THAT THE HOSPITAL DOES HAVE A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE FULL BOARD OF DIRECTORS REVIEWS THE FINANCIAL STATEMENTS AND HEARS THE AUDIT FIRM PRESENTATION. THE FOLLOWING PROCESS WAS IMPLEMENTED BY THE BOARD FOR REVIEW OF THE AUDIT FIRM. FOR AUDIT FIRM SELECTION, A REQUEST FOR PROPOSAL IS PREPARED, INTERNAL STAFF SELECTS THE TOP TWO OR THREE CANDIDATES, AND THE FINANCE AND AUDIT COMMITTEE RECOMMENDS AN AUDIT FIRM TO THE FULL BOARD. BASED ON THE PROPOSAL RESPONSES AND INTERVIEWS/PRESENTATIONS BY THE AUDIT FIRMS, THE FULL BOARD OF DIRECTORS THEN VOTES BASED ON THIS RECOMMENDATION AND SELECTS THE INDEPENDENT ACCOUNTING FIRM. THERE WAS NO CHANGE TO THIS PROCESS IN 2013.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
SAUK PRAIRIE MEMORIAL HOSPITAL FOUNDATION LTD
80 FIRST STREETPRAIRIE DU SACWI53578930841113FUNDRAISINGWI501(C)3LINE 9N/A0
FRIENDS OF SAUK PRAIRIE MEMORIAL HOSPITAL
260 26TH STREETPRAIRIE DU SACWI53578391453754VOLUNTEERINGWI501(C)3LINE 11 - TYPE III-FN/A0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd