ASCENSION CALUMET HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- ASCENSION CALUMET HOSPITAL INC (EIN 39-0905385)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-13
- IRS object ID
- 201312259349302896
- Schema version
- 2011v1.5
- 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 J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-13T16:03:05-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390758449 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12237 | AddressLine1 |
| City | GREEN BAY | City |
| State | WI | State |
| ZIP Code | 543072237 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390905385 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALUMET MEDICAL CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CALU | NameControl |
| Phone | 9208492386 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 614 MEMORIAL DR | AddressLine1 |
| City | CHILTON | City |
| State | WI | State |
| ZIP Code | 53014 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JEFF BADGER | Name |
| Title | CFO | Title |
| Phone | 9208497544 | Phone |
| Date Signed | 2013-08-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TERRI REXRODE CPA MST | Name |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | Phone |
| Date Prepared | 2013-08-13 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JEFF BADGER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 614 MEMORIAL DR | AddressLine1 |
| City | CHILTON | City |
| State | WI | State |
| ZIP Code | 53014 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 22450578 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.AFFINITYHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1954 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | CALUMET MEDICAL CENTER PROUDLY SERVES THE CALUMET COUNTY AREA WITH A HISTORY OF MORE THAN A HALF CENTURY OF QUALITY CARE. THE FACILITY PROVIDES TOTAL HEALTH CARE, INCLUDING EMERGENCY/TRAUMA AND SURGICAL SERVICES AS WELL AS MANY MEDICAL SPECIALTIES. WITH 25 PATIENT BEDS, CALUMET MEDICAL CENTER TREATS PATIENTS WITH DIGNITY AND COMPASSION. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 243 | TotalNbrEmployees |
| Total Nbr Volunteers | 79 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 244103 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 90313 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 22722680 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 22180155 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 159043 | InvestmentIncomePriorYear |
| Investment Income Current Year | 118233 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 31100 | OtherRevenuePriorYear |
| Other Revenue Current Year | 36483 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 23156926 | TotalRevenuePriorYear |
| Total Revenue Current Year | 22425184 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 12070945 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11760748 | 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 | 9521610 | OtherExpensePriorYear |
| Other Expenses Current Year | 9413539 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 21592555 | TotalExpensesPriorYear |
| Total Expenses Current Year | 21174287 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1564371 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1250897 | RevenuesLessExpensesCY |
| Total Assets BOY | 23570362 | TotalAssetsBOY |
| Total Assets EOY | 24067757 | TotalAssetsEOY |
| Total Liabilities BOY | 3248309 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2310504 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 20322053 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 21757253 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | CALUMET MEDICAL CENTER HAS ADOPTED THE MISSION STATEMENT OF AFFINITY HEALTH SYSTEM. THE MISSION OF AFFINITY HEALTH SYSTEM IS TO LIVE OUT THE HEALING MINISTRY OF CHRIST BY PROVIDING SERVICES THAT PROMOTE THE HEALTH AND WELL-BEING OF THE COMMUNITIES WE SERVE, ESPECIALLY THE POOR. | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 16593608 | Expense |
| Revenue | 22180155 | Revenue |
| Description | CALUMET MEDICAL CENTER, INC. OPERATES A 25 BED CRITICAL ACCESS HOSPITAL FACILITY PROVIDING MEDICAL, SURGICAL, EMERGENCY, OUTPATIENT, CLINIC, HOSPICE, AND HOME HEALTH SERVICES TO RESIDENTS IN CALUMET COUNTY REGARDLESS OF ABILITY TO PAY. THE EMERGENCY DEPARTMENT INCLUDES 24 HOUR A DAY/7 DAYS A WEEK EMERGENCY PHYSICIAN COVERAGE, SERVING 4,642 PATIENTS IN 2012, WITH 6,953 PROCEDURES PERFORMED. THE EMERGENCY DEPARTMENT ALSO OFFERS WALK-IN CLINIC SERVICES FOR AFTER DOCTOR'S OFFICE HOURS. THE SURGERY DEPARTMENT PERFORMED 652 PROCEDURES IN 2012, 617 ENDOSCOPIES, AND 1,228 ONE DAY SURGERIES. THE RADIOLOGY DEPARTMENT CONDUCTED 10,204 TESTS IN 2011. THE RADIOLOGY DEPARTMENT CONDUCTED 8,868 TESTS IN 2012. RADIOLOGY DEPARTMENT SERVICES INCLUDE RADIOLOGY, MRI, DIGITAL MAMMOGRAPHY, CT SCANS, ULTRASOUNDS, DEXASCAN, AND NUCLEAR MEDICINE. | Description |
| Total Program Service Expense | 16593608 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 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 | 0 | 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 | 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 |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 20 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 243 | 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 | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | 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 | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 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 | TIMOTHY RICHMAN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9208497550 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 614 MEMORIAL DRIVE | AddressLine1 |
| City | CHILTON | City |
| State | WI | State |
| ZIP Code | 53014 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| WAYNE WIETING | |||||||
| CHAIRPERSON | 0.30 | X | X | 0 | 0 | 0 | |
| DANIEL NEUFELDER | |||||||
| VICE CHAIRPERSON/CEO - AHS | 2.30 | X | X | 42186 | 857305 | 94160 | |
| JAMES BURNETT | |||||||
| TREASURER | 0.30 | X | X | 0 | 0 | 0 | |
| ALLAN UTECHT | |||||||
| SECRETARY | 0.30 | X | X | 0 | 0 | 0 | |
| PETER JANU MD | |||||||
| DIRECTOR | 0.30 | X | 0 | 505366 | 44954 | ||
| GENE TIPLER MD | |||||||
| DIRECTOR | 0.30 | X | 0 | 257988 | 46819 | ||
| JANE GEHL | |||||||
| DIRECTOR | 0.30 | X | 0 | 0 | 0 | ||
| TRAVIS ANDERSEN | |||||||
| DIRECTOR | 0.30 | X | 0 | 354322 | 52189 | ||
| CRAIG OLSON MD | |||||||
| DIRECTOR | 0.30 | X | 0 | 0 | 0 | ||
| TIMOTHY RICHMAN | |||||||
| PRESIDENT & CEO | 40.00 | X | 216634 | 0 | 41610 | ||
| JEFF BADGER | |||||||
| CFO - AHS | 2.00 | X | 21587 | 438706 | 69379 | ||
| JENNIFER LEIGH MEDIN WEBER | |||||||
| DIRECTOR PATIENT SUPPORT | 40.00 | 125785 | 0 | 28707 | X | ||
| JUDITH ARCHE STRODTHOFF | |||||||
| MANAGER INPATIENT SERVICES | 40.00 | 107947 | 0 | 22970 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 514139 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2413687 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 400788 | TotalOtherCompensation |
| Number Individuals GT100 K | 2 | 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 |
|---|---|---|---|---|---|
| AFFINITY MEDICAL GROUP | |||||
| 222 W COLLEGE AVE | APPLETON | WI | 54915 | PROFESSIONAL SERVICES | 1732953 |
| ACUTE CARE INC | |||||
| 1609 N ANKENY BLVD SUITE 200 | ANKENY | IA | 50023 | PROFESSIONAL SERVICES | 1078148 |
| ST ELIZABETH HOSPITAL | |||||
| 222 W COLLEGE AVE | APPLETON | WI | 54915 | PROFESSIONAL SERVICES | 549597 |
| NXC IMAGING | |||||
| 2118 4TH AVE SOUTH | MINNEAPOLIS | MN | 55404 | IMAGING SERVICES | 355995 |
| MERCY MEDICAL CENTER | |||||
| 222 W COLLEGE AVE | APPLETON | WI | 54915 | PROFESSIONAL SERVICES | 168886 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 9 | NumberOfContractorsGT100K |
| Related Organizations | 45128 | RelatedOrganizations |
| All Other Contributions | 45185 | AllOtherContributions |
| Total Contributions | 90313 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE REVENU | 621110 | 21932913 | 21932913 |
| OTHER OPERATING REVENU | 621110 | 186271 | 186271 |
| MISCELLANEOUS REVENUE | 621110 | 60971 | 60971 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 22180155 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 117233 | TotalRevenueColumn |
| Exclusion | $117,233 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 61877 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 25394 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 36483 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 36483 | TotalRevenueColumn |
| Exclusion | $36,483 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1000 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1000 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1000 | TotalRevenueColumn |
| Exclusion | $1,000 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 22425184 | TotalRevenueColumn |
| Related Or Exempt Function Income | 22180155 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $154,716 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 329686 | Total |
| Management And General | 329686 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8726364 | Total |
| Program Services | 6846224 | ProgramServices |
| Management And General | 1880140 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 235239 | Total |
| Program Services | 184663 | ProgramServices |
| Management And General | 50576 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1864713 | Total |
| Program Services | 1484273 | ProgramServices |
| Management And General | 380440 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 604746 | Total |
| Program Services | 474726 | ProgramServices |
| Management And General | 130020 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20200 | Total |
| Management And General | 20200 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3847324 | Total |
| Program Services | 3204723 | ProgramServices |
| Management And General | 642601 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20468 | Total |
| Management And General | 20468 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3340807 | Total |
| Program Services | 2797440 | ProgramServices |
| Management And General | 543367 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6793 | Total |
| Program Services | 6603 | ProgramServices |
| Management And General | 190 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 514485 | Total |
| Program Services | 347277 | ProgramServices |
| Management And General | 167208 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 86030 | Total |
| Program Services | 45326 | ProgramServices |
| Management And General | 40704 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 870252 | Total |
| Program Services | 587420 | ProgramServices |
| Management And General | 282832 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58020 | Total |
| Management And General | 58020 | ManagementAndGeneral |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 594264 | 594264 | |
| DUES AND LICENSES | 54896 | 20669 | 34227 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21174287 | Total |
| Program Services | 16593608 | ProgramServices |
| Management And General | 4580679 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1442 | BOY |
| EOY | 1550 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7516419 | BOY |
| EOY | 8083038 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3384256 | BOY |
| EOY | 3896030 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45229 | BOY |
| EOY | 46680 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 18350895 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 12773669 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5555308 | BOY |
| EOY | 5577226 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6466840 | BOY |
| EOY | 6217308 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 600868 | BOY |
| EOY | 245925 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23570362 | BOY |
| EOY | 24067757 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2960938 | BOY |
| EOY | 2012080 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 287371 | BOY |
| EOY | 298424 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3248309 | BOY |
| EOY | 2310504 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20322053 | BOY |
| EOY | 21757253 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20322053 | BOY |
| EOY | 21757253 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23570362 | BOY |
| EOY | 24067757 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1250897 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 184303 | 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 |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| 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 | $1,268 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 1268 | 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 | THE LOBBYING PORTION OF WHA DUES | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9352 | OtherCostOrOtherBasis |
| Book Value | 9352 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10271068 | OtherCostOrOtherBasis |
| Depreciation | 7116134 | Depreciation |
| Book Value | 3154934 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 224588 | OtherCostOrOtherBasis |
| Depreciation | 189811 | Depreciation |
| Book Value | 34777 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7845887 | OtherCostOrOtherBasis |
| Depreciation | 5467724 | Depreciation |
| Book Value | 2378163 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 5577226 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ACC RETIREMENT OBLIGATION | $59,208 |
| ACCUMULATED ACCRETION | $239,216 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 298424 | TotalOfAmounts |
| Total Revenue | 22425184 | TotalRevenue |
| Total Expenses | 21174287 | TotalExpenses |
| Excess Or Deficit For Year | 1250897 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 185166 | NetUnrealizedGLOnInvestments |
| Other | -$863 | OtherAmount |
| Total Adjustments | 184303 | TotalAdjustments |
| Excess Or Deficit Per FS | 1435200 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 22388127 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 25394 | OtherRevenues |
| Revenue Not Rptd F990 | 25394 | RevenueNotRptdF990 |
| Revenue Subtotal | 22362733 | RevenueSubtotal |
| Other Revenues Not Included | 62451 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 62451 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 22425184 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 21199681 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 25394 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 25394 | ExpensesNotRptdF990 |
| Expenses Subtotal | 21174287 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 21174287 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | MINISTRY RECOGNIZES THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. EXAMPLES OF TAX POSITIONS FOR MINISTRY'S NOT-FOR-PROFIT CORPORATIONS INCLUDE THEIR TAX-EXEMPT STATUS AND VARIOUS POSITIONS RELATED TO THE POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50 PERCENT LIKELIHOOD OF BEING RECOGNIZED UPON ULTIMATE SETTLEMENT. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | RECOGNIZED DEFERRED INCOME -38,809. WORKERS COMPENSATION ADJUSTMENT 121,164. FMV ADJUSTMENT OF ASSETS -83,218. TOTAL TO SCHEDULE D, PART XI, LINE 8: -863. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSE IN REVENUE 25,394. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | CAPITAL CONTRIBUTIONS 62,451. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSE IN REVENUE 25,394. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 662.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 112 | PersonsServed |
| Total Community Benefit Expense | 148094 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 148094 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00720 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1059 | PersonsServed |
| Total Community Benefit Expense | 637103 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 637103 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03100 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1171 | PersonsServed |
| Total Community Benefit Expense | 785197 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 785197 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03820 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 1804 | PersonsServed |
| Total Community Benefit Expense | 108995 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1500 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 107495 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00520 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 42 | PersonsServed |
| Total Community Benefit Expense | 22895 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 22895 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 450 | PersonsServed |
| Total Community Benefit Expense | 15938 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 15938 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 8 | NumberOfActivitiesOrPrograms |
| Persons Served | 2296 | PersonsServed |
| Total Community Benefit Expense | 147828 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1500 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 146328 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00710 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 8 | NumberOfActivitiesOrPrograms |
| Persons Served | 3467 | PersonsServed |
| Total Community Benefit Expense | 933025 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1500 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 931525 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04530 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Environmental Improvements EnvironmentalImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 139 | PersonsServed |
| Total Community Building Expense | 2875 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 2875 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 139 | PersonsServed |
| Total Community Building Expense | 2875 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2875 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $594,264 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 11720993 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11304845 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 416148 | 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 | CALUMET MEDICAL CENTER INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 614 MEMORIAL DRIVE | AddressLine1 |
| City | CHILTON | City |
| State | WI | State |
| ZIP Code | 53014 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALUMET MEDICAL CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 662.000000000000 | 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 In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Lowest Negotiated Rates | X | LowestNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: IT IS THE POLICY OF THE ORGANIZATION TO PROVIDE MEDICALLY NECESSARY HEALTH CARE SERVICES TO PEOPLE IN THE COMMUNITIES IT SERVES, REGARDLESS OF THEIR ABILITY TO PAY. AFFINITY CARE FINANCIAL ASSISTANCE IS GRANTED BASED UPON THE PATIENT'S INABILITY TO PAY AND TO INDIVIDUALS WHO ARE UNINSURED, UNDERINSURED OR MEDICALLY INDIGENT. AFFINITY CARE WORKS IN COLLABORATION WITH OTHER FINANCIAL (BOTH PUBLIC AND PRIVATE) ASSISTANCE PROGRAMS. THIS IS TO ENSURE HOLISTIC WELLNESS OF PATIENTS BY FACILITATING KNOWLEDGE OF AVAILABLE SERVICES AND PROGRAMS FOR HEALTH WHILE PRACTICING GOOD STEWARDSHIP OF FUNDS. KEY CRITERIA UTILIZED TO DETERMINE ELIGIBILITY FOR AFFINITY CARE FINANCIAL ASSISTANCE INCLUDES FAMILY SIZE, FEDERAL POVERTY INCOME GUIDELINES AND AVAILABLE ASSETS. THE AVAILABLE ASSET TEST INCLUDES CONSIDERATION OF THE AMOUNT OF EQUITY IN A HOME, AUTOMOBILES, AND SAVINGS ACCOUNTS WHICH ARE CONSIDERED PART OF TOTAL ALLOWABLE INCOME WHEN ASSESSING AGAINST THE FEDERAL POVERTY INCOME GUIDELINES. | ||
| PART I, LINE 7: AMOUNTS CALCULATED IN PART I, LINE 7 ARE DETERMINED BOTH ON A COST ACCOUNTING SYSTEM AND A COST-TO-CHARGE RATIO. OTHER BENEFITS ARE DETERMINED BASED ON THE DIRECT AND INDIRECT COSTS (WHERE ALLOCATED) ASSOCIATED WITH A PROGRAM NET OF EARNED REVENUE. DETAIL FOR EACH PROGRAM/ACTIVITY IS MAINTAINED AND DETERMINED AT THE DEPARTMENT LEVEL. CHARITY CARE AND MEANS-TESTED PROGRAMS ARE DETERMINED BASED ON A COST-TO-CHARGE RATIO CONSISTENT WITH WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES. PRIOR YEAR COST REPORT SETTLEMENTS ARE EXCLUDED FROM THE SHORTFALL CALCULATION IN ORDER TO GET A TRUE FISCAL YEAR SHORTFALL AMOUNT. | ||
| PART I, L7 COL(F): BAD DEBT EXPENSE OF $594,264 INCLUDED ON FORM 990, PART IX, LINE 25 WAS EXCLUDED FROM THE DENOMINATOR PER INSTRUCTIONS WHEN CALCULATING THE PERCENT OF TOTAL EXPENSES ON SCHEDULE H. | ||
| PART II: COMMUNITY-BUILDING ACTIVITIES INCLUDE PROGRAMS THAT, WHILE NOT DIRECTLY RELATED TO HEALTH CARE, PROVIDE OPPORTUNITIES TO ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS, SUCH AS POVERTY, HOMELESSNESS, AND ENVIRONMENTAL PROBLEMS. THESE ACTIVITIES SUPPORT COMMUNITY ASSETS BY OFFERING THE EXPERTISE AND RESOURCES OF THE ORGANIZATION. COSTS FOR THESE ACTIVITIES INCLUDE CASH, IN-KIND DONATIONS, AND EXPENDITURES FOR THE DEVELOPMENT OF A VARIETY OF COMMUNITY HEALTH PROGRAMS AND PARTNERSHIPS. ANOTHER EXAMPLE IS HEALTH CAREER PRESENTATIONS IN WHICH PROFESSIONALS FROM CALUMET MEDICAL CENTER GO TO CAREER CLASSES AT AREA HIGH SCHOOLS AND UNIVERSITIES TO TALK ABOUT THEIR PROFESSIONS (I.E. PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, CARDIAC & PULMONARY REHAB) | ||
| PART III, LINE 4: NO FOOTNOTE EXISTS IN THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBE BAD DEBT EXPENSE. BAD DEBT EXPENSE IS RECORDED IN A CONSISTENT MANNER WITH THE ORGANIZATION'S COLLECTION POLICIES. BAD DEBT EXPENSE INCLUDES ACCOUNTS WHICH ARE WRITTEN OFF AND ESTIMATES MADE ON LIVE ACCOUNTS BASED ON HISTORICAL PAYMENT TRENDS AND ACCOUNT MODELING.A NUMBER OF PATIENTS ARE TRULY UNABLE TO PAY THEIR OUT-OF-POCKET LIABILITY, BUT DO NOT COMPLETE THE PROCESS REQUIRED TO APPLY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S AFFINITY CARE POLICY. THESE PATIENTS WOULD QUALIFY FOR AFFINITY CARE IF THEY COMPLETED THE CHARITY APPLICATION, SO THE BAD DEBT EXPENSE ASSOCIATED WITH TREATING THEM SHOULD BE TREATED AS COMMUNITY BENEFIT. THE ORGANIZATION DOES RESERVE THE RIGHT TO PRESUME ELIGIBILITY BASED ON ADMINISTRATIVE REVIEW TO HELP IDENTIFY INDIGENT PATIENTS AND MINIMIZE THE INSTANCES OF WHEN THEY BECOME A BAD DEBT. THE ADMINISTRATIVE REQUIREMENTS TO DETERMINE WHETHER PATIENTS WHO DO NOT COOPERATE WITH THE FINANCIAL ASSISTANCE PROCESS WOULD HAVE QUALIFIED FOR CHARITY CAN BE BURDENSOME, PARTICULARLY FOR SMALL BALANCES. | ||
| PART III, LINE 9B: CALUMET MEDICAL CENTER HAS A DEBT COLLECTION POLICY WHICH SETS FORTH COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO QUALIFY OR MAY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE CHARITY CARE PROGRAM. SUFFICIENT FINANCIAL COUNSELING SUPPORT IS MADE AVAILABLE TO PATIENTS SO THEY CAN EASILY ACCESS PATIENT FINANCIAL SERVICE REPRESENTATIVES AND HAVE THEIR QUESTIONS ANSWERED, AND GAIN AN UNDERSTANDING OF THE REASONS WHY THEY OWE A BALANCE. ACCOUNTS ARE DESIGNATED AS CHARITY CARE IN THE BUSINESS OFFICES SO NO ADDITIONAL TIME IS SPENT ON COLLECTION EFFORTS. | ||
| PART V, SECTION B, LINE 9: ANYONE AT 200% POVERTY GUIDELINES IS ELIGIBLE FOR FREE CARE. | CALUMET MEDICAL CENTER, INC. | |
| PART V, SECTION B, LINE 10: ANYONE BETWEEN 200-662% OF POVERTY GUIDELINES AND OTHER CRITERION IS ELIGIBLE FOR DISCOUNTED CARE BASED ON A SLIDING SCALE. | CALUMET MEDICAL CENTER, INC. | |
| PART VI, LINE 2: CALUMET MEDICAL CENTER PERFORMS COMMUNITY NEEDS ASSESSMENTS AS NEEDED. WHEN A NEED IS IDENTIFIED, THE HOSPITAL DEVELOPS A PLAN TO IMPLEMENT A PROGRAM EITHER THROUGH COMMUNITY COLLABORATION OR INDIVIDUALLY. OUTCOMES FROM THE PROGRAMS ARE MEASURED AND CONSIDERED IN SUBSEQUENT COMMUNITY NEEDS ASSESSMENTS. COMMUNITY BENEFIT PLANS ARE PRESENTED TO SENIOR LEADERSHIP AND BOARD MEMBERS TO ENSURE THE FINDINGS ARE INCORPORATED INTO THE ORGANIZATION'S STRATEGY AND POLICY DEVELOPMENT. FOR EXAMPLE, SENIOR LEADERS ARE REQUIRED TO PROVIDE DIRECT SERVICE HOURS TO THE POOR AS PART OF THEIR PERFORMANCE GOALS. | ||
| PART VI, LINE 3: CALUMET MEDICAL CENTER GOES TO GREAT LENGTHS IN ORDER TO INFORM AND EDUCATE PATIENTS/PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS AND UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE FINANCIAL ASSISTANCE POLICY AND APPLICATION IS POSTED ON THE ORGANIZATION'S WEBSITE. ADMISSIONS AND OTHER KEY AREAS CONTAIN SUMMARY INFORMATION OF THE FINANCIAL ASSISTANCE POLICY. AS PART OF THE INTAKE/DISCHARGE PROCESS, PATIENTS ARE PROVIDED WITH A COPY OF THE BROCHURE AND OTHER INFORMATION FOR FINANCIAL ASSISTANCE. IF DURING THE COURSE OF THE PATIENT REGISTRATION PROCESS, CARE ENCOUNTER, TREATMENT, OR UPON DISCHARGE IT BECOMES EVIDENT THAT A PATIENT MAY NEED FINANCIAL ASSISTANCE; THE PATIENT SHALL BE REFERRED TO CALUMET MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM. PATIENTS MAY BE IDENTIFIED AS NEEDING FINANCIAL ASSISTANCE AT ANY TIME DURING THE COURSE OF AN ENCOUNTER. A REFERRAL FOR CONSIDERATION OF FINANCIAL ASSISTANCE CAN BE INITIATED BY ANY MEMBER OF THE HOSPITAL'S WORKFORCE, INCLUDING MEDICAL STAFF MEMBERS, WHO BECOME AWARE OF THE PATIENT'S POTENTIAL NEED FOR FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY WAS ALSO TRANSLATED INTO DIALECTS PREVALENT IN THE COMMUNITY IN ORDER TO REACH OUT TO THOSE THAT MAY SPEAK ANOTHER LANGUAGE (SPANISH AND HMONG). PATIENT REGISTRATION STAFF AND FINANCIAL COUNSELORS ARE PROVIDED WITH SCRIPTS TO FOLLOW WHEN INTERACTING WITH PATIENTS. AS PART OF THE FINANCIAL ASSISTANCE PROCESS, PATIENTS MUST REGISTER WITH THE COUNTY PUBLIC ASSISTANCE TO SEE IF THEY MAY QUALIFY UNDER ANY OTHER FEDERAL OR STATE PROGRAMS. | ||
| PART VI, LINE 4: WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT" THIS IS A WORK IN PROGRESS. THE ORGANIZATION PROVIDED SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT, WHICH IS NOT QUANTIFIED. CALUMET MEDICAL CENTER, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY - CARE THAT WITHOUT OUR HOSPITAL, MAY NOT BE AVAILABLE LOCALLY.CERTAIN SPECIALIZED SERVICES AVAILABLE INCLUDE: I/P REHABILITATION SERVICES, I/P SUB-ACUTE (SNF) SERVICES. | ||
| PART VI, LINE 5: CALUMET MEDICAL CENTER'S GOVERNING BOARD CONSISTS PRIMARILY OF PERSONS WHO RESIDE WITHIN THE PRIMARY SERVICE AREA. MOST ARE NOT EMPLOYEES OF THE ORGANIZATION. THE ORGANIZATION STRIVES TO FURTHER ITS EXEMPT PURPOSES BY THE FOLLOWING:CALUMET MEDICAL CENTER PARTICIPATES IN GOVERNMENT-SPONSORED HEALTH PROGRAMS (MEDICARE, MEDICAID, CHAMPUS, GENERAL RELIEF, AND SPECIALIZED COUNTY PROGRAMS.)CALUMET MEDICAL CENTER DONATES FOOD TO AREA SHELTERS. THEY ALSO DONATE MEDICAL SUPPLIES AND MEDICATIONS TO CLINICS IN THIRD WORLD COUNTRIES.CALUMET MEDICAL CENTER DONATED FUNDS TO SUPPORT AREA ORGANIZATIONS THAT PROVIDE SERVICES TO THE FOLLOWING SECTORS OF OUR POPULATION: LOW-INCOME, HOMELESS, PHYSICALLY AND MENTALLY CHALLENGED AND CHRONICALLY ILL. CALUMET MEDICAL CENTER OPERATES THE ONLY PARAMEDIC-LEVEL AMBULANCE SERVICE IN CALUMET COUNTY. THIS SERVICE OPERATES AT A LOSS AND IS SUBSIDIZED BY THE HOSPITAL.CALUMET MEDICAL CENTER PROVIDES COMMUNITY HEALTH IMPROVEMENT SERVICES THROUGH HEALTH EDUCATION LECTURES, HEALTH FAIRS AND SUPPORT GROUPS.CALUMET MEDICAL CENTER CONDUCTS CARDIAC REHABILITATION AND DIABETIC EDUCATION SESSIONS. THIS SERVICE IS PROVIDED AT A COST TO THE PATIENT THAT IS FAR BELOW THE COST TO OFFER THE SERVICE.DISCOUNTED CARE IS PROVIDED TO LOW INCOME FAMILIES UP TO 662% OF FEDERAL POVERTY GUIDELINES.CALUMET MEDICAL CENTER SERVES AS A SPONSOR SITE FOR CLINICAL TRAINING OF COLLEGE STUDENTS IN VARIOUS HEALTH CARE PROGRAMS.CALUMET MEDICAL CENTER OFFERS ATHLETIC TRAINING SERVICES TO LOCAL HIGH SCHOOLS THAT WOULD OTHERWISE NOT HAVE THIS SERVICE AVAILABLE TO THEIR STUDENTS. THE SERVICE IS OFFERED AT A COST TO THE SCHOOLS THAT IS FAR BELOW THE COST TO OFFER THE SERVICE. | ||
| PART VI, LINE 6: CALUMET MEDICAL CENTER, OF CHILTON, WISCONSIN IS A COMMUNITY CRITICAL ACCESS HOSPITAL MANAGED BY AN AFFILIATED HEALTH CARE SYSTEM CALLED AFFINITY HEALTH SYSTEM. AFFINITY HEALTH SYSTEM ALSO HAS TWO OTHER HOSPITALS, ST. ELIZABETH HOSPITAL, IN APPLETON, WI AND MERCY MEDICAL CENTER, IN OSHKOSH, WI. IN ADDITION TO THE HOSPITALS, AFFINITY HEALTH SYSTEM ALSO HAS 25 AREA CLINICS UNDER THE CONTROL OF AFFINITY MEDICAL GROUP. THE MISSION OF AFFINITY, AS A CATHOLIC HEALTH CARE SYSTEM, IS TO LIVE OUT THE HEALING MINISTRY OF CHRIST BY PROVIDING SERVICES THAT PROMOTE THE HEALTH AND WELL BEING OF THE COMMUNITIES WE SERVE, ESPECIALLY THE POOR. AFFINITY HEALTH SYSTEM IS SPONSORED BY MINISTRY HEALTH CARE, HEADQUARTERED IN MILWAUKEE, WI. THE 3 HOSPITALS AND THE 25 CLINICS PROVIDE FREE OR MINIMAL COST HEALTH EDUCATION, SUPPORT, AND SCREENING SERVICES FOR THE POPULATIONS THEY SERVE. CALUMET MEDICAL CENTER, MERCY MEDICAL CENTER, AND ST. ELIZABETH HOSPITAL PROVIDE SUPPORT FOR EDUCATIONAL PROGRAMS TO EDUCATE FUTURE HEALTH CARE PROFESSIONALS. THERE IS ALSO AN EXPECTATION THAT ALL PEOPLE IN MANAGEMENT SERVICES AT AFFINITY HEALTH SYSTEM WILL PROVIDE DIRECT SERVICES TO THE POOR. | ||
| WI | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | X | TravelForCompanions |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 0 | 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 | 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 (7 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DANIEL NEUFELDER | |||||||||||||
| 30566 | 621156 | 10617 | 215763 | 1003 | 20386 | 3369 | 68467 | 1047 | 21277 | 46602 | 947049 | 0 | 0 |
| PETER JANU MD | |||||||||||||
| 0 | 503220 | 0 | 0 | 0 | 2146 | 0 | 22565 | 0 | 22389 | 0 | 550320 | 0 | 0 |
| GENE TIPLER MD | |||||||||||||
| 0 | 256451 | 0 | 0 | 0 | 1537 | 0 | 22821 | 0 | 23998 | 0 | 304807 | 0 | 0 |
| TRAVIS ANDERSEN | |||||||||||||
| 0 | 279091 | 0 | 54151 | 0 | 21080 | 0 | 32330 | 0 | 19859 | 0 | 406511 | 0 | 0 |
| TIMOTHY RICHMAN | |||||||||||||
| 163010 | 0 | 38174 | 0 | 15450 | 0 | 20628 | 0 | 20982 | 0 | 258244 | 0 | 0 | 0 |
| JEFF BADGER | |||||||||||||
| 16063 | 326438 | 4230 | 85963 | 1294 | 26305 | 2084 | 42361 | 1169 | 23765 | 24840 | 504832 | 0 | 0 |
| JENNIFER LEIGH MEDIN WEBER | |||||||||||||
| 125145 | 0 | 0 | 0 | 640 | 0 | 7782 | 0 | 20925 | 0 | 154492 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 1B | ReturnReference |
| Explanation | BUSINESS TRAVEL EXPENSES FOR SPOUSES OF EXECUTIVES AND GOLF CLUB MEMBERSHIP FOR EXECUTIVES ARE REIMBURSED AS PART OF THEIR EXECUTIVE FLEX CREDIT ACCOUNT. RECEIPTS ARE PROVIDED TO SR. ADMINISTRATIVE ASSISTANT IN HR WHO REVIEWS FOR ACCURACY, COMPLETES A REIMBURSEMENT FORM WITH SUBSTANTIATION TO PAYROLL FOR REIMBURSEMENT. THESE REIMBURSEMENTS ARE TAXABLE AND, WHEN ADDED TO THE COMPENSATION PACKAGE TAKEN AS A WHOLE, HAVE BEEN INCLUDED WHEN COMPARED TO THE COMPENSATION STUDIES. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| NEW PROGRAM SERVICES | FORM 990, PART III, LINE 2 | CALUMET MEDICAL CENTER BEGAN ORTHOPAEDICS SERVICES IN 2012 THROUGH A COLLABORATION WITH ORTHOPAEDICS ASSOCIATES OF MANITOWOC. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE CORPORATE MEMBERS OF CALUMET MEDICAL CENTER, INC. ARE CALUMET AREA COMMUNITY HEALTH FOUNDATION, INC. AND AFFINITY HEALTH SYSTEM. | |
| FORM 990, PART VI, SECTION A, LINE 7A | AFFINITY HEALTH SYSTEM HAS THE POWER TO APPROVE AND REMOVE THE ORGANIZATION'S BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION A, LINE 7B | CORPORATE MEMBERS, CALUMET AREA COMMUNITY HEALTH FOUNDATION, INC. AND AFFINITY HEALTH SYSTEM, APPROVE ALL MODIFICATIONS OF THE ARTICLES OF INCORPORATION AND PROVISIONS OF THE BYLAWS AS WELL AS APPROVE THE DISSOLUTION, CONSOLIDATION OR MERGER OF THE ORGANIZATION. AFFINITY HEALTH SYSTEM ALSO HAS MANAGING POWERS OVER THE ORGANIZATION. AFFINITY HEALTH SYSTEM'S CORPORATE MEMBERS AND MINISTRY HEALTH CARE, INC. MAY ACT IN ALL RESPECTS IN THE PLACE OF AFFINITY HEALTH SYSTEM TO THE ORGANIZATION. IN FEBRUARY 2012, MINISTRY HEALTH CARE, INC. BECAME THE SOLE OWNER OF AFFINITY HEALTH SYSTEM. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE CONTROLLER AND CFO OF AFFINITY HEALTH SYSTEM PERFORM A DETAIL REVIEW OF THE 990. AFTER MANAGEMENT REVIEW, A COPY OF THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST AND DUALITY STATEMENT IS COMPLETED BY THE BOARD OF DIRECTORS ON AN ANNUAL BASIS. | |
| FORM 990, PART VI, SECTION B, LINE 15 | CALUMET MEDICAL CENTER (ORGANIZATION) HAS A COMPENSATION COMMITTEE CONSISTING OF FOUR MEMBERS OF THE BOARD OF DIRECTORS, WHICH CONSIST OF TWO REPRESENTATIVES OF THE CORPORATE MEMBERS. NO MEMBER IS AN AFFINITY MEDICAL GROUP PHYSICIAN OR A MEMBER OF THE EXECUTIVE TEAM OF THE ORGANIZATION. THE COMPENSATION COMMITTEE (THOSE WITHOUT CONFLICT) HAS AUTHORITY TO APPROVE ANY AND ALL AMOUNTS OF COMPENSATION FOR MEMBERS OF THE EXECUTIVE TEAM OF THE ORGANIZATION. THE COMPENSATION COMMITTEE AT LEAST ANNUALLY INVESTIGATES, EVALUATES, REVIEWS, DETERMINES AND DOCUMENTS THE COMPENSATION OF THE SENIOR MANAGEMENT TEAM OF THE ORGANIZATION. THE COMPENSATION COMMITTEE CONSIDERS DATA FROM INDEPENDENT SOURCES PROVIDING INFORMATION AS TO AMOUNTS PAID BY COMPARABLE ORGANIZATIONS FOR COMPARABLE POSITIONS AND INSURE THE INDIVIDUALS ARE PAID NO MORE THAN FAIR MARKET, REASONABLE COMPENSATION FOR SERVICES RENDERED. | |
| FORM 990, PART VI, SECTION C, LINE 19 | ONLY THE FINANCIAL STATEMENTS ARE MADE PUBLIC AS BY WAY OF FILING THE ANNUAL IRS FORM 990, WHICH BY LAW IS AVAILABLE TO THE PUBLIC. | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 185,166. RECOGNIZED DEFERRED INCOME -38,809. WORKERS COMPENSATION ADJUSTMENT 121,164. FMV ADJUSTMENT OF ASSETS -83,218. TOTAL TO FORM 990, PART XI, LINE 5: 184,303. |
| AUDITED FINANCIAL STATEMENTS | FORM 990 PART XI LINE 2B-2C | THE ORGANIZATION DOES NOT RECEIVE SEPARATELY AUDITED FINANCIAL STATEMENTS. THE ORGANIZATION IS AUDITED AND REPORTED THROUGH CONSOLIDATED FINANCIAL STATEMENTS OF AFFINITY HEALTH SYSTEM. THE AUDIT COMMITTEE IS RESPONSIBLE FOR THE AUDITOR SELECTION. THE AUDIT STATEMENTS ARE REVIEWED BY THE CONTROLLER, CFO, MINISTRY HEALTH CFO, AND THE AUDIT COMMITTEE. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| HOURS WORKED FOR RELATED ORGANIZATIONS | FORM 990, PART VII | DANIEL NEUFELDER WORKED AN AVERAGE OF 38 HOURS PER WEEK FOR RELATED ORGANIZATIONS. TRAVIS ANDERSEN WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR RELATED ORGANIZATIONS. PETER JANU WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR RELATED ORGANIZATIONS. GENE TIPLER WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR RELATED ORGANIZATIONS. JEFF BADGER WORKED AN AVERAGE OF 38 HOURS PER WEEK FOR RELATED ORGANIZATIONS. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (31 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| AFFINITY HEALTH SYSTEM | |||||||||||
| 1570 MIDWAY PL | MENASHA | WI | 54952 | 391568866 | SUPPORT RELATED HEALTHCARE ORGANIZATIONS | IL | 501(C)(3) | 11, TYPE II | MINISTRY HEALTH CARE INC | 0 | |
| MERCY MEDICAL CENTER OF OSHKOSH INC | |||||||||||
| 500 S OAKWOOD | OSHKOSH | WI | 54904 | 390806268 | HOSPITAL | WI | 501(C)(3) | LINE 3 | AFFINITY HEALTH SYSTEM | 0 | |
| NETWORK HEALTH SYSTEM INC | |||||||||||
| 1570 APPLETON ROAD | MENASHA | WI | 54952 | 391127163 | CLINICAL HEALTHCARE SERVICES | WI | 501(C)(3) | LINE 3 | AFFINITY HEALTH SYSTEM | 0 | |
| MERCY HEALTH FOUNDATION INC | |||||||||||
| PO BOX 3370 | OSHKOSH | WI | 54903 | 237140261 | PUBLIC WELFARE THROUGH COMMUNITY HEALTH DEVELOPMENT | WI | 501(C)(3) | LINE 9 | AFFINITY HEALTH SYSTEM | 0 | |
| ST ELIZABETH HOSPITAL FOUNDATION INC | |||||||||||
| 1506 S ONEIDA STREET | APPLETON | WI | 54915 | 391256677 | RAISE FUNDS IN SUPPORT OF ST. ELIZABETH HOSPITAL AND RELATED ENTITIES | WI | 501(C)(3) | LINE 7 | AFFINITY HEALTH SYSTEM | 0 | |
| ST ELIZABETH HOSPITAL INC | |||||||||||
| 1506 S ONEIDA STREET | APPLETON | WI | 54915 | 390816818 | HOSPITAL | WI | 501(C)(3) | LINE 3 | AFFINITY HEALTH SYSTEM | 0 | |
| MARIAN HEALTH SYSTEMS INC | |||||||||||
| 1923 SOUTH UTICA AVENUE | TULSA | OK | 74104 | 363659989 | PARENT CORP | DE | 501(C)(3) | 11, TYPE I | 0 | N/A | |
| MINISTRY HEALTH CARE INC | |||||||||||
| 11925 W LAKE PARK DR STE 100 | MILWAUKEE | WI | 53224 | 391490371 | PARENT CORP - MANAGEMENT SERVICES | WI | 501(C)(3) | 11, TYPE II | MARIAN HEALTH SYSTEM INC | 0 | |
| AGAPE COMMUNITY CENTER OF MILWAUKEE INC | |||||||||||
| 6100 NORTH 42ND STREET | MILWAUKEE | WI | 53209 | 391461846 | COMMUNITY CENTER | WI | 501(C)(3) | 11, TYPE 1 | MINISTRY HEALTH CARE INC | 0 | |
| SACRED HEART-SAINT MARY'S HOSPITALS INC | |||||||||||
| 401 WEST MOHAWK DRIVE/2251 NORTH SH | TOMAHAWKRHINELANDER | WI | 54487 | 391390638 | HOSPITALS | WI | 501(C)(3) | LINE 3 | MINISTRY HEALTH CARE INC | 0 | |
| MINISTRY WEIGHT MANAGEMENT INC | |||||||||||
| 2251 NORTH SHORE DRIVE | RHINELANDER | WI | 54501 | 391829015 | HEALTH SERVICES | WI | 501(C)(3) | LINE 3 | SACRED HEART-SAINT MARY'S HOSPITALS INC | 0 | |
| HOWARD YOUNG HEALTH CARE INC | |||||||||||
| 240 MAPLE STREET | WOODRUFF | WI | 54568 | 391499115 | HOME OFFICE | WI | 501(C)(3) | LINE 3 | MINISTRY HEALTH CARE INC | 0 | |
| HOWARD YOUNG MEDICAL CENTER INC | |||||||||||
| 240 MAPLE STREET | WOODRUFF | WI | 54568 | 390873606 | HOSPITAL | WI | 501(C)(3) | LINE 3 | HOWARD YOUNG HEALTH CARE INC | 0 | |
| EAGLE RIVER MEMORIAL HOSPITAL | |||||||||||
| 201 HOSPITAL ROAD | EAGLE RIVER | WI | 54521 | 390985690 | HOSPITAL | WI | 501(C)(3) | LINE 3 | THE HOWARD YOUNG MEDICAL CENTER INC | 0 | |
| DR KATE NEWCOMB CONVALESCENT CENTER INC | |||||||||||
| 301 ELM ST | WOODRUFF | WI | 54568 | 391357365 | LTC FACILITY | WI | 501(C)(3) | LINE 3 | HOWARD YOUNG HEALTH CARE INC | 0 | |
| SAINT MICHAEL'S HOSPITAL OF STEVENS POINT INC | |||||||||||
| 900 ILLINOIS AVENUE | STEVENS POINT | WI | 54481 | 390808443 | HOSPITAL | WI | 501(C)(3) | LINE 3 | MINISTRY HEALTH CARE INC | 0 | |
| GOOD SAMARITAN HEALTH CENTER | |||||||||||
| 601 SOUTH CENTER AVENUE | MERRILL | WI | 54452 | 390808503 | HOSPITAL | WI | 501(C)(3) | LINE 3 | MINISTRY HEALTH CARE INC | 0 | |
| SAINT CLAIRE'S HOSPITAL OF WESTON INC | |||||||||||
| 3400 MINISTRY PARKWAY | WESTON | WI | 54476 | 721531917 | HOSPITAL | WI | 501(C)(3) | LINE 3 | MINISTRY HEALTH CARE INC | 0 | |
| MINISTRY MEDICAL GROUP INC | |||||||||||
| 824 ILLINOIS AVENUE | STEVENS POINT | WI | 54481 | 391965593 | CLINICS | WI | 501(C)(3) | LINE 3 | MINISTRY HEALTH CARE INC | 0 | |
| MINISTRY HOME CARE INC | |||||||||||
| 611 ST JOSEPH AVENUE 4S | MARSHFIELD | WI | 54449 | 391936201 | HOME CARE/HOSPICE | WI | 501(C)(3) | LINE 3 | MINISTRY HEALTH CARE INC | 0 | |
| SAINT JOSEPH'S HOSPITAL OF MARSHFIELD INC | |||||||||||
| 611 SAINT JOSEPH AVENUE | MARSHFIELD | WI | 54449 | 390847631 | HOSPITAL | WI | 501(C)(3) | LINE 3 | MINISTRY HEALTH CARE INC | 0 | |
| OUR LADY OF VICTORY HOSPITAL INC | |||||||||||
| 1120 PINE STREET | STANLEY | WI | 54768 | 390807065 | HOSPITAL | WI | 501(C)(3) | LINE 3 | MINISTRY HEALTH CARE INC | 0 | |
| DOOR COUNTY MEMORIAL HOSPITAL | |||||||||||
| 323 SOUTH 18TH AVENUE | STURGEON BAY | WI | 54235 | 390806324 | HOSPITAL/CLINIC/NURSING HOME | WI | 501(C)(3) | LINE 3 | MINISTRY HEALTH CARE INC | 0 | |
| SAINT ELIZABETHS HOSPITAL OF WABASHA INC | |||||||||||
| 1200 GRANT BLVD WEST | WABASHA | MN | 55981 | 410693877 | HOSPITAL/NURSING HOME | MN | 501(C)(3) | LINE 3 | MINISTRY HEALTH CARE INC | 0 | |
| GOOD SAMARITAN HEALTH CENTER FOUNDATION OF MERRILL WISC INC | |||||||||||
| 601 SOUTH CENTER AVENUE | STEVENS POINT | WI | 54452 | 391627755 | CHARITABLE FOUNDATION | WI | 501(C)(3) | 11, TYPE I | MINISTRY HEALTH CARE INC | 0 | |
| FOUNDATION OF SAINT JOSEPHS HOSPITAL OF MARSHFIELD INC | |||||||||||
| 611 SAINT JOSEPH AVENUE | MARSHFIELD | WI | 54449 | 391684957 | CHARITABLE FOUNDATION | WI | 501(C)(3) | 11, TYPE I | SAINT JOSEPH'S HOSPITAL OF MARSHFIELD INC | 0 | |
| PARTNERS WITH SAINT JOSEPHS HOSPITAL OF MARSHFIELD INC | |||||||||||
| 611 SAINT JOSEPH AVENUE | MARSHFIELD | WI | 54449 | 396094701 | HOSPITAL AUXILIARY | WI | 501(C)(3) | 11, TYPE III-FI | SAINT JOSEPH'S HOSPITAL OF MARSHFIELD INC | 0 | |
| HOWARD YOUNG FOUNDATION INC | |||||||||||
| 240 MAPLE ST | WOODRUFF | WI | 54568 | 391521169 | FOUNDATION | WI | 501(C)(3) | LINE 7 | MINISTRY HEALTH CARE INC | 0 | |
| HOWARD YOUNG CLINICS INC | |||||||||||
| 240 MAPLE ST | WOODRUFF | WI | 54568 | 391969706 | CLINICS | WI | 501(C)(3) | LINE 3 | HOWARD YOUNG HEALTH CARE INC | 0 | |
| SAINT MICHAELS FOUNDATION OF STEVENS POINT INC | |||||||||||
| 900 ILLINOIS AVENUE | STEVENS POINT | WI | 54481 | 391657410 | CHARITABLE FOUNDATION | WI | 501(C)(3) | 11, TYPE I | SAINT MICHAEL'S HOSPITAL OF STEVENS POINT INC | 0 | |
| FOUNDATION OF SAINT CLARES HOSPITAL OF WESTON INC | |||||||||||
| 3400 MINISTRY PARKWAY | WESTON | WI | 54476 | 753193633 | CHARITABLE FOUNDATION | WI | 501(C)(3) | 11, TYPE I | ST CLARES HOSPITAL OF WESTON INC | 0 | |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TWIN MED LLP | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 8005 | AddressLine1 |
| City | MENASHA | City |
| State | WI | State |
| ZIP Code | 54952 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391180341 | EIN |
| Primary Activity | RENTAL PROPERTY | PrimaryActivity |
| Legal Domicile State | WI | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| NETWORK HEALTH PLAN INC | ||||||||
| 1570 MIDWAY PLACE | MENASHA | WI | 54952 | 391442058 | INSURANCE | WI | N/A | C |
| NETWORK HEALTH INSURANCE CORPORATION | ||||||||
| 1570 MIDWAY PLACE | MENASHA | WI | 54952 | 392020474 | INSURANCE | WI | N/A | C |
| VICTORY MEDICAL GROUP CLINICS | ||||||||
| CLINICS | WI | N/A | C | |||||
| LAKE SHORE HEALTH SERVICES LLC | ||||||||
| CLINIC | WI | N/A | C | |||||
| 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 |
| Sale Of Assets To Other Org | 1 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 1 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |