AMERY REGIONAL MEDICAL CENTER INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- AMERY REGIONAL MEDICAL CENTER INC (EIN 39-0908320)
- Tax period
- 2012-05-01 to 2013-04-30
- Filed
- 2014-03-17
- IRS object ID
- 201440769349300219
- 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 K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-03-17T11:51:29-05:00 | Timestamp |
| Tax Period End Date | 2013-04-30 | 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 | 7601 FRANCE AVENUE SOUTH SUITE 400 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55435 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-05-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390908320 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMERY REGIONAL MEDICAL CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | AMER | NameControl |
| Phone | 7152688000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 265 GRIFFIN STREET EAST | AddressLine1 |
| City | AMERY | City |
| State | WI | State |
| ZIP Code | 54001 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHAEL KARUSCHAK JR | Name |
| Title | CHIEF EXECUTIVE OFFICER | Title |
| Phone | 7152688000 | Phone |
| Date Signed | 2014-03-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TIM A RITTER CPA | Name |
| PTIN | P00732856 | PTIN |
| Phone | 9525483400 | Phone |
| Date Prepared | 2014-03-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MICHAEL KARUSCHAK JR | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 265 GRIFFIN STREET EAST | AddressLine1 |
| City | AMERY | City |
| State | WI | State |
| ZIP Code | 54001 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 52536143 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.AMERYMEDICALCENTER.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1998 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE CONVENIENT, QUALITY HEALTHCARE SERVICES TO ALL PEOPLE IN A CARING, EFFICIENT AND FINANCIALLY RESPONSIBLE MANNER THAT WILL ENHANCE THE QUALITY OF LIFE IN OUR COMMUNITY; TO PROMOTE COMMUNITY WELLNESS; AND, TO DO SO WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 540 | TotalNbrEmployees |
| Total Nbr Volunteers | 40 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 49655 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 146624 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 51948450 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 51291839 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 234131 | InvestmentIncomePriorYear |
| Investment Income Current Year | 59099 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -126035 | OtherRevenuePriorYear |
| Other Revenue Current Year | 938573 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 52106201 | TotalRevenuePriorYear |
| Total Revenue Current Year | 52436135 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 90435 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 49754 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 22649882 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 21080450 | 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 | 29688558 | OtherExpensePriorYear |
| Other Expenses Current Year | 30865977 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 52428875 | TotalExpensesPriorYear |
| Total Expenses Current Year | 51996181 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -322674 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 439954 | RevenuesLessExpensesCY |
| Total Assets BOY | 60799357 | TotalAssetsBOY |
| Total Assets EOY | 60240421 | TotalAssetsEOY |
| Total Liabilities BOY | 42155485 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 40761461 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 18643872 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 19478960 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | AMERY REGIONAL MEDICAL CENTER (ARMC) IS COMMITTED TO PROVIDE ACCESSIBLE, COMPREHENSIVE, QUALITY HEALTHCARE AND TO PROMOTE THE HEALTH AND WELLNESS OF OUR COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 39432910 | Expense |
| Grants | 49754 | Grants |
| Revenue | 51790510 | Revenue |
| Description | AMERY REGIONAL MEDICAL CENTER (ARMC), A 25-BED CRITICAL ACCESS HOSPITAL WITH A 10 BED GERIATRIC PSYCH DISTINCT PART UNIT, WHICH PROMOTES HEALTH OF THE COMMUNITY BY PROVIDING A VARIETY OF HEALTH CARE SERVICES. IN ADDITION, THERE ARE 6 INFANT BEDS. AMERY REGIONAL MEDICAL CENTER HAD 1,128 ADMISSIONS IN 2013; 127 LIVE BIRTHS; 5,431 VISITS TO THE EMERGENCY CENTER; AND 1,786 SURGICAL CASES (INCLUDING AMBULATORY).ADDITIONAL PROGRAMS WHICH BENEFIT THE COMMUNITY INCLUDE:HEALTH PROFESSIONS TRAINING: STUDENTS IN NURSING, PHYSICIAN ASSISTANT PROGRAMS, PHYSICAL THERAPY, MEDICAL RECORDS, MEDICAL ASSISTANT, LAB TECHNICIAN, NURSE PRACTITIONERS, AND MEDICAL ADMINISTRATIVE ASSISTANTS STUDY AT THE MEDICAL CENTER. WE ALSO HAVE AN AGREEMENT WITH UW MADISON FOR 4TH YEAR MEDICAL STUDENTS AND UM-DULUTH FOR FIRST YEAR MED STUDENTS.PREVENTIVE CARE A PRIORITY: AMERY REGIONAL MEDICAL CENTER HAS TAKEN STEPS TO ENHANCE PREVENTIVE CARE FOR PEOPLE OF ALL AGES THROUGH THE DEVELOPMENT OF GUIDELINES TO ENSURE THAT THOSE WHO COME HERE FOR PREVENTIVE CARE RECEIVE THE SCREENINGS AND RECOMMENDATIONS APPROPRIATE TO THEIR PERSONAL AND FAMILY HISTORY.COMMUNITY RELATIONS: ARMC REACHES OUT TO PEOPLE AND COMMUNITIES THROUGHOUT POLK COUNTY, PARTS OF BARRON, BURNETT, AND ST. CROIX COUNTIES THROUGH COMMUNITY RELATIONS. ARMC'S CONCERN FOR THE GROWTH AND DEVELOPMENT OF THE SURROUNDING COMMUNITIES AS WELL A AS INDIVIDUAL WELFARE IS DEMONSTRATED BY PROVIDING EDUCATION AND RESOURCES TO ENCOURAGE POSITIVE COMMUNITY RELATIONS. IMPLEMENTATION OF VARIOUS PROGRAMS IS SPECIFICALLY INTENDED TO IMPROVE THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE. EXAMPLES INCLUDE DRUG AWARENESS PROGRAMS, RADIO HEALTH PROGRAMS, HEALTH FAIRS, LOCAL FOOD SHELF DONATIONS, CHILDREN'S SAFETY EVENTS, SCHOLARSHIPS TO SEVEN AREA HIGH SCHOOLS, VARIOUS SPONSORSHIPS, AND INVOLVEMENT IN THE AMERICAN CANCER SOCIETY ANNUAL 'WALK FOR LIFE' AS WELL AS ANNUAL INVOLVEMENT AND SPONSORSHIP IN THE ALZHEIMER'S ASSOCIATION "MEMORY WALK", AND ADOPT-A-FAMILY PROGRAM FOR FAMILIES IN NEED. PARTNERSHIPS WITH SCHOOLS, CHURCHES AND OTHER ORGANIZATIONS MAKE MANY OF THESE PROGRAMS POSSIBLE. FOR EXAMPLE, ARMC IS A STRONG ADVOCATE AND MEMBER OF THE ST. CROIX VALLEY SART (SEXUAL ASSAULT RESPONSE TEAM), WHICH FORMED IN ORDER TO HELP THOSE WHO HAVE EXPERIENCED ACUTE RAPE TRAUMA OR DOMESTIC ABUSE. TWO MEMBERS OF ARMC MEDICAL STAFF DONATED THEIR TIME AND SERVICES IN HAITI AND JAMAICA WHILE ARMC PROVIDED NEEDED PHARMACEUTICAL SUPPLIES TO AID THEIR EFFORTS. ARMC STAFF AND EMPLOYEES ALSO DONATE BLOOD TO THE AMERICAN RED CROSS BI-ANNUALLY. (SEE COMMUNITY EDUCATION FOR ADDITIONAL PROGRAMS/EDUCATION).IN ADDITION, STAFF AND EMPLOYEES DONATE MONTLY PROCEEDS COLLECTED FROM THE DENIM DAY INITIATIVE WHICH GIVES BACK TO LOCAL AREA AND NON-PROFIT ORGANIZATIONS LIKE LOCAL FOOD SHELVES, AMERICAN HEART ASSOCIATION, ARNELL HUMANE SOCIETY, AND ACS. HEALTH AND WELLNESS INFORMATION IS READILY AVAILABLE TO THE COMMUNITIES THROUGH BROCHURES, POSTERS, AND HEALTH INFORMATION VIA COMPUTER SOFTWARE AND THE ARMC WEBSITE. THE MEDICAL CENTER HAS A COMPUTER AVAILABLE IN THE WAITING AREAS FOR PATIENTS THAT PROVIDE EDUCATIONAL INFORMATION VIA SOFTWARE AND THROUGH INTERNET ACCESS. THERE ARE VARIOUS AREAS THROUGHOUT THE FACILITIES WHERE THIS INFORMATION IS AVAILABLE. DISEASE SPECIFIC INFORMATION ON BREAST CANCER, DEPRESSION, DIABETES, COLON CANCER, AUTISM, HEALTHY LIVING, ETC. ARE PROMOTED AND COINCIDE WITH THE HEALTH OBSERVANCES CALENDAR. IN ADDITION, KNOWLEDGE AND AWARENESS ON HEALTH-RELATED ISSUES ARE ADDRESSED IN A COMMUNITY NEWSLETTER DELIVERED QUARTERLY TO OVER 34,000 HOMES.COMMUNITY EDUCATION: ARMC HELPS EDUCATE THE LOCAL COMMUNITIES IN REGARDS TO HEALTH ISSUES BY PROVIDING THE FOLLOWING TYPES OF COMMUNITY EDUCATION: ASTHMA, BREASTFEEDING, CPR, CARDIAC SUPPORT, DIABETES, EXPECTANT PARENTS, HEALTH FAIRS, NUTRITION COUNSELING, PRENATAL, SMOKING CESSATION, AND SPORTS MEDICINE. THE MEDICAL CENTER ALSO WORKS CLOSELY WITH LOCAL AND COUNTY REPRESENTATIVES TO INFORM THE COMMUNITY ABOUT GOVERNMENTAL BENEFITS AND PROGRAMS AVAILABLE. THE MEDICAL CENTER PROVIDES EDUCATION AT OUR SCHOOLS BY HOLDING A 3RD GRADE HEALTH FAIR, 6TH GRADE & 8TH GRADE EDUCATIONAL SESSIONS, AND MEDICAL PROFESSIONAL SPEAKERS AT HEALTH CAREERS DAY FOR HIGH SCHOOL STUDENTS AND FOR HEALTH EDUCATION IN MIDDLE SCHOOL.CHARITY CARE: ARMC PROVIDES MEDICAL CARE TO MEMBERS OF THE COMMUNITY REGARDLESS OF ABILITY TO PAY. CHARITY CARE IN THE AMOUNT OF $1,536,071 WAS PROVIDED IN THE CURRENT YEAR. COMMUNITY BENEFITS: ARMC ESTIMATES THE COST OF THE PROVISION OF ADDITIONAL COMMUNITY BENEFITS TO BE $70,461.61 INCLUDING DONATIONS TO VARIOUS LOCAL CHARITABLE ORGANIZATIONS AND CIVIC GROUPS AND SCHOLARSHIPS TO NON-EMPLOYEES. ARMC HAS A HEALTH BENEFITS COUNSELOR WHICH HAS HELPED 84 UNINSURED PATIENTS WITH 402 APPLICATIONS RECEIVED FREE DRUGS AT AN AWP OF $227,597. ARMC IS ALSO COMMITTED TO PROVIDE FOR THE MENTAL HEALTH OF THE COMMUNITY BY ENSURING THAT SERVICES ARE PROVIDED IN AMERY. THE MEDICAL CENTER HAS A COURTESY VAN AVAILABLE TO PATIENTS IN NEED OF TRANSPORT FOR THEIR MEDICAL NEEDS. | Description |
| Total Program Service Expense | 39432910 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 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 | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 41 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 540 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| 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 | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | 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 | 0 | 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 |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SCOTT EDIN CHIEF FINANCIAL OFFICER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7152688000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 265 GRIFFIN STREET EAST | AddressLine1 |
| City | AMERY | City |
| State | WI | State |
| ZIP Code | 54001 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| DYLAN COE MD | ||||||||
| DIRECTOR | 1.00 | 1.00 | X | 1200 | 0 | 0 | ||
| DAN DRAXLER | ||||||||
| DIRECTOR | 1.00 | 1.00 | X | 0 | 0 | 0 | ||
| HEIDI ERSPAMER | ||||||||
| DIRECTOR | 1.00 | 1.00 | X | 1200 | 0 | 0 | ||
| BETH HEINZ | ||||||||
| DIRECTOR | 1.00 | 1.00 | X | 0 | 0 | 0 | ||
| KATHRYN ISAKSON | ||||||||
| DIRECTOR | 1.00 | 1.00 | X | 26832 | 0 | 597 | ||
| NANCY MAGNINE PAC | ||||||||
| DIRECTOR | 1.00 | 1.00 | X | 0 | 0 | 0 | ||
| RANAE NYGAARD | ||||||||
| DIRECTOR | 1.00 | 1.00 | X | 105904 | 0 | 9461 | ||
| MARYANN SCOGLIO | ||||||||
| DIRECTOR (THRU DECEMBER) | 1.00 | 1.00 | X | 1200 | 0 | 0 | ||
| ANN SEAGREN MD | ||||||||
| DIRECTOR | 1.00 | 1.00 | X | 0 | 0 | 0 | ||
| JOHN C WHITE | ||||||||
| DIRECTOR (THRU DECEMBER) | 1.00 | 1.00 | X | 1200 | 0 | 0 | ||
| DANIEL LIEN | ||||||||
| CHAIRMAN | 1.00 | 1.00 | X | 1200 | 0 | 0 | ||
| JAMES LEADHOLM | ||||||||
| VICE-CHAIR | 1.00 | 1.00 | X | 1200 | 0 | 0 | X | |
| MICHAEL JENSON | ||||||||
| TREASURER (THRU OCTOBER) | 1.00 | 1.00 | X | 1200 | 0 | 0 | X | |
| ROSS BULLARD | ||||||||
| TREASURER | 1.00 | 1.00 | X | 0 | 0 | 0 | X | |
| JOAN BYRNES | ||||||||
| SECRETARY | 1.00 | 1.00 | X | 1200 | 0 | 0 | X | |
| MIKE KARUSCHAK | ||||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | 1.00 | 255492 | 0 | 74460 | X | ||
| SCOTT EDIN | ||||||||
| CHIEF FINANCIAL OFFICER | 50.00 | 1.00 | 170235 | 0 | 43540 | X | ||
| JOYCE SCHAEFER | ||||||||
| ADMINISTRATOR OF PATIENT C | 40.00 | 0.00 | 128347 | 0 | 21290 | X | ||
| MARK TRYGGESTAD | ||||||||
| DIRECTOR OF PHARMACY | 40.00 | 0.00 | 143454 | 0 | 4703 | X | ||
| SANDRA REED | ||||||||
| ADMINISTRATOR OF CLINIC SE | 40.00 | 0.00 | 114159 | 0 | 21183 | X | ||
| MARK MOIOFFER | ||||||||
| PHARMACIST | 40.00 | 0.00 | 108752 | 0 | 12011 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1062775 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 187245 | TotalOtherCompensation |
| Number Individuals GT100 K | 7 | 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 |
|---|---|---|---|---|---|
| GROUP HEALTH INC | |||||
| PO BOX 64059 | ST PAUL | MN | 55164 | PHYSICIAN SERVICES | 8601122 |
| QUORUM HEALTH RESOURCES | |||||
| 105 CONTINENTAL PLACE | BRENTWOOD | TN | 37027 | MANAGEMENT SERVICES | 799141 |
| ANESTHETISTS INC | |||||
| 130 S KNOWLES AVENUE | NEW RICHMOND | WI | 54017 | CRNAS | 781595 |
| DERRICK CONSTRUCTION | |||||
| 1505 HWY 65 | NEW RICHMOND | WI | 54017 | GENERAL CONTRACTOR | 459835 |
| HEALOGICS WOUND CARE | |||||
| 3087 MOMENTUM PLACE | CHICAGO | IL | 60689 | WOUND HEALING MANAGEMENT | 370794 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 13 | NumberOfContractorsGT100K |
| Federated Campaigns | 500 | FederatedCampaigns |
| Related Organizations | 10902 | RelatedOrganizations |
| Government Grants | 120000 | GovernmentGrants |
| All Other Contributions | 15222 | AllOtherContributions |
| Total Contributions | 146624 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | 50218819 | 50218819 |
| OTHER OPERATING REVENUE | 900099 | 896431 | 896431 |
| FITNESS CENTER REVENUE | 624110 | 156846 | 156846 |
| CONTRACT SERVICE REVENUE | 900099 | 19743 | 19743 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 51291839 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 143985 | TotalRevenueColumn |
| Exclusion | $143,985 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 140409 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 140409 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 140409 | TotalRevenueColumn |
| Exclusion | $140,409 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 15122 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 100008 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -84886 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -84886 | TotalRevenueColumn |
| Exclusion | -$84,886 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| EHR INCENTIVE | 900099 | 498671 | 498671 | |
| CAFETERIA & OTHER SERVICES | 900099 | 299493 | $299,493 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 798164 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 52436135 | TotalRevenueColumn |
| Related Or Exempt Function Income | 51790510 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $499,001 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42754 | Total |
| Program Services | 42754 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7000 | Total |
| Program Services | 7000 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 133592 | Total |
| Program Services | 50681 | ProgramServices |
| Management And General | 82911 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16663702 | Total |
| Program Services | 12637433 | ProgramServices |
| Management And General | 4026269 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 245325 | Total |
| Program Services | 186050 | ProgramServices |
| Management And General | 59275 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2579220 | Total |
| Program Services | 1956031 | ProgramServices |
| Management And General | 623189 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1458611 | Total |
| Program Services | 1106183 | ProgramServices |
| Management And General | 352428 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 799141 | Total |
| Management And General | 799141 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 82504 | Total |
| Program Services | 8316 | ProgramServices |
| Management And General | 74188 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 48630 | Total |
| Management And General | 48630 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11774069 | Total |
| Program Services | 9777020 | ProgramServices |
| Management And General | 1997049 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 285293 | Total |
| Program Services | 238304 | ProgramServices |
| Management And General | 46989 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4374933 | Total |
| Program Services | 3317866 | ProgramServices |
| Management And General | 1057067 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1545794 | Total |
| Program Services | 52470 | ProgramServices |
| Management And General | 1493324 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1480160 | Total |
| Program Services | 1122525 | ProgramServices |
| Management And General | 357635 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 141743 | Total |
| Program Services | 107495 | ProgramServices |
| Management And General | 34248 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65237 | Total |
| Program Services | 49474 | ProgramServices |
| Management And General | 15763 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1415930 | Total |
| Program Services | 1073814 | ProgramServices |
| Management And General | 342116 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4101631 | Total |
| Program Services | 3110599 | ProgramServices |
| Management And General | 991032 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 147043 | Total |
| Program Services | 111515 | ProgramServices |
| Management And General | 35528 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| DRUG EXPENSE | 1987785 | 1987785 |
| MEDICAL EQUIPMENT | 1239750 | 1239750 |
| BAD DEBT EXPENSE | 905203 | 905203 |
| FOOD EXPENSE | 242742 | 242742 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 228389 | Total |
| Program Services | 101900 | ProgramServices |
| Management And General | 126489 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51996181 | Total |
| Program Services | 39432910 | ProgramServices |
| Management And General | 12563271 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 180645 | BOY |
| EOY | 1438294 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4230265 | BOY |
| EOY | 5459052 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8168872 | BOY |
| EOY | 7784010 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 669222 | BOY |
| EOY | 671069 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 91509 | BOY |
| EOY | 46868 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 59106096 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 25498591 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35773527 | BOY |
| EOY | 33607505 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7142325 | BOY |
| EOY | 4438100 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3956262 | BOY |
| EOY | 6253246 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46297 | BOY |
| EOY | 35404 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 540433 | BOY |
| EOY | 506873 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 60799357 | BOY |
| EOY | 60240421 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4976876 | BOY |
| EOY | 4688918 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36990952 | BOY |
| EOY | 36041698 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 187657 | BOY |
| EOY | 30845 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42155485 | BOY |
| EOY | 40761461 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18559832 | BOY |
| EOY | 19394920 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 84040 | BOY |
| EOY | 84040 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18643872 | BOY |
| EOY | 19478960 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 60799357 | BOY |
| EOY | 60240421 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 439954 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | -1753 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 396887 | 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 | $2,203 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 2203 | 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 | A PERCENTAGE OF MEMBERSHIP DUES PAID TO WISCONSIN HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION IS FOR LOBBYING EXPENSES. WISCONSIN HOSPITAL ASSOCIATION LOBBIES TO PROMOTE POLICIES THAT HELP IMPROVE THE DELIVERY OF HOSPITAL CARE IN WISCONSIN AND OPPOSE POLICIES THAT NEGATIVELY IMPACT THAT CARE DELIVERY. AMERICAN HOSPITAL ASSOCIATION WORKS ON KEY ISSUES INCLUDING MEDICARE, ACCESS AND COVERAGE, AFFORDABILITY, AND OTHER ISSUES AFFECTION HOSPITALS. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1028135 | OtherCostOrOtherBasis |
| Book Value | 1028135 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 27677488 | OtherCostOrOtherBasis |
| Depreciation | 9788603 | Depreciation |
| Book Value | 17888885 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 29072253 | OtherCostOrOtherBasis |
| Depreciation | 14954079 | Depreciation |
| Book Value | 14118174 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1328220 | OtherCostOrOtherBasis |
| Depreciation | 755909 | Depreciation |
| Book Value | 572311 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 33607505 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (7 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| CERTIFICATES OF DEPOSIT | 2099165 | C |
| INVESTMENT MONEY MARKET NATIONAL MORTGAGES | 2049106 | C |
| INVESTMENT IN CMDI | 1118558 | C |
| INVESTMENT IN JOHNSON DRUGS | 64398 | C |
| INVESTMENT IN ASSISTED LIVING | 283102 | C |
| INVESTMENT IN AMERY DIALYSIS | 333035 | C |
| INVESTMENT IN CANCER CENTER OF WI | 305882 | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 6253246 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CAPITAL LEASE OBLIGATIONS | Description |
| Amount | $30,845 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 30845 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 51959142 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -1753 | NetUnrealizedGainsInvestments |
| Other Revenues | -475240 | OtherRevenues |
| Revenue Not Rptd F990 | -476993 | RevenueNotRptdF990 |
| Revenue Subtotal | 52436135 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 52436135 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 51090978 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 51090978 | ExpensesSubtotal |
| Other Expenses Not Included | 905203 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 905203 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 51996181 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS 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 TAX AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. MANAGEMENT DOES NOT BELIEVE THE HOSPITAL HAS ANY MATERIAL UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS. THE HOSPITAL RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2012 AND 2011. FEDERAL RETURNS FOR TAX YEARS 2008 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | UNREALIZED GAIN ON INVESTMENTS IN UNCONSOLIDATED AFFILIATES 396,887. PROVISION FOR BAD DEBT -905,203. REVENUE OF CONSOLIDATED ENTITY 33,076. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBT 905,203. |
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 |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| 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 | 1177407 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1177407 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02300 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5713971 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3354239 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2359732 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04620 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6891378 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3354239 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3537139 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06920 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16396 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 795 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 15601 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13111 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 13111 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 33446 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8304 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 25142 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 62953 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9099 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 53854 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6954331 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3363338 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3590993 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07030 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $547,055 | BadDebtExpenseAmount |
| Amount Attributable To | 410292 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 15384987 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 20651933 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -5266946 | 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 | 2 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)
| Facility NumberFacilityNumber | Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Critical Access HospitalCriticalAccessHospital | Er24 HoursEr24Hours |
|---|---|---|---|---|---|---|---|---|
| AMERY REGIONAL MEDICAL CENTER | ||||||||
| 1 | 265 GRIFFIN STREET EAST | AMERY | WI | 54001 | X | X | X | X |
| ARMC WEST CAMPUS | ||||||||
| 2 | 230 DERONDA STREET | AMERY | WI | 54001 | X | X | X | |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (2 entries)
| Hospital Facility NumberHospitalFacilityNumber | CHNA ConductedCHNAConducted | Community DefinitionCommunityDefinition | Community DemographicsCommunityDemographics | Existing ResourcesExistingResources | How Data ObtainedHowDataObtained | Community Health NeedsCommunityHealthNeeds | Other Health IssuesOtherHealthIssues | Consulting ProcessConsultingProcess | Information GapsInformationGaps | Needs Assessment ConductedNeedsAssessmentConducted | Take Into AccountTakeIntoAccount | Other FacilitiesOtherFacilities | CHNA Widely AvailableCHNAWidelyAvailable | Own WebsiteOwnWebsite | On RequestOnRequest | Other MethodOtherMethod | Adopt Implement StrategyAdoptImplementStrategy | Execute Implement StrategyExecuteImplementStrategy | Include Operational PlansIncludeOperationalPlans | Prioritize Health NeedsPrioritizeHealthNeeds | Prioritize ServicesPrioritizeServices | All Needs AddressedAllNeedsAddressed | Organization Incur Excise TaxOrganizationIncurExciseTax | Eligibility Criteria ExplainedEligibilityCriteriaExplained | Uses FPG FreeUsesFPGFree | FPG Free PercentFPGFreePercent | Uses FPG DiscountedUsesFPGDiscounted | FPG Discount PercentFPGDiscountPercent | Explains BasisExplainsBasis | Income LevelIncomeLevel | Asset LevelAssetLevel | Medical IndigencyMedicalIndigency | Insurance StatusInsuranceStatus | Uninsured DiscountUninsuredDiscount | Medicaid MedicareMedicaidMedicare | Explains Application MethodExplainsApplicationMethod | Includes Publicity MeasuresIncludesPublicityMeasures | Posted On WebsitePostedOnWebsite | Available On RequestAvailableOnRequest | Actions On NonpaymentActionsOnNonpayment | Collection ActivitiesCollectionActivities | Notify Upon AdmissionNotifyUponAdmission | Notify Before DischargeNotifyBeforeDischarge | Notified All PatientsNotifiedAllPatients | Documented DeterminationDocumentedDetermination | Nondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicy | Average Negotiated RatesAverageNegotiatedRates | Amounts Generally BilledAmountsGenerallyBilled | Gross ChargesGrossCharges |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AMERY REGIONAL MEDICAL CENTER | |||||||||||||||||||||||||||||||||||||||||||||||||
| 1 | 1 | X | X | X | X | X | X | X | X | 12 | 1 | 1 | 1 | X | X | X | X | X | X | X | X | 1 | 0 | 1 | 1 | 100.000000000000 | 1 | 200.000000000000 | 1 | X | X | X | X | X | X | 1 | 1 | X | X | 1 | 0 | X | X | X | X | 1 | X | 0 | 0 |
| ARMC WEST CAMPUS | |||||||||||||||||||||||||||||||||||||||||||||||||
| 2 | 1 | X | X | X | X | X | X | X | X | 12 | 1 | 1 | 1 | X | X | X | X | X | X | X | X | 1 | 0 | 1 | 1 | 100.000000000000 | 1 | 200.000000000000 | 1 | X | X | X | X | X | X | 1 | 1 | X | X | 1 | 0 | X | X | X | X | 1 | X | 0 | 0 |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 5 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (5 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| ARMC REHAB SERVICES | ||||
| 220 N KELLER AVENUE | AMERY | WI | 54001 | REHABILITATION |
| LUCK MEDICAL CLINIC | ||||
| 137 FIRST AVENUE | LUCK | WI | 54853 | RURAL HEALTH CLINIC |
| TURTLE LAKE MEDICAL CLINIC | ||||
| 550 MARTIN AVENUE | TURTLE LAKE | WI | 54889 | CLINIC |
| CLEAR LAKE CLINIC | ||||
| 357 THIRD AVENUE | CLEAR LAKE | WI | 54005 | CLINIC |
| LUCK PT & FITNESS | ||||
| 2547 STATE ROAD 35 SUITE 5 | LUCK | WI | 54853 | PHYSICAL THERAPY |
Form990 Schedule H Part VI Form990ScheduleHPartVI (18 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7: THE ORGANIZATION USES A COST TO CHARGES METHODOLOGY AS DETERMINED BY WORKSHEET 2 OF THE INSTRUCTIONS. | ||
| 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 $ 905203. | ||
| PART II: ARMC PROMOTES THE HEALTH OF THE COMMUNITY IT SERVICES IN A VARIETY OF WAYS. SOME WAYS, AS DESCRIBED BELOW, ARE TOO BURDENSOME TO RECORD EXACT AMOUNTS ADMINISTRATIVELY. HOWEVER, THAT DOES NOT DIMINISH THE VALUE THESE ACTIVITIES SERVE. ARMC PROVIDES A VARIETY OF PATIENT EDUCATION PROGRAMS THAT PROMOTE HEALTHY LIFESTYLES & WE PROVIDE A COMMUNITY FITNESS CENTER FOR OUR AREAS. THE COMMUNITY FITNESS CENTER'S ELIGIBILITY REQUIREMENTS ARE:1.MUST PROVIDE A REFERRAL FROM A PROVIDER OR SCHOOL.2.INDIVIDUAL MUST WORK OUT 10 TIMES A MONTH.3.A MINIMUM FEE WILL BE REQUIRED BY THE INDIVIDUAL THE FIRST VISIT OF EACH MONTH TO CONTINUE WORKING OUT FOR AN ENTIRE MONTH. THE FEE WILL BE BASED ON ABILITY TO PAY AND AT THE DISCRETION OF THE DIRECTOR OF REHAB. 4.THE MONTHLY CHARGE FOR A MEMBERSHIP IS $40. THE HOSPITAL WILL SUPPLEMENT THE REMAINDER OF THE AMOUNT DUE FOR THE MEMBERSHIP AFTER THE MEMBER PAYS THEIR FEE.5.QUALIFICATIONS ARE BASED UPON THE 90% COLUMN ON A CURRENT YEAR ARMC ASSISTANCE PROGRAM ALLOWANCE CHART.6.A COPY OF LAST YEAR'S TAX RETURN OR A LETTER FROM THE SCHOOL INDICATING REDUCED OR FREE LUNCH QUALIFICATION WITH THE AMOUNTS.7.COMPLETE ALL THE FITNESS CENTER REQUIRED PAPERWORK FOR MEMBERSHIP, AND IF UNDER AGE MUST HAVE PARENT OR GUARDIAN SIGNATURES.8.COMPLETE AN APPLICATION FOR FINANCIAL ASSISTANCE FOR THE FITNESS CENTER. | ||
| PART III, LINE 4: ARMC USES THE COST TO CHARGE COST METHODOLOGY TO DETERMINE AMOUNT REPORTED AS BAD DEBT. ARMC BELIEVES THAT MANY OF THE ACCOUNTS IN BAD DEBT WOULD HAVE QUALIFIED FOR CHARITY CARE IF THE GUARANTORS WOULD HAVE COMPLETED THE FINANCIAL ASSISTANCE PAPERWORK. ARMC IS PROVIDING SERVICES TO INDIVIDUALS/FAMILIES IN OUR SERVICE AREA WHO ARE UNABLE/UNWILLING TO PAY FOR THESE SERVICES. THIS IS COMPARABLE TO PROVIDING CHARITY CARE WHICH WE ALSO INCLUDE AS A COMMUNITY BENEFIT.THE FINANCIAL STATEMENTS DO NOT HAVE A SEPARATE BAD DEBT FOOTNOTE. THE FOLLOWING IS PART OF THE PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY FOOTNOTE: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (INCLUDING BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE.THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. | ||
| PART III, LINE 8: THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO AS REQUIRED BY MEDICARE. THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE ARMC IS INCURRING THE COST OF PROVIDING SERVICES TO MEDICARE PATIENTS AND NOT GETTING PAID COMPLETELY BY MEDICARE FOR THE COST OF PROVIDING THESE SERVICES. | ||
| PART III, LINE 9B: ARMC IS COMMITTED TO MEETING THE HEALTHCARE NEEDS OF THE COMMUNITY. AS PART OF THIS MISSION, WE ADMINISTER A FINANCIAL ASSISTANCE PROGRAM TO HELP PATIENTS WHO NEED MEDICAL CARE BUT HAVE DIFFICULTY WITH RELATED MEDICAL EXPENSES. IN OUR FACILITIES, NON-ELECTIVE PROFESSIONAL MEDICAL SERVICES WILL BE PROVIDED WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY AND FINANCIAL ASSISTANCE WILL BE MADE AVAILABLE. PROGRAM ELIGIBILITY IS BASED ON INCOME, ASSETS, LIABILITIES AND FAMILY SIZE UTILIZING A SLIDING DISCOUNT BASED ON THE LATEST HEALTH AND HUMAN/SERVICES (HHS) FEDERAL POVERTY GUIDELINES. PATIENTS IN NEED OF FINANCIAL ASSISTANCE ARE SENT AN APPLICATION AND FOLLOWED UP IN COORDINATION WITH THE HEALTH BENEFITS COUNSELOR. WE BELIEVE THAT MANY OF THE ACCOUNTS IN BAD DEBT WOULD HAVE QUALIFIED FOR CHARITY CARE IF THE GUARANTORS WOULD HAVE COMPLETED THE FINANCIAL ASSISTANCE PAPERWORK. | ||
| PART V, SECTION B, LINE 3: THE CHNA USED A COMBINATION OF SURVEY'S TO DETERMINE THE LIFESTYLE AND PERCEIVED HEALTH OF THE COMMUNITY. THE ASSESSMENT INCLUDED PHONE SURVEYS, PAPER SURVEYS KEPT AT MEDICAL CENTERS, THROUGH THE MEDICAL CENTERS WEBSITES, AND SURVEYS MAILED DIRECTLY TO COMMUNITY MEMBERS. IN TOTAL, THE ASSESSMENT RECEIVED INPUT FROM 1,770 COMMUNITY MEMBERS TO DEVELOP 10 AREAS OF FOCUS. THERE WERE FOUR COMMUNITY FORUMS IN WHICH COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE 10 AREAS OF FOCUS. AT THE COMMENCEMENT OF EACH DISCUSSION, THOSE IN ATTENDENCE PLACED VOTES ON THE TOP 5 AREAS. FOLLOWING THESE OUTREACH ACTIVITIES, A GROUP OF APPROXIMATELY 20 COMMUNITY PARTNERS PARTICIPATED IN A PROCESS FOCUSING ON REVIEW AND DISCUSSION OF COMPILED DATA ON THE CURRENT HEALTH STATUS OF COMMUNITY MEMBERS, AS WELL AS VOTING RESULTS FROM THE FORUMS. DURING THE MEETING, THIS GROUP COMPLETED A PAPER SURVEY TO CAST THEIR VOTES TO DETERMINE THE TOP THREE HEALTH FOCUS AREAS FOR THE COMMUNITY. THESE THREE AREAS DETERMINED WERE: 1. MENTAL HEALTH2. OBESITY3. ALCOHOL USE | AMERY REGIONAL MEDICAL CENTER | |
| PART V, SECTION B, LINE 3: THE CHNA USED A COMBINATION OF SURVEY'S TO DETERMINE THE LIFESTYLE AND PERCEIVED HEALTH OF THE COMMUNITY. THE ASSESSMENT INCLUDED PHONE SURVEYS, PAPER SURVEYS KEPT AT MEDICAL CENTERS, THROUGH THE MEDICAL CENTERS WEBSITES, AND SURVEYS MAILED DIRECTLY TO COMMUNITY MEMBERS. IN TOTAL, THE ASSESSMENT RECEIVED INPUT FROM 1,770 COMMUNITY MEMBERS TO DEVELOP 10 AREAS OF FOCUS. THERE WERE FOUR COMMUNITY FORUMS IN WHICH COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE 10 AREAS OF FOCUS. AT THE COMMENCEMENT OF EACH DISCUSSION, THOSE IN ATTENDENCE PLACED VOTES ON THE TOP 5 AREAS. FOLLOWING THESE OUTREACH ACTIVITIES, A GROUP OF APPROXIMATELY 20 COMMUNITY PARTNERS PARTICIPATED IN A PROCESS FOCUSING ON REVIEW AND DISCUSSION OF COMPILED DATA ON THE CURRENT HEALTH STATUS OF COMMUNITY MEMBERS, AS WELL AS VOTING RESULTS FROM THE FORUMS. DURING THE MEETING, THIS GROUP COMPLETED A PAPER SURVEY TO CAST THEIR VOTES TO DETERMINE THE TOP THREE HEALTH FOCUS AREAS FOR THE COMMUNITY. THESE THREE AREAS DETERMINED WERE: 1. MENTAL HEALTH2. OBESITY3. ALCOHOL USE | ARMC WEST CAMPUS | |
| PART V, SECTION B, LINE 4: THE FOLLOWING HOSPITALS PARTICIPATED IN COMMUNITY HEALTH NEEDS ASSESSMENT: POLK COUNTY HEALTH DEPARTMENTAMERY REGIONAL MEDICAL CENTEROSCEOLA MEDICAL CENTERST. CROIX REGIONAL MEDICAL CENTER | AMERY REGIONAL MEDICAL CENTER | |
| PART V, SECTION B, LINE 4: THE FOLLOWING HOSPITALS PARTICIPATED IN COMMUNITY HEALTH NEEDS ASSESSMENT: POLK COUNTY HEALTH DEPARTMENTAMERY REGIONAL MEDICAL CENTEROSCEOLA MEDICAL CENTERST. CROIX REGIONAL MEDICAL CENTER | ARMC WEST CAMPUS | |
| PART V, SECTION B, LINE 5C: THE CHNA IS AVAILABLE ON THE ORGANIZATION'S WEBSITE: HTTP://WWW.AMERYMEDICALCENTER.ORG/AMERY2.NSF/VIEW/CHNA_2013THE CHNA IS ALSO AVAILABLE ON THE POLK COUNTY HEALTH DEPARTMENT WEBSITE: HTTP://HEALTHYPOLKCOUNTY.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ | AMERY REGIONAL MEDICAL CENTER | |
| PART V, SECTION B, LINE 5C: THE CHNA IS AVAILABLE ON THE ORGANIZATION'S WEBSITE: HTTP://WWW.AMERYMEDICALCENTER.ORG/AMERY2.NSF/VIEW/CHNA_2013THE CHNA IS ALSO AVAILABLE ON THE POLK COUNTY HEALTH DEPARTMENT WEBSITE: HTTP://HEALTHYPOLKCOUNTY.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ | ARMC WEST CAMPUS | |
| PART VI, LINE 2: THE ORGANIZATION COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT IN COORDINATION WTIH THE POLK COUNTY HEALTH DEPARTMENT, OSCEOLA MEDICAL CENTER, AND ST. CROIX REGIONAL MEDICAL CENTER IN FISCAL YEAR 2013. THIS CHNA IDENTIFIED THE TOP TEN COMMUNITY NEEDS AND PROVIDES DETAILED STATISTICS BREAKING DOWN THOSE NEEDS AND THEIR EFFECT ON THE COMMUNITY IN RELATION WITH THE MEDICAL CENTER'S ROLE IN ADDRESSING THOSE NEEDS. | ||
| PART VI, LINE 3: ARMC'S PATIENT FINANCIAL SERVICES DEPARTMENT WORKS WITH EACH PATIENT REGARDING ACCOUNT BALANCES LEFT TO PATIENT RESPONSIBILITY. PATIENTS WHO ARE NOT ALREADY ON GOVERNMENT ASSISTANCE OR HAVE LIMITED ASSISTANCE, ARE REFERRED TO OUR HEALTH BENEFITS COUNSELOR, WHO WORKS WITH THEM TO EVALUATE ASSISTANCE OPTIONS AND ASSISTS IN GETTING APPLICATIONS OR CONTACTS WITH THE APPROPRIATE PROGRAMS. IF ADDITIONAL ASSISTANCE IS NEEDED, THE COUNSELOR WILL WORK WITH THE PATIENT TO APPLY FOR FINANCIAL ASSISTANCE WITH THE MEDICAL CENTER AND HELPS THEM THROUGH THE PROCESS. THE FINANCIAL ASSISTANCE PROGRAM AND APPLICATION ARE LOCATED ON THE ARMC INTERNET SITE TO ALLOW PATIENTS DIRECT ACCESS TO THIS INFORMATION. | ||
| PART VI, LINE 4: THE MEDICAL CENTER'S SERVICE AREA INCLUDES FIFTEEN DIFFERENT ZIP CODES IN NORTHWEST WISCONSIN THAT PRIMARILY REPRESENT POLK COUNTY. IT INCLUDES A RURAL HEALTH CLINIC IN LUCK, MEDICALLY UNDERSERVED AREA AND MENTAL HEALTH MEDICALLY UNDERSERVED AREA IN AMERY. THE WOUND CENTER & INPATIENT PSYCH SERVICE DRAWS PATIENTS FROM OUTSIDE OUR NORMAL SERVICE AREA. | ||
| PART VI, LINE 5: TEN OF OUR TWELVE BOARD MEMBERS LIVE IN OUR SERVICE AREA. WE HAVE AN OPEN MEDICAL STAFF WHICH INCLUDES PROVIDERS FROM THE COMMUNITY, OTHER COMMUNITIES AS WELL AS THE TWIN CITIES. ANY SURPLUS FUNDS GENERATED ARE USED TO PURCHASE EQUIPMENT, BUILD NEW FACILITIES, AND EXPAND SERVICES AVAILABLE IN OUR COMMUNITY. | ||
| PART VI, LINE 6: ARMC BECAME AFFILIATED WITH HEALTH PARTNERS MEDICAL GROUP IN 1998 WHEN HOSPITAL AND CLINIC SERVICES WERE MERGED. THE MERGER ELIMINATED DUPLICATIVE SERVICES THAT HAD BEEN PROVIDED BY BOTH ORGANIZATIONS. HEALTH PARTNERS MEDICAL GROUP IS A 12% OWNER IN ARMC. | ||
| WI | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MENTAL HEALTH TASK FORCE OF POLK COUNTY | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 432 | AddressLine1 |
| City | ST CROIX FALLS | City |
| State | WI | State |
| ZIP Code | 54024 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 271566890 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 7500 | AmountOfCashGrant |
| Purpose Of Grant | SUPPORT MENTAL HEALTH AWARENESS AND EDUCATION IN POLK COUNTY | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | STUDENT SCHOLARSHIPS | TypeOfGrant |
| Number Of Recipients | 7 | NumberOfRecipients |
| Amount Of Cash Grant | 7000 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: EACH EMPLOYEE APPROVED FOR SCHOLARSHIP ASSISTANCE MUST SUBMIT ACTIVITY TO ARMC. EMPLOYEES SUBMIT GRADES AND RECEIPTS LINKED TO THEIR SCHOLARSHIP. ARMC ALSO GRANTS DONATIONS TO CERTAIN ORGANIZATIONS IN THE SERVICE AREA WHOSE MISSION AND PURPOSE IS ALIGNED WITH THAT OF ARMC. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MIKE KARUSCHAK | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | 255492 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 74460 | 0 | 329952 | 0 | 0 | 0 |
| SCOTT EDIN | ||||||||||||||
| CHIEF FINANCIAL OFFICER | 170235 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 43540 | 0 | 213775 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 4A | RANAE NYGAARD RECEIVED RETIREMENT PAY OF $40,698 IN FISCAL YEAR 2013. | |
| PART III | MICHAEL KARUSCHAK AND SCOTT EDIN ARE EMPLOYEES OF THE MANAGEMENT COMPANY QUORUM HEALTH RESOURCE. THEIR COMPENSATION INCLUDES SALARY AND BENEFITS PAID BY QUORUM HEALTH RESOURCE AND REIMBURSED BY AMERY REGIONAL MEDICAL CENTER. | SUPPLEMENTAL INFORMATION |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)
| Bond ReferenceBondReferenceCd | Issuer EINIssuerEIN | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| VILLAGE OF LUCK WISCONSIN | |||||||
| A | 396006307 | 2011-04-28 | 8500000 | REFINANCING EXISTING INDEBTEDNESS | 0 | 0 | 0 |
| CITY OF AMERY WISCONSIN | |||||||
| B | 396005378 | 2011-04-13 | 8500000 | REFINANCE EXISTING INDEBTEDNESS | 0 | 0 | 0 |
| VILLAGE OF CLEAR LAKE WISCONSIN | |||||||
| C | 396006238 | 2011-03-29 | 8500000 | REFINANCE EXISTING INDEBTEDNESS | 0 | 0 | 0 |
| TOWN OF BLACK BROOK POLK COUNTY WISCONSIN | |||||||
| D | 391169876 | 2011-05-13 | 6150000 | REFINANCE EXISTING INDEBTEDNESS | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)
| Bond ReferenceBondReferenceCd | Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Other Spent ProceedsOtherSpentProceeds | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|---|
| A | 397628 | 8500000 | 170000 | 8330000 | 2007 | 1 | 0 | 1 | 1 |
| B | 397628 | 8500000 | 170000 | 8330000 | 2007 | 1 | 0 | 1 | 1 |
| C | 397628 | 8500000 | 170000 | 8330000 | 2007 | 1 | 0 | 1 | 1 |
| D | 282709 | 6150000 | 123000 | 6027000 | 2007 | 1 | 0 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Bond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTest | Change In Use Bond Financed PropChangeInUseBondFinancedProp | Non Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 1 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 1 | 0 | 0 |
| C | 0 | 0 | 0 | 0 | 1 | 0 | 0 |
| D | 0 | 0 | 0 | 0 | 1 | 0 | 0 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (4 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 | 1 | 0 | 0 | 0 | 0 |
| B | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 |
| C | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 |
| D | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 |
Form990 Schedule K Part V Form990ScheduleKPartV (4 entries)
| Bond ReferenceBondReferenceCd | Proc To Undertk Corrective ActionProcToUndertkCorrectiveAction |
|---|---|
| A | 0 |
| B | 0 |
| C | 0 |
| D | 0 |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | FORM 990, SCHEDULE K, PART IV, LINE 2A THRU 2C | Identifier |
| Return Reference | REBATE CALCULATION | ReturnReference |
| Explanation | REBATE CALCULATION IS NOT DUE BUT EVERY 5 YEARS. THERE IS NO REBATE CACLULATION DUE FOR ANY BONDS LISTED IN SCHEDULE K, PART I. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TOWN OF LINCOLN POLK COUNTY WISCONSIN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 391406159 | IssuerEIN |
| Date Issued | 2011-05-31 | DateIssued |
| Issue Price | 6150000 | IssuePrice |
| Description Of Purpose | REFINANCE EXISTING INDEBTEDNESS | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Amount Retired | 282709 | AmountRetired |
| Total Proceeds | 6150000 | TotalProceeds |
| Issuance Costs From Proceeds | 123000 | IssuanceCostsFromProceeds |
| Capital Expenditures | 1709792 | CapitalExpenditures |
| Other Spent Proceeds | 4317208 | OtherSpentProceeds |
| Year Of Subst Completion | 2007 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Iss Meet Prvt Security Pay Test | 1 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 0 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 1 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 1 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 0 | ProcToUndertkCorrectiveAction |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE CEO AND CFO OF THE ORGANIZATION ARE EMPLOYED BY QUORUM HEALTH RESOURCES. THE BOARD OF DIRECTORS MAINTAINS ULTIMATE AUTHORITY, SUPERVISION, DIRECTION, AND CONTROL OVER THE BUSINESS, POLICIES, OPERATIONS AND ASSETS OF ARMC. THEIR DUTIES ARE TO EXECUTE AND PERFORM THE ADMINISTRATIVE FUNCTIONS OF ARMC AND ROUTINELY COMMUNICATE WITH THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS TWO CORPORATE MEMBERS: GROUP HEALTH PLAN, INC. AND AMERY MEDICAL CENTER FOUNDATION INC. | |
| FORM 990, PART VI, SECTION A, LINE 7A | TWO DIRECTORS ARE APPOINTED BY GROUP HEALTH PLAN, INC. SEVEN DIRECTORS SHALL BE COMMUNITY REPRESENTATIVES AND ARE APPOINTED BY AMERY REGIONAL MEDICAL CENTER FOUNDATION INC. THREE DIRECTORS ARE PHYSICIANS OR OTHER HEALTH CARE PROVIDERS. THESE DIRECTORS ARE NOMINATED BY THE PHYSICIAN GROUP STAFFING THE ORGANIZATION'S PRIMARY OUTPATIENT CLINIC AND ELECTED BY BOTH OF THE ORGANIZATION'S MEMBERS. | |
| FORM 990, PART VI, SECTION A, LINE 7B | IN GENERAL, THE AFFAIRS OF THE ORGANIZATION ARE MANAGED BY THE BOARD OF DIRECTORS. HOWEVER, APPROVAL IS REQUIRED FROM THE MEMBERS FOR THE FOLLOWING ACTIONS: - THE MORTGAGE, LEASE, SALE, OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ORGANIZATION'S ASSETS - THE MERGER, CONSOLIDATION, OR DISSOLUTION OF THE ORGANIZATION - THE AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION - THE AMENDMENT OF CERTAIN ARTICLES OF THE BYLAWS - THE APPROVAL OF AGREEMENTS BETWEEN THE ORGANIZATION AND GROUP HEALTH PLAN, INC. OR ANY OF ITS AFFILIATES | |
| FORM 990, PART VI, SECTION A, LINE 8B | THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. | |
| FORM 990, PART VI, SECTION B, LINE 11 | FORM 990 IS REVIEWED BY THE ORGANIZATION'S SENIOR ACCOUNTANT, THEN THE CEO AND CFO PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE. | |
| FORM 990, PART VI, SECTION B, LINE 12C | AS PART OF THE PERFORMANCE REVIEW PROCESS, PERSONS ARE ASKED TO REVIEW THE CONFLICT OF INTEREST POLICY AND THEN COMPLETE A FORM AND SIGN. THE HUMAN RESOURCE DEPARTMENT ENSURES THE FORM IS RETURNED BY ALL STAFF AND REVIEWS THE FORMS. IF A POTENTIAL CONFLICT IS IDENTIFIED, THE COMPLIANCE OFFICER FOLLOWS UP. THE GOVERNING BOARD, CEO, AND CFO COMPLETE AND SIGN THE CONFLICT OF INTEREST FORM YEARLY. THE FORMS ARE REVIEWED BY THE BOARD SECRETARY AND IF A POTENTIAL CONFLICT IS IDENTIFIED, THE COMPLIANCE OFFICER FOLLOWS UP. BOARD MEMBERS WITH CONFLICTS ARE RESTRICTED FROM VOTING ON SUCH MATTERS. | |
| THE BOARD OF DIRECTORS APPROVES THE CONTRACT BETWEEN THE ORGANIZATION AND QUORUM HEALTH SERVICES FOR CEO AND CFO SERVICES. | ||
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART IX, LINE 11G | PROVIDER SERVICES : PROGRAM SERVICE EXPENSES 5,338,965. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,338,965. ER SERVICES : PROGRAM SERVICE EXPENSES 1,692,044. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,692,044. OTHER PROFESSIONAL SERVICES : PROGRAM SERVICE EXPENSES 2,746,011. MANAGEMENT AND GENERAL EXPENSES 1,997,049. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,743,060. | OTHER FEES |
| FORM 990, PART XI, LINE 9: | UNREALIZED GAIN ON INVESTMENTS IN UNCONSOLIDATED AFFILIATES 396,887. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C | THE BOARD OF DIRECTORS OF THE ORGANIZATION ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMERY REGIONAL MEDICAL CENTER FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 265 GRIFFIN STREET | AddressLine1 |
| City | AMERY | City |
| State | WI | State |
| ZIP Code | 54001 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391726539 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivities |
| Legal Domicile State | WI | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 7 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | 0 | ControlledOrg |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMERY REGIONAL MEDICAL CENTER PHARMACY LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 265 GRIFFIN STREET E | AddressLine1 |
| City | AMERY | City |
| State | WI | State |
| ZIP Code | 54001 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390908320 | EIN |
| Primary Activity | PHARMACEUTICAL | PrimaryActivity |
| Legal Domicile State | MN | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMERY REGIONAL MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Share Of Total Income | 25795 | ShareOfTotalIncome |
| Share Of EOY Assets | 94983 | ShareOfEOYAssets |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 1 | GeneralOrManagingPartner |
| Percentage Ownership | 0.50000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | 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 | 0 | 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 | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |