THEDACARE MEDICAL CENTER-BERLIN INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- THEDACARE MEDICAL CENTER-BERLIN INC (EIN 39-0806359)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-14
- IRS object ID
- 201422269349303667
- 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 H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-14T15:46:28-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | 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 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12237 | AddressLine1 |
| City | GREEN BAY | City |
| State | WI | State |
| ZIP Code | 543072237 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390806359 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTH NETWORK INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COMM | NameControl |
| Phone | 9203611313 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 MEMORIAL DR | AddressLine1 |
| City | BERLIN | City |
| State | WI | State |
| ZIP Code | 54923 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TOM KRYSTOWIAK | Name |
| Title | CFO | Title |
| Phone | 9203611313 | Phone |
| Date Signed | 2014-08-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TERRI REXRODE CPA MST | Name |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | Phone |
| Date Prepared | 2014-08-14 | 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 | TOM KRYSTOWIAK | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 MEMORIAL DRIVE | AddressLine1 |
| City | BERLIN | City |
| State | WI | State |
| ZIP Code | 54923 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 90903872 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CHNWI.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1910 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | COMMUNITY HEALTH NETWORK, INC PROVIDES INPATIENT AND OUTPATIENT HOSPITAL AND CLINIC SERVICES, HOME CARE SERVICES AND SKILLED NURSING SERVICES TO GREEN LAKE COUNTY AND SURROUNDING COUNTIES WITH TOTAL NET PATIENT SERVICE REVENUES OF $81,218,000 (TOTAL GROSS REVENUE OF $178,246,000). | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 841 | TotalNbrEmployees |
| Total Nbr Volunteers | 110 | TotalNbrVolunteers |
| Total Gross UBI | 1464052 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -27760 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 19553 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 51692 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 81269090 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 84988117 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 518236 | InvestmentIncomePriorYear |
| Investment Income Current Year | 591288 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -221653 | OtherRevenuePriorYear |
| Other Revenue Current Year | 738685 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 81585226 | TotalRevenuePriorYear |
| Total Revenue Current Year | 86369782 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 23599 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 21039 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 48214027 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 48085669 | 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 | 34669919 | OtherExpensePriorYear |
| Other Expenses Current Year | 37740787 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 82907545 | TotalExpensesPriorYear |
| Total Expenses Current Year | 85847495 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1322319 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 522287 | RevenuesLessExpensesCY |
| Total Assets BOY | 56315090 | TotalAssetsBOY |
| Total Assets EOY | 59518792 | TotalAssetsEOY |
| Total Liabilities BOY | 29406798 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 32090661 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 26908292 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 27428131 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE SUPERIOR SERVICES TO IMPROVE THE HEALTH OF THOSE WE SERVE. | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 70369044 | Expense |
| Grants | 21039 | Grants |
| Revenue | 80669145 | Revenue |
| Description | COMMUNITY HEALTH NETWORK OPERATES A 25-BED ACUTE CARE FACILITY, 50 BED EXTENDED CARE FACILITY, PHYSICIAN CLINICS LOCATED IN 8 COMMUNITIES, A HOME HEALTH AGENCY, REHABILITATION SERVICES AND RETAIL PHARMACY SERVICES. IN PURSUIT OF OUR PRIMARY EXEMPT PURPOSE OF PROVIDING HEALTH CARE SERVICES, COMMUNITY HEALTH NETWORK PROVIDES MEDICAL CARE AND HEALTH INFORMATION AIMED AT IMPROVING THE HEALTH STATUS OF THE COMMUNITIES WE SERVE. WE BELIEVE THAT WE HAVE A SPECIAL DUTY TO MEET THE NEEDS OF THE POOR, INDIGENT, AND MEDICALLY UNDERSERVED IN OUR COMMUNITIES AND SURROUNDING AREAS. WE HAVE PROVIDED CARE TO ALL PATIENTS WITHOUT REGARD FOR THE ABILITY TO PAY. COMMUNITY HEALTH NETWORK OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. IT HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. THE MAJORITY OF THE BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT INDIVIDUALS WHO ARE REPRESENTATIVE OF THE COMMUNITY. COMMUNITY HEALTH NETWORK ENGAGES IN TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS THROUGH INTERNSHIP PROGRAMS. IT OPERATES A WOMAN'S HEALTH AND RESOURCE CLINIC THAT PROVIDES SERVICES TO UNINSURED AND UNDERINSURED WOMEN THROUGH A STATE OF WISCONSIN GRANT PROGRAM. COMMUNITY HEALTH NETWORK'S VISION INCLUDES A HEALTHIER COMMUNITY. TO ACHIEVE THIS VISION, IT CONTINUALLY ASSESSES THE COMMUNITIES FOR OPPORTUNITIES FOR HEALTH CARE IMPROVEMENT. DIABETES MANAGEMENT HAS BEEN IDENTIFIED AS A COMMUNITY NEED. DIABETES MANAGEMENT AND EDUCATION CONTINUES TO BE A COMMUNITY PROGRAM OFFERED TO THE COMMUNITY AT NO COST. COMMUNITY HEALTH NETWORK PARTICIPATES IN GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS SUCH AS MEDICAID, MEDICARE, CHAMPUS, AND TRICARE. IN FISCAL YEAR 2013 OVER 1700 ACCOUNTS RECEIVED CHARITY CARE WITH A TOTAL COST OF OVER $1.5 MILLION. THE COST OF SERVICES PROVIDED TO MEDICAID PATIENTS THAT WERE NOT REIMBURSED TOTALED MORE THAN $3.4 MILLION. COMMUNITY HEALTH NETWORK'S LOSS FOR PROVIDING LONG TERM CARE SERVICES TO THE COMMUNITIES WAS $476,000 IN 2013. FINANCIAL AND IN-KIND CONTRIBUTIONS TO THE COMMUNITY TOTALED APPROXIMATELY $80,000. IN ADDITION, COMMUNITY HEALTH NETWORK ACTIVELY PROVIDED OR PARTICIPATED IN THE FOLLOWING COMMUNITY-BASED ACTIVITIES AND PROGRAMS OF WHICH APPROXIMATELY 7,000 PERSONS IN THE COMMUNITIES THAT WE SERVE PARTICIPATED AT A TOTAL COST TO COMMUNITY HEALTH NETWORK OF APPROXIMATELY $120,000. - GENERAL HEALTH EDUCATION SERVICES SUCH AS HEALTH FAIRS; CANCER EDUCATION; HEART DISEASE EDUCATION; DIABETES EDUCATION; FAMILY, PARENT, AND SIBLING EDUCATION; FAMILY PLANNING; AND WOMEN'S HEALTH EDUCATION- PROVIDED HEALTH INFORMATION ON THE CORPORATION'S WEB SITE AND THROUGH HEALTH RELATED PUBLICATIONS DISTRIBUTED AT NO CHARGE- SUPPORT GROUPS SUCH AS DIABETES, CANCER, AND BEREAVEMENT- HOSTED SELF-HELP AND WELLNESS PROGRAMS SUCH AS NUTRITION, WEIGHT MANAGEMENT AND FITNESS,- BLOOD PRESSURE SCREENINGS, CHOLESTEROL TESTING AND SCHOOL-BASED TESTING- GUIDANCE, REFERRAL AND ENROLLMENT ASSISTANCE FOR PUBLIC MEDICAL PROGRAMS AND OTHER FAMILY SUPPORT ASSISTANCE- DISCOUNTED OR FREE MEDICAL SUPPLIES AND EQUIPMENT TO THOSE UNABLE TO PAY- DELIVERED HOT IN-HOME MEALS- PROMOTED PARTICIPATION IN BLOOD DRIVES BY EMPLOYEES- CONTRIBUTED TO THE EDUCATION OF STUDENT NURSES AND OTHER HEALTH CARE PROFESSIONALS- PROVIDED FIRST AID FOR COMMUNITY SPORTING EVENTS- PARTICIPATED IN WORK SITE HEALTH EDUCATION PROGRAMS - MADE CASH CONTRIBUTIONS TO SUPPORT COMMUNITY SERVICES AND EVENTS- PROVIDED MEETING ROOMS TO COMMUNITY GROUPS AT NO CHARGE | Description |
| Total Program Service Expense | 70369044 | 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 | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | 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 | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | 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 | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 1 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 49 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 841 | 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 | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | 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 | 0 | 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 | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | THOMAS KRYSTOWIAK | NamePerson |
| Telephone Number | 9203611313 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 MEMORIAL DRIVE | AddressLine1 |
| City | BERLIN | City |
| State | WI | State |
| ZIP Code | 54923 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| PAT MCCONNELL | ||||||||
| BOARD MEMBER | 1.00 | X | 2300 | 0 | 0 | |||
| PAUL KUJAWA | ||||||||
| BOARD MEMBER | 1.00 | X | 3900 | 0 | 0 | |||
| FRANK CUMBERBATCH | ||||||||
| BOARD MEMBER | 1.00 | X | 3400 | 0 | 0 | |||
| THOMAS RIEK | ||||||||
| BOARD MEMBER | 1.00 | X | 4100 | 0 | 0 | |||
| NATHAN LUEDKE | ||||||||
| BOARD MEMBER | 1.00 | X | 3300 | 0 | 0 | |||
| JOLENE HOSTAK | ||||||||
| BOARD MEMBER | 1.00 | X | 2900 | 0 | 0 | |||
| P MICHAEL SHATTUCK MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 41.00 | X | 228258 | 0 | 24391 | |||
| KELLY WHITE | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| KRISTIN GALATOWITSCH | ||||||||
| CHAIRMAN | 1.00 | X | 8687 | 0 | 0 | X | ||
| RUSSELL KUEHN | ||||||||
| VICE CHAIRMAN | 1.00 | X | 4900 | 0 | 0 | X | ||
| THOMAS WILLETT DO | ||||||||
| SECRETARY | 1.00 | X | 18200 | 0 | 0 | X | ||
| LARRY WISE | ||||||||
| TREASURER | 1.00 | X | 6100 | 0 | 0 | X | ||
| JOHN FEENEY | ||||||||
| PRESIDENT/CEO | 40.00 | X | 328115 | 0 | 19091 | X | ||
| THOMAS KRYSTOWIAK | ||||||||
| CFO | 40.00 | 206172 | 0 | 31546 | X | 1.00 | ||
| DONALD CAVES | ||||||||
| EXECUTIVE VICE PRESIDENT | 31.00 | 71342 | 62883 | 19744 | X | 9.00 | ||
| DAVID JONES MD | ||||||||
| PHYSICIAN | 40.00 | 1469805 | 0 | 29437 | X | |||
| URI VAISMAN MD | ||||||||
| PHYSICIAN | 40.00 | 876665 | 0 | 36315 | X | |||
| JOHN HORAN MD | ||||||||
| PHYSICIAN | 40.00 | 794641 | 0 | 22276 | X | |||
| HORZCE LO MD | ||||||||
| PHYSICIAN | 40.00 | 583244 | 0 | 42925 | X | |||
| DAVID KURTZ MD | ||||||||
| PHYSICIAN | 40.00 | 674522 | 0 | 30987 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 5290551 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 62883 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 256712 | TotalOtherCompensation |
| Number Individuals GT100 K | 52 | 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 |
|---|---|---|---|---|---|
| ZR ENTERPRISES SC | |||||
| 5567ANGLES LANE | GREENDALE | WI | 53129 | ER PHYSICIAN SERVICE | 1482744 |
| CENTRAL WI ANESTHESIA ASSOC SC | |||||
| PO BOX 249 | BERLIN | WI | 54923 | ANESTHESIA SERVICES | 556029 |
| SHARED MEDICAL SERVICES | |||||
| PO BOX 330 | COTTAGE GROVE | WI | 53527 | MRI SERVICES | 458187 |
| DAVID RESEN | |||||
| 225 MEMORIAL DR | BERLIN | WI | 54923 | PHYSICIAN SERVICES | 225169 |
| HALL RENDER KILLIAN HEATH & LYMAN PC | |||||
| 39778 TREASURY CTR | CHICAGO | IL | 60694 | CONSULTING/LEGAL SERVICES | 184219 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Related Organizations | 38143 | RelatedOrganizations |
| All Other Contributions | 13549 | AllOtherContributions |
| Total Contributions | 51692 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|---|
| PATIENT SERVICE REVENUE | 624100 | 69274372 | 65740259 | $3,534,113 | |
| PHARMACY REVENUE | 446110 | 15592938 | 14128886 | 1464052 | |
| CAFETERIA REVENUE | 900099 | 120807 | $120,807 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 84988117 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 386628 | TotalRevenueColumn |
| Exclusion | $386,628 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 320741 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 382056 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -61315 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -61315 | TotalRevenueColumn |
| Exclusion | -$61,315 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4247916 | Securities |
| Other | 108778 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4074207 | Securities |
| Other | 77827 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 173709 | Securities |
| Other | 30951 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 204660 | TotalRevenueColumn |
| Exclusion | $204,660 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | EHR INCENTIVE INCOME | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 800000 | TotalRevenueColumn |
| Related Or Exempt Function Income | 800000 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 800000 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 86369782 | TotalRevenueColumn |
| Related Or Exempt Function Income | 80669145 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 1464052 | UnrelatedBusinessRevenue |
| Exclusion | $4,184,893 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21039 | Total |
| Program Services | 21039 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4917840 | Total |
| Program Services | 730543 | ProgramServices |
| Management And General | 4187297 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34705714 | Total |
| Program Services | 33861849 | ProgramServices |
| Management And General | 843865 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 582884 | Total |
| Program Services | 510301 | ProgramServices |
| Management And General | 72583 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5839847 | Total |
| Program Services | 4959934 | ProgramServices |
| Management And General | 879913 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2039384 | Total |
| Program Services | 1690812 | ProgramServices |
| Management And General | 348572 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 57752 | Total |
| Management And General | 57752 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7082240 | Total |
| Program Services | 5917770 | ProgramServices |
| Management And General | 1164470 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 209687 | Total |
| Program Services | 7694 | ProgramServices |
| Management And General | 201993 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14576096 | Total |
| Program Services | 14160469 | ProgramServices |
| Management And General | 415627 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1500176 | Total |
| Program Services | 39071 | ProgramServices |
| Management And General | 1461105 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1098079 | Total |
| Program Services | 1050855 | ProgramServices |
| Management And General | 47224 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 348005 | Total |
| Program Services | 304224 | ProgramServices |
| Management And General | 43781 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63142 | Total |
| Program Services | 1694 | ProgramServices |
| Management And General | 61448 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 794796 | Total |
| Program Services | 776670 | ProgramServices |
| Management And General | 18126 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2920292 | Total |
| Program Services | 2907405 | ProgramServices |
| Management And General | 12887 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 591938 | Total |
| Program Services | 383001 | ProgramServices |
| Management And General | 208937 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | Program ServicesProgramServices |
|---|---|---|---|
| PROVISION FOR BAD DEBTS | 4436105 | 4436105 | |
| EQUIPMENT RENTAL AND MA | 3138548 | 292188 | 2846360 |
| MEDICAID ASSESSMENT | 560352 | 560352 | |
| LICENSES, DUES, AND CER | 204654 | 76910 | 127744 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 158925 | Total |
| Program Services | 71609 | ProgramServices |
| Management And General | 87316 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 85847495 | Total |
| Program Services | 70369044 | ProgramServices |
| Management And General | 15478451 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3964 | BOY |
| EOY | 3846 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7730522 | BOY |
| EOY | 4172746 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10921018 | BOY |
| EOY | 16558337 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 112500 | BOY |
| EOY | 118917 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 961108 | BOY |
| EOY | 1111303 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 975529 | BOY |
| EOY | 736969 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 55688033 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 36122037 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20813974 | BOY |
| EOY | 19565996 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10986755 | BOY |
| EOY | 12356990 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 93734 | BOY |
| EOY | 45607 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3715986 | BOY |
| EOY | 4848081 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 56315090 | BOY |
| EOY | 59518792 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6345323 | BOY |
| EOY | 7018223 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12820000 | BOY |
| EOY | 12490000 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3135230 | BOY |
| EOY | 3335305 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7106245 | BOY |
| EOY | 9247133 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29406798 | BOY |
| EOY | 32090661 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25787171 | BOY |
| EOY | 26268159 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1121121 | BOY |
| EOY | 1159972 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26908292 | BOY |
| EOY | 27428131 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 56315090 | BOY |
| EOY | 59518792 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 522287 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | -41299 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 38851 | 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 Consolidated | X | FinancialStatementConsolidated |
| 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 | $5,455 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 5455 | 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 | WHA DUES OF $5,455. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 11731635 | BeginningOfYearBalance |
| Contributions | 1188523 | Contributions |
| Investment Earnings Or Losses | 1208164 | InvestmentEarningsOrLosses |
| Other Expenditures | 811361 | OtherExpenditures |
| End Of Year Balance | 13316961 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 9942971 | BeginningOfYearBalance |
| Contributions | 1110976 | Contributions |
| Investment Earnings Or Losses | 1431598 | InvestmentEarningsOrLosses |
| Other Expenditures | 753910 | OtherExpenditures |
| End Of Year Balance | 11731635 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 9548648 | BeginningOfYearBalance |
| Contributions | 1099960 | Contributions |
| Investment Earnings Or Losses | 46867 | InvestmentEarningsOrLosses |
| Other Expenditures | 752504 | OtherExpenditures |
| End Of Year Balance | 9942971 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 8326892 | BeginningOfYearBalance |
| Contributions | 1558801 | Contributions |
| Investment Earnings Or Losses | 644527 | InvestmentEarningsOrLosses |
| Other Expenditures | 981572 | OtherExpenditures |
| End Of Year Balance | 9548648 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 8370586 | BeginningOfYearBalance |
| Contributions | 1484600 | Contributions |
| Investment Earnings Or Losses | -454237 | InvestmentEarningsOrLosses |
| Other Expenditures | 1074057 | OtherExpenditures |
| End Of Year Balance | 8326892 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.91000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.00000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.09000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 1 | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | 1 | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 897715 | OtherCostOrOtherBasis |
| Book Value | 897715 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19462727 | OtherCostOrOtherBasis |
| Depreciation | 10911989 | Depreciation |
| Book Value | 8550738 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1219996 | OtherCostOrOtherBasis |
| Depreciation | 1122339 | Depreciation |
| Book Value | 97657 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 32304119 | OtherCostOrOtherBasis |
| Depreciation | 23269561 | Depreciation |
| Book Value | 9034558 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1803476 | OtherCostOrOtherBasis |
| Depreciation | 818148 | Depreciation |
| Book Value | 985328 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 19565996 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (6 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| RECEIVABLE FROM PHYSICIANS | 77500 |
| UNAMORTIZED BOND ISSUE COSTS | 420410 |
| INTEREST RECEIVABLE | 1748 |
| ACCOUNTS RECEIVABLE - WILD ROSE | 2388451 |
| ASSETS HELD BY FOUNDATION | 1159972 |
| EHR INCENTIVE | 800000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 4848081 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (6 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEFERRED COMPENSATION | $6,561,475 |
| ACCRUED INTEREST | $90,532 |
| SELF FUNDED HEALTH INSURANCE | $18,888 |
| NET AMOUNTS PAYABLE FROM THIRD-PARTY REIMBURSEMENT PROGRAMS | $1,003,807 |
| MISCELLANEOUS | $1,192,872 |
| DEFERRED PHYSICIAN COMP | $379,559 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 9247133 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 82313285 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -41299 | NetUnrealizedGainsInvestments |
| Other Revenues | 38851 | OtherRevenues |
| Revenue Not Rptd F990 | -2448 | RevenueNotRptdF990 |
| Revenue Subtotal | 82315733 | RevenueSubtotal |
| Other Revenues Not Included | 4054049 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 4054049 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 86369782 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 81793446 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 382056 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 382056 | ExpensesNotRptdF990 |
| Expenses Subtotal | 81411390 | ExpensesSubtotal |
| Other Expenses Not Included | 4436105 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 4436105 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 85847495 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | ENDOWMENT FUNDS ARE TO BE UTILIZED TO SUPPORT THE ORGANIZATION'S MISSION AND PURPOSE. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, COMMUNITY HEALTH NETWORK, INC. 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 THAT POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2013, 2012, OR 2011. COMMUNITY HEALTH NETWORK, INC. IS ALSO ENGAGED, TO A LIMITED EXTENT, IN ACTIVITIES THAT THE INTERNAL REVENUE SERVICE CONSIDERS UNRELATED TO THE ORGANIZATION'S EXEMPT PURPOSE AND, THEREFORE, TAXABLE. THESE ACTIVITIES, HOWEVER, ANNUALLY RESULT IN NET OPERATING LOSSES FOR INCOME TAX PURPOSES. COMMUNITY HEALTH NETWORK, INC. DOES NOT PRESENTLY ANTICIPATE THAT A TAX BENEFIT FROM THESE NET OPERATING LOSSES WILL BE REALIZED IN THE FUTURE. ACCORDINGLY, ANY POTENTIAL DEFERRED TAX ASSET RESULTING FROM THE AVAILABILITY OF NET OPERATING LOSS CARRYFORWARDS IS OFFSET BY A VALUATION ALLOWANCE OF EQUAL AMOUNT. NO DEFERRED TAX ASSETS AND LIABILITIES HAVE BEEN RECOGNIZED, SINCE NO OTHER DIFFERENCES EXIST BETWEEN THE FINANCIAL AND TAX BASES OF REPORTING THE ORGANIZATION'S ASSETS AND LIABILITIES. COMMUNITY HEALTH NETWORK INC.'S POLICY IS TO RECOGNIZE INTEREST AND ANY PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. AS OF AND FOR THE YEARS ENDED SEPTEMBER 30, 2013, 2012, AND 2011, THERE WAS NO INCOME TAX EXPENSE, TAX PENALTIES, OR INTEREST RELATED TO TAX PENALTIES RECORDED BY THE ORGANIZATION IN THE CONSOLIDATED FINANCIAL STATEMENTS. FEDERAL INCOME TAX RETURNS FOR THE YEAR ENDED SEPTEMBER 30, 2010, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY MAJOR TAX JURISDICTIONS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN BENEFICIAL INTEREST OF PARTNERS HEALTH SYSTEM FOUNDATION, INC. 38,851. | |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | RENTAL EXPENSES -382,056. PROVISION FOR BAD DEBT 4,436,105. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 382,056. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBT 4,436,105. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| 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 | 2186385 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2186385 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02690 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9545812 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5746080 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3799732 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04670 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11732197 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5746080 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5986117 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07360 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 60694 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 60694 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5243 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5243 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 478946 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 478946 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00590 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 544883 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 544883 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00670 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12277080 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5746080 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6531000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08030 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,951,886 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 12936428 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 12936480 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -52 | 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 | BERLIN MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 MEMORIAL DRIVE | AddressLine1 |
| City | BERLIN | City |
| State | WI | State |
| ZIP Code | 54923 | 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 |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BERLIN MEMORIAL HOSPITAL | 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 | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 0 | CollectionActivities |
| 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 | 13 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (13 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| CHN MEDICAL OFFICE BUILDING | ||||
| 225 MEMORIAL DRIVE | BERLIN | WI | 54923 | OUTPATIENT PHYSICIAN CLINIC |
| CHN MEDICAL CENTER - WAUTOMA | ||||
| N HIGHWAY 22 | WAUTOMA | WI | 54982 | OUTPATIENT PHYSICIAN CLINIC |
| CHN MEDICAL CENTER - MARKESAN | ||||
| 340 ENTERPRISE DRIVE | MARKESAN | WI | 53946 | OUTPATIENT PHYSICIAN CLINIC |
| CHN MEDICAL CENTER - PRINCETON | ||||
| 502 W WATER STREET | PRINCETON | WI | 54968 | OUTPATIENT PHYSICIAN CLINIC |
| CHN MEDICAL CENTER - MONTELLO | ||||
| 315 CHURCH STREET | MONTELLO | WI | 53949 | OUTPATIENT PHYSICIAN CLINIC |
| CHN MEDICAL CENTER - RIPON | ||||
| 1080 FOND DU LAC STREET | RIPON | WI | 54971 | OUTPATIENT PHYSICIAN CLINIC |
| CHN MEDICAL CENTER - REDGRANITE | ||||
| 402 PRESTON LANE | REDGRANITE | WI | 54970 | OUTPATIENT PHYSICIAN CLINIC |
| CHN MEDICAL CENTER - EASTRIDGE | ||||
| W832 HIGHWAY 91 | BERLIN | WI | 54923 | OUTPATIENT PHYSICIAN CLINIC |
| CHN ORTHOPEDICS & SPORTS MEDICINE | ||||
| 191 MEMORIAL DRIVE | BERLIN | WI | 54923 | OUTPATIENT PHYSICIAN CLINIC |
| JULIETTE MANOR | ||||
| 169 EAST HURON STREET | BERLIN | WI | 54923 | SKILLED NURSING FACILITY |
| CHN HOME CARE | ||||
| 270 MARQUETTE STREET | BERLIN | WI | 54923 | HOME HEALTH CARE |
| COMMUNITY MEDICAL CENTER - GREEN LAKE | ||||
| 670 CTY HIGHWAY A | GREEN LAKE | WI | 54941 | OUTPATIENT PHYSICIAN CLINIC |
| CHN MEDICAL CENTER - GREEN LAKE | ||||
| N6205 BUSSE DR | GREEN LAKE | WI | 54941 | OUTPATIENT PHYSICIAN CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 7: THE NUMBERS IN THE TABLE FOR CHARITY CARE AND UNREIMBURSED MEDICAID WERE DERIVED FROM USE OF THE WORKSHEET 2 COST-TO-CHARGE RATIO. THE COST OF THE COMMUNITY HEALTH IMPROVEMENTS WERE CALCULATED BASED ON LABOR COSTS, SUPPLY COSTS AND ROOM COSTS. HEALTH PROFESSIONAL EDUCATION COSTS WERE BASED ON THE AMOUNT OF SCHOLARSHIPS AWARDED AND THE ROOM & LABOR COSTS FOR PROVIDING COMMUNITY EDUCATION FOR HEALTH PROFESSIONALS IN OUR COMMUNITIES. CASH IS THE AMOUNT OF CONTRIBUTIONS TO THE COMMUNITY AND IN-KIND DONATIONS ARE BASED ON THE COST OF THE IN-KIND DONATION. | |
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 4436105. | |
| PART II: COMMUNITY HEALTH NETWORK ENGAGES IN SEVERAL COMMUNITY BUILDING ACTIVITIES. OUR DISASTER READINESS PROGRAMS ARE DEVELOPED TO EXCEED THE MINIMUM REQUIREMENTS IN ORDER TO PROVIDE A RESPONSIBLE LEVEL OF SERVICE TO THE COMMUNITY. WE ALSO PROVIDE MEETING ROOMS AND SUPPORT TO OTHER NOT-FOR-PROFIT ORGANIZATIONS THAT IMPROVE THE HEALTH OF THE COMMUNITY. ALL OF THESE EFFORTS ARE FOCUSED ON MINIMIZING THE HEALTH IMPACT OF CATASTROPHES, LARGE AND SMALL, AS WELL AS SUPPORTING HEALTH ACTIVITIES AND GROUPS WITH A QUALITY OF LIFE FOCUS. | |
| PART III, LINE 4: USED COST TO CHARGE RATIO BASED ON COST BEING THE TOTAL OPERATING EXPENSE NET OF COMMUNITY BENEFIT EXPENSE AND NON-PATIENT CARE OPERATIONS AND CHARGES BEING PATIENT CHARGES NET OF COMMUNITY BENEFIT CHARGES. MANY PATIENTS WHOSE ACCOUNTS/OUT-OF-POCKET LIABILITY ARE WRITTEN OFF TO BAD DEBT ARE UNABLE TO PAY BUT DID NOT COMPLETE THE PROCESS FOR CHARITY CARE/FINANCIAL ASSISTANCE. BECAUSE THESE PATIENTS WOULD HAVE QUALIFIED FOR CHARITY CARE, BUT DIDN'T COMPLETE THE PROCESS, THESE BAD DEBT WRITE-OFFS SHOULD BE CONSIDERED COMMUNITY BENEFIT AS CHARITY CARE. IN ADDITION, COMMUNITY HEALTH NETWORK CONTINUES TO SERVE PATIENTS WHOSE ACCOUNTS ARE WRITTEN OFF TO BAD DEBT EVEN THOUGH THERE IS A GOOD CHANCE FUTURE SERVICES MAY CONTINUE TO BE WRITTEN OFF TO BAD DEBT, WHICH DEMONSTRATES A COMMUNITY BENEFIT - SERVING PATIENTS EVEN THOUGH WE MAY NOT BE PAID. | |
| PART III, LINE 8: ANY SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE CHN CONTINUES TO SERVE THE MEDICARE POPULATION REGARDLESS OF WHETHER THEY COVER THEIR COSTS. COMMUNITY HEALTH NETWORK HAS A SURPLUS BECAUSE IT IS A CRITICAL ACCESS HOSPITAL AND AS A CRITICAL ACCESS HOSPITAL, IT RECEIVES 101% OF ITS COST PER THE MEDICARE COST REPORT. | |
| PART III, LINE 9B: PATIENTS WHO HAVE AN APPLICATION OUTSTANDING ARE NOT KNOWINGLY SENT TO COLLECTIONS. PATIENTS WHO QUALIFY FOR 100% CHARITY HAVE THE ENTIRE AMOUNT OF THE BILL WRITTEN OFF AND NO FURTHER COLLECTION PROCEDURES ARE DONE. BALANCES REMAINING AFTER CHARITY CARE PERCENTAGE HAS BEEN DETERMINED (THOSE WHO QUALIFY FOR FINANCIAL ASSISTANCE/PARTIAL CHARITY CARE) ARE CONSIDERED SELF PAY AND PAYMENT ARRANGEMENTS MUST BE MADE. SHOULD THE PATIENT FAIL TO MAKE PAYMENT ARRANGEMENTS OR MAINTAIN THE PAYMENTS AGREED UPON THEY WILL BE NOTIFIED IN WRITING THAT THE ACCOUNT BALANCE IS PAST DUE AND THE ACCOUNT WILL BE SUBJECT TO NORMAL COLLECTION PROCEDURES. | |
| PART V, SECTION B, LINE 3: IN ORDER TO ENSURE CONSIDERATION OF BROAD COMMUNITY INTERESTS, THE CREATION OF THE 2013 CHNA WAS A PARTNERSHIP BETWEEN COMMUNITY HEALTH NETWORK, INC. D/B/A BERLIN MEMORIAL HOSPITAL ("CHN") AND EACH COUNTY HEALTH DEPARTMENT THAT COMPRISES CHN'S PRIMARY SERVICE AREA: GREEN LAKE COUNTY, WAUSHARA COUNTY AND MARQUETTE COUNTY. | BERLIN MEMORIAL HOSPITAL |
| PART V, SECTION B, LINE 4: WILD ROSE COMMUNITY MEMORIAL HOSPITAL | BERLIN MEMORIAL HOSPITAL |
| PART V, SECTION B, LINE 5C: COMMUNITY HEALTH NETWORK, INC. PROVIDES INFORMATION REGARDING THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN ON THE HOME PAGE OF THE COMMUNITY HEALTH NETWORK, INC. WEBSITE. | BERLIN MEMORIAL HOSPITAL |
| PART V, SECTION B, LINE 7: FOR EXAMPLE, ALTHOUGH WE ARE ACTIVE IN THE PREVENTION OF ALCOHOL AND DRUG ABUSE BY PARTICIPATION ON OUR COUNTY COALITIONS, WE ARE UNABLE TO ADDRESS BEYOND THAT BASED ON FINANCIAL CONSTRAINTS AND DIFFICULTY IN RECRUITING IN THIS AREA. CHN MANAGES THESE BEHAVIORS THROUGH PRIMARY CARE SERVICES. ADDITIONALLY, WE ARE ACTIVELY LOOKING FOR PARTNERSHIPS WITH LARGER HEALTH SYSTEMS TO INCREASE SPECIALTY SERVICES THAT CAN ADDRESS THESE NEEDS. WE DO NOT INTEND TO ADDRESS ENVIRONMENTAL AND OCCUPATIONAL HEALTH IN WAUSHARA COUNTY THE WAY THAT COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIES IT AS IT IS BEYOND OUR SCOPE. | BERLIN MEMORIAL HOSPITAL |
| PART V, SECTION B, LINE 20D: COMMUNITY HEALTH NETWORK, INC. MAINTAINS WRITTEN POLICIES TO DETERMINE PATIENTS' ABILITY TO PAY AND ELIGIBILITY FOR FINANCIAL ASSISTANCE. APPLICANTS TO THE COMMUNITY CARE ASSISTANCE PROGRAM ARE REQUIRED TO COMPLETE AN APPLICATION TO DETERMINE ELIGIBILITY AND MAY QUALIFY FOR 25%, 50% OR 100% REDUCTION IN GROSS CHARGES. ELIGIBILITY IS DETERMINED ON THE BASIS ON A PATIENTS INCOME AND ASSETS. COMMUNITY CARE WILL BE APPROVED IN A THREE (3) TIER PROGRAM.1. 100% FOR APPLICANTS AT OR BELOW 150% OF FEDERAL POVERTY GUIDELINES.2. 50% FOR APPLICANTS BETWEEN 150% AND 200% OF FEDERAL POVERTY GUIDELINES.3. 25% FOR APPLICANTS BETWEEN 200% AND 300% OF FEDERAL POVERTY GUIDELINES. | BERLIN MEMORIAL HOSPITAL |
| PART VI, LINE 2: COMMUNITY HEALTH NETWORK WORKS IN COLLABORATION WITH GREEN LAKE AND WAUSHARA COUNTY PUBLIC HEALTH TO ASSESS COMMUNITY NEEDS IN ORDER TO CREATE A PLAN OF CARE BASED ON THOSE ISSUES AND CONCERNS IDENTIFIED. COMMUNITY HEALTH NETWORK ALSO PARTICIPATES WITH THE GREEN LAKE COUNTY AND WAUSHARA COUNTY WELLNESS COALITION. IN THE EFFORT TO PROVIDE COMPREHENSIVE CARE, THE WELLNESS COALITION ALSO STRIVES TO DECREASE INEFFICIENCIES DUE TO OVERLAP OF CARE PROVIDERS AND ORGANIZATIONS IN THE AREA. COMMUNITY HEALTH NETWORK ALSO ASSESSES COMMUNITY NEED BY USING UNIVERSITY OF WISCONSIN HEALTH RANKINGS WHICH PROVIDES COUNTY BY COUNTY BREAKDOWNS OF HEALTH OUTCOMES, HEALTH FACTORS, AND HEALTH ISSUES TO ASSIST IN DETERMINING COMMUNITY NEED. | |
| PART VI, LINE 3: SELF PAY PATIENTS ARE CONTACTED BY A MEMBER OF THE PATIENT ACCOUNTING STAFF TO INFORM THEM OF AVAILABLE GOVERNMENT PROGRAMS AND CHARITY CARE. IF APPROPRIATE, THE PATIENT ACCOUNTING STAFF WILL OFFER ASSISTANCE WITH THE COMPLETION OF THE COMMUNITY CARE (CHARITY CARE) APPLICATION. | |
| PART VI, LINE 4: COMMUNITY HEALTH NETWORK PRIMARILY SERVES RESIDENTS FROM GREEN LAKE, MARQUETTE, AND WAUSHARA COUNTIES. THE SERVICE AREA HAD AN ESTIMATED POPULATION OF 59,000 AND IS MOSTLY RURAL. THE POPULATION CONSISTS OF 18.9% UNDER THE AGE OF 18, 26.8% FROM 18 TO 44, 32.8% FROM 45 TO 64 AND 21.5% WHO WERE 65 AND OLDER. PORTIONS OF THE COMMUNITY HEALTH NETWORK SERVICE AREA ARE FEDERALLY QUALIFIED HPSA AREAS. COMMUNITY HEALTH NETWORK OPERATES THE ONLY HOSPITAL IN GREEN LAKE COUNTY. | |
| PART VI, LINE 5: THE 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 ORGANIZATION, NOR FAMILY MEMBERS THEREOF. COMMUNITY HEALTH NETWORK CONDUCTS HEALTH FAIRS FOR THE COMMUNITY TO ENCOURAGE HEALTHY LIFESTYLES AND TO RAISE AWARENESS OF HEALTH ISSUES AND TRENDS. COMMUNITY HEALTH NETWORK ALSO CONDUCTS CPR AND FIRST AID CLASSES, EDUCATION AND OUTREACH FOR SENIOR CITIZENS, AND EDUCATION OPPORTUNITIES FOR PHYSICIANS AND MEDICAL STUDENTS. IN ADDITION, WE ADMINISTER A DIABETES SUPPORT GROUP. | |
| PART VI, LINE 6: COMMUNITY HEALTH NETWORK ENGAGES IN SEVERAL COMMUNITY BUILDING ACTIVITIES. OUR DISASTER READINESS PROGRAMS ARE DEVELOPED TO EXCEED THE MINIMUM REQUIREMENTS IN ORDER TO PROVIDE A RESPONSIBLE LEVEL OF SERVICE TO THE COMMUNITY. WE ALSO PROVIDE MEETING ROOMS AND SUPPORT TO OTHER NOT-FOR-PROFIT ORGANIZATIONS THAT IMPROVE THE HEALTH OF THE COMMUNITY. ALL OF THESE EFFORTS ARE FOCUSED ON MINIMIZING THE HEALTH IMPACT OF CATASTROPHES, LARGE AND SMALL, AS WELL AS SUPPORTING HEALTH ACTIVITIES AND GROUPS WITH A QUALITY OF LIFE FOCUS. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PARTNERS HEALTH SYSTEM FOUNDATION INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 MEMORIAL DRIVE | AddressLine1 |
| City | BERLIN | City |
| State | WI | State |
| ZIP Code | 54923 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 731639346 | EINOfRecipient |
| Amount Of Cash Grant | 21039 | AmountOfCashGrant |
| Purpose Of Grant | FOUNDATION FUNDRAISING EVENT | PurposeOfGrant |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 1 | 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| P MICHAEL SHATTUCK MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | 195277 | 0 | 32981 | 0 | 0 | 0 | 5325 | 0 | 19066 | 0 | 252649 | 0 | 0 | 0 |
| JOHN FEENEY | ||||||||||||||
| PRESIDENT/CEO | 278115 | 0 | 50000 | 0 | 0 | 0 | 0 | 0 | 19091 | 0 | 347206 | 0 | 0 | 0 |
| THOMAS KRYSTOWIAK | ||||||||||||||
| CFO | 175502 | 0 | 20000 | 0 | 10670 | 0 | 9166 | 0 | 22380 | 0 | 237718 | 0 | 0 | 0 |
| DONALD CAVES | ||||||||||||||
| EXECUTIVE VICE PRESIDENT | 0 | 62883 | 0 | 0 | 71342 | 0 | 0 | 1464 | 16490 | 1790 | 87832 | 66137 | 0 | 0 |
| DAVID JONES MD | ||||||||||||||
| PHYSICIAN | 898225 | 0 | 512780 | 0 | 58800 | 0 | 0 | 0 | 29437 | 0 | 1499242 | 0 | 0 | 0 |
| URI VAISMAN MD | ||||||||||||||
| PHYSICIAN | 692531 | 0 | 184134 | 0 | 0 | 0 | 14185 | 0 | 22130 | 0 | 912980 | 0 | 0 | 0 |
| JOHN HORAN MD | ||||||||||||||
| PHYSICIAN | 648991 | 0 | 96804 | 0 | 48846 | 0 | 0 | 0 | 22276 | 0 | 816917 | 0 | 0 | 0 |
| HORZCE LO MD | ||||||||||||||
| PHYSICIAN | 513594 | 0 | 69650 | 0 | 0 | 0 | 9405 | 0 | 33520 | 0 | 626169 | 0 | 0 | 0 |
| DAVID KURTZ MD | ||||||||||||||
| PHYSICIAN | 529846 | 0 | 144676 | 0 | 0 | 0 | 11057 | 0 | 19930 | 0 | 705509 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINES 4A-B | ALL HIGHLY COMPENSATED PARTICIPATE, BUT DID NOT RECEIVE PAYMENT FROM A NON-QUALIFIED PLAN. DONALD CAVES RECEIVED $71,342 OF SEVERANCE. |
| PART I, LINE 5 | RADIOLOGISTS RECEIVE 50% OF REVENUE FROM PROFESSIONAL FEES OVER $2.2 MILLION. IN CALENDAR YEAR 2012, DR. KURTZ RECEIVED $144,676 AND DR. VAISMAN RECEIVED $184,134. SERVICES PROVIDED BY RADIOLOGISTS AT WILD ROSE HOSPITAL ARE INCLUDED. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Bond ReferenceBondReferenceCd | Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|---|
| WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY | ||||||||
| A | 391337855 | 97710VUX4 | 2004-08-01 | 10060000 | WISCONSIN HEALTH AND EDUCATIONAL FACILITIES BOND HAS THE ADDITIONAL CUSIP NU | 0 | 0 | 0 |
| WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY | ||||||||
| B | 391337855 | 97710VVF2 | 2004-08-01 | 5000000 | WISCONSIN HEALTH AND EDUCATIONAL FACILITIES BOND HAS THE ADDITIONAL CUSIP NU | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Bond ReferenceBondReferenceCd | Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Refunding EscrowRefundingEscrow | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Working Capital ExpendituresWorkingCapitalExpenditures |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 1495000 | 10060000 | 3746185 | 755310 | 201200 | 5357305 | 2005 | 1 | 0 | 1 | 1 | |
| B | 1075000 | 5000000 | 2712071 | 100000 | 2102286 | 2005 | 1 | 0 | 1 | 1 | 85643 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Bond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTest | Change In Use Bond Financed PropChangeInUseBondFinancedProp | Non Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 1 | 0 | 0 | 0.00600 | 0.00000 | 0.00600 | 1 | 0 | 1 |
| B | 0 | 1 | 0 | 0 | 0.00600 | 0.00000 | 0.00600 | 1 | 0 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiled | Rebate Not Due YetRebateNotDueYet | Exception To RebateExceptionToRebate | No Rebate DueNoRebateDue | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Written Proc To Monitor ReqsWrittenProcToMonitorReqs |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
| B | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 1 |
Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)
| Bond ReferenceBondReferenceCd | Proc To Undertk Corrective ActionProcToUndertkCorrectiveAction |
|---|---|
| A | 1 |
| B | 1 |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE K, PART I, LINE A: | Identifier |
| Explanation | WISCONSIN HEALTH AND EDUCATIONAL FACILITIES BOND HAS THE ADDITIONAL CUSIP NUMBERS: 97710VUZ9 97710VUY2 97710VVA3 97710VVB1 97710VVC9 97710VVD7 97710VVE5 | Explanation |
Schedule L IRS990ScheduleL
Loan Table LoanTable (3 entries)
| Purpose Of LoanPurposeOfLoan | Loan From OrganizationLoanFromOrganization | Original PrincipalOriginalPrincipalAmount | Balance DueBalanceDue | DefaultDefault | Approved By BoardApprovedByBoard | Written AgreementWrittenAgreement |
|---|---|---|---|---|---|---|
| DR HORAN | ||||||
| COMPENSATION ADVANCE | X | $225,000 | 75000 | 0 | 1 | 1 |
| DR JONES | ||||||
| COMPENSATION ADVANCE | X | $30,000 | 21000 | 0 | 1 | 1 |
| DR CAVES | ||||||
| COMPENSATION ADVANCE | X | $47,917 | 22917 | 0 | 1 | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 118917 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | P MICHAEL SHATTUCK MD | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | CHN BOARD MEMBER | Relationship |
| Amount Of Transaction | 138636 | AmountOfTransaction |
| Description Of Transaction | CHN RENTS SPACE FROM DR. SHATTUCK FOR MEDICAL GROUP OFFICES | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| NEW PROGRAM SERVICES | FORM 990, PART III, LINE 2 | CHN IS OFFERING UROLOGY SERVICES, WHICH BEGAN OPERATIONS IN FY 2013. |
| FORM 990, PART VI, SECTION A, LINE 2 | RUSSELL KUEHN AND THOMAS WILLETT ARE MEMBERS OF THE BOARD OF DIRECTORS OF 1ST NATIONAL BANK. THOMAS WILLETT AND PATRICK MCCONNELL HAVE A BUSINESS RELATIONSHIP. | |
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERSHIP MAY BE OBTAINED BY ANYONE EIGHTEEN OR MORE YEARS OF AGE AND EITHER: (A) RESIDE OR WORK IN THE CORPORATION'S SERVICE AREA, WHICH IS DEFINED AS THE FOLLOWING ZIP CODES: 53919, 53923, 53926, 53930, 53931, 53935, 53939, 53946, 53947, 53949, 53952, 53953, 53956, 53964, 54909, 54921, 54923, 54930, 54934, 54940, 54941, 54943, 54960, 54963, 54964, 54965, 54966, 54967, 54968, 54970, 54971, 54976, 54980, 54982, 54984, AND 54986. AN INDIVIDUAL IS DEEMED TO WORK WITHIN THE CORPORATION'S SERVICE AREA IF HIS OR HER PRIMARY SOURCE OF INCOME STEMS FROM WORK PERFORMED IN THE SERVICE AREA; OR (B) AN EMPLOYEE OF THE CORPORATION OR MEMBER OF HIS OR HER FAMILY. MAY BECOME A MEMBER OF THE CORPORATION UPON SUBMISSION OF A SIGNED APPLICATION DELIVERED TO THE PRINCIPAL OFFICE OF THE CORPORATION. THE CORPORATION'S BOARD OF DIRECTORS OR ITS DESIGNEE(S) HAS THE AUTHORITY TO, FROM TIME TO TIME, MAKE GOOD FAITH DETERMINATIONS REGARDING WHETHER AN APPLICANT OR AN EXISTING MEMBER MEETS THE QUALIFICATIONS FOR MEMBERSHIP OF THE CORPORATION. ANY PERSON WHO DOES NOT MEET THE CRITERIA AS DETERMINED BY THE BOARD OF DIRECTORS OR ITS DESIGNEE(S) WILL NOT BE A MEMBER. AN INDIVIDUAL'S MEMBERSHIP SHALL BE TERMINATED UPON DEATH, RESIGNATION OR THE FAILURE TO MEET THE QUALIFICATION. INDIVIDUALS GRANTED HONORARY MEMBERSHIP IN THE CORPORATION SHALL BE ENTITLED TO LIFELONG VOTING MEMBERSHIP IN THE CORPORATION. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THERE ARE TWELVE DIRECTORS ON THE BOARD OF DIRECTORS THAT ARE ELECTED ANNUALLY BY THE MEMBERS AT THE ANNUAL MEETING OR AT A SPECIAL MEETING HELD FOR SUCH PURPOSE. THE CHIEF EXECUTIVE OFFICER IS AN EX-OFFICIO MEMBER OF THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION A, LINE 7B | PER BYLAWS, MEMBERS HAVE THE FOLLOWING RESERVED POWERS 2.2.1 TO APPROVE ALL AMENDMENTS AND RESTATEMENTS OF ARTICLES OF INCORPORATION AND BYLAWS 2.2.2 TO VOTE ON NOMINATIONS TO FILL OPEN BOD POSITIONS AT THE ANNUAL MEETING 2.2.3. TO RECEIVE AN ANNUAL REPORT ON THE CORPORATIONS BUSINESS AND OPERATIONS 2.2.4 TO VOTE ON NOMINATIONS TO FILL OPEN NON-DIRECTOR GOVERNANCE AND NOMINATIONS COMMITTEE POSITIONS PURSUANT TO THE PROCEDURES ET FORTH IN SECTION 6.6.4 OF THESE BYLAWS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE BOARD OF DIRECTORS HAS DELEGATED THE DETAIL REVIEW OF THE FORM 990 TO THE MANAGEMENT OF THE CORPORATION. THEY COMPLETED THEIR REVIEW PRIOR TO SUBMISSION. | |
| FORM 990, PART VI, SECTION B, LINE 12C | IT IS THE DIRECTOR, OFFICER AND/OR COMMITTEE MEMBER'S RESPONSIBILITY TO DISCLOSE TO THE BOARD OF DIRECTORS OR COMMITTEE CONSIDERING A TRANSACTION, ANY POTENTIAL FINANCIAL INTEREST. THE CHAIRPERSON OF THE BOARD OR COMMITTEE MAY THEN QUESTION THE INTERESTED PERSON FURTHER. THE BOARD OR COMMITTEE MAKES THE DECISION WHETHER A CONFLICT OF INTEREST EXISTS. IN ADDITION TO THE ABOVE, DIRECTORS, OFFICERS AND COMMITTEE MEMBERS EXECUTE AND DELIVER TO CHN A "CERTIFICATE REGARDING CONFLICTS OF INTEREST" ON AN ANNUAL BASIS. PER THE POLICY, THE BOARD IS TO CONDUCT PERIODIC REVIEWS OF ITS TRANSACTIONS AND ARRANGEMENTS. REVIEW SHALL INCLUDE: - WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE AND ARE THE RESULT OF ARM'S-LENGTH BARGAINING - WHETHER ACQUISITIONS OF PHYSICIAN PRACTICES AND OTHER PROVIDER SERVICES RESULT IN PRIVATE INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT - WHETHER PARTNERSHIPS, JOINT VENTURES, AND OTHER TYPES OF ARRANGEMENTS FURTHER CHN'S CHARITABLE PURPOSE AND DO NOT RESULT IN PRIVATE INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT | |
| THE COMPENSATION DETERMINATION FOR THE CEO OF COMMUNITY HEALTH NETWORK IS AS FOLLOWS: THE CEO IS UNDER AN EMPLOYMENT CONTRACT. HIS SALARY IS REVIEWED PER HIS CONTRACT BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS (THOSE WITHOUT CONFLICT). THE EXECUTIVE COMMITTEE REVIEWS COMPENSATION BENCHMARK DATA, COMPARES THE DATA WITH THE CEO'S CURRENT SALARY AND MAKES A SALARY DETERMINATION WHICH IS THEN VOTED ON BY THE EXECUTIVE COMMITTEE. THE COMPENSATION DETERMINATION FOR THE CFO IS AS FOLLOWS. ONCE A YEAR, CHN'S CEO REVIEWS COMPENSATION BENCHMARK DATA AND COMPARES THE DATA WITH THE CFO'S CURRENT SALARY AND THE PROPOSED INCREASE. BASED ON THE DATA, THE CEO, A PERSON WITHOUT CONFLICT, DETERMINES THE CFO'S SALARY FOR THE COMING YEAR. THE SALARY IS DISCUSSED AND AGREED UPON BY CHN'S CEO AND THE INDIVIDUAL. THE QUESTIONS WERE MARKED "NO" AS THE PROCESS FOR 2012 WAS NOT DOCUMENTED. | ||
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION BELIEVES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE THE PROPERTY OF THE ORGANIZATION AND DOES NOT MAKE THEM AVAILABLE TO THE PUBLIC. | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 9: | CHANGE IN BENEFICIAL INTEREST OF PARTNERS HEALTH SYSTEM FOUNDATION, INC. 38,851. |
| RESPONSIBLE FOR THE AUDIT | FORM 990, PART XII, LINE 2C | MANAGEMENT PROVIDES OVERSIGHT OF THE AUDIT. THE AUDIT IS PRESENTED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. |
| OVERSIGHT OF AUDIT | FORM 990, PART XI, LINE 2C | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEDICAL CENTER OF GREEN LAKE LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 670 COUNTY HWY A | AddressLine1 |
| City | GREEN LAKE | City |
| State | WI | State |
| ZIP Code | 54941 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 261424367 | EIN |
| Primary Activities | CLINIC | PrimaryActivities |
| Legal Domicile State | WI | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTH NETWORK INC | BusinessNameLine1 |
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| PARTNERS HEALTH SYSTEM FOUNDATION INC | |||||||||||
| 225 MEMORIAL DRIVE | BERLIN | WI | 54923 | 731639346 | SUPPORTING ORGANIZATION | WI | 501(C)(3) | LINE 11B, II | PARTNERS HEALTH SYSTEM INC | 1 | |
| WILD ROSE COMMUNITY MEMORIAL HOSPITALINC | |||||||||||
| PO BOX 243 | WILD ROSE | WI | 54984 | 396089134 | HOSPITAL | WI | 501(C)(3) | LINE 3 | PARTNERS HEALTH SYSTEM INC | 1 | |
| PARTNERS HEALTH SYSTEM INC | |||||||||||
| 225 MEMORIAL DRIVE | BERLIN | WI | 54923 | 271119447 | SUPPORTING ORGANIZATION | WI | 501(C)(3) | LINE 11B, II | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |