CUMBERLAND MEMORIAL HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CUMBERLAND MEMORIAL HOSPITAL INC (EIN 39-0831153)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-02-13
- IRS object ID
- 201410449349300126
- Schema version
- 2012v2.1
- 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 G
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-02-13T09:17:14-06:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390758449 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPLFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3703 OAKWOOD HILLS PARKWAY | AddressLine1 |
| City | EAU CLAIRE | City |
| State | WI | State |
| ZIP Code | 54702 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390831153 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CUMBERLAND MEMORIAL HOSPITAL & EXTENDED | BusinessNameLine1 |
| Business Name Line2 | CARE UNIT INC | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CUMB | NameControl |
| Phone | 7158222741 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1110 7TH AVENUE | AddressLine1 |
| City | CUMBERLAND | City |
| State | WI | State |
| ZIP Code | 54829 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHAEL GUTSCH | Name |
| Title | CEO | Title |
| Phone | 7158222741 | Phone |
| Date Signed | 2014-02-10 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | HOLLY POKRANDT CPA | Name |
| PTIN | P00449155 | PTIN |
| Phone | 7158323407 | Phone |
| Date Prepared | 2014-02-05 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MICHAEL GUTSCH | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1110 7TH AVENUE | AddressLine1 |
| City | CUMBERLAND | City |
| State | WI | State |
| ZIP Code | 54829 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 19965305 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CUMBERLANDHEALTHCARE.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1955 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. IS COMMITTED TO CREATING A HEALTHIER COMMUNITY THROUGH PROVIDING AN ARRAY OF HIGH-QUALITY ACUTE CARE, AMBULATORY, AND SKILLED NURSING FACILITY SERVICES TO RESIDENTS OF THE SERVICE AREA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 0 | NbrIndependentVotingMembers |
| Total Nbr Employees | 298 | TotalNbrEmployees |
| Total Nbr Volunteers | 127 | TotalNbrVolunteers |
| Total Gross UBI | 1212 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 86518 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 117358 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 22522381 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 19803662 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 32527 | InvestmentIncomePriorYear |
| Investment Income Current Year | 35606 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1882 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 22641426 | TotalRevenuePriorYear |
| Total Revenue Current Year | 19958508 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 13244081 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 12127633 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8423202 | OtherExpensePriorYear |
| Other Expenses Current Year | 8382276 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 21667283 | TotalExpensesPriorYear |
| Total Expenses Current Year | 20509909 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 974143 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -551401 | RevenuesLessExpensesCY |
| Total Assets BOY | 17177122 | TotalAssetsBOY |
| Total Assets EOY | 17410002 | TotalAssetsEOY |
| Total Liabilities BOY | 6300432 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 7084713 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 10876690 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 10325289 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO BE AN INDEPENDENT, COMMUNITY-BASED HEALTH SYSTEM DEDICATED TO PROVIDING EXCEPTIONAL QUALITY CARE, EVERY STEP OF THE WAY. | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 14362089 | Expense |
| Revenue | 17216829 | Revenue |
| Description | CUMBERLAND MEMORIAL HOSPITAL-EXTENDED CARE UNIT, INC. IS AN INDEPENDENT, NONPROFIT, COMMUNITY-BASED FACILITY THAT SERVES NORTHWEST WISCONSIN. CUMBERLAND MEMORIAL HOSPITAL BECAME A CRITICAL ACCESS HOSPITAL ON AUGUST 19, 2005, LICENSED FOR 25 ACUTE CARE BEDS, INCLUDING 3 IN THE BIRTHPLACE. THE HOSPITAL ALSO PROVIDED MENTAL HEALTH INPATIENT AND OUTPATIENT SERVICES THROUGH DECEMBER 31, 2012. SERVICES OF THE HOSPITAL INCLUDE, BUT ARE NOT LIMITED TO, THERAPY, OBSTETRICS, AND GENERAL SURGERY. ACUTE CARE DAYS TOTALED 1,582 IN 2013, SWING BED DAYS TOTALED 662, NEWBORN DAYS TOTALED 78, AND BEHAVIORAL HEALTH DAYS TOTALED 765. DURING FISCAL YEAR 2013, CUMBERLAND MEMORIAL HOSPITAL PROVIDED 36 INPATIENT AND 391 OUTPATIENT SURGERIES ALONG WITH 263 SCOPE PROCEDURES. THERE WERE ALSO 2,530 EMERGENCY ROOM VISITS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3449651 | Expense |
| Revenue | 2420484 | Revenue |
| Description | CUMBERLAND EXTENDED CARE UNIT, A 50 BED SKILLED NURSING HOME, IS DEDICATED TO MEETING THE PHYSICAL, MENTAL, EMOTIONAL, AND SPIRITUAL NEEDS OF THE RESIDENTS AND FAMILIES SERVED. TOTAL NURSING HOME DAYS IN FISCAL YEAR 2013 WERE 14,574. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 141108 | Expense |
| Revenue | 165137 | Revenue |
| Description | THE LAKEWOOD REGENCY APARTMENTS ARE ATTACHED TO THE CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT. THESE SPACIOUS APARTMENTS WERE DESIGNED AS A COMFORTABLE AND CONVENIENT LIVING CHOICE FOR SENIORS KEEPING SOCIAL INTEREST AND PERSONAL SAFETY IN MIND. THE OCCUPANCY PERCENTAGE FOR 2013 WAS APPROXIMATELY 75%. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 17952848 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 51 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 298 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 0 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANGIE MARTENS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7158222741 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1110 7TH AVENUE | AddressLine1 |
| City | CUMBERLAND | City |
| State | WI | State |
| ZIP Code | 54829 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| CHARLES CHRISTENSEN | |||||||
| CHAIRMAN | 2.00 | X | X | 4425 | 0 | 0 | |
| TOM LINGEN MD | |||||||
| TRUSTEE | 1.00 | X | 4350 | 0 | 0 | ||
| CANDY COTONE | |||||||
| VICE CHAIRMAN | 1.00 | X | X | 3525 | 0 | 0 | |
| ANN HENDRICKS | |||||||
| SECRETARY | 1.00 | X | X | 4275 | 0 | 0 | |
| JOSEPH LESCHISIN | |||||||
| TRUSTEE | 1.00 | X | 3300 | 0 | 0 | ||
| MATT GORES | |||||||
| TRUSTEE | 1.00 | X | 4050 | 0 | 0 | ||
| MARTIN PETERS | |||||||
| TREASURER | 1.00 | X | X | 3225 | 0 | 0 | |
| MARY ANN CLARK | |||||||
| NURSING HOME ADMINISTRATOR | 37.00 | X | 121388 | 0 | 18997 | ||
| ANGIE MARTENS | |||||||
| CFO | 40.00 | X | 135632 | 0 | 5522 | ||
| MIKE GUTSCH | |||||||
| CEO (BEGINNING 7/24/12) | 40.00 | X | 92489 | 0 | 11666 | ||
| DR CHARLES MAYO II | |||||||
| CHIEF PSYCHIATRIST | 40.00 | 235221 | 0 | 47026 | X | ||
| JEFFREY KUEHN | |||||||
| CRNA | 20.00 | 196545 | 0 | 37080 | X | ||
| DONALD FULLERTON | |||||||
| CRNA | 20.00 | 185935 | 0 | 42722 | X | ||
| LAURIE POLUBINSKY | |||||||
| PSYCHIATRIST | 40.00 | 255763 | 0 | 21559 | X | ||
| BENJAMIN BRENNA | |||||||
| DIRECTOR OF REHAB | 40.00 | 115369 | 0 | 40883 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1365492 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 225455 | TotalOtherCompensation |
| Number Individuals GT100 K | 9 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CUMBERLAND CLINIC | |||||
| 1110 7TH AVENUE | CUMBERLAND | WI | 54829 | ER PHYSICIANS | 586582 |
| SHARED MEDICAL TECHNOLOGY | |||||
| 202 W NEWTON ST | RICE LAKE | WI | 54868 | RADIOLOGY | 235583 |
| DELTA LOCUM TENENS | |||||
| 1755 WITTINGTON PLACE SUITE 175 | DALLAS | TX | 75234 | ER PHYSICIANS | 229735 |
| ABM JANITORIAL SERVICES LLC | |||||
| 75 REMITTANCE DRIVE SUITE 3011 | CHICAGO | IL | 60675 | JANITORIAL SERVICES | 199392 |
| WIPFLI LLP | |||||
| 3703 OAKWOOD HILLS PKWY | EAU CLAIRE | WI | 54701 | ACCOUNTING & IT SERVICES | 177282 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 8 | NumberOfContractorsGT100K |
| Fundraising Events | 11260 | FundraisingEvents |
| Government Grants | 8807 | GovernmentGrants |
| All Other Contributions | 97291 | AllOtherContributions |
| Total Contributions | 117358 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| HOSPITAL REVENUE | 621990 | 17218041 | 17216829 | 1212 |
| NURSING HOME REVENUE | 623000 | 2420484 | 2420484 | |
| APARTMENT REVENUE | 623990 | 165137 | 165137 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 19803662 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17732 | TotalRevenueColumn |
| Exclusion | $17,732 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8188 | TotalRevenueColumn |
| Exclusion | $8,188 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 9959 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 273 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 9686 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9686 | TotalRevenueColumn |
| Exclusion | $9,686 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 8406 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 11260 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 6524 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1882 | TotalRevenueColumn |
| Exclusion | $1,882 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 19958508 | TotalRevenueColumn |
| Related Or Exempt Function Income | 19802450 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 1212 | UnrelatedBusinessRevenue |
| Exclusion | $37,488 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 697643 | Total |
| Program Services | 174036 | ProgramServices |
| Management And General | 523607 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8362244 | Total |
| Program Services | 7966157 | ProgramServices |
| Management And General | 396087 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 187071 | Total |
| Program Services | 176643 | ProgramServices |
| Management And General | 10428 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2255720 | Total |
| Program Services | 2074662 | ProgramServices |
| Management And General | 181058 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 624955 | Total |
| Program Services | 564583 | ProgramServices |
| Management And General | 60372 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 122420 | Total |
| Management And General | 122420 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 93340 | Total |
| Management And General | 93340 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2397055 | Total |
| Program Services | 2330608 | ProgramServices |
| Management And General | 66447 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 108895 | Total |
| Management And General | 108895 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 760582 | Total |
| Program Services | 601955 | ProgramServices |
| Management And General | 158627 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 193879 | Total |
| Management And General | 193879 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 552206 | Total |
| Program Services | 458276 | ProgramServices |
| Management And General | 93930 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1140800 | Total |
| Program Services | 946750 | ProgramServices |
| Management And General | 194050 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 127579 | Total |
| Management And General | 127579 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PROVISION FOR BAD DEBTS | 1228550 | 1228550 | |
| BILLABLE MEDICAL SUPPLI | 967621 | 967621 | |
| REPAIRS & MAINTENACE | 280817 | 264198 | 16619 |
| EQUIPMENT RENT & LEASES | 214060 | 49089 | 164971 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 194472 | Total |
| Program Services | 149720 | ProgramServices |
| Management And General | 44752 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20509909 | Total |
| Program Services | 17952848 | ProgramServices |
| Management And General | 2557061 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 57828 | BOY |
| EOY | 987426 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5052682 | BOY |
| EOY | 5040577 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2827477 | BOY |
| EOY | 3046638 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 379297 | BOY |
| EOY | 376144 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55912 | BOY |
| EOY | 55992 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 21584635 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 13872063 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7326721 | BOY |
| EOY | 7712572 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 122700 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1477205 | BOY |
| EOY | 67953 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17177122 | BOY |
| EOY | 17410002 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2060726 | BOY |
| EOY | 1543251 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 204768 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4239706 | BOY |
| EOY | 5031694 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 305000 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6300432 | BOY |
| EOY | 7084713 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10876690 | BOY |
| EOY | 10325289 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10876690 | BOY |
| EOY | 10325289 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17177122 | BOY |
| EOY | 17410002 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -551401 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $2,949 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 2949 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. (CMH) PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. WHA HAS NOTIFIED CMH THAT $1,329 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. CMH IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, CMH PAYS MEMBERSHIP FEES TO THE RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO DOES PROVIDE ANALYSIS ON CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. RWHC DETERMINED THAT $1,620 OF THE FEES PAID BY CMH IN 2013 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTHCARE ENVIRONMENT IN THE STATE OF WISCONSIN. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 320897 | OtherCostOrOtherBasis |
| Book Value | 320897 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12672907 | OtherCostOrOtherBasis |
| Depreciation | 7120856 | Depreciation |
| Book Value | 5552051 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8558216 | OtherCostOrOtherBasis |
| Depreciation | 6751207 | Depreciation |
| Book Value | 1807009 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 32615 | OtherCostOrOtherBasis |
| Book Value | 32615 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 7712572 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | AMOUNTS PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAMS | Description |
| Amount | $305,000 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 305000 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 19986900 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 28392 | OtherRevenues |
| Revenue Not Rptd F990 | 28392 | RevenueNotRptdF990 |
| Revenue Subtotal | 19958508 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 19958508 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 20538301 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 28392 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 28392 | ExpensesNotRptdF990 |
| Expenses Subtotal | 20509909 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 20509909 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE FACILITY DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE FACILITY'S POLICY IS TO RECOGNIZE INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. IN 2013 AND 2012, THERE WERE NO PAYMENTS OF INCOME TAX EXPENSE, TAX PENALTIES, OR INTEREST RELATED TO TAX PENALTIES RECORDED BY THE FACILITY IN THE FINANCIAL STATEMENTS. THE FACILITY RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2013 OR 2012. FEDERAL RETURNS FOR THE YEARS ENDED JUNE 30, 2010, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE IRS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | DIETARY REVENUE NETTED AGAINST DIETARY EXPENSES 21,868. FUNDRAISING EXPENSES NET AGAINST REVENUE 6,524. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | DIETARY EXPENSES NETTED AGAINST DIETARY REVENUE 21,868. FUNDRAISING EXPENSES NET AGAINST REVENUE 6,524. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF OUTING | NameOfEvent1 |
| Gross Receipts Event1 | 19666 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 11260 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 8406 | GrossRevenueEvent1 |
| Other Direct Expenses Event1 | 6524 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 19666 | GrossReceiptsTotal |
| Charitable Contributions Total | 11260 | CharitableContributionsTotal |
| Gross Revenue Total Events | 8406 | GrossRevenueTotalEvents |
| Other Direct Expenses Total Events | 6524 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 6524 | DirectExpenseSummaryEvents |
| Net Income Summary | 1882 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 150.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 90540 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 90540 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00470 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2813347 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2554407 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 258940 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01340 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2903887 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2554407 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 349480 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01810 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 214748 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 214748 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01110 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 11000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3208817 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2040770 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1168047 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06060 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2595 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2595 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3437160 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2040770 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1396390 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07240 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6341047 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4595177 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1745870 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09050 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 14000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 14000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 14000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 14000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $713,128 | BadDebtExpenseAmount |
| Amount Attributable To | 142626 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5466044 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 5356975 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 109069 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CUMBERLAND MEMORIAL HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1110 7TH AVENUE | AddressLine1 |
| City | CUMBERLAND | City |
| State | WI | State |
| ZIP Code | 54829 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | AMBULANCE SERVICE; CLINIC | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CUMBERLAND MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 1 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Other Method | X | OtherMethod |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 150.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| CUMBERLAND EXTENDED CARE UNIT | ||||
| 1110 7TH AVENUE | CUMBERLAND | WI | 54829 | SKILLED NURSING FACILITY |
| LAKEWOOD REGENCY APARTMENTS | ||||
| 1110 7TH AVENUE | CUMBERLAND | WI | 54829 | SENIOR LIVING APARTMENTS |
Form990 Schedule H Part VI Form990ScheduleHPartVI (18 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST TO CHARGE RATIO IS APPLIED AGAINST HOSPITAL REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. THE COSTING METHODOLOGY USED IS BASED ON MEDICARE COST REPORTING METHODS. | ||
| PART I, LINE 7G: THE COST OF SUBSIDIZED 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 THE INPATIENT PSYCHIATRIC UNIT THROUGH DECEMBER 31, 2012, THE SKILLED NURSING HOME, THE CLINIC AND THE OPERATION OF THE EMERGENCY ROOM DEPARTMENT. THESE SERVICES ARE UNAVAILABLE TO MEMBERS OF THE COMMUNITY OTHER THAN THROUGH CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. IT HAS BEEN THE GOAL OF CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. | ||
| PART I, L7 COL(F): THERE ARE SOME INDIVIDUALS THAT WOULD QUALIFY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, HOWEVER, THESE INDIVIDUALS ARE UNABLE TO COMPLETE THE REQUIRED FORMS AND THEREFORE ARE DENIED FINANCIAL ASSISTANCE. THE HOSPITAL ESTIMATES A SMALL PERCENTAGE OF THE HOSPITAL'S BAD DEBT EXPENSE IS ATTRIBUTABLE TO THESE PATIENTS WHO WOULD OTHERWISE BE ELIGIBLE FOR CHARITY CARE AS NOTED IN PART III, SECTION A, LINE 3. | ||
| PART II: 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. CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE HOSPITAL BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. SEE PART 1, LINE 7 FOR THE CALCULATED COST OF PROVIDING COMMUNITY SERVICES. CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC., LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY HEALTH SERVICES: AMBULANCE SERVICES, BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES & URGENT CARE, EXTENDED CARE, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH, AND SURGICAL SERVICES. | ||
| PART III, LINE 4: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. 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 SMALL AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE.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 FISCAL YEAR TO ESTIMATE THE COST OF THE CHARITY CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO PROVIDES DISCOUNTS TO ELIGIBLE UNINSURED OR UNDERINSURED PATIENTS UNDER ITS CHARITY CARE POLICY. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED OR UNDERINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. | ||
| PART III, LINE 8: CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. IS DESIGNATED A CRITICAL ACCESS HOSPITAL AND AS SUCH A PORTION OF ITS REVENUE IS 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 AT CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE SERVICES, INC. OR AMBULANCE SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT METHODOLOGY AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY AND AMBULANCE 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 CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREA OF CUMBERLAND, 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 EXPENSE. 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 ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. | ||
| PART III, LINE 9B: UNDER THE HOSPITAL'S COLLECTION AND CHARITABLE CARE POLICIES, CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE HOSPITAL'S CHARITABLE CARE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE. ALL INPATIENT SELF-PAY ADMISSIONS ARE SCREENED BY THE HOSPITAL'S FINANCIAL COUNSELOR TO ALLOW THESE PATIENTS THE ABILITY TO COMPLETE THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL, DEPENDING UPON THE PATIENT'S CONDITION, THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPELTE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION. DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICES AS WELL AS THE CHARITY AND COMMUNITY CARE PROGRAM TO ALLOW PATENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. INCLUDED IN THE POLICY, IT IS ALSO NOTED THAT THE HOSPITAL RESERVES THE RIGHT TO MAKE OR GRANT ADDITIONAL CHARITY CARE ON A CASE BY CASE BASIS. | ||
| PART V, SECTION B, LINE 3: AS PART OF THE CHNA PROCESS, CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. GATHERED A GROUP OF HEALTH CARE LEADERS TO FORM A STEERING COMMITTEE TO LEAD THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR BARRON COUNTY. THE STEERING COMMITTEE, WHICH CONSISTED OF HEALTH CARE PROFESSIONALS AND COMMUNITY MEMBERS, WORKED WITH TWO INDIVIDUALS FROM THE WISCONSIN STATE DEPARTMENT OF HEALTH TO PROVIDE EXPERTISE AND TO PROVIDE GUIDANCE ON THE CHNA PROCESS. THE STEERING COMMITTEE CONDUCTED A SURVEY TO ENGAGE THE COMMUNITY IN THE PROCESS AND TO GATHER INPUT ON WHAT THE COMMUNITY AT LARGE FELT WERE THE HEALTH CONCERNS FOR BARRON COUNTY. THE SURVEYS WERE DISTRIBUTED BY THE COMMITTEE MEMBERS TO LIBRARIES, HOSPITALS, CLINICS, THE FREE CLINIC, FOOD PANTRIES, AND SENIOR CENTERS. IN ADDITION, IN MARCH OF 2012, A PRESS RELEASE WAS RELEASED TO MULTIPLE LOCAL NEWSPAPERS ANNOUNCING THE INITIATIVE AND ASKING FOR COMMUNITY PARTICIPATION. THE SURVEY WAS TRANSLATED INTO BOTH THE SPANISH AND SOMALI LANGUAGES, WHICH ARE BOTH PREVALENT LANGUAGES IN BARRON COUNTY, TO ENSURE THAT THE OPINIONS OF THOSE COMMUNITIES WERE INCLUDED AND DISTRIBUTED AT KEY COMMUNITY CENTERS FOR BOTH POPULATIONS. OVER 1,100 SURVEYS WERE COMPLETED BOTH ONLINE AND ON PAPER AND THE RESULTS WERE TABULATED.IN ADDITION TO THE SURVEY, THE COMMITTEE HOSTED A COMMUNITY PLANNING DAY, IN SEPTEMBER 2012 AND INVITED BUSINESS LEADERS, HEALTH EXPERTS AND THE GENERAL COMMUNITY TO COME TOGETHER TO HELP SELECT THE TOP THREE HEALTH PRIORITIES FOR BARRON COUNTY. EIGHTY FIVE COMMUNITY MEMBERS FROM BARRON COUNTY WERE IN ATTENDANCE. AFTER THE DAY OF DISCUSSION AND DATA SHARING, PARTICIPANTS WERE EACH GIVEN THREE VOTES AND ASKED TO VOTE FOR THEIR TOP THREE HEALTH FOCUS CONCERNS. | CUMBERLAND MEMORIAL HOSPITAL, INC. | |
| PART V, SECTION B, LINE 4: CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. WORKED WITH BARRON COUNTY PUBLIC HEALTH (BARRON, WI), LAKEVIEW MEDICAL CENTER/MARSHFIELD CLINIC (RICE LAKE, WI) AND MAYO CLINIC HEALTH SYSTEM - NORTHLAND (BARRON, WI) TO IDENTIFY AND PRIORITIZE HEALTH NEEDS. | CUMBERLAND MEMORIAL HOSPITAL, INC. | |
| PART V, SECTION B, LINE 5C: COPIES OF THE COMMUNITY HEALTH NEEDS ASSESSMENT WERE DISTRIBUTED TO THE SENIOR CENTER AND TO THE PUBLIC LIBRARY. THE HOSPITAL ALSO BRINGS EXTRA COPIES OF THE CHNA TO THE COMMUNITY EVENTS IN WHICH THEY PARTAKE. | CUMBERLAND 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 CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. SERVES. THERE WERE ITEMS IDENTIFIED IN THE CHNA WHICH WERE NOT ADDRESSED, HOWEVER, ALL ITEMS WERE CONSIDERED IF A NEED WAS BROUGHT TO THE ATTENTION OF THE STEERING COMMITTEE 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 CONSTRAINT OF PROVIDING A NEW SERVICE FOR A LIMITED POPULATION OF PEOPLE. OVER THE NEXT THREE YEARS, THE HOSPITAL WILL CONTINUE TO PLAY A LEADING ROLE IN ADDRESSING THE HEALTH NEEDS OF THOSE WITHIN THE COMMUNITY, CONGRUENT WITH THE HOSPITAL'S MISSION. | CUMBERLAND MEMORIAL HOSPITAL, INC. | |
| PART V, SECTION B, LINE 14G: THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE THROUGH THE BUSINESS OFFICE STAFF. PATIENTS ARE ENCOURAGED TO CONTACT A FINANCIAL COUNSELOR FOR FURTHER INFORMATION ON THE FINANCIAL ASSISTANCE POLICY. THE HOSPITAL'S WEBSITE ALSO ENCOURAGES PATIENTS TO INQUIRE ABOUT THE FINANCIAL ASSISTANCE POLICY. | CUMBERLAND MEMORIAL HOSPITAL, INC. | |
| PART V, SECTION B, LINE 20D: THE HOSPITAL DETERMINES THE AMOUNT CHARGED TO FAP-ELIGIBLE INDIVIDUALS USING AN INCOME-BASED SLIDING FEE BASED ON FEDERAL POVERTY GUIDELINES. IF THE INDIVIDUAL IS AT 100% OR LESS OF THE FEDERAL POVERTY GUIDELINES THEN THEY GENERALLY RECEIVE FREE CARE. IF THE INDIVIDUAL EARNS BETWEEN 100% AND 150% OF THE FEDERAL POVERTY GUIDELINES THEN THEY RECEIVE A DISCOUNTED PRICE BASED ON A SLIDING FEE SCALE. | CUMBERLAND MEMORIAL HOSPITAL, INC. | |
| PART VI, LINE 2: THE HOSPITAL ASSESSES THE NEEDS OF THE COMMUNITY THROUGH SURVEYS AND BY RECOGNIZING WHY CERTAIN PATIENTS ARE REFERRED OUT OF THE AREA. THE HOSPITAL THEN ATTEMPTS TO GET SPECIALISTS IN THE IDENTIFIED AREAS INTO THE FACILITY TO SEE PATIENTS AND MEET THEIR NEEDS.AS PART OF THE STRATEGIC PLANNING PROCESS, CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO IDENTIFY COMMUNITY NEEDS. DURING FY 2013, THE HOSPITAL AQUIRED CUMBERLAND MEDICAL CLINIC AND BEGAN PROVIDING CLINICAL CARE SERVICES. OVER THE NEXT FEW YEARS, THE HOSPITAL WILL CONTINUE TO WORK TO ADDRESS ALL OF THE HEALTH NEEDS OF THOSE WITHIN THE COMMUNITY. | ||
| PART VI, LINE 3: IF A PATIENT IS IDENTIFIED AS UNINSURED, HOSPITAL STAFF WORKS WITH THE PATIENT OR THEIR FAMILY TO DETERMINE IF THEY ARE ELIGIBLE FOR ANY TYPE OF GOVERNMENT PROGRAM OR QUALIFY FOR THE HOSPITAL'S CHARITY CARE PROGRAM. | ||
| PART VI, LINE 4: THE HOSPITAL SERVES THE COMMUNITIES OF CUMBERLAND, WI AND ALMENA, WI AND SURROUNDING COMMUNITIES WITHIN A 20 MILE RADIUS. THERE ARE THREE OTHER HOSPITALS LOCATED IN THE RURAL AREA THAT THE ORGANIZATION SERVES. | ||
| PART VI, LINE 5: A MAJORITY OF OUR ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE HOSPITAL, NOR FAMILY MEMBERS THEREOF. OUR HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. WE ALSO PARTICIPATE IN COMMUNITY HEALTH FAIRS AND PROVIDE SERVICE AT SPORTING EVENTS. SURPLUS FUNDS ARE INVESTED BACK INTO THE HOSPITAL AND ITS EQUIPMENT TO ENSURE THE NEEDED SERVICES ARE CONTINUED TO BE PROVIDED IN THIS COMMUNITY. | ||
| WI | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR CHARLES MAYO II | ||||||||||||||
| CHIEF PSYCHIATRIST | 235221 | 0 | 0 | 0 | 0 | 0 | 9695 | 0 | 37331 | 0 | 282247 | 0 | 0 | 0 |
| JEFFREY KUEHN | ||||||||||||||
| CRNA | 196545 | 0 | 0 | 0 | 0 | 0 | 8081 | 0 | 28999 | 0 | 233625 | 0 | 0 | 0 |
| DONALD FULLERTON | ||||||||||||||
| CRNA | 185935 | 0 | 0 | 0 | 0 | 0 | 5811 | 0 | 36911 | 0 | 228657 | 0 | 0 | 0 |
| LAURIE POLUBINSKY | ||||||||||||||
| PSYCHIATRIST | 252192 | 0 | 0 | 0 | 3571 | 0 | 7640 | 0 | 13919 | 0 | 277322 | 0 | 0 | 0 |
| BENJAMIN BRENNA | ||||||||||||||
| DIRECTOR OF REHAB | 113065 | 0 | 0 | 0 | 2304 | 0 | 3675 | 0 | 37208 | 0 | 156252 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 4A | ReturnReference |
| Explanation | DEB KUNFERMAN, CEO RESIGNED FROM THE ORGANIZATION IN FISCAL YEAR 2012 AND RECEIVED 90 DAYS SEVERANCE PAY IN CALENDAR YEAR 2012 TOTALING $44,636. THIS AMOUNT IS NOT INCLUDED ON FORM 990, SCHEDULE J AS THE AMOUNT IS BELOW THE REPORTING THRESHOLDS. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF CUMBERLAND | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 396005423 | IssuerEIN |
| CUSIP Number | 230849FE6 | CUSIPNumber |
| Date Issued | 2008-10-23 | DateIssued |
| Issue Price | 5166566 | IssuePrice |
| Description Of Purpose | REMODELING PROJECT | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Amount Retired | 1411566 | AmountRetired |
| Total Proceeds | 5166566 | TotalProceeds |
| Amount In Reserve Fund | 517000 | AmountInReserveFund |
| Issuance Costs From Proceeds | 103400 | IssuanceCostsFromProceeds |
| Capital Expenditures | 2524863 | CapitalExpenditures |
| Other Spent Proceeds | 2021303 | OtherSpentProceeds |
| Year Of Subst Completion | 2009 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 0 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 0 | ProcToUndertkCorrectiveAction |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| JORENE OSTERMAN RN | |||
| FAMILY MEMBER OF DR. TOM LINGEN, BOARD MEMBER | 68977 | EMPLOYMENT COMPENSATION | 0 |
| LAURI RANALLO | |||
| FAMILY MEMBER OF CHARLES CHRISTENSEN, CHAIRMAN | 40475 | EMPLOYMENT COMPENSATION | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| NEW PROGRAM SERVICES | FORM 990, PART III, LINE 2 | DURING FISCAL YEAR 2013, CMH-ECU AQUIRED CUMBERLAND MEDICAL CLINIC AND BEGAN PROVIDING CLINICAL CARE SERVICES ON MARCH 1, 2013. TOTAL CLINIC VISITS FOR THE FIRST FOUR MONTHS OF OPERATIONS TOTALED 6,902. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE BOARD OF DIRECTORS APPROVED AN AMENDMENT TO THE BYLAWS IN APRIL 2013. THE AMENDMENT REMOVED THE LANGUAGE THAT STATED THAT A MEMBER OF THE CITY COUNCIL WAS REQUIRED TO SIT ON THE GOVERNING BOARD. NO FURTHER CHANGES WERE MADE. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE CHIEF FINANCIAL OFFICER REVIEWED THE RETURN. THE BOARD MEMBERS OF CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. AND EXTENDED CARE UNIT, INC. WERE THEN GIVEN A COPY OF FORM 990 AND GIVEN AN OPPORTUNITY TO COMMENT BEFORE SUBMISSION TO THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. REQUIRES ITS BOARD MEMBERS TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. OFFICERS AND KEY EMPLOYEES OF CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. SIGN A CODE OF CONDUCT STATEMENT. IN THE CODE OF CONDUCT STATEMENT IT MENTIONS THE CONFLICT OF INTEREST. | |
| FORM 990, PART VI, SECTION B, LINE 15 | EXECUTIVE SALARIES ARE SET ANNUALLY CONSIDERING COMPENSATION LEVELS AT SIMILARLY SITUATED ORGANIZATIONS (TYPICALLY NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS IN SIMILAR REVENUE CATEGORIES). THE BOARD OF DIRECTORS IS RESPONSIBLE FOR SETTING THE SALARY OF THE CEO BASED ON THEIR JOB PERFORMANCE. THE BOARD RELIES UPON COMPARABILITY DATA DEVELOPED BY OUTSIDE CONSULTANTS TO SUPPORT ITS DECISION MAKING PROCESS AND TO ENSURE COMPETITIVE SALARY LEVELS. ALL OTHER NON-UNION WAGES ARE REVIEWED SEMI-ANNUALLY IN COMPARISON TO THE RURAL WISCONSIN HEALTH COOPERATIVE WAGE SURVEY. THIS WAGE SURVEY INCLUDES WAGE DATA OF 27 RURAL HEALTHCARE ORGANIZATIONS. THE GOAL OF CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. IS TO REMAIN WITHIN THE WAGE SURVEY AVERAGES, BASED ON YEARS OF SERVICE TO BE COMPETITIVE WITH SIMILAR ORGANIZATIONS. | |
| FORM 990, PART VI, SECTION C, LINE 19 | CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| OTHER FEES | FORM 990, PART IX, LINE 11G | FEE FOR SERVICES: PROGRAM SERVICE EXPENSES 592,800. MANAGEMENT AND GENERAL EXPENSES 66,447. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 659,247. PURCHASED NURSING SERVICES: PROGRAM SERVICE EXPENSES 182,272. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 182,272. PURCHASED RADIOLOGY/NUCLEAR MEDICINE SERVICES: PROGRAM SERVICE EXPENSES 502,044. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 502,044. CONSTRACTED PHYSICIANS: PROGRAM SERVICE EXPENSES 450,206. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 450,206. CONTRACTED ER PHYSICIANS: PROGRAM SERVICE EXPENSES 603,286. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 603,286. |
| OVERSIGHT OF THE AUDIT AND INDEPENDENT ACCOUNTANT: | FORM 990, PART XII, LINE 2C | CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC.'S ENTIRE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THE AUDITED FINANCIAL STATEMENTS ARE REVIEWED BY THE BOARD OF DIRECTORS ANNUALLY AND ANY QUESTIONS OR CONCERNS REGARDING THE STATEMENTS ARE ADDRESSED BY THE INDEPENDENT ACCOUNTANTS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |