EDGERTON HOSPITAL AND HEALTH SERVICES INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- EDGERTON HOSPITAL AND HEALTH SERVICES INC (EIN 39-0819992)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-08-08
- IRS object ID
- 201432209349300233
- Schema version
- 2013v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-08-08T11:34:08-05:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Nicollet Mall Ste 1300 | AddressLine1 |
| City | Minneapolis | City |
| State | MN | State |
| ZIP Code | 554027033 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390819992 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Edgerton Hospital and Health Services Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | EDGE | BusinessNameControlTxt |
| Phone | 6088843441 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11101 North Sherman Road | AddressLine1 |
| City | Edgerton | City |
| State | WI | State |
| ZIP Code | 53534 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Charles Roeder | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 6088843441 | PhoneNum |
| Signature | 2014-08-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim Hunwardsen CPA | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | PhoneNum |
| Preparation | 2014-08-07 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | James Pernau | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11101 North Sherman Road | AddressLine1 |
| City | Edgerton | City |
| State | WI | State |
| ZIP Code | 53534 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $19,483,140 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.edgertonhospital.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1968 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | Serve area communities with exceptional quality and innovative health services | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 225 | TotalEmployeeCnt |
| Total Volunteers | 108 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $492,253 | PYContributionsGrantsAmt |
| CY Contributions Grants | $158,654 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,729,089 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $19,300,282 | CYProgramServiceRevenueAmt |
| PY Investment Income | $13,397 | PYInvestmentIncomeAmt |
| CY Investment Income | $9,737 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$20,058 | PYOtherRevenueAmt |
| CY Other Revenue | $10,575 | CYOtherRevenueAmt |
| PY Total Revenue | $19,214,681 | PYTotalRevenueAmt |
| CY Total Revenue | $19,479,248 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $174,587 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $140,717 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,607,677 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,611,551 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,629,668 | PYOtherExpensesAmt |
| CY Other Expenses | $11,438,506 | CYOtherExpensesAmt |
| PY Total Expenses | $20,411,932 | PYTotalExpensesAmt |
| CY Total Expenses | $21,190,774 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,197,251 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,711,526 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $32,899,272 | TotalAssetsBOYAmt |
| Total Assets EOY | $30,903,747 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $27,855,769 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $27,567,603 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,043,503 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,336,144 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | To provide exceptional healthcare for our communities | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $18,511,680 | ExpenseAmt |
| Grant | $140,717 | GrantAmt |
| Revenue | $19,300,282 | RevenueAmt |
| Desc | Edgerton Hospital and Health Services, Inc. is an 18-bed acute care hospital located in Edgerton, Wisconsin.There were 383 total adult admissions in 2013. Total patient days were 2,823 with an average daily census of 7.8 patients. Emergency room and urgent care visits for 2013 were 5,499.Preventive Care Services:Edgerton Hospital and Health Services (Edgerton Hospital) provides several types of free health screenings during the year. These include: blood pressure, dietary counseling and education, diabetes, and cancer screenings.Emergency Room:Edgerton Hospital's Emergency Room is fully staffed 24 hours a day, seven days a week. Edgerton Hospital is affiliated with "Life Flight," a helicopter service that delivers patients to area tertiary care centers. Edgerton Hospital's Urgent Care Center provides another level of walk-in care when appropriate.Community Outreach:Edgerton Hospital works closely with the community to provide hospital and hospital-related services responsive to the specific needs of Edgerton and surrounding farming communities. Edgerton Hospital partners with other city services (such as the police and fire departments) to provide emergency equipment and training necessary to enhance area emergency services. Edgerton Hospital also participates in cooperative emergency response training (with the county and other community services) in preparation for local or area disasters. Community Education:Events are held at the Hospital or conducted by Hospital staff several times a year. In addition, Edgerton Hospital provides targeted outreach to the transient recreational communities within the service area. Charity Care:The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The amount of charges foregone for services provided under the Hospital's charity care policy was approximately $464,000 for the year ended December 31, 2013. The estimated costs of the charges foregone, based upon an overall cost-to-charge ratio calculation, for the year ended December 31, 2013, was $282,000. | Desc |
| Total Program Service Expenses | $18,511,680 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 23 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 225 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Charles Roeder | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6088841656 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11101 North Sherman Road | AddressLine1 |
| City | Edgerton | City |
| State | WI | State |
| ZIP Code | 53534 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| James Schultz | ||||||||
| Chair | 0.30 | 0.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Jay Peterson DC | ||||||||
| Vice Chair | 0.30 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Donald Bice | ||||||||
| Treasurer | 0.30 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Melva Sue Larson | ||||||||
| Treasurer until July 2013 | 0.30 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Steve Thompson | ||||||||
| Secretary | 0.30 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Kamal Muzaffar MD | ||||||||
| Chief of Staff | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Dennis Litsheim MD | ||||||||
| Trustee | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Terry Johnson DVM | ||||||||
| Trustee | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Lawanna Schieldt | ||||||||
| Trustee until July 2013 | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Sara Karman | ||||||||
| Trustee until July 2013 | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Matthew Roethe | ||||||||
| Trustee until July 2013 | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Fred Falk | ||||||||
| Trustee until July 2013 | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| Charlie Johnson | ||||||||
| Trustee until July 2013 | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Linda Taplin Statz | ||||||||
| Trustee until July 2013 | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| James Pernau | ||||||||
| CEO | 40.00 | 0.30 | Yes (X) | $184,712 | $0 | $22,250 | ||
| Charles Roeder | ||||||||
| CFO | 40.00 | 0.00 | Yes (X) | $140,121 | $0 | $14,380 | ||
| Todd Crowley | ||||||||
| Pharmacist | 40.00 | 0.00 | $141,415 | $0 | $12,655 | Yes (X) | ||
| Sharon Adrian | ||||||||
| Nurse Supervisor | 40.00 | 0.00 | $102,665 | $0 | $15,635 | Yes (X) | ||
| Laurie Drewson | ||||||||
| Occupational Therapy | 40.00 | 0.00 | $100,568 | $0 | $6,608 | Yes (X) | ||
| Brenda Nolen | ||||||||
| Family Nurse Practitioner | 40.00 | 0.00 | $100,517 | $0 | $16,494 | Yes (X) | ||
| Heather Prestil | ||||||||
| Registered Pharmacist | 40.00 | 0.00 | $119,957 | $0 | $1,228 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $889,955 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $89,250 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Southern Wisconsin Emergency Physicians | |||||
| PO Box 793 | Traverse City | MI | 49685 | ER Physicians | $1,250,132 |
| Wisconsin Integrated Information | |||||
| 1808 W Beltline Hwy | Madison | WI | 53713 | Epic and other application | $290,035 |
| Stoughton Hospital | |||||
| PO Box 78216 | Milwaukee | WI | 53278 | Certified Registered Nurse Anesthetists | $289,701 |
| Rock Valley Radiologists | |||||
| PO Box 2103 | Janesville | WI | 53546 | Radiology physicians | $257,000 |
| Aviand's | |||||
| 1751 W Cty Rd B | Roseville | MN | 55113 | Food services management | $131,491 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $139,015 | RelatedOrganizationsAmt |
| Government Grants | $18,807 | GovernmentGrantsAmt |
| All Other Contributions | $832 | AllOtherContributionsAmt |
| Total Contributions | $158,654 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 622110 | $18,824,678 | $18,824,678 |
| MEHR Incentive payment | 900099 | $330,681 | $330,681 |
| Other supporting revenue | 900099 | $144,923 | $144,923 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $19,300,282 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,129 | TotalRevenueColumnAmt |
| Exclusion | $13,129 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $10,575 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $10,575 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,575 | TotalRevenueColumnAmt |
| Exclusion | $10,575 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $500 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $3,892 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$3,392 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$3,392 | TotalRevenueColumnAmt |
| Exclusion | -$3,392 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,479,248 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,300,282 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $20,312 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $140,717 | TotalAmt |
| Program Services | $140,717 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $364,244 | TotalAmt |
| Management And General | $364,244 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,281,823 | TotalAmt |
| Program Services | $6,329,867 | ProgramServicesAmt |
| Management And General | $951,956 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,731 | TotalAmt |
| Program Services | $16,148 | ProgramServicesAmt |
| Management And General | $22,583 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,366,277 | TotalAmt |
| Program Services | $1,273,557 | ProgramServicesAmt |
| Management And General | $92,720 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $560,476 | TotalAmt |
| Program Services | $462,802 | ProgramServicesAmt |
| Management And General | $97,674 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,054 | TotalAmt |
| Management And General | $88,054 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,895 | TotalAmt |
| Management And General | $43,895 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,535,162 | TotalAmt |
| Program Services | $3,946,800 | ProgramServicesAmt |
| Management And General | $588,362 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $143,017 | TotalAmt |
| Program Services | $1,301 | ProgramServicesAmt |
| Management And General | $141,716 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $753,768 | TotalAmt |
| Program Services | $517,465 | ProgramServicesAmt |
| Management And General | $236,303 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $376,036 | TotalAmt |
| Program Services | $372,890 | ProgramServicesAmt |
| Management And General | $3,146 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,581 | TotalAmt |
| Program Services | $18,967 | ProgramServicesAmt |
| Management And General | $22,614 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,407 | TotalAmt |
| Program Services | $47,046 | ProgramServicesAmt |
| Management And General | $24,361 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,687,987 | TotalAmt |
| Program Services | $1,687,987 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,748,229 | TotalAmt |
| Program Services | $1,748,229 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,736 | TotalAmt |
| Program Services | $65,736 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Provision for bad debts | $1,170,260 | $1,170,260 |
| Medical supplies | $558,900 | $558,900 |
| Medicaid Provider Tax | $92,162 | $92,162 |
| Food costs | $57,422 | $57,422 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,890 | TotalAmt |
| Program Services | $3,424 | ProgramServicesAmt |
| Management And General | $1,466 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,190,774 | TotalAmt |
| Program Services | $18,511,680 | ProgramServicesAmt |
| Management And General | $2,679,094 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,651,923 | BOYAmt |
| EOY | $1,780,205 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,527 | BOYAmt |
| EOY | $5,886 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,791,041 | BOYAmt |
| EOY | $2,516,599 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $326,426 | BOYAmt |
| EOY | $340,723 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $149,892 | BOYAmt |
| EOY | $154,776 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $28,510,751 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,078,445 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,549,309 | BOYAmt |
| EOY | $22,432,306 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,885,721 | BOYAmt |
| EOY | $2,199,929 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,069 | BOYAmt |
| EOY | $18,236 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $456,577 | BOYAmt |
| EOY | $456,577 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,069,787 | BOYAmt |
| EOY | $998,510 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,899,272 | BOYAmt |
| EOY | $30,903,747 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,993,747 | BOYAmt |
| EOY | $2,097,148 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $724,760 | BOYAmt |
| EOY | $483,173 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,545,077 | BOYAmt |
| EOY | $24,927,282 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $592,185 | BOYAmt |
| EOY | $60,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,855,769 | BOYAmt |
| EOY | $27,567,603 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,029,434 | BOYAmt |
| EOY | $3,317,783 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,069 | BOYAmt |
| EOY | $18,361 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,043,503 | BOYAmt |
| EOY | $3,336,144 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,899,272 | BOYAmt |
| EOY | $30,903,747 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,711,526 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $4,167 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $50,000 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $562,849 | OtherCostOrOtherBasisAmt |
| Book Value | $612,849 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $485,524 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $20,196,546 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,688,883 | DepreciationAmt |
| Book Value | $17,993,187 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $97,208 | OtherCostOrOtherBasisAmt |
| Depreciation | $90,784 | DepreciationAmt |
| Book Value | $6,424 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,648,657 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,112,730 | DepreciationAmt |
| Book Value | $2,535,927 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $21,618 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $1,448,349 | OtherCostOrOtherBasisAmt |
| Depreciation | $186,048 | DepreciationAmt |
| Book Value | $1,283,919 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $22,432,306 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated third party payor settlements | Desc |
| Amt | $60,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $60,000 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | The Hospital is organized as a Wisconsin non-profit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, they are also subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose, if applicable. The Organization believes it has appropriate support for any tax positions taken affecting its annual filing requirments, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 125.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 225.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $282,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $282,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01410 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $282,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $282,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01410 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,390,542 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,826,870 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,563,672 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07810 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,390,542 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,826,870 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,563,672 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07810 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,672,542 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,826,870 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,845,672 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09220 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,170,260 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $390,048 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,584,855 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,614,238 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$29,383 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Edgerton Hospital and Health Services | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11101 North Sherman Road | AddressLine1 |
| City | Edgerton | City |
| State | WI | State |
| ZIP Code | 53534 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.edgertonhospital.com | WebsiteAddressTxt |
| State License | 1022 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | Provider based clinic - Milton Clinic | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Edgerton Hospital and Health Services | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.edgertonhospital.com | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| Include Operational Plan | Yes (X) | IncludeOperationalPlanInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| Other Needs Addressed | Yes (X) | OtherNeedsAddressedInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 125.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 225.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| Other Factors | Yes (X) | OtherFactorsInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Edgerton Hospital and Health Services | Part V, Section B, Line 3: Interviews regarding health needs in the community served by Edgerton Hospital were conducted with 17 key informants, including external stakeholders (those not affiliated with Edgerton Hospital - such as religious leaders, community leaders, representative from the local media, Hispanic population representative, school officials, local health department, EMS, etc.) and internal Edgerton Hospital staff. The interviews provided input on a wide range of community health issues, including barriers to access to health services, changes in community population, prevalence of certain health conditions, social determinants of health, health disparities, and other topics. The interviews were guided by a structured interview guide, and interviewees were encouraged to identify and discuss current and emerging issues affecting community health. |
| Edgerton Hospital and Health Services | Part V, Section B, Line 6i: Edgerton Hospital and Health Services, Inc. adopted an implementation strategy to address the community health needs identified in its Community Health Needs Assessment. The implementation strategy is posted to their website at www.edgertonhospital.com. |
| Edgerton Hospital and Health Services | Part V, Section B, Line 7: The following needs will not be addressed due to lack of hospital resources and funds: Lack of affordable and accessible care, lack of access to dental care, gender/racial/ethnic disparities, mental health, unsafe sex, unemployment and high rates of violent crime and child abuse.The Hospital was unable to address smoking/tobacco use in 2013 due to lack of hospital resources and funds. This will be addressed in the future.Edgerton Hospital has begun to address diet and exercise related issues and alcohol and drug abuse. |
| Edgerton Hospital and Health Services | Part V, Section B, Line 12i: Other living expenses and financial obligations relative to household/family size are considered in the calculation for amounts charged to patients. |
| Edgerton Hospital and Health Services | Part V, Section B, Line 14g: A summary of the financial assistance policy was made available to the public upon admission, included as a brochure in registration areas, emergency room, and waiting rooms of the Hospital, and is available on our website. |
| Edgerton Hospital and Health Services | Part V, Section B, Line 18e: All accounts were reviewed for possible financial assistance prior to sending to a collection agency. |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | In addition to providing free or discounted care based on Federal Poverty Guidelines, Edgerton Hospital provides certain accommodations to patients who have trouble paying their bills. These practices include offering uninsured patients a cash discount for prompt payment of the estimated or final charges for services provided. Edgerton Hospital provides interest-bearing loans through H.E.L.P. Financial Inc. Payment arrangements are also available for accounts to be paid within 6 months at no interest. |
| Part I, Line 6a: | Edgerton Hospital and Health Services makes its community benefit report available to the public by providing it upon request. |
| Part I, Line 7: | Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from total expenses to determine the percentage was $1,170,260. |
| Part III, Line 4: | All past due accounts are reviewed to determine if a patient qualifies for charity care, or federal, state, or local assistance. Before an account is written off to bad debt all discounts and payments are applied, including contractual allowances. After every attempt is made to collect the unpaid balance, the account is written off to bad debt. Payments on accounts that were written off as bad debt reduces bad debt expense.Bad debt expense on line 2 is reported at charges as presented on the financial statements.A reasonable estimate of the Organization's bad debt expense attributable to patients under the Organization's financial assistance policy is one-third of bad debt expense. This is based on an estimate of incomplete applications.The footnote to the Organization's financial statements can be found on page 9 of the attached audited financial statements. |
| Part III, Line 8: | Edgerton Hospital and Health Services, Inc. is a critical access hospital and in prior years has not shown a Medicare shortfall. There was a shortfall for 2013 due to sequestration. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit. Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services. |
| Part III, Line 9b: | Edgerton Hospital and Health Services provides a charitable program consisting of partial or total discounts for those patients who are uninsured, underinsured, and/or unable to pay for necessary healthcare services and are determined eligible to receive such care. As part of the debt collection policy patients are given a written notice after 30 days, 45 days, 60 days, and 70 days. This is followed up by a phone call and if there is no response the account is sent to a pre-collection agency and then the collection agency. For patients known to qualify for charity care or financial assistance, this process is followed for the portion they are responsible for. On accounts which have been assigned to outside collection agencies and are later approved for Community Care, the hospital will request such agencies to cancel and return accounts to the hospital, and to reverse any applicable detrimental credit information created against the patient/guarantor. |
| Part VI, Line 2: | We use the following tools to assess health care needs of the communities we serve: (1) Patient exit questionnaires; (2) Involvement in community groups such as the Edgerton Coalition for a Healthy Community where we assess health needs based upon discussions and topics brought up by the Coalition members; (3) Analysis of data received from the Wisconsin Hospital Association and the Rock County Department of Health; and (4) Utilization of the Intelimed software program which allows us to analyze data from facilities comparable to ours.The Community Health Needs Assessment (CHNA) and implementation strategy is complete and posted to our website at www.edgertonhospital.com. |
| Part VI, Line 3: | A summary of our community care program is listed on our Hospital website and is contained in a brochure that is available to all patients at all registration areas, emergency room, and waiting rooms in the Hospital. The policy is also provided upon admission and upon request. The complete packet of information, along with an application, is given to any patient upon request. Posters which explain our community care program are located in the Emergency Department and inform patients to contact the Business Office for more information. Billing staff discuss the availability of various government benefits, state programs, and assist the patient on how to qualify for such programs where applicable. |
| Part VI, Line 4: | Edgerton is located 30 miles south of Madison and 12 Miles north of Janesville on the northern edge of Rock County. Edgerton is in a rural, agricultural area. The 2010 population of Edgerton and Rock County was 5,461 and 160,331 with a projected county growth to 186,331 by 2035. Rock County is dominated by service and manufacturing sectors. The median household income for the county is $49,716, the poverty level is at 12.4% and the population aged 65+ is at 13.8%.There are multiple hospitals within 30 miles of Edgerton including three facilities in Madison, one in Janesville, one in Stoughton and one in Fort Atkinson.Madison Hospitals (30 miles distant)* St.Mary's - 440 bed acute care hospital * Meriter - 448 bed acute care hospital* University of Wisconsin Hospital - 536 bed acute care hospitalOther Hospitals (20 or less miles distant)* Mercy Hospital - Located 12 miles south - 240 bed acute care hospital* Stoughton Hospital - located 12 miles northwest - 35 bed acute care, critical access hospital* Fort Atkinson - Located 17 miles northeast - 82 bed acute care hospital |
| Part VI, Line 5: | Edgerton Hospital is an 18-bed critical access hospital located in Edgerton, Wisconsin. Our Board of Trustees is comprised of persons who reside in our primary service area who are not employees of our Organization. The Hospital extends medical staff privileges to all qualified physicians in the community and all surplus funds are reinvested in patient care and plant upgrades. Our Organization is the fiscal agent for the Edgerton Coalition for a Healthy Community and one of our employees is the Project Director of the Coalition. We hold an annual health fair for the community and offer many health related community education classes at little or no cost to the attendees. We provide and staff a First Aid tent at our local community summer festival. Our CEO sits on the Board of Directors of the local Hope Institute of Uganda with meetings held in Janesville, Wisconsin. |
| Part VI, Line 7, Reports Filed With States | WI |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Edgerton Hospital Capital Foundation Inc | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11101 North Sherman Road | AddressLine1 |
| City | Edgerton | City |
| State | WI | State |
| ZIP Code | 53534 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 203161048 | RecipientEIN |
| IRC Section | 501(c)(3) | IRCSectionDesc |
| Cash Grant | $137,831 | CashGrantAmt |
| Purpose Of Grant | Support for operating expenses | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Edgerton Hospital provides support to assist with operating expenses for Edgerton Hospital Capital Foundation, Inc. The Foundation must provide documentation of what the funding was used for. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| James Pernau | ||||||||||||||
| CEO | $161,712 | $0 | $0 | $0 | $23,000 | $0 | $1,634 | $0 | $22,082 | $0 | $208,428 | $0 | $0 | $0 |
| Charles Roeder | ||||||||||||||
| CFO | $117,121 | $0 | $0 | $0 | $23,000 | $0 | $1,319 | $0 | $14,376 | $0 | $155,816 | $0 | $0 | $0 |
| Todd Crowley | ||||||||||||||
| Pharmacist | $134,260 | $0 | $0 | $0 | $7,155 | $0 | $1,311 | $0 | $12,850 | $0 | $155,576 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Rock Valley Radiologists | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Officer and 33.3% owner is a member of the Board | RelationshipDescriptionTxt |
| Transaction | $257,000 | TransactionAmt |
| Transaction | Radiology physician services | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | The Executive Committee consists of the Board Chair, Vice Chair, Secretary, and Treasurer of the Corporation. The Executive Committee has power to transact all regular business of the Corporation during the interim between meetings of the Board of Trustees, except the power to: elect officers of the Corporation, fill vacancies in the Board of Trustees or in the Executive Committee, amend or repeal any provisions of these Bylaws, appropriate funds of the Corporation not included in the budget or exceeding an amount for any one purpose in any one fiscal year fixed or authorized by the Board from time to time, or adopt programs which would involve continuing activity or support by the Corporation for more than one fiscal year. Minutes of the Executive Committee summarizing its actions must be submitted to the Board at its next regularly scheduled meeting. |
| Form 990, Part VI, Section A, line 7a | The Board of Trustees consists of two classes: Class E Trustees and Class S Trustees. SSM Health Care of Wisconsin, Inc. has the right to appoint and remove the Class S Trustees. SSM Health Care of Wisconsin, Inc. also has the right to appoint an alternate who will serve instead of a Class S Trustee with voting rights if the Class S Trustee is unable to attend a meeting of the Board of Trustees. Class E Trustees are appointed by the Board of Trustees. Class E and Class S Trustees have the same voting rights. |
| Form 990, Part VI, Section B, line 11 | The Form 990 is provided to the Trustees of the Board before it is filed. The return is reviewed by the Accounting Manager and CFO. |
| Form 990, Part VI, Section B, line 12c | Board members, officers, and employees complete and sign a conflict of interest policy annually. The employee handbook contains a conflict of interest policy. The Board Chair and CEO review the potential conflicts of Board members and the HR department reviews the potential conflicts of employees. Potential conflicts may include but are not limited to ownership or control of an entity that contracts with Edgerton Hospital. Board members with conflicts are restricted from voting on such matters and the conflict is made a matter of record in the minutes. |
| Form 990, Part VI, Section B, line 15a | The Board determines compensation for the CEO. It is based on an annual performance review and comparability data. The Board provides substantiation of the deliberation and decision for the compensation process. The process is completed annually and was last completed in 2013. The CEO determines the salary of the CFO based on comparability data. |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents, conflict of interest policy, and financials statements are available to the public upon request. The financial statements are also attached to the Form 990. |
| Form 990, Part IX, line 11g | Equipment repair, rental and service agreements: Program service expenses 755,135. Management and general expenses 282,912. Fundraising expenses 0. Total expenses 1,038,047. Physician, consulting & professional fees: Program service expenses 2,484,856. Management and general expenses 280,199. Fundraising expenses 0. Total expenses 2,765,055. Contract fees & purchased services: Program service expenses 706,809. Management and general expenses 25,251. Fundraising expenses 0. Total expenses 732,060. |
| Form 990, Part XI, line 9: | Change in net assets of Edgerton Memorial Community Hospital Auxiliary 4,167. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Edgerton Hospital Capital Foundation Inc | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11101 North Sherman Road | AddressLine1 |
| City | Edgerton | City |
| State | WI | State |
| ZIP Code | 53534 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 203161048 | EIN |
| Primary Activities | Provide financial support for Edgerton Hospital and Health Services, Inc. | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 11a, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Edgerton Hospital and Health Services Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Edgerton Hospital Capital Foundation Inc | ||
| C | $139,015 | General ledger |
| Edgerton Hospital Capital Foundation Inc | ||
| B | $137,831 | General ledger |