SAUK PRAIRIE HEALTHCARE INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- SAUK PRAIRIE HEALTHCARE INC (EIN 39-0872080)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-08-14
- IRS object ID
- 201202279349301725
- Schema version
- 2011v1.2
- 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 | 2012-08-14T11:07:46-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | 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 | 2011-01-01 | 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 | 2012-08-10 | 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 | 2012-08-10 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | 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 | 76146374 | 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 | 552 | TotalNbrEmployees |
| Total Nbr Volunteers | 150 | TotalNbrVolunteers |
| Total Gross UBI | 7353 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -14761 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 399816 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 277316 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 58575786 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 57852534 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 896938 | InvestmentIncomePriorYear |
| Investment Income Current Year | 621744 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -237596 | OtherRevenuePriorYear |
| Other Revenue Current Year | -213678 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 59634944 | TotalRevenuePriorYear |
| Total Revenue Current Year | 58537916 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 100855 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 119289 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 28665526 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 30437774 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 93514 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 23944125 | OtherExpensePriorYear |
| Other Expenses Current Year | 23226236 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 52710506 | TotalExpensesPriorYear |
| Total Expenses Current Year | 53783299 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 6924438 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 4754617 | RevenuesLessExpensesCY |
| Total Assets BOY | 65343589 | TotalAssetsBOY |
| Total Assets EOY | 72991043 | TotalAssetsEOY |
| Total Liabilities BOY | 6689879 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 8864607 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 58653710 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 64126436 | 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 | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 39687590 | Expense |
| Grants | 94392 | Grants |
| Revenue | 53281119 | 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 2011 WERE 1,769 WITH PATIENT DAYS OF 4,650. KEY PATIENT SERVICES INCLUDED 269 BIRTHS IN THE NURSERY, 5,203 SURGICAL PROCEDURES, 53,768 REHABILITATION THERAPY SERVICES, 24,353 MEDICAL IMAGING SERVICES, AND 13,783 EMERGENCY ROOM VISITS ARE AMONG MANY OF THE SERVICES PROVIDED TO PATIENTS IN 2011. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4848517 | Expense |
| Revenue | 4564062 | Revenue |
| Description | SPMH ALSO OWNS AND OPERATES PHYSICIAN PRACTICES IN SPRING GREEN, BLACK EARTH, PLAIN, AND LODI, WISCONSIN. TOTAL CLINIC VISITS TO THESE FOUR SITES FOR 2011 WAS 35,109. | 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 1,700 INPATIENTS IN 2011, 269 BABIES ENTERED THE WORLD HERE, AND THE HOSPITAL HAD 55,500 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 35,000 VISITS IN 2011. AS A CHARITABLE ORGANIZATION, SPMHC PROVIDED OVER $2 MILLION IN FREE CARE TO PATIENTS IN OUR SERVICE AREA IN 2011, 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 44536107 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 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 |
| 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 | 37 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 552 | 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 | 1 | 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 | 4.80 | X | 18200 | 0 | 0 | ||
| TAMMY ADLER | |||||||
| VICE PRESIDENT | 4.60 | X | 20300 | 0 | 0 | X | |
| NEIL BISHOP | |||||||
| TRUSTEE | 4.80 | X | 18100 | 0 | 0 | ||
| RICHARD MARINO | |||||||
| TRUSTEE | 4.60 | X | 18800 | 0 | 0 | ||
| TOM SCHWARZ | |||||||
| PRESIDENT | 5.60 | X | 25206 | 0 | 0 | X | |
| ALLAN PECKHAM | |||||||
| SECRETARY | 3.30 | X | 13900 | 0 | 0 | X | |
| JOHN DEGIOVANNI | |||||||
| TRUSTEE | 1.60 | X | 7171 | 0 | 0 | ||
| PHILLIP KEISER | |||||||
| TRUSTEE | 2.50 | X | 10600 | 0 | 0 | ||
| DALE CARLSON | |||||||
| TREASURER | 3.00 | X | 12400 | 0 | 0 | X | |
| ROXI MAIER | |||||||
| TRUSTEE | 3.60 | X | 14221 | 0 | 0 | ||
| VICKIE WENZEL SCHLICK | |||||||
| TRUSTEE | 2.50 | X | 10400 | 0 | 0 | ||
| ROBERTA ECCHER | |||||||
| VP, HUMAN RESOURCES | 50.00 | 135273 | 0 | 14543 | X | ||
| CAROL MAY | |||||||
| VP, FINANCE & OPERATIONS | 50.00 | 178753 | 0 | 18260 | X | ||
| LARRY SCHROEDER | |||||||
| CEO | 50.00 | 284595 | 0 | 23309 | X | ||
| KEN CARLSON | |||||||
| VP, PLANNING & BUSINESS DE | 50.00 | 150955 | 0 | 15787 | X | ||
| CARLA PECK | |||||||
| VP, QUALITY & COMPLIANCE | 50.00 | 131928 | 0 | 13181 | X | ||
| MARGARET SHEEKS | |||||||
| VP, PATIENT SERVICES | 50.00 | 141931 | 0 | 14864 | X | ||
| MARK STARR | |||||||
| ANESTHESIA-CRNA | 40.00 | 232018 | 0 | 19690 | X | ||
| MILES MORGAN | |||||||
| ER PHYSICIAN | 40.00 | 261488 | 0 | 10275 | X | ||
| THOMAS MURPHY | |||||||
| ANESTHESIA-CRNA | 40.00 | 230313 | 0 | 13644 | X | ||
| ERIC WARBASSE | |||||||
| ER PHYSICIAN | 40.00 | 226913 | 0 | 18473 | X | ||
| ROLLAND TAYLOR | |||||||
| ER PHYSICIAN | 40.00 | 217669 | 0 | 10984 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2361134 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 173010 | TotalOtherCompensation |
| Number Individuals GT100 K | 42 | 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 |
|---|---|---|---|---|---|
| KAHLER SLATER INC | |||||
| 111 W WISCONSIN AVE | MILWAUKEE | WI | 53203 | ARCHITECTURAL SERVICES | 1031024 |
| SHARED IMAGING SERVICES | |||||
| PO BOX 45686 | MADISON | WI | 53744 | NUCLEAR MED, ECHO, ULTRASOUND SERVICES | 856770 |
| CENTRAL MINNESOTA DIAGNOSTIC INC | |||||
| 150 10TH ST NW | MILACA | MN | 56353 | MRI SERVICE | 630700 |
| SHARED MEDICAL SERVICES INC | |||||
| PO BOX 330 | COTTAGE GROVE | WI | 53527 | CT SCAN SERVICE | 457080 |
| KRAEMER BROTHERS | |||||
| PO BOX 219 | PLAIN | WI | 53577 | CONSTRUCTION/BUILDING SERVICES | 442195 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 13 | NumberOfContractorsGT100K |
| Related Organizations | 153184 | RelatedOrganizations |
| Government Grants | 49132 | GovernmentGrants |
| All Other Contributions | 75000 | AllOtherContributions |
| Total Contributions | 277316 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| HOSPITAL PATIENT REVEN | 621990 | 52043794 | 52043794 | |
| CLINIC REVENUE | 621110 | 4564062 | 4564062 | |
| OTHER HOSPITAL SERVICE | 621990 | 978736 | 971383 | 7353 |
| CAFETERIA AND VENDING | 621990 | 206817 | 206817 | |
| LIFELINE SERVICES | 621990 | 59125 | 59125 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 57852534 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 633842 | TotalRevenueColumn |
| Exclusion | $633,842 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 275692 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 489370 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -213678 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -213678 | TotalRevenueColumn |
| Exclusion | -$213,678 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 17106540 | Securities |
| Other | 450 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 17091915 | Securities |
| Other | 27173 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 14625 | Securities |
| Other | -26723 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -12098 | TotalRevenueColumn |
| Exclusion | -$12,098 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 58537916 | TotalRevenueColumn |
| Related Or Exempt Function Income | 57845181 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 7353 | UnrelatedBusinessRevenue |
| Exclusion | $408,066 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 119289 | Total |
| Program Services | 119289 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1231322 | Total |
| Management And General | 1231322 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23374004 | Total |
| Program Services | 20019527 | ProgramServices |
| Management And General | 3283038 | ManagementAndGeneral |
| Fundraising | 71439 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 980014 | Total |
| Program Services | 839369 | ProgramServices |
| Management And General | 137650 | ManagementAndGeneral |
| Fundraising | 2995 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3236620 | Total |
| Program Services | 2772123 | ProgramServices |
| Management And General | 454605 | ManagementAndGeneral |
| Fundraising | 9892 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1615814 | Total |
| Program Services | 1374056 | ProgramServices |
| Management And General | 236696 | ManagementAndGeneral |
| Fundraising | 5062 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51937 | Total |
| Management And General | 51937 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 102973 | Total |
| Management And General | 102973 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1923697 | Total |
| Program Services | 1250203 | ProgramServices |
| Management And General | 673494 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 197627 | Total |
| Program Services | 26341 | ProgramServices |
| Management And General | 171286 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 149584 | Total |
| Program Services | 113445 | ProgramServices |
| Management And General | 36134 | ManagementAndGeneral |
| Fundraising | 5 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 239039 | Total |
| Management And General | 239039 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 995925 | Total |
| Program Services | 943448 | ProgramServices |
| Management And General | 50728 | ManagementAndGeneral |
| Fundraising | 1749 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29333 | Total |
| Program Services | 23137 | ProgramServices |
| Management And General | 6196 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 165594 | Total |
| Program Services | 104146 | ProgramServices |
| Management And General | 61448 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2208106 | Total |
| Program Services | 2208106 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1504820 | Total |
| Program Services | 94082 | ProgramServices |
| Management And General | 1410738 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| SUPPLIES | 14860861 | 14179357 | 679132 | 2372 |
| BAD DEBT EXPENSE | 513515 | 513515 | ||
| OTHER EXPENSES | 391441 | 67652 | 323789 | |
| REPAIRS & MAINTENANCE | 381154 | 377681 | 3473 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -489370 | Total |
| Program Services | -489370 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53783299 | Total |
| Program Services | 44536107 | ProgramServices |
| Management And General | 9153678 | ManagementAndGeneral |
| Fundraising | 93514 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 58135 | BOY |
| EOY | 129498 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14951206 | BOY |
| EOY | 11453265 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5346579 | BOY |
| EOY | 6265081 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 955466 | BOY |
| EOY | 979178 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 640445 | BOY |
| EOY | 923503 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 54133832 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 28449706 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19942751 | BOY |
| EOY | 25684126 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17009420 | BOY |
| EOY | 23239127 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 115188 | BOY |
| EOY | 356917 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6324399 | BOY |
| EOY | 3960348 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 65343589 | BOY |
| EOY | 72991043 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5854760 | BOY |
| EOY | 6807135 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 150653 | BOY |
| EOY | 1262770 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 684466 | BOY |
| EOY | 794702 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6689879 | BOY |
| EOY | 8864607 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53076103 | BOY |
| EOY | 57419720 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4521671 | BOY |
| EOY | 5601205 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1055936 | BOY |
| EOY | 1105511 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 58653710 | BOY |
| EOY | 64126436 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 65343589 | BOY |
| EOY | 72991043 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 4754617 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 718109 | 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 Separate | X | FinancialStatementSeparate |
| 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 | $9,767 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 9767 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| EXPLANATION OF OTHER LOBBYING ACTIVITIES: | PART II-B, LINE 1I: | SAUK PRAIRIE MEMORIAL HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP 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 $6,863 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 $2,904 OF THE FEES PAID BY SPMHC IN 2011 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 | 1147396 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 49575 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1196971 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 0 | BeginningOfYearBalance |
| 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 | 0.92360 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.07640 | 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 | 5585154 | OtherCostOrOtherBasis |
| Book Value | 5585154 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19747004 | OtherCostOrOtherBasis |
| Depreciation | 10735970 | Depreciation |
| Book Value | 9011034 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 25976449 | OtherCostOrOtherBasis |
| Depreciation | 17713736 | Depreciation |
| Book Value | 8262713 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2825225 | OtherCostOrOtherBasis |
| Book Value | 2825225 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 25684126 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| ACCRUED INTEREST RECEIVABLE | 1232 |
| INVESTMENT IN CENTRAL MN DIAGNOSTIC | 755000 |
| INTEREST IN NET ASSETS OF FOUNDATION | 3204116 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 3960348 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DEFERRED COMPENSATION PLAN LIABILITY | Description |
| Amount | $794,702 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 794702 | TotalOfAmounts |
| Total Revenue | 58537916 | TotalRevenue |
| Total Expenses | 53783299 | TotalExpenses |
| Excess Or Deficit For Year | 4754617 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -411000 | NetUnrealizedGLOnInvestments |
| Other | $1,129,109 | OtherAmount |
| Total Adjustments | 718109 | TotalAdjustments |
| Excess Or Deficit Per FS | 5472726 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 58932894 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 489370 | OtherRevenues |
| Revenue Not Rptd F990 | 489370 | RevenueNotRptdF990 |
| Revenue Subtotal | 58443524 | RevenueSubtotal |
| Other Revenues Not Included | 94392 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 94392 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 58537916 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 54178277 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 489370 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 489370 | ExpensesNotRptdF990 |
| Expenses Subtotal | 53688907 | ExpensesSubtotal |
| Other Expenses Not Included | 94392 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 94392 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 53783299 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (7 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: | 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, 2011 AND 2010, 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 2011 AND 2010. FEDERAL TAX RETURNS FOR YEARS 2008 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | NET ASSETS RELEASED FROM RESTRICTIONS -81,184. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 1,210,293. TOTAL TO SCHEDULE D, PART XI, LINE 8: 1,129,109. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENT EXPENSES NETTED 489,370. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | GOOD NEIGHBOR CLINIC SERVICES PROVIDED 94,392. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | RENT EXPENSES NETTED 489,370. | |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | GOOD NEIGHBOR CLINIC DONATIONS 94,392. |
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 | 995017 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 995017 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01870 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3550806 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2651672 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 899134 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01690 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4545823 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2651672 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1894151 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03560 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 576601 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 120017 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 456584 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00860 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 55636 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 55636 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9255636 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6672008 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2583628 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04850 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 172783 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 172783 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00320 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10060656 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6792025 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3268631 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06130 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14606479 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9443697 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5162782 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09690 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 18583 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 18583 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1653 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1653 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1408 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1408 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 11674 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 11674 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2964 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2964 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 36282 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 36282 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $252,698 | BadDebtExpenseAmount |
| Amount Attributable To | 126349 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 11823410 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 15536988 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -3713578 | 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 |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Other | X | Other |
| Needs Assessment Conducted | 10 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 1 | OtherFacilities |
| CHNA Widely Available | 0 | CHNAWidelyAvailable |
| 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 |
| 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 |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | 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 (21 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 $ 513515. | ||
| 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 THE "CLUB SCRUB" PROGRAM. 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 THE FOUR OUTLYING PHYSICIAN CLINICS, CRNA SERVICES PROVIDED TO PATIENTS UNDERGOING ANESTHESIA AT THE HOSPITAL, AND A SIGNIFICANT PORTION OF LAB SERVICES WHICH ARE REIMBURSED BY THE MEDICARE PROGRAM UNDER ANOTHER METHODOLOGY. PHYSICIAN COVERAGE AND OUTPATIENT LAB 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 ORGANIZATON 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.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) AND 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 WILL BE MADE PUBLICLY AVAILABLE IN SEPTEMBER 2012. | 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: 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 13G: 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 ON HEALTH INSURANCE. | SAUK PRAIRIE MEMORIAL HOSPITAL, INC. | |
| PART V, SECTION B, LINE 19D: THE HOSPITAL FOLLOWS ITS NORMAL PROCEDURES FOR COLLECTION OF THESE ACCOUNTS, INCLUDING DISCOUNTS BASED ON INCOME/ASSET LEVELS, PROMPT PAYMENT, OR MEDICAL INDIGENCE. | SAUK PRAIRIE MEMORIAL HOSPITAL, INC. | |
| PART V, SECTION B, LINE 21: 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 ROOM 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) 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 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, HOWEVER, AGRICULTURE AND TOURISM REPRESENT A CONSIDERABLE NUMBER OF LOW-PAYING JOBS, TYPICALLY 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 (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|---|---|---|
| THE GOOD NEIGHBOR CLINIC OF SAUK PRAIRIE INC | ||||||||||
| 1906 NORTH ST | PRAIRIE DU SAC | WI | 53578 | 391963290 | 501(C)3 | 0 | 95389 | COST | MEDICAL SERVICES AND SUPPLIES | TO PROVIDE MEDICAL ASSISTANCE TO THOSE WHO NORMALLY COULD NOT AFFORD IT |
| ST VINCENT DE PAUL SOCIETY OF SAUK-PRAIRIEROXBURY INC | ||||||||||
| 815 19TH STREET | PRAIRIE DU SAC | WI | 53578 | 391802875 | 501(C)3 | 23900 | TO PROVIDE DENTAL SERVICES TO THOSE THAT COULD NOT NORMALLY AFFORD THESE SERVICES. | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CAROL MAY | |||||||||||||
| 166178 | 0 | 12002 | 0 | 573 | 0 | 8638 | 0 | 9622 | 0 | 197013 | 0 | 0 | 0 |
| LARRY SCHROEDER | |||||||||||||
| 251733 | 0 | 23150 | 0 | 9712 | 0 | 12250 | 0 | 11059 | 0 | 307904 | 0 | 0 | 0 |
| KEN CARLSON | |||||||||||||
| 140752 | 0 | 10048 | 0 | 155 | 0 | 7267 | 0 | 8520 | 0 | 166742 | 0 | 0 | 0 |
| MARGARET SHEEKS | |||||||||||||
| 129534 | 0 | 6037 | 0 | 6360 | 0 | 6812 | 0 | 8052 | 0 | 156795 | 0 | 0 | 0 |
| MARK STARR | |||||||||||||
| 219735 | 0 | 980 | 0 | 11303 | 0 | 10889 | 0 | 8801 | 0 | 251708 | 0 | 0 | 0 |
| MILES MORGAN | |||||||||||||
| 261488 | 0 | 0 | 0 | 0 | 0 | 12250 | 0 | -1975 | 0 | 271763 | 0 | 0 | 0 |
| THOMAS MURPHY | |||||||||||||
| 222797 | 0 | 6162 | 0 | 1354 | 0 | 11328 | 0 | 2316 | 0 | 243957 | 0 | 0 | 0 |
| ERIC WARBASSE | |||||||||||||
| 226913 | 0 | 0 | 0 | 0 | 0 | 9254 | 0 | 9219 | 0 | 245386 | 0 | 0 | 0 |
| ROLLAND TAYLOR | |||||||||||||
| 217669 | 0 | 0 | 0 | 0 | 0 | 10766 | 0 | 218 | 0 | 228653 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | IN 2011, THE BOARD 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, AND MARK STARR. |
| PART I, LINE 6 | SPMHC HAS AN INCENTIVE PAYMENT PLAN THAT ONLY GOES INTO EFFECT IF NET EARNINGS (OPERATING INCOME) IS WITHIN 98% OF BUDGET. THEN, DEPENDING ON WHETHER QUALITY, SAFETY, AND MANAGEMENT GOALS ARE MET, INCENTIVE PAY MAY BE AWARDED. MAXIMUM INCENTIVE IS $30,000 FOR THE CEO, $15,000 FOR VPS, AND $7,500 FOR DIRECTOR LEVEL EMPLOYEES AND MANAGERS. |
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 (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| NEW PROGRAM SERVICES | FORM 990, PART III, LINE 2 | SAUK PRAIRIE MEMORIAL HOSPITAL, INC. ADDED OUTPATIENT PULMONARY REHABILITATION SERVICE. THIS SERVICE ASSISTS COPD PATIENTS IN MAINTAINING AND IMPROVING THE QUALITY OF LIFE. |
| FORM 990, PART VI, SECTION A, LINE 4 | SAUK PRAIRIE MEMORIAL HOSPITAL ASSOCIATION, ON RECOMMENDATION OF THE BOARD OF DIRECTORS, APPROVED CHANGES TO THE CORPORATE BYLAWS IN 2011. THE MOST SIGNIFICANT CHANGE WAS TO ELIMINATE A CAP ON THE NUMBER OF TERMS MEMBERS OF THE BOARD OF DIRECTORS CAN SERVE. | |
| 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 BOD 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. 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 ON A REQUEST BASIS. | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -411,000. NET ASSETS RELEASED FROM RESTRICTIONS -81,184. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 1,210,293. TOTAL TO FORM 990, PART XI, LINE 5: 718,109. |
| SELECTION OF INDEPENDENT ACCOUNTANT | 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 TWO OR THREE TOP 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 2011. |
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 | 7 | N/A | 0 |
| FRIENDS OF SAUK PRAIRIE MEMORIAL HOSPITAL | ||||||||||
| 80 FIRST STREET | PRAIRIE DU SAC | WI | 53578 | 391453754 | VOLUNTEERING | WI | 501(C)3 | 11 TYPE 3 | 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 |
| 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 | 153184 | FAIR MARKET VALUE |
| SAUK PRAIRIE MEMORIAL HOSPITAL FOUNDATION LTD | ||
| N | 76501 | COST |