SAUK PRAIRIE HEALTHCARE INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: SAUK PRAIRIE HEALTHCARE INC (EIN 39-0872080)
Tax period: 2012-01-01 to 2012-12-31
Filed: 2013-11-11
IRS object ID: 201303169349301700
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 L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-11-11T08:48:03-06:00	Timestamp
Tax Period End Date	2012-12-31	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	3703 OAKWOOD HILLS PKWY/PO BOX 690	AddressLine1
City	EAU CLAIRE	City
State	WI	State
ZIP Code	547020690	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	390872080	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	SAUK PRAIRIE MEMORIAL HOSPITAL INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	SAUK	NameControl
Phone	6086433311	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	80 FIRST STREET	AddressLine1
City	PRAIRIE DU SAC	City
State	WI	State
ZIP Code	53578	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	CAROL J MAY	Name
Title	CFO	Title
Phone	6086433311	Phone
Date Signed	2013-11-07	DateSigned
Authorize Third Party	0	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	PAUL M TRACZEK CPA	Name
PTIN	P01368830	PTIN
Phone	7158323407	Phone
Date Prepared	2013-10-29	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

Field	Value	IRS element (for citing)
Business Name Line1	SAUK PRAIRIE MEMORIAL HOSPITAL & CLINICS	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	CAROL J MAY	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	80 FIRST STREET	AddressLine1
City	PRAIRIE DU SAC	City
State	WI	State
ZIP Code	53578	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	90405183	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.SPMH.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1956	YearFormation
State Legal Domicile	WI	StateLegalDomicile
Activity Or Mission Description	EXTRAORDINARY HEALTHCARE FROM THE HEART - ONE PERSON AT A TIME.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	11	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	1	NbrIndependentVotingMembers
Total Nbr Employees	575	TotalNbrEmployees
Total Nbr Volunteers	137	TotalNbrVolunteers
Total Gross UBI	12442	TotalGrossUBI
Net Unrelated Business Txbl Income	-7171	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	277316	ContributionsGrantsPriorYear
Contributions Grants Current Year	4584045	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	57852534	ProgramServiceRevenuePriorYear
Program Service Revenue CY	62255934	ProgramServiceRevenueCY
Investment Income Prior Year	621744	InvestmentIncomePriorYear
Investment Income Current Year	1422042	InvestmentIncomeCurrentYear
Other Revenue Prior Year	-213678	OtherRevenuePriorYear
Other Revenue Current Year	-207536	OtherRevenueCurrentYear
Total Revenue Prior Year	58537916	TotalRevenuePriorYear
Total Revenue Current Year	68054485	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	119289	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	90792	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	30437774	SalariesEtcPriorYear
Salaries Etc Current Year	33100731	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	96022	TotalFundrsngExpCurrentYear
Other Expense Prior Year	23226236	OtherExpensePriorYear
Other Expenses Current Year	25618608	OtherExpensesCurrentYear
Total Expenses Prior Year	53783299	TotalExpensesPriorYear
Total Expenses Current Year	58810131	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	4754617	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	9244354	RevenuesLessExpensesCY
Total Assets BOY	72991043	TotalAssetsBOY
Total Assets EOY	84288271	TotalAssetsEOY
Total Liabilities BOY	8864607	TotalLiabilitiesBOY
Total Liabilities EOY	11106633	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	64126436	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	73181638	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	MISSION: EXTRAORDINARY HEALTHCARE FROM THE HEART - ONE PERSON AT A TIME.VISION: WE WILL SET THE STANDARD FOR COMMUNITY-BASED HEALTHCARE THAT IMPROVES THE HEALTH AND QUALITY OF LIFE OF THE PEOPLE WE SERVE.SEE CONTINUATION OF MISSION AND VISION INFORMATION UNDER STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS PART 4C.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	43541039	Expense
Grants	90792	Grants
Revenue	57324618	Revenue
Description	SAUK PRAIRIE MEMORIAL HOSPITAL, INC. (SPMHC), A 36-BED ACUTE CARE GENERAL HOSPITAL, IS A NONPROFIT, NONSTOCK WISCONSIN CORPORATION PROVIDING SERVICES TO SAUK CITY, PRAIRIE DU SAC, AND THE SURROUNDING COMMUNITIES.TOTAL ADMISSIONS FOR 2012 WERE 1,777 WITH PATIENT DAYS OF 4,159. KEY PATIENT SERVICES INCLUDED 281 BIRTHS IN THE NURSERY, 5,362 SURGICAL PROCEDURES, 53,302 REHABILITATION THERAPY SERVICES, 23,916 MEDICAL IMAGING SERVICES, AND 13,970 EMERGENCY ROOM VISITS ARE AMONG MANY OF THE SERVICES PROVIDED TO PATIENTS IN 2012.	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	4977955	Expense
Revenue	4918874	Revenue
Description	SPMHC ALSO OWNS AND OPERATES PHYSICIAN PRACTICES IN SPRING GREEN, BLACK EARTH, PLAIN, AND LODI, WISCONSIN. TOTAL CLINIC VISITS TO THESE FOUR SITES FOR 2012 WAS 33,620.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Description	SPMHC FULFILLS ITS MISSION AND VISION BY OFFERING HIGH-QUALITY SERVICES IN RURAL COMMUNITIES, THEREBY ALLOWING OUR PATIENTS TO BE TREATED LOCALLY WITHOUT LENGTHY COMMUTES OR WAITING. SPMHC HAS GAINED A REGIONAL REPUTATION OF EXCELLENCE IN ORTHOPEDICS, GENERAL SURGERY, SPINE SURGERY, AND GYNECOLOGIC SURGERY. THE HOSPITAL TREATED MORE THAN 1,100 INPATIENTS IN 2012, 281 BABIES ENTERED THE WORLD HERE, AND THE HOSPITAL HAD 55,600 OUTPATIENT VISITS. SPMHC OPERATES FOUR CLINICS IN RURAL AREAS: LODI, SPRING GREEN, PLAIN, AND BLACK EARTH, BRINGING PRIMARY CARE TO THOSE COMMUNITIES. THE CLINICS HAD MORE THAN 33,000 VISITS IN 2012. AS A CHARITABLE ORGANIZATION, SPMHC PROVIDED OVER $2 MILLION IN FREE CARE TO PATIENTS IN OUR SERVICE AREA IN 2012, IN ADDITION TO SUBSIDIZING SERVICES THAT DO NOT COVER COSTS, FREE HEALTH SCREENINGS, EDUCATIONAL PROGRAMS, AND YOUTH OUTREACH.AS THE LARGEST EMPLOYER IN THE COMMUNITY, SPMHC HAS A POSITIVE ECONOMIC IMPACT ON ITS COMMUNITIES. IT DIRECTLY AND INDIRECTLY CREATES 847 JOBS AND ITS IMPACT ON THE LOCAL ECONOMY IS OVER $54 MILLION ANNUALLY.	Description

Activity Other ActivityOther

Field	Value	IRS element (for citing)
Description	SAUK PRAIRIE HOSPITAL ADDED STEREOTACTIC BREAST BIOPSY. THIS PROCEDURE ALLOWS A RADIOLOGIST TO USE MAMMOGRAPHY TO HELP PINPOINT THE SPOT IN THE BREAST THAT NEEDS REMOVAL. THE PROCEDURE IS DONE USING LOCAL ANESTHESIA AND USES A VACUUM ASSISTED DEVICE TO EXTRACT THE BREAST TISSUE.	Description

Field	Value	IRS element (for citing)
Total Program Service Expense	48518994	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	1	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	1	ReportFin48Footnote
Independent Audit Financial Stmt	1	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	0	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
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	1	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	35	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	575	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	1	UnrelatedBusinessIncome
Form990-T Filed	1	Form990-TFiled
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	11	NbrVotingGoverningBodyMembers
Number Independent Voting Members	1	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	1	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	WI	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	CAROL J MAY	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	6086433311	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	80 FIRST STREET	AddressLine1
City	PRAIRIE DU SAC	City
State	WI	State
ZIP Code	53578	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
NANCY BREUNIG
TRUSTEE	5.70	X	23100	0	0
TAMMY ADLER
VICE PRESIDENT	5.10	X	22500	0	0	X
NEIL BISHOP
TRUSTEE	3.90	X	15621	0	0
RICHARD MARINO
TRUSTEE	4.40	X	18800	0	0
TOM SCHWARZ
PRESIDENT	5.00	X	22825	0	0	X
ALLAN PECKHAM
SECRETARY	4.40	X	18900	0	0	X
JOHN DEGIOVANNI
TRUSTEE	1.50	X	6485	0	0
PHILLIP KEISER
TRUSTEE	2.80	X	12200	0	0
DALE CARLSON
TREASURER	3.80	X	16800	0	0	X
ROXI MAIER
TRUSTEE	3.50	X	13400	0	0
VICKIE WENZEL
TRUSTEE	2.60	X	10200	0	0
ROBERTA BOS
VP, HUMAN RESOURCES	50.00		140829	0	15369	X
CAROL MAY
VP, FINANCE & OPERATIONS	50.00		185441	0	19501	X
LARRY SCHROEDER
CEO	50.00		329054	0	23652	X
KENNETH CARLSON
VP, PLANNING & BUSINESS DE	50.00		147763	0	11689	X
CARLA PECK
VP, QUALITY & COMPLIANCE	50.00		139428	0	14942	X
MARGARET SHEEKS
VP, PATIENT SERVICES	50.00		144219	0	15064	X
MARK STARR
ANESTHESIA-CRNA	40.00		240738	0	20780		X
MILES MORGAN
ER PHYSICIAN	40.00		291522	0	21394		X
LINDA YOUNGREN
ER PHYSICIAN	40.00		286973	0	23126		X
ERIC WARBASSE
ER PHYSICIAN	36.00		278258	0	21149		X
SUSAN TORHORST
ER PHYSICIAN	40.00		244510	0	22875		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	2609566	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	209541	TotalOtherCompensation
Number Individuals GT100 K	48	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
KRAEMER BROTHERS
PO BOX 219	PLAIN	WI	53577	CONSTRUCTION SERVICES	5544262
KB DISTRIBUTION
PO BOX 219	PLAIN	WI	53577	CONSTRUCTION SERVICES	3346229
KAHLER SLATER INC
111 W WISCONSIN AVE	MILWAUKEE	WI	53203	ARCHITECTURAL SERVICES	2841925
NAVIN HAFFTY & ASSOCIATES
200 CORDWAINER DR SUITE 100	NORWELL	MA	02061	IT CONSULTING	1128212
SHARED IMAGING SERVICES
PO BOX 45686	MADISON	WI	53744	NUCLEAR MED, ECHO, ULTRASOUND SERVICES	777546

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	16	NumberOfContractorsGT100K
Related Organizations	4567600	RelatedOrganizations
Government Grants	16445	GovernmentGrants
Total Contributions	4584045	TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue
HOSPITAL PATIENT REVENUE	621990	56327952	56327952
CLINIC REVENUE	621110	4918874	4918874
OTHER HOSPITAL SERVICES	621990	795115	782673	12442
CAFETERIA AND VENDING	621990	213993	213993

Field	Value	IRS element (for citing)
Total Program Service Revenue	62255934	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	728026	TotalRevenueColumn
Exclusion	$728,026	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	271409	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	478945	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	-207536	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	-207536	TotalRevenueColumn
Exclusion	-$207,536	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	22565769	Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	21840127	Securities
Other	31626	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	725642	Securities
Other	-31626	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	694016	TotalRevenueColumn
Exclusion	$694,016	ExclusionAmount

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	68054485	TotalRevenueColumn
Related Or Exempt Function Income	62243492	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	12442	UnrelatedBusinessRevenue
Exclusion	$1,214,506	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	90792	Total
Program Services	90792	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	1367782	Total
Management And General	1367782	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	25226388	Total
Program Services	21386905	ProgramServices
Management And General	3767177	ManagementAndGeneral
Fundraising	72306	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	1066432	Total
Program Services	904120	ProgramServices
Management And General	159255	ManagementAndGeneral
Fundraising	3057	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	3656089	Total
Program Services	3099629	ProgramServices
Management And General	545981	ManagementAndGeneral
Fundraising	10479	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	1784040	Total
Program Services	1411047	ProgramServices
Management And General	367914	ManagementAndGeneral
Fundraising	5079	Fundraising

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	54963	Total
Management And General	54963	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	168307	Total
Management And General	168307	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	2147533	Total
Program Services	1159035	ProgramServices
Management And General	988498	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	159844	Total
Program Services	21126	ProgramServices
Management And General	138718	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	140894	Total
Program Services	110459	ProgramServices
Management And General	30435	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	256539	Total
Management And General	256539	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	1005429	Total
Program Services	947498	ProgramServices
Management And General	56269	ManagementAndGeneral
Fundraising	1662	Fundraising

Travel Travel

Field	Value	IRS element (for citing)
Total	57177	Total
Program Services	40251	ProgramServices
Management And General	16926	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	143193	Total
Program Services	91832	ProgramServices
Management And General	51361	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	2984834	Total
Program Services	2984834	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	1404797	Total
Program Services	63122	ProgramServices
Management And General	1341675	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral	FundraisingFundraising
SUPPLIES	16154190	15546565	604186	3439
BAD DEBT EXPENSE	684419	684419
REPAIRS & MAINTENANCE	394851	393168	1683
OTHER EXPENSES	340583	63137	277446

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	-478945	Total
Program Services	-478945	ProgramServices

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	58810131	Total
Program Services	48518994	ProgramServices
Management And General	10195115	ManagementAndGeneral
Fundraising	96022	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	129498	BOY
EOY	83605	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	11453265	BOY
EOY	10117751	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	6265081	BOY
EOY	7090553	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	979178	BOY
EOY	1021571	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	923503	BOY
EOY	1109941	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	74484160	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	30478996	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	25684126	BOY
EOY	44005164	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	23239127	BOY
EOY	17061165	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	356917	BOY
EOY	367117	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	3960348	BOY
EOY	3431404	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	72991043	BOY
EOY	84288271	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	6807135	BOY
EOY	9139801	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	1262770	BOY
EOY	990495	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	794702	BOY
EOY	976337	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	8864607	BOY
EOY	11106633	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	57419720	BOY
EOY	67575074	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	5601205	BOY
EOY	4419653	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1105511	BOY
EOY	1186911	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	64126436	BOY
EOY	73181638	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	72991043	BOY
EOY	84288271	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	9244354	ReconcilationRevenueExpenses
Reconciliation Unrealized Invest	911000	ReconciliationUnrealizedInvest
Reconcilation Other Changes	-1100152	ReconcilationOtherChanges
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Separate	X	FinancialStatementSeparate

Field	Value	IRS element (for citing)
Audit Committee	1	AuditCommittee
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	Volunteers
Paid Staff Or Management	0	PaidStaffOrManagement
Media Advertisements	0	MediaAdvertisements
Mailings Members	1	MailingsMembers
Mailings Members	$0	MailingsMembersAmount
Publications Or Broadcast	0	PublicationsOrBroadcast
Grants Other Organizations	0	GrantsOtherOrganizations
Direct Contact Legislators	1	DirectContactLegislators
Direct Contact Legislators	$0	DirectContactLegislatorsAmount
Rallies Demonstrations	0	RalliesDemonstrations
Other Activities	1	OtherActivities
Other Activities	$10,173	OtherActivitiesAmount
Total Lobbying Expenditures IIB	10173	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV (2 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
EXPLANATION OF LOBBYING ACTIVITIES:	PART II-B, LINE 1:	SAUK PRAIRIE MEMORIAL HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. AHA AND WHA HAVE NOTIFIED SPMHC THAT APPROXIMATELY $7,093 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. SPMHC IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, SPMHC PAYS MEMBERSHIP FEES TO THE RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO DOES PROVIDE ANALYSIS ON CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGH WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. RWHC DETERMINED THAT APPROXIMATELY $3,080 OF THE FEES PAID BY SPMHC IN 2012 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTHCARE ENVIRONMENT IN THE STATE OF WISCONSIN.
PART IV, SUPPLEMENTAL INFORMATION:		PART II-B, LINE 1 (D AND G): REPRESENTATIVES FROM SPMHC ANNUALLY PARTICIPATE IN THE WISCONSIN HOSPITAL ASSOCIATION'S ADVOCACY DAY WHERE THE REPRESENTATIVES ARE GIVEN THE OPPORTUNITY TO GATHER WITH OTHER HEALTHCARE ORGANIZATIONS IN THE STATE OF WISCONSIN AND ALSO MEET WITH STATE GOVERNMENT REPRESENTATIVES WITH THE PURPOSE OF IMPROVING THE DELIVERY OF HEALTHCARE NOT ONLY AT SPMHC BUT ALSO COLLECTIVELY IN THE STATE OF WISCONSIN. AS ISSUES OR PROPOSED LEGISLATION ARISE THROUGHOUT THE YEAR, OFFICIALS OF SPMHC WILL SEND LETTERS OF COMMENT TO LOCAL, STATE, AND FEDERAL GOVERNMENT REPRESENTATIVES TO EITHER SHOW SUPPORT OF PROPOSED CHANGES OR VOICE AN OPINION TO IMPROVE THE OUTCOME OF PROPOSED LEGISLATION OR OTHER CHANGES. THESE ACTIVITIES RESULT IN MINIMAL COST TO THE OPERATION OF SPMHC.

Schedule D IRS990ScheduleD

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	1196971	BeginningOfYearBalance
Investment Earnings Or Losses	132615	InvestmentEarningsOrLosses
End Of Year Balance	1329586	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	1147396	BeginningOfYearBalance
Investment Earnings Or Losses	49575	InvestmentEarningsOrLosses
End Of Year Balance	1196971	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Contributions	1084880	Contributions
Investment Earnings Or Losses	92516	InvestmentEarningsOrLosses
Grants Or Scholarships	30000	GrantsOrScholarships
End Of Year Balance	1147396	EndOfYearBalance

Field	Value	IRS element (for citing)
Board Designated EOY Balance	0.00000	BoardDesignatedEOYBalance
Permanent Endowment EOY Balance	0.89270	PermanentEndowmentEOYBalance
Term Endowment EOY Balance	0.10730	TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs	0	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	1	EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R	1	AreRelatedOrgsListedScheduleR

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	7611008	OtherCostOrOtherBasis
Book Value	7611008	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	19377154	OtherCostOrOtherBasis
Depreciation	11432082	Depreciation
Book Value	7945072	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	29436914	OtherCostOrOtherBasis
Depreciation	19046914	Depreciation
Book Value	10390000	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	18059084	OtherCostOrOtherBasis
Book Value	18059084	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	44005164	TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
Description	DEFERRED COMPENSATION PLAN LIABILITY	Description
Amount	$976,337	Amount

Field	Value	IRS element (for citing)
Total Of Amounts	976337	TotalOfAmounts
Footnote In Part XIII	X	FootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt	64786038	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	911000	NetUnrealizedGainsInvestments
Other Revenues	478945	OtherRevenues
Revenue Not Rptd F990	1389945	RevenueNotRptdF990
Revenue Subtotal	63396093	RevenueSubtotal
Other Revenues Not Included	4658392	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	4658392	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	68054485	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	59198284	TotExpensesEtcAuditedFinclStmt
Other Expenses Included	478945	OtherExpensesIncluded
Expenses Not Rptd F990	478945	ExpensesNotRptdF990
Expenses Subtotal	58719339	ExpensesSubtotal
Other Expenses Not Included	90792	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	90792	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	58810131	TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (6 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:	PART V, LINE 4:	THE SCHNELLER SISTERS FUND SHALL BE HELD AS A SEPARATE PERMANENT ENDOWMENT FUND ON THE BOOKS AND RECORDS OF THE FOUNDATION, THE INCOME FROM WHICH SHALL BE DISTRIBUTED TO SAUK PRAIRIE MEMORIAL HOSPITAL FOR UNRESTRICTED NEEDS. ALL DISTRIBUTIONS FROM THE SCHNELLER SISTERS FUND SHALL BE DESIGNATED AS HAVING BEEN MADE "IN MEMORY OF THE SCHNELLER SISTERS: CECELIA SCHNELLER MUELLER, ADLYNN F. BALFANZ, AND MARY ANN ROSAR."
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:	PART X, LINE 2:	THE HOSPITAL IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SIMILAR STATE OF WISCONSIN TAX LAWS. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE HOSPITAL DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OR THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE HOSPITAL IS ALSO ENGAGED, TO A LIMITED EXTENT, IN ACTIVITIES WHICH THE INTERNAL REVENUE SERVICE CONSIDERS UNRELATED TO THE HOSPITAL'S EXEMPT PURPOSE AND, THEREFORE, TAXABLE. THESE ACTIVITIES, HOWEVER, ANNUALLY RESULT IN NET OPERATING LOSSES FOR INCOME TAX PURPOSES. THE HOSPITAL DOES NOT PRESENTLY ANTICIPATE THAT A TAX BENEFIT FROM THESE NET OPERATING LOSSES WILL BE REALIZED IN THE FUTURE. ACCORDINGLY, ANY POTENTIAL DEFERRED TAX ASSET RESULTING FROM THE AVAILABILITY OF NET OPERATING LOSS CARRYFORWARDS IS OFFSET BY A VALUATION ALLOWANCE OF EQUAL AMOUNT. NO DEFERRED TAX ASSETS AND LIABILITIES HAVE BEEN RECOGNIZED SINCE NO OTHER DIFFERENCES EXIST BETWEEN THE FINANCIAL AND TAX BASES OF REPORTING THE HOSPITAL'S ASSETS AND LIABILITIES. THE HOSPITAL'S POLICY IS TO RECOGNIZE INTEREST AND ANY PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. AS OF AND FOR THE YEARS ENDING DECEMBER 31, 2012 AND 2011, THERE WAS NO INCOME TAX EXPENSE, TAX PENALTIES, OR INTEREST RELATED TO TAX PENALTIES RECORDED BY THE HOSPITAL IN THE FINANCIAL STATEMENTS. IN ADDITION, THE HOSPITAL RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS IN 2012 AND 2011. FEDERAL TAX RETURNS FOR YEARS 2009 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE.
PART XI, LINE 2D - OTHER ADJUSTMENTS:		RENTAL EXPENSES NETTED AGAINST RENTAL INCOME 478,945.
PART XI, LINE 4B - OTHER ADJUSTMENTS:		GOOD NEIGHBOR CLINIC SERVICES PROVIDED 90,792. CONTRIBUTIONS FROM RELATED ORGANIZATION 4,567,600.
PART XII, LINE 2D - OTHER ADJUSTMENTS:		RENTAL EXPENSES NETTED AGAINST RENTAL INCOME 478,945.
PART XII, LINE 4B - OTHER ADJUSTMENTS:		GOOD NEIGHBOR CLINIC DONATIONS 90,792.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
FPG Reference Free Care	1	FPGReferenceFreeCare
Pcent100	X	Pcent100
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent400	X	Pcent400
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	1042431	TotalCommunityBenefitExpense
Net Community Benefit Expense	1042431	NetCommunityBenefitExpense
Percent Of Total Expense	0.01790	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	3826734	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2665692	DirectOffsettingRevenue
Net Community Benefit Expense	1161042	NetCommunityBenefitExpense
Percent Of Total Expense	0.02000	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	4869165	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2665692	DirectOffsettingRevenue
Net Community Benefit Expense	2203473	NetCommunityBenefitExpense
Percent Of Total Expense	0.03790	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	541728	TotalCommunityBenefitExpense
Direct Offsetting Revenue	120495	DirectOffsettingRevenue
Net Community Benefit Expense	421233	NetCommunityBenefitExpense
Percent Of Total Expense	0.00720	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	104873	TotalCommunityBenefitExpense
Net Community Benefit Expense	104873	NetCommunityBenefitExpense
Percent Of Total Expense	0.00180	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	13992845	TotalCommunityBenefitExpense
Direct Offsetting Revenue	11290719	DirectOffsettingRevenue
Net Community Benefit Expense	2702126	NetCommunityBenefitExpense
Percent Of Total Expense	0.04650	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	200407	TotalCommunityBenefitExpense
Net Community Benefit Expense	200407	NetCommunityBenefitExpense
Percent Of Total Expense	0.00340	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	14839853	TotalCommunityBenefitExpense
Direct Offsetting Revenue	11411214	DirectOffsettingRevenue
Net Community Benefit Expense	3428639	NetCommunityBenefitExpense
Percent Of Total Expense	0.05890	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	19709018	TotalCommunityBenefitExpense
Direct Offsetting Revenue	14076906	DirectOffsettingRevenue
Net Community Benefit Expense	5632112	NetCommunityBenefitExpense
Percent Of Total Expense	0.09680	PercentOfTotalExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	15681	TotalCommunityBuildingExpense
Net Community Building Expense	15681	NetCommunityBuildingExpense
Percent Of Total Expense	0.00030	PercentOfTotalExpense

Leadership Development LeadershipDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	1546	TotalCommunityBuildingExpense
Net Community Building Expense	1546	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Coalition Building CoalitionBuilding

Field	Value	IRS element (for citing)
Total Community Building Expense	9919	TotalCommunityBuildingExpense
Net Community Building Expense	9919	NetCommunityBuildingExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

Field	Value	IRS element (for citing)
Total Community Building Expense	9558	TotalCommunityBuildingExpense
Net Community Building Expense	9558	NetCommunityBuildingExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Workforce Development WorkforceDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	1204	TotalCommunityBuildingExpense
Net Community Building Expense	1204	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Other Other

Field	Value	IRS element (for citing)
Total Community Building Expense	27002	TotalCommunityBuildingExpense
Direct Offsetting Revenue	19923	DirectOffsettingRevenue
Net Community Building Expense	7079	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Total Community Building Expense	64910	TotalCommunityBuildingExpense
Direct Offsetting Revenue	19923	DirectOffsettingRevenue
Net Community Building Expense	44987	NetCommunityBuildingExpense
Percent Of Total Expense	0.00080	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReported
Bad Debt Expense	$336,705	BadDebtExpenseAmount
Amount Attributable To	168352	AmountAttributableTo
Amount Reimbursed By Medicare	12794253	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	16068847	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-3274594	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	SAUK PRAIRIE MEMORIAL HOSPITAL INC	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	80 FIRST ST	AddressLine1
City	PRAIRIE DU SAC	City
State	WI	State
ZIP Code	53578	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Er24 Hours	X	Er24Hours
Other	ALSO OPERATES 4 OUTPATIENT CLINICS	Other

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	SAUK PRAIRIE MEMORIAL HOSPITAL INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
CHNA Conducted	1	CHNAConducted
Community Definition	X	CommunityDefinition
Community Demographics	X	CommunityDemographics
Existing Resources	X	ExistingResources
How Data Obtained	X	HowDataObtained
Community Health Needs	X	CommunityHealthNeeds
Other Health Issues	X	OtherHealthIssues
Identifying Process	X	IdentifyingProcess
Consulting Process	X	ConsultingProcess
Information Gaps	X	InformationGaps
Other	X	Other
Needs Assessment Conducted	12	NeedsAssessmentConducted
Take Into Account	1	TakeIntoAccount
Other Facilities	1	OtherFacilities
CHNA Widely Available	1	CHNAWidelyAvailable
Own Website	X	OwnWebsite
On Request	X	OnRequest
Other Method	X	OtherMethod
Adopt Implement Strategy	X	AdoptImplementStrategy
Execute Implement Strategy	X	ExecuteImplementStrategy
Develop Community Plan	X	DevelopCommunityPlan
Participate Community Plan	X	ParticipateCommunityPlan
Include Operational Plans	X	IncludeOperationalPlans
Adopt Budget	X	AdoptBudget
Prioritize Health Needs	X	PrioritizeHealthNeeds
Prioritize Services	X	PrioritizeServices
Other Needs Addressed	X	OtherNeedsAddressed
All Needs Addressed	0	AllNeedsAddressed
Organization Incur Excise Tax	0	OrganizationIncurExciseTax
Eligibility Criteria Explained	1	EligibilityCriteriaExplained
Uses FPG Free	1	UsesFPGFree
FPG Free Percent	100.000000000000	FPGFreePercent
Uses FPG Discounted	1	UsesFPGDiscounted
FPG Discount Percent	400.000000000000	FPGDiscountPercent
Explains Basis	1	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Medical Indigency	X	MedicalIndigency
Insurance Status	X	InsuranceStatus
Uninsured Discount	X	UninsuredDiscount
Medicaid Medicare	X	MedicaidMedicare
State Regulation	X	StateRegulation
Explains Application Method	1	ExplainsApplicationMethod
Includes Publicity Measures	1	IncludesPublicityMeasures
Posted On Website	X	PostedOnWebsite
Attached To Invoices	X	AttachedToInvoices
Posted In Emergency Room	X	PostedInEmergencyRoom
Posted In Admission Office	X	PostedInAdmissionOffice
Provided On Admission	X	ProvidedOnAdmission
Available On Request	X	AvailableOnRequest
Other Publicity	X	OtherPublicity
Actions On Nonpayment	1	ActionsOnNonpayment
Permit Report To Credit Agency	X	PermitReportToCreditAgency
Permit Lawsuit	X	PermitLawsuit
Collection Activities	1	CollectionActivities
Report To Credit Agency	X	ReportToCreditAgency
Lawsuit	X	Lawsuit
Notify Upon Admission	X	NotifyUponAdmission
Notify Before Discharge	X	NotifyBeforeDischarge
Notified All Patients	X	NotifiedAllPatients
Documented Determination	X	DocumentedDetermination
Nondiscrim Emergency Care Policy	1	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	0	AmountsGenerallyBilled
Gross Charges	0	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	4	NumberOfOtherFacilities

Other Facilities OtherFacilities (4 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
LODI MEDICAL CLINIC
160 VALLEY DRIVE	LODI	WI	53555	PHYSICIAN CLINIC
RIVER VALLEY MEDICAL CLINIC
436 SUNRISE DRIVE	SPRING GREEN	WI	53588	RURAL HEALTH CLINIC
BLACK EARTH MEDICAL CLINIC
1529 STATE STREET A	BLACK EARTH	WI	53515	PHYSICIAN CLINIC
PLAIN MEDICAL CLINIC
825 MAIN STREET	PLAIN	WI	53577	RURAL HEALTH CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (22 entries)

ExplanationExplanation	IdentifierIdentifier	Return ReferenceReturnReference
PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS PRIMARILY BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICES REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. THE COSTING METHOD FOR SUBSIDIZED HEALTH SERVICES IS BASED ON INTERNAL RECORDS AND ALLOCATIONS WHICH ARE SIMILAR TO A DIRECT COSTING ACCOUNTING SYSTEM FOR THESE SERVICES NOTED AS SUBSIDIZED HEALTH SERVICES.
PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT SAUK PRAIRIE MEMORIAL HOSPITAL INCLUDE THE OPERATION OF SEVERAL HOSPITAL DEPARTMENTS THAT OPERATE AT A LOSS FROM OPERATIONS, BUT ARE CONSIDERED VITAL HOSPITAL AND CLINIC SERVICES SUCH AS THE INTENSIVE CARE UNIT, OUTPATIENT PHYSICIAN CLINICS, INCLUDING INTERNAL MEDICINE, AND SEVERAL OTHER DEPARTMENTS. A LARGE PORTION OF THESE SERVICES ARE ACCESSED BY COMMUNITY MEMBERS THROUGH THE HOSPITAL'S EMERGENCY SERVICES DEPARTMENT. IT IS THE GOAL OF SAUK PRAIRIE MEMORIAL HOSPITAL TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY.
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 $ 684419.
PART II: SPMHC'S COMMUNITY BUILDING EFFORTS PROMOTE BOTH THE PHYSICAL AND ECONOMIC HEALTH OF THE COMMUNITIES WE SERVE. FROM AN ECONOMIC PERSPECTIVE, SPMHC STAFF CONTRIBUTE HUNDREDS OF HOURS TO CHAMBERS OF COMMERCE ACTIVITIES AND SUPPORT WORKFORCE DEVELOPMENT THROUGH COMMUNITY AND EDUCATIONAL PROGRAMS. THE PHYSICAL HEALTH OF THE COMMUNITY IS SUPPORTED THROUGH THE DEVELOPMENT OF HEALTH-RELATED COALITIONS, PARTICULARLY THE SAUK PRAIRIE WELLNESS MOVEMENT.
PART III, LINE 4: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY REPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE ORGANIZATION HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES PATIENTS ARE UNABLE TO COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE ORGANIZATION PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE.THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL.
PART III, LINE 8: WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PATIENTS, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.THE TOTAL MEDICARE REVENUE SHOWN ON SCHEDULE H IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY THE CHARGES FROM MEDICARE PROGRAM BENEFICIARIES THAT ARE REPORTED ON THE HOSPITAL'S MEDICARE COST REPORT. THE AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT SAUK PRAIRIE MEMORIAL HOSPITAL, PHYSICIAN SERVICES FOR THE INTERNAL MEDICINE (HOSPITALIST) PROGRAM, PHYSICIAN SERVICES PROVIDED AT TWO OF THE FOUR OUTLYING PHYSICIAN CLINICS, CRNA SERVICES PROVIDED TO PATIENTS UNDERGOING ANESTHESIA AT THE HOSPITAL, AND A SIGNIFICANT PORTION OF LAB AND PHYSICAL THERAPY SERVICES WHICH ARE REIMBURSED BY THE MEDICARE PROGRAM UNDER ANOTHER METHODOLOGY. PHYSICIAN COVERAGE OUTPATIENT LAB SERVICES AND OUTPATIENT PHYSICAL THERAPY SERVICES ARE REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT SAUK PRAIRIE MEMORIAL HOSPITAL AND CLINICS PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST TO CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE DIVIDED BY HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES, WHICH ARE REIMBURSED ON A COST REPORTING METHODOLOGY. INCLUDING THE FEE SCHEDULE ITEMS, SUCH AS PHYSICIAN SERVICES, WOULD PRODUCE A LARGER LOSS OR SHORTFALL ON THESE SERVICES TO BE REPORTED ON THE FORM 990 IN ANY GIVEN YEAR.
PART III, LINE 9B: IT IS THE POLICY OF SAUK PRAIRIE MEMORIAL HOSPITAL AND CLINICS THAT EACH PATIENT RECEIVES CARE REGARDLESS OF THE ABILITY TO PAY. IF DURING THE COLLECTION PROCESS A PATIENT DOES NOT COMPLETE THE NECESSARY PAPERWORK OR RESPOND TO ATTEMPTS BY THE HOSPITAL TO PROVIDE CHARITY SERVICES, THE PATIENT MAY STILL REQUEST CHARITY INFORMATION AND COMPLETE THE INFORMATION AT ANY TIME DURING THE COLLECTION PROCESS. THE PATIENT WILL BE REFERRED TO THE ORGANIZATION'S CHARITY CARE POLICY AND CAN QUALIFY FOR CHARITY CARE, AND HAVE ANY COLLECTION ISSUES REVERSED BY THE ORGANIZATION, IF THEY SHOW A NEED FOR THE CARE BASED ON THE ORGANIZATION'S POLICY.
PART V, SECTION B, LINE 1J: INPUT FROM LOCAL PHYSICIANS WITH REGARD TO THE HIGHEST COMMUNITY HEALTH NEEDS WAS ALSO INCLUDED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT.	SAUK PRAIRIE MEMORIAL HOSPITAL, INC.
PART V, SECTION B, LINE 3: IN FEBRUARY-MARCH 2011 A MORE FORMALIZED PROCESS WAS DONE TO UPDATE THE 2010 PRELIMINARY COMMUNITY HEALTH NEEDS ASSESSMENT. SPMHC COMMISSIONED MATOUSEK & ASSOCIATES, A MARKETING RESEARCH AND CONSULTING FIRM LOCATED IN GREEN BAY, WI, TO CONDUCT RESEARCH WITH RESIDENTS OF KEY COMMUNITIES WE SERVE. A TOTAL OF 14 FOCUS GROUPS WERE HELD IN FIVE COMMUNITIES WITH COMMUNITY AND BUSINESS LEADERS, AND WITH RANDOMLY SELECTED WOMEN. A TOTAL OF 140 INDIVIDUALS PARTICIPATED IN GROUP INTERVIEWS. EACH FACILITATED SESSION RESULTED IN A LIST OF PRIORITIZED HEALTH NEEDS AND ISSUES. IN JUNE 2012, A COMMUNITY LISTENING SESSION WAS CONDUCTED IN SPANISH WITH 8 RESIDENTS OF THE BLUFFVIEW NEIGHBORHOOD LOCATED ACROSS FROM THE FORMER BADGER ORDINANCE PLANT ON HWY 12. MANY RESIDENTS OF THE BLUFFVIEW NEIGHBORHOOD ARE CONSIDERED LOW-INCOME AND MANY ARE ETHNICALLY HISPANIC WITH CLOSE FAMILY TIES TO MEXICO. THE ISSUES RAISED BY THE FOCUS GROUP WERE CARRIED TO THE SAUK PRAIRIE WELLNESS MOVEMENT (SPWM) WHO WILL PLAN TO ADDRESS THE NEEDS.ADDITIONALLY, INDIVIDUAL INTERVIEWS WERE ALSO CONDUCTED WITH HOSPITAL BOARD MEMBERS.ADDITIONAL INPUT WAS ALSO PROVIDED BY MEMBERS OF THE HOSPITAL'S LEADERSHIP TEAM. MEMBERS OF OUR LEADERSHIP TEAM ARE ACTIVELY ENGAGED IN COMMUNITY ORGANIZATIONS INCLUDING THE GOOD NEIGHBOR CLINIC BOARD (LOCAL FREE CLINIC), DEVELOPMENT OF A DENTAL CLINIC FOR LOW-INCOME INDIVIDUALS, SAFETY COALITION, AND VARIOUS COMMUNITY ORGANIZATIONS. IN THAT CAPACITY, THEY INTERACT ABOUT COMMUNITY HEALTH ISSUES WITH COMMUNITY MEMBERS. SPMHC IS ALSO REPRESENTED BY 11 COMMUNITY MEMBERS ON ITS BOARD OF DIRECTORS WHO SERVE AS THE COMMUNITY "EARS" OF OUR ORGANIZATION.	SAUK PRAIRIE MEMORIAL HOSPITAL, INC.
PART V, SECTION B, LINE 4: SPMHC WORKED WITH REEDSBURG AREA MEDICAL CENTER (REEDSBURG, WI), ST. CLARE HOSPITAL (BARABOO, WI), AND THE SAUK COUNTY DEPARTMENT OF HEALTH TO IDENTIFY AND PRIORITIZE HEALTH NEEDS.	SAUK PRAIRIE MEMORIAL HOSPITAL, INC.
PART V, SECTION B, LINE 5C: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS MADE OFFICIALLY PUBLICLY AVAILABLE IN MARCH 2013. THIS WAS ANNOUNCED VIA A COMMUNITY NEWSLETTER TO MORE THAN 20,000 HOUSEHOLDS, AND IT WAS INTERNALLY ANNOUNCED TO EMPLOYEES AND MEDICAL STAFF OF SPMHC. THE CHNA HAS ALSO BEEN PRESENTED AT VARIOUS COMMUNITY SERVICE ORGANIZATION MEETINGS.	SAUK PRAIRIE MEMORIAL HOSPITAL, INC.
PART V, SECTION B, LINE 6I: THE PRIMARY OBJECTIVE OF THE SPMHC COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") IS TO "DECREASE OBESITY AND INCREASE PHYSICAL ACTIVITY."IN THE PAST YEAR, SPMHC HAS ENGAGED IN FOUR ACTIVITIES TO ADDRESS THE REDUCTION OF OBESITY AND INCREASING PHYSICAL ACTIVITY. THESE INCLUDE: 1) "KIDS COUNT" OBESITY REDUCTION PROJECT: IN COLLABORATION WITH THE SAUK PRAIRIE SCHOOL DISTRICT, SPMHC HAS DEVELOPED A 5-YEAR PROJECT TARGETED TOWARD 3RD GRADERS TO INCREASE CLASSROOM ACTIVITY, IMPROVE NUTRITION, AND INCREASE PHYSICAL ACTIVITIES. THIS PROJECT HAS NOW EXPANDED TO INCLUDE THE INCOMING 3RD GRADE CLASS AND NEW 4TH GRADERS (LAST YEAR'S 3RD GRADERS).2) WISCONSIN HEIGHTS COMMUNITY GARDEN: SPMHC ORGANIZED LOCAL VOLUNTEERS IN THE WISCONSIN HEIGHTS SCHOOL DISTRICT TO CREATE A 2-ACRE COMMUNITY GARDEN IN AN EFFORT TO IMPROVE ACCESS TO NUTRITIONAL FOOD AND TO RAISE AWARENESS ABOUT THE VALUE OF HEALTHY EATING HABITS. THE INITIAL TARGET NUMBER OF GARDENERS WAS SET AT 10. THIS GOAL WAS FAR EXCEEDED AS THE GARDEN ATTRACTED 30 PARTICIPANTS.3) SAUK PRAIRIE WELLNESS MOVEMENT: THIS GROUP WAS ORIGINALLY FORMED AS THE SAUK PRAIRIE OBESITY REDUCTION COLLABORATION BY PRAIRIE CLINIC, S.C., A LOCAL PRIMARY CARE CLINIC. THE GROUP'S ORIGINAL MISSION TO "WORK TOGETHER AS A COMMUNITY TO CHAMPION THE REDUCTION OF OBESITY IN OUR COMMUNITY" REMAINS INTACT. SINCE THE GROUP'S ORIGINAL MEETING IN OCTOBER 2010, THE GROUP HAS GROWN IN NUMBER OF PARTICIPANTS, CREATED A NEW IDENTITY AS THE WELLNESS MOVEMENT, PARTICIPATED IN A HEALTH NEEDS ASSESSMENT, AND DETERMINED ITS FIRST TWO INITIATIVES, THE KIDS COUNT INITIATIVE (DESCRIBED ABOVE) AND WELLNESS IN THE WORKPLACE. 4) GETTING BETTER PROGRAM: THIS PROGRAM FOCUSES ON MORBIDLY OBESE/CHRONICALLY SYMPTOMATIC ADULTS WHO INDICATE A DESIRE TO CHANGE THEIR CURRENT STATE OF HEALTH. CLINICAL AND BEHAVIORAL DATA OF THE 24 STUDY PARTICIPANTS INDICATES A SIGNIFICANT CHANGE IN BODY MASS INDEX, HGA1C LEVELS, AND A WILLINGNESS TO MAINTAIN CHANGES IN EXERCISE AND DIETARY HABITS.	SAUK PRAIRIE MEMORIAL HOSPITAL, INC.
PART V, SECTION B, LINE 7: AS WITH ALL HEALTHCARE ORGANIZATIONS, ADEQUATE RESOURCES ARE NOT AVAILABLE TO ADDRESS EVERY UNMET HEALTH NEED IN THE COMMUNITIES SPMHC SERVES. SPMHC'S PHILOSOPHICAL POSITION REGARDING THE HEALTH OF THE COMMUNITY IS TO FOCUS ON FEWER, RATHER THAN MANY, INITIATIVES SO THAT THOSE WE WORK ON HAVE A HIGHER CHANCE OF SUCCESS.	SAUK PRAIRIE MEMORIAL HOSPITAL, INC.
PART V, SECTION B, LINE 14G: INFORMATION ABOUT THE POLICY IS INCLUDED ON BILLING INVOICES, ON ADMISSION INFORMATION, ON THE WEBSITE, AND IS REFERENCED IN COLLECTION EFFORTS. IT IS ALSO MENTIONED IN COMMUNITY TALKS OF HEALTH INSURANCE.	SAUK PRAIRIE MEMORIAL HOSPITAL, INC.
PART V, SECTION B, LINE 17E: WE ATTEMPT TO CONTACT THE PATIENT TO SEE IF THEY QUALIFY FOR COMMUNITY CARE. IF WE CANNOT CONTACT THE PATIENT OR IF THE PATIENT HAS OTHER ACCOUNTS IN BAD DEBT, THE ACCOUNTS GO INTO OUR NORMAL COLLECTION PROCESS.	SAUK PRAIRIE MEMORIAL HOSPITAL, INC.
PART V, SECTION B, LINE 20D: THE HOSPITAL FOLLOWS ITS NORMAL PROCEDURES FOR COLLECTION OF THESE ACCOUNTS, INCLUDING DISCOUNTS BASED ON INCOME/ASSET LEVELS, PROMPT PAYMENT, OR MEDICAL INDIGENCE. THE AVERAGE DISCOUNT OF THE THREE LARGEST MANAGED CARE CONTRACTS IS USED TO CALCULATE THE MAXIMUM RATE CHARGED TO FAP ELIGIBLE PATIENTS.	SAUK PRAIRIE MEMORIAL HOSPITAL, INC.
PART V, SECTION B, LINE 22: PATIENTS WITHOUT INSURANCE AND NOT ELIGIBLE FOR FINANCIAL ASSISTANCE ARE GIVEN OPPORTUNITIES FOR DISCOUNTS UNDER INTERNAL PROGRAMS. IF PATIENTS DO NOT AVAIL THEMSELVES OF SUCH OPPORTUNITIES, THEY MAY BE CHARGED THE GROSS CHARGE.	SAUK PRAIRIE MEMORIAL HOSPITAL, INC.
PART VI, LINE 2: SPMHC ENGAGES IN THE FOLLOWING ACTIVITIES TO ASSESS THE HEALTHCARE NEEDS OF THE 42,000 RESIDENTS THROUGHOUT ITS 700 SQUARE MILE PRIMARY SERVICE AREA: - ANALYZE HEALTH STATUS INFORMATION, EPIDEMIOLOGICAL DATA, AND HOSPITAL DISCHARGE DATA FURNISHED BY THE STATE OF WISCONSIN AND SAUK COUNTY TO IDENTIFY ISSUES AND TRENDS.- MEET PERIODICALLY WITH THE COUNTY HEALTH DEPARTMENT AND TWO OTHER NEARBY HOSPITALS TO ASSESS HIGH PRIORITY HEALTH NEEDS AND COORDINATE ACTION.- PARTICIPATE IN AND HELP COORDINATE COUNTY-WIDE INPUT SESSIONS WITH THE COUNTY HEALTH DEPARTMENT.- LEAD AND PARTICIPATE IN COMMUNITY WELLNESS GROUPS AND INITIATIVES THROUGHOUT THE SERVICE AREA.- CONDUCT "COMMUNITY HEALTH NEED" FOCUS GROUPS CONSISTING OF COMMUNITY LEADERS AND RANDOMLY SELECTED RESIDENTS. - ANALYZE THE POPULATION-BASED NEED FOR MEDICAL PROVIDERS BY SPECIALTY. THIS INFORMATION IS ASSESSED AND MODIFIED BY MEMBERS OF THE SPMHC MEDICAL STAFF.- SPMHC LEADER PARTICIPATION AND LEADERSHIP IN CIVIC AND COMMUNITY SERVICE ORGANIZATIONS.- ACTIVELY ENGAGE SPMHC BOARD MEMBERS IN COMMUNITY HEALTH IMPROVEMENT INITIATIVES AND PROVIDE THE BOARD WITH MONTHLY UPDATES REGARDING COMMUNITY HEALTH ACTIVITIES.
PART VI, LINE 3: 1. AT THE TIME OF REGISTRATION, A REGISTRATION SPECIALIST WILL INQUIRE IF THERE IS HEALTH INSURANCE. IF NOT, THEY WILL BE ADVISED OF SPMHC'S COMMUNITY CARE PROGRAM IF THEY RESIDE WITHIN OUR SERVICE AREA OR THOSE WHO HAVE A SAUK PRAIRIE BASED PHYSICIAN WILL ALSO BE CONSIDERED FOR ELIGIBILITY. COMMUNITY CARE INFORMATION IS ALSO POSTED ON THE HOSPITAL WEBSITE AND BILLS STATE THAT IF THE PATIENT IS HAVING DIFFICULTY PAYING THEY SHOULD CONTACT A HOSPITAL REPRESENTATIVE, AS THEY MAY BE ELIGIBLE FOR FREE OR REDUCED FEES.2. ANY PATIENT REQUESTING ADDITIONAL INFORMATION ABOUT THE COMMUNITY CARE PROGRAM WILL BE REFERRED TO THE PATIENT ACCOUNTS SPECIALIST, WHO WILL EXPLAIN THE PROGRAM AND ITS ELIGIBILITY CRITERIA. WHEN APPLICABLE, ALL GOVERNMENT ASSISTANCE PROGRAMS SUCH AS MEDICAL ASSISTANCE, BADGER CARE, AND CRIME VICTIMS MUST BE EXHAUSTED BEFORE APPLYING FOR COMMUNITY CARE (EXCEPTION: THE GOVERNMENT PROGRAM APPLICATION MAY BE WAIVED BASED ON RELIGIOUS BELIEFS). COMMUNITY CARE IS NOT AVAILABLE FOR ELECTIVE PROCEDURES. PERSONS RESIDING IN THE SAUK PRAIRIE MEMORIAL HOSPITAL & CLINICS PRIMARY SERVICE AREA WILL BE CONSIDERED FOR ELIGIBILITY DETERMINATION. IN THE CASE OF EMERGENCY SERVICES, COMMUNITY CARE MAY BE EXTENDED TO THOSE RESIDING OUTSIDE OF THE PRIMARY SERVICE AREA.3. THE INFORMATION IS ALSO POSTED ON OUR WEBSITE UNDER "PREPARING FOR YOUR STAY." IF AT ANY TIME PRIOR TO, DURING, OR AFTER THE SERVICES ARE PROVIDED THE PATIENT EXPRESSED CONCERNS ABOUT PAYMENT, THE COMMUNITY CARE PROGRAM IS EXPLAINED. INFORMATION IS ALSO PRINTED ON PATIENT STATEMENTS AND DISCUSSED WITH THE PATIENT DURING THE BILLING PROCESS.
PART VI, LINE 4: SPMHC'S PRIMARY SERVICE AREA ENCOMPASSES A 700 SQUARE MILE REGION IN RURAL SOUTH CENTRAL WISCONSIN, INCLUDING SAUK, SOUTHERN COLUMBIA, NORTHWEST DANE, NORTHERN IOWA AND EASTERN RICHLAND COUNTIES. THE HOSPITAL IS LOCATED IN SAUK PRAIRIE (COMMON NAME FOR THE NEIGHBORING MUNICIPALITIES OF SAUK CITY AND PRAIRIE DU SAC) AND THE CLINICS ARE LOCATED IN FOUR TOWNS SURROUNDING SAUK PRAIRIE (BLACK EARTH, SPRING GREEN, PLAIN, AND LODI). NO OTHER HOSPITALS ARE LOCATED WITHIN THE PRIMARY SERVICE AREA, HOWEVER, EIGHT INPATIENT HOSPITALS (INCLUDING 5 RURAL AND 3 TERTIARY FACILITIES) ARE LOCATED WITHIN A 30 MILE RADIUS OF SPMHC.DEMOGRAPHIC ANALYSIS INDICATES A 5-YEAR GROWTH RATE OF 2.5% COMPARED TO THE STATE OF WISCONSIN'S RATE OF 1.9%. AGE GROUPS THAT WILL GROW AT A CONSIDERABLY FASTER RATE THAN THE STATE INCLUDE 0-17 YEAR OLDS (1.9%), 25-34 (15.2%), AND 65+ (16.6%). HEALTH ISSUES AFFECTING THESE AGE SEGMENTS INCLUDE PRENATAL SCREENING, TEEN PREGNANCY, LACK OF ACCESS TO HEALTHCARE, AND MEDICAL ISSUES ASSOCIATED WITH AGING.THE AREA HAS LITTLE RACIAL AND ETHNIC DIVERSITY, ALTHOUGH THE NUMBER OF HISPANIC RESIDENTS HAS INCREASED CONSIDERABLY SINCE 2000. SPECIFIC HEALTH-RELATED ISSUES CONFRONTING THIS POPULATION INCLUDE DIABETES, ACCESS TO CARE, AND LANGUAGE BARRIERS.AVERAGE HOUSEHOLD INCOME OF SERVICE AREA RESIDENTS IS 10% HIGHER THAN THE STATE AVERAGE. THIS DIFFERENCE IS DUE IN LARGE PART BECAUSE OF THE RELATIVELY STRONG JOB MARKET IN MADISON, WHICH ATTRACTS COMMUTERS FROM THE SERVICE AREA. THROUGHOUT THE SERVICE AREA AGRICULTURE AND TOURISM REPRESENT A CONSIDERABLE NUMBER OF JOBS, WHICH TYPICALLY ARE LOW-PAYING AND WITHOUT HEALTH BENEFITS.A PORTION OF THE SPMHC PRIMARY SERVICE AREA IS DESIGNATED AS A MEDICALLY UNDERSERVED AREA/POPULATION. THIS AREA IS LOCATED IN THE TOWN OF ARENA (MCD 02575).
PART VI, LINE 5: SPMHC IS AN INDEPENDENT COMMUNITY HOSPITAL GOVERNED BY AN 11-MEMBER BOARD OF DIRECTORS WHO RESIDE WITHIN THE PRIMARY SERVICE AREA. THE BOARD IS ELECTED BY THE 1,200 MEMBER COMMUNITY HOSPITAL ASSOCIATION. AN INDEPENDENT HOSPITAL IS A CRUCIAL PART OF SPMHC'S VISION, BECAUSE IT KEEPS CONTROL AT THE LOCAL LEVEL, NOT IN A CORPORATE HEADQUARTERS LOCATED ELSEWHERE. LOCAL CONTROL ALLOWS THE HOSPITAL TO MAKE DECISIONS THAT ARE BEST FOR THE LOCAL COMMUNITIES.THE SPMHC MEDICAL STAFF PRIVILEGES ALL QUALIFIED PHYSICIANS IN ITS COMMUNITIES. THE VAST MAJORITY OF THE ACTIVE MEDICAL STAFF PRACTICE SOLELY AT THE SAUK PRAIRIE MEMORIAL HOSPITAL OR ASSOCIATED CLINICS. THE SPMHC STRATEGIC PLAN SPECIFICALLY ADDRESS OUR DESIRE TO "IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE" AND THE ORGANIZATION'S EFFORTS TO ASSESS THE NEEDS OF THE COMMUNITY AND ADDRESS THOSE NEEDS. SPMHC PROMOTES COMMUNITY HEALTH THROUGH A BROAD ARRAY OF APPROACHES. THE FOLLOWING LIST DESCRIBES SPECIFIC PROGRAMS AND ACTIVITIES THAT CONTRIBUTE TO IMPROVING THE HEALTH OF THE COMMUNITY AND ENHANCING THE PROVISION OF MEDICAL CARE:- TRAINING MEDICAL STUDENTS, NURSING STUDENTS, AND OTHER HEALTH PROFESSIONS- CONTRIBUTE TIME AND FINANCIAL RESOURCES IN THE DEVELOPMENT OF A DENTAL COLLABORATIVE, WITH OTHER INDIVIDUALS AND ORGANIZATIONS IN THE COMMUNITY, TO OPEN A DENTAL CLINIC WHICH WILL PROVIDE SERVICES TO UNINSURED AND UNDERINSURED MEMBERS OF THE COMMUNITIES SERVED WHO WOULD OTHERWISE NOT HAVE ACCESS OR THE ABILITY TO ACCESS THESE SERVICES ON A REGULAR BASIS- ORGANIZE AND/OR PARTICIPATE IN FREE COMMUNITY HEALTH EDUCATION EVENTS AND SEMINARS- ORGANIZE AND/OR PARTICIPATE IN HEALTH FAIRS- ORGANIZE AND/OR PARTICIPATE IN HEALTH EDUCATION LECTURES AND WORKSHOPS- OFFER CPR/FIRST AID CLASSES- OFFER CHILDBIRTH CLASSES- ISSUE EDUCATIONAL NEWS RELEASES- CONDUCT SCHOOL HEALTH EDUCATION PROGRAMS- CONDUCT SELF-HELP PROGRAMS- CONDUCT COMMUNITY-BASED CLINICAL SCREENINGS (HEARING AID CHECKS, BLOOD PRESSURE AND CHOLESTEROL SCREENING)- CONDUCT IMMUNIZATION CLINICS- PROVIDE SERVICES FOR THE GOOD NEIGHBOR CLINIC- MEDICATION TAKE BACK DAY- MOBILE MEALS- DISCOUNTED EQUIPMENT AND SUPPLIES- TRANSPORTATION TOKENS (FOR LOCAL TAXI)
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	THE GOOD NEIGHBOR CLINIC OF SAUK PRAIRIE INC	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1906 NORTH ST	AddressLine1
City	PRAIRIE DU SAC	City
State	WI	State
ZIP Code	53578	ZIPCode

Field	Value	IRS element (for citing)
EIN Of Recipient	391963290	EINOfRecipient
IRC Section	501(C)3	IRCSection
Amount Of Non Cash Assistance	90792	AmountOfNonCashAssistance
Method Of Valuation	COST	MethodOfValuation
Description Of Non Cash Assistance	MEDICAL SERVICES AND SUPPLIES	DescriptionOfNonCashAssistance
Purpose Of Grant	TO PROVIDE MEDICAL ASSISTANCE TO THOSE WHO NORMALLY COULD NOT AFFORD IT	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 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: SAUK PRAIRIE MEMORIAL HOSPITAL FOLLOWS THE FOLLOWING PROCESS TO PROVIDE ADDITIONAL SUPPLIES TO THE GOOD NEIGHBOR CLINIC ("GNC"): - GNC STAFF REQUESTS PRODUCT FROM MATERIALS STAFF. - IF TOTAL VALUE EXCEEDS $100, MATERIALS STAFF PROVIDES LIST OF PRODUCTS AND ASSOCIATED COSTS (WITHOUT MARK UPS) IN AN E-MAIL TO CFO AND COPY OF EMAIL TO FINANCE & MATERIALS DIRECTORS. - CFO WILL RESPOND BACK TO THE E-MAIL (VIA REPLY TO ALL) INDICATING WHETHER THE REQUEST SHOULD BE BILLABLE OR A CHARITABLE CONTRIBUTION. - MATERIALS STAFF PULLS CENTRAL STORES PRODUCTS AND FORWARDS TO GNC. - IF REQUIRED, PURCHASE ORDER WILL BE CUT FOR NON-STOCK PRODUCTS. - FINANCE USES THE REPLY TO ALL FROM CFO AS INFORMATION REQUIRED FOR BILLING GNC FOR THE PRODUCTS IF REQUIRED. - FINANCE CAN FIND GENERAL LEDGER BREAKDOWNS FOR PRODUCTS VIA A GENERAL LEDGER DISTRIBUTION REPORT FOR GOOD NEIGHBOR CLINIC AS REQUIRED. IF THE REQUEST IS UNDER $100, THE REQUESTS WILL BE PROCESSED THROUGH AND WILL BE CONSIDERED A CHARITABLE CONTRIBUTION. SAUK PRAIRIE MEMORIAL HOSPITAL ALSO PROVIDES A SIGNIFICANT AMOUNT OF MEDICAL SERVICES TO PATIENTS OF THE GOOD NEIGHBOR CLINIC. THE HOSPITAL RELIES UPON THE INCOME REQUIREMENTS SCREENING PROCESS BY THE GOOD NEIGHBOR CLINIC TO REFER PATIENTS IN NEED OF FREE CARE FOR SERVICES.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Travel For Companions	X	TravelForCompanions
Written Policy Re T And E Expenses	1	WrittenPolicyReTAndEExpenses
Substantiation Required	1	SubstantiationRequired
Compensation Committee	X	CompensationCommittee
Independent Consultant	X	IndependentConsultant
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	1	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	1	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 (11 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
ROBERTA BOS
VP, HUMAN RESOURCES	132192	0	8500	0	137	0	6711	0	8658	0	156198	0	0	0
CAROL MAY
VP, FINANCE & OPERATIONS	174177	0	10650	0	614	0	8972	0	10529	0	204942	0	0	0
LARRY SCHROEDER
CEO	269483	0	29925	0	29646	0	12500	0	11152	0	352706	0	0	0
KENNETH CARLSON
VP, PLANNING & BUSINESS DE	137992	0	9605	0	166	0	7359	0	4330	0	159452	0	0	0
CARLA PECK
VP, QUALITY & COMPLIANCE	124000	0	7920	0	7508	0	6618	0	8324	0	154370	0	0	0
MARGARET SHEEKS
VP, PATIENT SERVICES	134985	0	8821	0	413	0	6653	0	8411	0	159283	0	0	0
MARK STARR
ANESTHESIA-CRNA	228044	0	939	0	11755	0	11321	0	9459	0	261518	0	0	0
MILES MORGAN
ER PHYSICIAN	291522	0	0	0	0	0	12500	0	8894	0	312916	0	0	0
LINDA YOUNGREN
ER PHYSICIAN	286973	0	0	0	0	0	12500	0	10626	0	310099	0	0	0
ERIC WARBASSE
ER PHYSICIAN	278258	0	0	0	0	0	10210	0	10939	0	299407	0	0	0
SUSAN TORHORST
ER PHYSICIAN	244510	0	0	0	0	0	12002	0	10873	0	267385	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReference	ExplanationExplanation
PART I, LINE 1A	IN 2012, THE BOARD HAS APPROVED A POLICY TO COMPENSATE THE CEO FOR THE TRAVEL OF HIS/HER SPOUSE FOR SPMHC RELATED BUSINESS ACTIVITY. THE CEO WILL BE COMPENSATED FOR REASONABLE TRAVEL EXPENSES INCURRED BY HIS SPOUSE. BOARD APPROVAL NEEDS TO BE RECEIVED PRIOR TO MAKING THE TRAVEL ARRANGEMENTS. THE COST OF ANY SUCH TRAVEL REIMBURSEMENTS ARE ADDED TO THE CEO'S W-2 FOR TAX REPORTING PURPOSES ALSO.
PART I, LINE 4B	THE FOLLOWING OFFICERS, DIRECTORS, AND EMPLOYEES PARTICIPATE IN THE HOSPITALS 457B DEFERRED COMPENSATION PLAN: CAROL MAY, LARRY SCHROEDER, MARGARET SHEEKS, AND MARK STARR.
PART I, LINE 6	SPMHC HAS AN INCENTIVE PAYMENT PLAN THAT ONLY GOES INTO EFFECT IF NET EARNINGS (OPERATING INCOME) IS 95% OR GREATER THAN THE BUDGETED AMOUNT. THEN, DEPENDING ON WHETHER QUALITY, SAFETY, AND OTHER MANAGEMENT GOALS ARE MET, INCENTIVE PAY MAY BE AWARDED. AN AMOUNT IS BUDGETED BASED ON THE FTE'S OF THE ORGANIZATION AND ATTAINING THESE GOALS. A LESSER AMOUNT MAY ALSO BE PAID OUT UNDER THE INCENTIVE PAYMENT PLAN IF THE NET EARNINGS (OPERATING INCOME) IS BETWEEN 80% TO 95% OF THE BUDGETED AMOUNT.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	SURGICAL ASSOCIATES OF SAUK PRAIRIE LLP	BusinessNameLine1

Field	Value	IRS element (for citing)
Relationship	DR. DEGIOVANNI IS A BOARD MEMBER OF SPMHC AND ALSO A GREATER THAN 5% OWNER.	Relationship
Amount Of Transaction	38421	AmountOfTransaction
Description Of Transaction	LEASE OF HOSPITAL SPACE FOR OPERATION OF PHYSICIAN CLINIC.	DescriptionOfTransaction
Sharing Of Revenues	0	SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6	ANNUAL MEMBERSHIP WILL BE CONFERRED FOR ONE YEAR UPON PERSONS CONTRIBUTING THE SUM OF TEN DOLLARS TO THE CORPORATION AND/OR THE SAUK PRAIRIE MEMORIAL HOSPITAL FOUNDATION. LIFE MEMBERSHIP WILL BE CONFERRED UPON PERSONS CONTRIBUTING THE SUM OF ONE HUNDRED DOLLARS TO THE CORPORATION AND/OR SAUK PRAIRIE MEMORIAL HOSPITAL FOUNDATION. TWO LIFE MEMBERSHIPS WILL BE CONFERRED UPON TWO PERSONS CONTRIBUTING THE SUM OF TWO HUNDRED DOLLARS OR MORE TO THE CORPORATION AND/OR SAUK PRAIRIE MEMORIAL HOSPITAL FOUNDATION.
FORM 990, PART VI, SECTION A, LINE 7A	AN ANNUAL AND LIFE MEMBERSHIP SHALL BE ENTITLED TO ONE VOTE AT THE ANNUAL MEETING OR AT ANY SPECIAL MEETINGS OF THE MEMBERSHIP. THOSE WITH LIFE MEMBERSHIPS MAY ALSO HOLD OFFICE AS A DIRECTOR OF THE CORPORATION OR SERVE ON A COMMITTEE. MEMBERS MAY VOTE ON ELECTIONS OF BOARD MEMBERS, CHANGES TO THE BYLAWS, AND OTHER BUSINESS ALLOWED BY LAW.
FORM 990, PART VI, SECTION B, LINE 11	THE BOARD OF DIRECTORS REVIEWS THE 990 AT ITS MONTHLY MEETING PRIOR TO SUBMISSION. IN THE EVENT MEETING AND DUE DATES ARE SUCH THAT THIS IS NOT POSSIBLE, THE BOARD WILL REVIEW AT THE FIRST MEETING AFTER SUBMISSION.
FORM 990, PART VI, SECTION B, LINE 12C	SINCE SAUK PRAIRIE MEMORIAL HOSPITAL IS A PART OF A SMALL COMMUNITY, CONFLICTS ARE GENERALLY KNOWN, IF NOT DISCLOSED THROUGH THE ANNUAL PROCESS CONDUCTED BY HUMAN RESOURCES. THE ANNUAL PROCESS INCLUDES ALL DIRECTOR LEVEL EMPLOYEES AND ABOVE OF THE HOSPITAL. THE BOARD OF DIRECTORS HAS A CONFLICT OF INTEREST POLICY AND MUST ANNUALLY SIGN A DISCLOSURE FORM STATING ANY POTENTIAL CONFLICTS OF INTEREST. THE BOARD PRESIDENT THEN DISCLOSES ANY CONFLICTS TO THE FULL BOARD OF DIRECTORS. CONFLICT OF INTEREST STATEMENTS COMPLETED BY BOARD MEMBERS ARE REVIEWED BY THE BOARD PRESIDENT AND EMPLOYEE'S CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY STAFF LEADERSHIP AND/OR ADMINISTRATION. THESE INDIVIDUALS ARE CHARGED WITH THE RESPONSIBILITY OF ENSURING THAT BUSINESS IS CONDUCTED IN A MANNER THAT ADHERES TO THE ORGANIZATION'S FORMALLY APPROVED CONFLICT OF INTEREST POLICY.
FORM 990, PART VI, SECTION B, LINE 15	THE BOARD OF DIRECTORS HAS ESTABLISHED POLICY BSR-14 TO ESTABLISH ITS COMPENSATION PHILOSOPHY WITH RESPECT TO EXECUTIVE COMPENSATION AND TO DEFINE PRACTICES ASSOCIATED IN ACCORDANCE WITH IRC 4958. SPMHC EXECUTIVE SALARY IS SET ANNUALLY CONSIDERING COMPENSATION LEVELS AT SIMILARLY SITUATED ORGANIZATIONS (TYPICALLY NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS IN OUR REVENUE CATEGORY). THE EXECUTIVE COMMITTEE IS RESPONSIBLE FOR SETTING SALARY FOR THE CEO BASED ON THE CEO'S JOB PERFORMANCE. THE COMMITTEE RELIES UPON COMPARABILITY DATA DEVELOPED BY OUTSIDE CONSULTANTS TO SUPPORT ITS DECISION MAKING PROCESS AND TO ENSURE COMPETITIVE SALARY LEVELS. THE BOARD REVIEWS BSR-14 ANNUALLY AT THE GOVERNANCE COMMITTEE. COMPENSATION FOR OTHER KEY EMPLOYEES IS ESTABLISHED BY APPLICATION OF SPMHC'S COMPENSATION PHILOSOPHY, WHEREIN RATES OF PAY ARE COMPARED TO MARKET RATES OBTAINED THROUGH PARTICIPATION IN WAGE AND BENEFIT SURVEYS. PAY RANGES ARE OBTAINED FROM SURVEYS OF SIMILARLY SITUATED HOSPITALS LOCATED WITHIN THE STATE OF WISCONSIN IN TERMS OF SIZE AND REVENUE CATEGORY. SPMHC ADOPTED A "MEET THE MARKET" APPROACH TO COMPENSATION FOR POSITIONS AT THESE LEVELS. THIS MEANS THAT SPMHC TARGETS THE MIDPOINT OF THE PAY RANGE ASSOCIATED WITH EACH POSITION.
FORM 990, PART VI, SECTION C, LINE 19	THE ABBREVIATED FINANCIAL STATEMENTS ARE A PART OF THE HOSPITAL'S ANNUAL REPORT PRESENTED TO THE PUBLIC AT THE ANNUAL MEETING AND POSTED ON THE HOSPITAL'S WEBSITE. THE ABBREVIATED FINANCIAL STATEMENTS ARE ALSO MADE PUBLICLY AVAILABLE THROUGH THE WISCONSIN HOSPITAL ASSOCIATION. THE HOSPITAL'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:	CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 3,467,448. CONTRIBUTION FROM RELATED ORGANIZATION -4,567,600.	CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2C	THE ORGANIZATION ANSWERED "YES" TO QUESTION 2C UNDER PART XI OF THE 990, INDICATING THAT THE ORGANIZATION DOES HAVE A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE FULL BOARD OF DIRECTORS REVIEWS THE FINANCIAL STATEMENTS AND HEARS THE AUDIT FIRM PRESENTATION. THE FOLLOWING PROCESS WAS IMPLEMENTED BY THE BOARD FOR REVIEW OF THE AUDIT FIRM. FOR AUDIT FIRM SELECTION, A REQUEST FOR PROPOSAL IS PREPARED, INTERNAL STAFF SELECTS THE TOP TWO OR THREE CANDIDATES, AND THE FINANCE AND AUDIT COMMITTEE RECOMMENDS AN AUDIT FIRM TO THE FULL BOARD. BASED ON THE PROPOSAL RESPONSES AND INTERVIEWS/PRESENTATIONS BY THE AUDIT FIRMS, THE FULL BOARD OF DIRECTORS THEN VOTES BASED ON THIS RECOMMENDATION AND SELECTS THE INDEPENDENT ACCOUNTING FIRM. THERE WAS NO CHANGE TO THIS PROCESS IN 2012.	SELECTION OF INDEPENDENT ACCOUNTANT

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Direct Controlling Entity NADirectControllingEntityNA	Controlled OrgControlledOrg
SAUK PRAIRIE MEMORIAL HOSPITAL FOUNDATION LTD
80 FIRST STREET	PRAIRIE DU SAC	WI	53578	930841113	FUNDRAISING	WI	501(C)3	LINE 9	N/A	0
FRIENDS OF SAUK PRAIRIE MEMORIAL HOSPITAL
80 FIRST STREET	PRAIRIE DU SAC	WI	53578	391453754	VOLUNTEERING	WI	501(C)3	LINE 11 - TYPE III	N/A	0

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	1	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	1	PerformOfServicesByOtherOrgs
Sharing Of Facilities	1	SharingOfFacilities
Sharing Of Paid Employees	1	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

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
SAUK PRAIRIE MEMORIAL HOSPITAL FOUNDATION LTD
C	4567600	FAIR MARKET VALUE
SAUK PRAIRIE MEMORIAL HOSPITAL FOUNDATION LTD
O	44327	COST