ASCENSION NE WISCONSIN INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- ASCENSION NE WISCONSIN INC (EIN 39-0816818)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-08-13
- IRS object ID
- 201242269349300934
- Schema version
- 2010v3.4
- 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 | 2012-08-13T10:13:19-05:00 | Timestamp |
| Tax Period End Date | 2011-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
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 | 2010-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390816818 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST ELIZABETH HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | STEL | NameControl |
| Phone | 9207382000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1506 S ONEIDA STREET | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 549151397 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JEFF BADGER | Name |
| Title | CFO | Title |
| Phone | 9207382000 | Phone |
| Date Signed | 2012-08-02 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TERRI REXRODE CPA | Name |
| Phone | 9206620016 | Phone |
| Date Prepared | 2012-08-02 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | 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 | 1506 S ONEIDA STREET | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 549151397 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 163846331 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.AFFINITYHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1899 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | FOR MORE THAN 100 YEARS, WE HAVE BEEN A LEADER IN PROVIDING QUALITY HEALTH CARE TO FOX VALLEY RESIDENTS, ESPECIALLY THE MEDICALLY UNDERSERVED. THE HOSPITAL MEETS A BROAD VARIETY OF PATIENT NEEDS THROUGH GENERAL CARE, SURGICAL SERVICES AND NUMEROUS MEDICAL SPECIALTIES INCLUDING CARDIOLOGY, ONCOLOGY, PEDIATRICS, EMERGENCY, INTENSIVE CARE AND OBSTETRICS. WITH 352 LICENSED PATIENT BEDS AND MORE THAN 420 SKILLED MEDICAL STAFF, WE OFFER COMPLETE, COMPASSIONATE, QUALITY HEALTH CARE FOR THE ENTIRE FAMILY.AVAILABLE SERVICES: ALLERGY; CANCER; CARDIAC REHABILITATION; CARDIOLOGY; CARDIOVASCULAR SURGERY; DIABETES, NUTRITION AND ENDOCRINOLOGY; EMERGENCY/TRAUMA; GENERAL SURGERY; GENETIC COUNSELING; GYNECOLOGY; HOSPITALIST; HYPERBARIC OXYGEN THERAPY; LABORATORY; LIFELINE HOME MONITORING; LIFESPAN; OBSTETRICS; ORTHOPAEDICS; PAIN MANAGEMENT; PALLIATIVE CARE (END OF LIFE CARE); PEDIATRICS; PSYCHIATRY/PSYCHOLOGY; PULMONOLOGY; SPIRITUAL SERVICES; UROLOGY; VASCULAR MEDICINE; AND WOUND CARE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1300 | TotalNbrEmployees |
| Total Nbr Volunteers | 467 | TotalNbrVolunteers |
| Total Gross UBI | 110875 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -20576 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 335395 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1523999 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 150372410 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 155146394 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 4739260 | InvestmentIncomePriorYear |
| Investment Income Current Year | 4770922 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 851529 | OtherRevenuePriorYear |
| Other Revenue Current Year | 721665 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 156298594 | TotalRevenuePriorYear |
| Total Revenue Current Year | 162162980 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 643255 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 547961 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 69353862 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 74256464 | 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 | 67540912 | OtherExpensePriorYear |
| Other Expenses Current Year | 71364575 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 137538029 | TotalExpensesPriorYear |
| Total Expenses Current Year | 146169000 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 18760565 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 15993980 | RevenuesLessExpensesCY |
| Total Assets BOY | 268264475 | TotalAssetsBOY |
| Total Assets EOY | 316311656 | TotalAssetsEOY |
| Total Liabilities BOY | 83211158 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 118794099 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 185053317 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 197517557 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | ST. ELIZABETH HOSPITAL 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 | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 110799387 | Expense |
| Grants | 547961 | Grants |
| Revenue | 154180896 | Revenue |
| Description | THE ENTITY BELIEVES THERE IS A STRONG DUTY TO MEET THE NEEDS OF THE POOR, INDIGENT, AND MEDICALLY UNDERSERVED IN THE COMMUNITIES. IN KEEPING WITH THE PHILOSOPHY OF EMPOWERMENT AND TRANSFORMATION OF ALL INDIVIDUALS, CARE HAS BEEN PROVIDED TO ALL PATIENTS WITHOUT REGARDS FOR ABILITY TO PAY.OTHER SERVICES INCLUDE:-FREE MAMMOGRAPHY SCREENING AND BREAST EXAMS FOR LOW INCOME WOMEN-FREE NEWLETTERS FOCUSING ON WOMENS HEALTH ISSUES-FREE HEART DISEASE SCREENING FOR INDIVIDUALS-CHILDREN'S HEALTH AND SAFETY ISSUES-FREE SPEAKERS BUREAU-WOMENS RUN FOR HEALTH-TEEN PREGNANCY, PARENTING, AND NURTURING PROGRAMS-THROUGH PATHWAY TO PEACE, A COMPREHENSIVE SERVICE FOR PARENTS AND FAMILIES WHO HAVE EXPERIENCED A PREGNANCY LOSS OF AN INFANT-TELEVISED MASS FOR THE HOMEBOUND IN THE COMMUNITY-CHAPLAINCY AND SUPPORT SERVICES FOR THOSE WHO HAVE HAD A FAMILY MEMBER OR FRIEND DIE-FREE BLOOD PRESSURE SCREENING-FREE PROSTATE SCREENING-COMMUNITY BLOOD DRIVES-HEALTH INFORMATION SPOTS ON TELEVISION AND RADIO | Description |
| Total Program Service Expense | 110799387 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| 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 | 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 | 60 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1300 | 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 | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | 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 | JEFF BADGER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9207201300 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1570 MIDWAY PLACE | AddressLine1 |
| City | MENASHA | City |
| State | WI | State |
| ZIP Code | 54952 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (29 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| DANIEL E NEUFELDER | ||||||||
| PRESIDENT CEO | 13.30 | X | X | 261340 | 572814 | 65400 | ||
| DAVID GITTER | ||||||||
| BOARD MEMBER | 0.30 | X | X | 0 | 0 | 0 | ||
| CATHERINE J TIERNEY | ||||||||
| BOARD MEMBER | 0.30 | X | X | 0 | 0 | 0 | ||
| JOSEPH MCCORMICK MD | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 1097589 | 41533 | |||
| BARBARA STRAND MD | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 264298 | 43300 | |||
| CARLA ALTEPETER | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| MARY HARP-JIRSCHELE | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| FREDERICK KLEIN MD | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| STEPHEN C MORTON | ||||||||
| BOARD TREASURER | 0.30 | X | X | 0 | 0 | 0 | ||
| JOHN RUSSO | ||||||||
| BOARD SECRETARY | 0.30 | X | X | 0 | 0 | 0 | ||
| THOMAS SCHMIDT | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| WAYNE TREMBLY | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| SUSAN VETTE | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| RICHARD WELLS | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| STACEY SENSOR DO | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 482023 | 40878 | |||
| MARK FAUSTICH MD | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 369720 | 35440 | |||
| JAY MULLER MD | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 373057 | 37687 | |||
| CHRISTOPHER ROCKE DO | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 232694 | 35386 | |||
| NICHOLAS DESIEN | ||||||||
| BOARD MEMBER / PRESIDENT - MINISTRY HEALTH CARE | 0.30 | X | X | 0 | 0 | 0 | ||
| JOHN OLIVERIO | ||||||||
| BOARD MEMBER / PRESIDENT - WFSI | 0.30 | X | X | 0 | 1813218 | 157725 | ||
| KATHRYN SIEMAN | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| MONICA VOMASTIC | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| JEFF BADGER | ||||||||
| CFO | 13.00 | X | 139259 | 305233 | 62470 | |||
| TRAVIS ANDERSEN | ||||||||
| PRESIDENT- STE | 40.00 | 359125 | 0 | 47409 | X | |||
| BRIAN HUMPHREY | ||||||||
| SR ULTRASOUND TECH | 40.00 | 159694 | 0 | 48234 | X | |||
| RICHARD GOODMAN | ||||||||
| MEDICAL PHYSICIST | 40.00 | 162924 | 0 | 21478 | X | |||
| JENNIE GAURKEE | ||||||||
| PHARMACY DIRECTOR | 40.00 | 162500 | 0 | 23781 | X | |||
| DEBRA LASTOFKA | ||||||||
| PHARMACIST | 40.00 | 146787 | 0 | 44540 | X | |||
| GARY MILLER | ||||||||
| PHARMACIST | 40.00 | 142042 | 0 | 21368 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1533671 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 5510646 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 726629 | TotalOtherCompensation |
| Number Individuals GT100 K | 23 | 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 HEALTH SYSTEM INC | |||||
| 1570 MIDWAY PLACE | MENASHA | WI | 54952 | CONSULTING/LEGAL/MISC/SALARIES/MISC SERV | 14071329 |
| THE BOLDT CO | |||||
| 2525 N ROEMER RD PO BOX 419 | APPLETON | WI | 54912 | PURCHASED SERVICES | 11548327 |
| HAMMEL GREEN & ABRAHAMSON INC | |||||
| 333 EASAT ERIE ST | MILWAUKEE | WI | 53202 | CONSULTING/DESIGN/MISC | 3304392 |
| WHEATON FRANCISCAN SERVICES INC | |||||
| 26W171 ROOSEVELT RD | WHEATON | IL | 60187 | MANAGEMENT | 1678296 |
| SHARED MEDICAL SERVICES | |||||
| PO BOX 330 | COTTAGE GROVE | WI | 53527 | MEDICAL SERVICES | 1028065 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 29 | NumberOfContractorsGT100K |
| All Other Contributions | 1523999 | AllOtherContributions |
| Total Contributions | 1523999 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|---|
| NET PATIENT REVENUE AN | 621990 | 154180896 | 154180896 | ||
| CAFETERIA INCOME | 722210 | 854623 | $854,623 | ||
| OUPATIENT LAB REVENUE | 621500 | 110875 | 110875 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 155146394 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4721919 | TotalRevenueColumn |
| Exclusion | $4,721,919 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 2392917 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1671252 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 721665 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 721665 | TotalRevenueColumn |
| Exclusion | $721,665 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 61102 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 12099 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 49003 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 49003 | TotalRevenueColumn |
| Exclusion | $49,003 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 162162980 | TotalRevenueColumn |
| Related Or Exempt Function Income | 154180896 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 110875 | UnrelatedBusinessRevenue |
| Exclusion | $6,347,210 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 547961 | Total |
| Program Services | 547961 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 847195 | Total |
| Management And General | 847195 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56349691 | Total |
| Program Services | 43828674 | ProgramServices |
| Management And General | 12521017 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2291517 | Total |
| Program Services | 1782337 | ProgramServices |
| Management And General | 509180 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11201050 | Total |
| Program Services | 8712154 | ProgramServices |
| Management And General | 2488896 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3567011 | Total |
| Program Services | 2774414 | ProgramServices |
| Management And General | 792597 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15361689 | Total |
| Program Services | 8171699 | ProgramServices |
| Management And General | 7189990 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30018988 | Total |
| Program Services | 29026407 | ProgramServices |
| Management And General | 992581 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29994 | Total |
| Program Services | 29994 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3563625 | Total |
| Program Services | 2708067 | ProgramServices |
| Management And General | 855558 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 297844 | Total |
| Program Services | 50925 | ProgramServices |
| Management And General | 246919 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2435907 | Total |
| Program Services | 1851092 | ProgramServices |
| Management And General | 584815 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8325245 | Total |
| Program Services | 6534308 | ProgramServices |
| Management And General | 1790937 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 445470 | Total |
| Management And General | 445470 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| OTHER EXPENSES | 6115035 | 161876 | 5953159 |
| BAD DEBT | 4589436 | 4589436 | |
| DUES AND LICENSES | 181342 | 30043 | 151299 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 146169000 | Total |
| Program Services | 110799387 | ProgramServices |
| Management And General | 35369613 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5282 | BOY |
| EOY | 5385 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16584094 | BOY |
| EOY | 20116092 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18088856 | BOY |
| EOY | 21057269 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 151829447 | BOY |
| EOY | 169736552 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2693852 | BOY |
| EOY | 2887120 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 489624 | BOY |
| EOY | 1583593 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 235477780 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 138662830 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74564231 | BOY |
| EOY | 96814950 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1233710 | BOY |
| EOY | 1252757 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2775379 | BOY |
| EOY | 2857938 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 268264475 | BOY |
| EOY | 316311656 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27073134 | BOY |
| EOY | 26217792 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44201773 | BOY |
| EOY | 75893644 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11936251 | BOY |
| EOY | 16682663 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 83211158 | BOY |
| EOY | 118794099 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 185004941 | BOY |
| EOY | 197469181 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 48376 | BOY |
| EOY | 48376 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 185053317 | BOY |
| EOY | 197517557 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 268264475 | BOY |
| EOY | 316311656 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 15993980 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -3529740 | 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 | $9,331 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 9331 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | ReturnReference |
| Explanation | AHA, WHA & CHA MEMBERSHIP DUES | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1368739 | OtherCostOrOtherBasis |
| Book Value | 1368739 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 101165278 | OtherCostOrOtherBasis |
| Depreciation | 50445228 | Depreciation |
| Book Value | 50720050 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2987838 | OtherCostOrOtherBasis |
| Depreciation | 2225322 | Depreciation |
| Book Value | 762516 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 111031055 | OtherCostOrOtherBasis |
| Depreciation | 85947842 | Depreciation |
| Book Value | 25083213 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 18924870 | OtherCostOrOtherBasis |
| Depreciation | 44438 | Depreciation |
| Book Value | 18880432 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 96814950 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO 3RD PARTY - RESERVE | $1,101,172 |
| PENSION LIABILITY | $15,336,814 |
| 457B PLAN | $244,677 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 16682663 | TotalOfAmounts |
| Total Revenue | 162162980 | TotalRevenue |
| Total Expenses | 146169000 | TotalExpenses |
| Excess Or Deficit For Year | 15993980 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 6017 | NetUnrealizedGLOnInvestments |
| Other | -$3,535,757 | OtherAmount |
| Total Adjustments | -3529740 | TotalAdjustments |
| Excess Or Deficit Per FS | 12464240 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 162352783 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 162352783 | RevenueSubtotal |
| Other Revenues Not Included | -189803 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -189803 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 162162980 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 147345209 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 1654170 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 1654170 | ExpensesNotRptdF990 |
| Expenses Subtotal | 145691039 | ExpensesSubtotal |
| Other Expenses Not Included | 477961 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 477961 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 146169000 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | FASB ASC SUBTOPIC 740-10, INCOME TAXES OVERALL, PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE AMOUNT OF UNRECOGNIZED TAX EXPENSE RELATED TO THESE CRITERIA FOR THE CORPORATION WAS ZERO AS OF SEPTEMBER 30, 2011 AND 2010. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | PENSION ADJUSTMENT -3,535,757. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | RENTAL EXPENSE IN REVENUE -1,654,170. CONTRIBUTIONS IN NET ASSETS 1,464,367. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSE IN REVENUE 1,654,170. | |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | GRANT TO SPONSOR ORGANIZATION 477,961. |
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 | 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) |
|---|---|---|
| Persons Served | 696 | PersonsServed |
| Total Community Benefit Expense | 1884611 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1884611 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01330 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 19006 | PersonsServed |
| Total Community Benefit Expense | 3802899 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3802899 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02690 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 850 | PersonsServed |
| Total Community Benefit Expense | 136511 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 136511 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 20552 | PersonsServed |
| Total Community Benefit Expense | 5824021 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 5824021 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04120 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 2778 | PersonsServed |
| Total Community Benefit Expense | 127038 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 127038 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Persons Served | 179 | PersonsServed |
| Total Community Benefit Expense | 1082860 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 165730 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 917130 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00650 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 1444 | PersonsServed |
| Total Community Benefit Expense | 3939034 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3467711 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 471323 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00330 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 17938 | PersonsServed |
| Total Community Benefit Expense | 1164617 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1164617 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00820 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 11 | NumberOfActivitiesOrPrograms |
| Persons Served | 22339 | PersonsServed |
| Total Community Benefit Expense | 6313549 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3633441 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2680108 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01890 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 11 | NumberOfActivitiesOrPrograms |
| Persons Served | 42891 | PersonsServed |
| Total Community Benefit Expense | 12137570 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3633441 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8504129 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06010 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 821 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 821 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 24 | PersonsServed |
| Total Community Building Expense | 122 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 122 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 576 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 576 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 390 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 390 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 24 | PersonsServed |
| Total Community Building Expense | 1909 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1909 | NetCommunityBuildingExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,759,045 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 55784719 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 57875073 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2090354 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | X | CostAccountingSystem |
| 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 | ST ELIZABETH HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1506 S ONEIDA STREET | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 54915 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Teaching Hospital | X | TeachingHospital |
| 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 | ST ELIZABETH HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: IT IS THE POLICY OF ST. ELIZABETH HOSPITAL 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 $4,589,436 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. SOME EXAMPLES INCLUDE: REBUILDING TOGETHER IN WHICH MANAGERS FROM ST. ELIZABETH HOSPITAL WENT OUT TO HELP LOW-INCOME ELDERLY MEMBERS OF THE COMMUNITY WITH REMODELING PROJECTS TO IMPROVE SAFETY OR CONDITION OF THEIR HOMES. ANOTHER EXAMPLE IS THE HEALTH CAREER EXPERIENCE DAY IN WHICH PROFESSIONALS FROM ST. ELIZABETH HOSPITAL HIGHLIGHT A VARIETY OF HEALTHCARE CAREERS AND TALK ABOUT THEIR PROFESSIONS (I.E. NURSING, SURGERY, LABORATORY AND RADIOLOGY) | ||
| PART III, LINE 4: NO FOOTNOTE EXISTS IN ST. ELIZABETH HOSPITALS FINANCIALS STATEMENTS THAT DESCRIBE BAD DEBT EXPENSE. BAD DEBT EXPENSE IS RECORDED IN A CONSISTENT MANNER WITH THE ORGANIZATIONS 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 HOSPITALS 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 HAVE A PRESUMPTIVE ELIGIBILITY PROGRAM IN PLACE 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 8: THE SHORTFALL ASSOCIATED WITH MEDICARE SHOULD BE CONSIDERED A COMMUNITY BENEFIT FOR SEVERAL REASONS. FIRST, IRS REV. RUL. 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NON-PROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. SECOND, FOR-PROFIT SPECIALTY HOSPITALS HAVE BEEN CARVING OUT CERTAIN HIGH-MARGIN SERVICES (I.E. CARDIAC, ORTHOPEDICS, AND ONCOLOGY), LEAVING GENERAL ACUTE CARE HOSPITALS WITH LOWER-MARGIN MEDICARE SERVICES. THIS INDICATES THAT MEDICARE LOSSES CAN BE A RESULT OF RENDERING THESE LOWER-MARGIN SERVICES (WHICH BENEFIT THE COMMUNITY) RATHER THAN INEFFICIENT OPERATIONS. LASTLY, THE COMMUNITY WHICH THE ORGANIZATION SERVES HAS MEDICARE AS THE LARGEST PAYER. THE ORGANIZATION MUST ACCEPT THESE PATIENTS REGARDLESS OF WHETHER THEY MAKE A SURPLUS OR DEFICIT FROM PROVIDING SUCH SERVICES. IF THE MEDICARE PARTICIPATION IS PREMISED ON THIS FACT, THEN PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH IS A COMMUNITY BENEFIT. THE DEMOGRAPHIC OF THE COMMUNITY IS ALSO AN AGING AND UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE SERVICES, CMS WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY. | ||
| PART III, LINE 9B: ST. ELIZABETH HOSPITAL 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 VI, LINE 7: ST. ELIZABETH HOSPITAL, INC. FILES THEIR COMMUNITY BENEFIT RESULTS IN THE STATE OF WISCONSIN. THEIR DATA IS INCORPORATED INTO A REPORT FOR ALL OF AFFINITY HEALTH SYSTEM THAT ULTIMATELY IS PUBLISHED IN THE AREA NEWSPAPERS. | ||
| PART VI, LINE 2: ST. ELIZABETH HOSPITAL PERFORMS COMMUNITY HEALTH NEEDS ASSESSMENTS AS NEEDED. PLANNING WORKGROUPS CONSISTING OF COMMUNITY PARTNERS ARE FORMED TO DEFINE THE COMMUNITY AND ITS HEALTH NEEDS THROUGH REVIEW OF UNITED WAY LIFE STUDY RESULTS, HEALTHY PEOPLE INITIATIVES, CENSUS DOCUMENTS, AND LOCAL GOVERNMENT HEALTH AND WELFARE AGENCIES. CONSIDERING OTHER COMMUNITY RESOURCES/ASSETS, DATA COLLECTION METHODS ARE USED TO IDENTIFY PARTICULAR PROBLEMS OR SUBGROUPS AND AREAS KNOWN TO HAVE HIGH POVERTY RATES AND TO BE UNDERSERVED. THE DATA IS ANALYZED AND PRIORITIES ARE SET BASED ON TRENDING INFORMATION WHICH MAY TARGET A SPECIFIC NEED. 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 HEALTH NEEDS ASSESSMENTS. THE LEADERSHIP AT AFFINITY TAKES THEIR COMMITMENT TO THE HEALTH AND WELL-BRING OF THE COMMUNITY IT SERVES VERY SERIOUSLY. IN FACT, IT IS CORE TO THE ORGANIZATIONS MISSION, 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. SENIOR LEADERS AND MANAGEMENT ARE ALSO HIGHLY ENCOURAGED TO PROVIDE DIRECT SERVICE TO THE POOR IN THEIR COMMUNITIES. ST. ELIZABETH AND THE LEADERSHIP ALSO SUBSCRIBE TO PUBLICATIONS LIKE THE ADVISORY BOARD TO COMPARE NATIONAL TRENDS TO LOCAL TRENDS TO ENSURE THE HOSPITAL IS RESOURCING AREAS TO MEET PATIENT NEEDS. | ||
| PART VI, LINE 3: ST. ELIZABETH HOSPITAL 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 ORGANIZATIONS AFFINITY CARE POLICY. THE AFFINITY CARE POLICY AND APPLICATION IS POSTED ON THE ORGANIZATIONS WEBSITE. ADMISSIONS AND OTHER KEY AREAS CONTAIN SUMMARY INFORMATION OF THE AFFINITY CARE POLICY. AS PART OF THE INTAKE/DISCHARGE PROCESS, PATIENTS ARE PROVIDED WITH A COPY OF THE POLICY 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 THE ORGANIZATIONS AFFINITY CARE PROGRAM. PATIENTS MAY BE IDENTIFIED AS NEEDING FINANCIAL ASSISTANCE AT ANY TIME DURING THE COURSE OF AN ENCOUNTER. A REFERRAL FOR CONSIDERATION OF AFFINITY CARE FINANCIAL ASSISTANCE CAN BE INITIATED BY ANY MEMBER OF THE HOSPITALS WORKFORCE, INCLUDING MEDICAL STAFF MEMBERS, WHO BECOME AWARE OF THE PATIENTS POTENTIAL NEED FOR AFFINITY CARE FINANCIAL ASSISTANCE. THE AFFINITY CARE BROCHURE 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 GUIDELINES TO FOLLOW WHEN INTERACTING WITH PATIENTS. AS PART OF THE AFFINITY CARE 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 HOSPITALS COMMUNITY BENEFIT, THIS IS A WORK IN PROGRESS. ST. ELIZABETH HOSPITAL 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. OUR HOSPITAL, 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 ADULT BEHAVIORAL HEALTH SERVICES, I/P ADOLESCENT BEHAVIORAL HEALTH SERVICES AND NEONATAL INTENSIVE CARE SERVICES | ||
| PART VI, LINE 6: ST. ELIZABETH HOSPITALS GOVERNING BOARD CONSISTS PRIMARILY OF PERSONS WHO RESIDE WITHIN THE PRIMARY SERVICE AREA. THEY ARE NOT EMPLOYEES OF THE ORGANIZATION.THE ORGANIZATION STRIVES TO FURTHER ITS EXEMPT PURPOSES BY THE FOLLOWING: ST. ELIZABETH HOSPITAL PARTICIPATES IN GOVERNMENT-SPONSORED HEALTH PROGRAMS (MEDICARE, MEDICAID, CHAMPUS, GENERAL RELIEF, SPECIALIZED COUNTY PROGRAMS AND AREA PRISONS ) ST. ELIZABETH HOSPITAL DONATES FOOD TO AN AREA HALF-WAY HOUSE AND THEIR DIETARY DEPARTMENT ALSO SUBSIDIZES MOBILE MEALS PROGRAMS FOR THE ELDERLY AND LOW INCOME INDIVIDUALS. ST. ELIZABETH HOSPITAL FOUNDATION 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. ST. ELIZABETH HOSPITAL WORKS WITH THE LOCAL PUBLIC HEALTH DEPARTMENT TO DO NEEDS ASSESSMENT FOR BEHAVIORAL HEALTH SERVICES. ST. ELIZABETH HOSPITAL PROVIDES COMMUNITY HEALTH IMPROVEMENT SERVICES THROUGH HEALTH EDUCATION LECTURES, HEALTH FAIRS AND SUPPORT GROUPS. ST. ELIZABETH HOSPITAL SUBSIDIZES YMCA INSTRUCTORS TO WORK WITH INDIVIDUALS WHO HAVE REHABILITATION NEEDS. ALSO HOLD FREE FOLLOW-UP CLINICS OF INFANTS BORN IN THE HOSPITAL NICU. DISCOUNTED CARE IS PROVIDED TO LOW INCOME FAMILIES UP TO 662% OF FEDERAL POVERTY GUIDELINES.. ST. ELIZABETH HOSPITAL IS A DISPROPORTIONATE SHARE HOSPITAL WITH A COMBINED MEDICAID AND SSI UTILIZATION OF OVER 31.53%. ST. ELIZABETH HOSPITAL PROVIDES A SUBSIDY TO UW-FAMILY PRACTICE PHYSICIAN RESIDENCY PROGRAM. ALSO SUBSIDIZE A SCHOOL OF MEDICAL TECHNOLOGY PROGRAM. ST. ELIZABETH HOSPITAL SERVES AS A SPONSOR SITE FOR CLINICAL TRAINING OF COLLEGE STUDENTS IN VARIOUS HEALTH CARE PROGRAMS. ST. ELIZABETH HOSPITAL HELPS TO SUBSIDIZE AN AREA COMMUNITY CLINIC THAT SERVES THE UNINSURED AND LOW INCOME MEMBERS OF THE COMMUNITY. SUPPORT CONSISTS OF CASH DONATIONS FOR OPERATIONS, NURSING STAFF AND LAB AND X-RAY SERVICES. | ||
| PART VI, LINE 7: ST. ELIZABETH HOSPITAL, OF APPLETON, WISCONSIN IS PART OF AN AFFILIATED HEALTH CARE SYSTEM CALLED AFFINITY HEALTH SYSTEM. AFFINITY HEALTH SYSTEM ALSO HAS TWO OTHER HOSPITALS, MERCY MEDICAL CENTER, IN OSHKOSH, WI AND CALUMET MEDICAL CENTER, IN CHILTON, WI. THE LATTER HOSPITAL QUALIFIES AS A CRITICAL ACCESS HOSPITAL. 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 BY PROVIDING SERVICES THAT PROMOTE THE HEALTH AND WELL BEING OF THE COMMUNITIES WE SERVE, ESPECIALLY THE POOR. AFFINITY HEALTH SYSTEM IS SPONSORED EQUALLY BY TWO CATHOLIC HEALTH SYSTEMS, MINISTRY HEALTH CARE, HEADQUARTERED IN MILWAUKEE, WI AND WHEATON FRANCISCAN HEALTH CARE, ALSO HEADQUARTERED IN MILWAUKEE, WI. ST. ELIZABETH HOSPITAL AND MERCY MEDICAL CENTER BOTH SUBSIDIZE AREA COMMUNITY MEDICAL CLINICS AS WELL AS COMMUNITY DENTAL CLINICS. THE 3 HOSPITALS AND THE 25 CLINICS PROVIDE FREE OR MINIMAL COST HEALTH EDUCATION, SUPPORT AND SCREENING SERVICES FOR THE POPULATIONS THEY SERVE. ST. ELIZABETH HOSPITAL AND MERCY MEDICAL CENTER BOTH 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. ST. ELIZABETH HOSPITAL HAS A FOUNDATION WHICH IS NOT INCLUDED WITHIN THE OPERATIONS OF THE ORGANIZATION. THE FOUNDATION PROVIDES CASH DONATIONS WHICH HELP SUPPORT THE MISSION OF THE ORGANIZATION AND THE AFFILIATED HEALTH CARE SYSTEM. EXAMPLES OF THE DONATIONS ARE INCLUDED IN ITEM #6 ABOVE. | ||
| 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 | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| WHEATON FRANSICAN SERVICES INC | |||||||
| 26 W 171 ROOSEVELT RD | WHEATON | IL | 601890667 | 363262111 | 501(C)(3) | 477961 | GRANT TO SERVE THE POOR |
| FOX CITIES COMMUNITY HEALTH CENTER INC | |||||||
| 1800 APPLETON RD | MENASHA | WI | 54952 | 202090446 | 501(C)(3) | 70000 | PROVIDE HEALTHCARE TO THE INDIGENT AND UNDERSERVED |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: EACH YEAR ST. ELIZABETH HOSPITAL PROVIDES A GRANT BASED ON AN INTEGRATION AGREEMENT. THE INTEGRATION AGREEMENT SUBSTANTIATES THE AMOUNT AND THE RECIPIENT OF THE GRANT. | Explanation |
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 | 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 | 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 (15 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 E NEUFELDER | |||||||||||||
| 192588 | 422120 | 66564 | 145898 | 2188 | 4796 | 15640 | 34280 | 4850 | 10630 | 281830 | 617724 | 0 | 0 |
| JOSEPH MCCORMICK MD | |||||||||||||
| 0 | 1096449 | 0 | 0 | 0 | 1140 | 0 | 18640 | 0 | 22893 | 0 | 1139122 | 0 | 0 |
| BARBARA STRAND MD | |||||||||||||
| 0 | 262911 | 0 | 0 | 0 | 1387 | 0 | 22346 | 0 | 20954 | 0 | 307598 | 0 | 0 |
| STACEY SENSOR DO | |||||||||||||
| 0 | 480983 | 0 | 0 | 0 | 1040 | 0 | 22374 | 0 | 18504 | 0 | 522901 | 0 | 0 |
| MARK FAUSTICH MD | |||||||||||||
| 0 | 368541 | 0 | 0 | 0 | 1179 | 0 | 28196 | 0 | 7244 | 0 | 405160 | 0 | 0 |
| JAY MULLER MD | |||||||||||||
| 0 | 372671 | 0 | 0 | 0 | 386 | 0 | 18692 | 0 | 18995 | 0 | 410744 | 0 | 0 |
| CHRISTOPHER ROCKE DO | |||||||||||||
| 0 | 232298 | 0 | 0 | 0 | 396 | 0 | 17670 | 0 | 17716 | 0 | 268080 | 0 | 0 |
| JOHN OLIVERIO | |||||||||||||
| 0 | 918033 | 0 | 527500 | 0 | 367685 | 0 | 92775 | 0 | 64950 | 0 | 1970943 | 0 | 350448 |
| JEFF BADGER | |||||||||||||
| 101843 | 223223 | 30422 | 66681 | 6994 | 15329 | 13320 | 29195 | 6252 | 13703 | 158831 | 348131 | 0 | 0 |
| TRAVIS ANDERSEN | |||||||||||||
| 263833 | 0 | 76004 | 0 | 19288 | 0 | 28086 | 0 | 19323 | 0 | 406534 | 0 | 0 | 0 |
| BRIAN HUMPHREY | |||||||||||||
| 159209 | 0 | 0 | 0 | 485 | 0 | 36584 | 0 | 11650 | 0 | 207928 | 0 | 0 | 0 |
| RICHARD GOODMAN | |||||||||||||
| 161878 | 0 | 0 | 0 | 1046 | 0 | 8396 | 0 | 13082 | 0 | 184402 | 0 | 0 | 0 |
| JENNIE GAURKEE | |||||||||||||
| 162201 | 0 | 0 | 0 | 299 | 0 | 8544 | 0 | 15237 | 0 | 186281 | 0 | 0 | 0 |
| DEBRA LASTOFKA | |||||||||||||
| 146265 | 0 | 0 | 0 | 522 | 0 | 37522 | 0 | 7018 | 0 | 191327 | 0 | 0 | 0 |
| GARY MILLER | |||||||||||||
| 140549 | 0 | 0 | 0 | 1493 | 0 | 7178 | 0 | 14190 | 0 | 163410 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1B | 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. |
| PART I, LINE 4B | JOHN OLIVERIO RECEIVED A 2010 TAXABLE PAYOUT OF $350,448 RELATED TO A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN KNOW AS THE WHEATON FRANCISCAN SERVICES BENEFIT RESTORATION PLAN. |
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 | MORTON PHARMACY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | STEPHEN MORTON, A DIRECTOR, IS AN OWNER OF MORTON PHARMACY | Relationship |
| Amount Of Transaction | 4955 | AmountOfTransaction |
| Description Of Transaction | PURCHASE OF PHARMACEUTICALS | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | WHEATON FRANSICAN SERVICES, INC IS A CORPORATE MEMBER AND AFFINITY HEALTH SYSTEM IS A MANAGING MEMBER. | |
| FORM 990, PART VI, SECTION A, LINE 7A | WHEATON FRANCISCAN SERVICES, INC. HAS THE POWER TO APPROVE AND REMOVE DIRECTORS FROM ST. ELIZABETH HOSPITAL | |
| FORM 990, PART VI, SECTION A, LINE 7B | AMENDMENTS OF THE ARTICLES OF INCORPORATION AND BYLAWS MUST BE APPROVED BY WHEATON FRANCISCAN SERVICES, INC. | |
| 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. | |
| THE BOARD OF DIRECTORS RECEIVES A CONFLICT OF INTEREST QUESTIONNAIRE EVERY YEAR. | FORM 990, PART VI, SECTION B, LINE 12C | |
| EACH YEAR THE ORGANIZATION ENGAGES AN INDEPENDENT COMPENSATION FIRM TO PROVIDE MARKET DATA FOR CEO, EXECUTIVES AND KEY EMPLOYEE POSTIONS. THIS STUDY IS SHARED WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS FOR THEIR REVIEW AND RECOMMENDATIONS REGARDING ANY COMPENSATION CHANGES. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT MEMBERS. THE CEO REVIEWS EACH EXECUTIVE AND KEY EMPLOYEE'S ANNUAL PERFORMANCE APPRAISAL RATINGS IN MAKING HIS COMPENSATION RECOMMENDATIONS TO THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE HAS THE FINAL AUTHORITY TO APPROVE ANY AND ALL AMOUNTS OF COMPENSATION FOR MEMBERS OF THE EXECUTIVE TEAM. THE FINAL APPROVAL OF COMPENSATION AMOUNTS ARE DOCUMENTED. | FORM 990, PART VI, SECTION B, LINE 15 | |
| THE ORGANIZATION BELIEVES THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND POLICES ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. | FORM 990, PART VI, SECTION C, LINE 19 | |
| HOURS WORKED FOR RELATED ORGANIZATIONS | MARK FAUSTICH, MD WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR A RELATED ORGANIZATIONS. JOSEPH MCCORMICK, MD WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR A RELATED ORGANIZATION. JAY MULLER, MD WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR A RELATED ORGANIZATIONS. CHRISTOPHER ROCKE, MD WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR A RELATED ORGANIZATIONS. STACEY SENSOR, DO WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR A RELATED ORGANIZATIONS. BARBARA STRAND, MD WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR A RELATED ORGANIZATIONS. DANIEL NEUFELDER WORKED AN AVERAGE OF 27 HOURS PER WEEK FOR RELATED ORGANIZATIONS. JEFF BADGER WORKED AN AVERAGE OF 27 HOURS PER WEEK FOR RELATED ORGANIZATIONS. JOHN OLIVERIO WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR A RELATED ORGANIZATIONS. | FORM 990, PART VII |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 6,017. PENSION ADJUSTMENT -3,535,757. TOTAL TO FORM 990, PART XI, LINE 5: -3,529,740. | FORM 990, PART XI, LINE 5: |
| PROCESS FOR OVERSIGHT OF AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT | ST. ELIZABETH HOSPITAL, INC. (ORGANIZATION) DOES NOT RECEIVE SEPARATELY AUDITED FINANCIAL STATEMENTS. THE ORGANIZATION IS AUDITED AND REPORTED THROUGH CONSOLIDATED FINANCIAL STATEMENTS. THE AUDIT COMMITTEE IS RESPONSIBLE FOR THE AUDITOR SELECTION. THE AUDIT STATEMENTS ARE REVIEWED BY THE CONTROLLER, CFO, AND THE AUDIT COMMITTEE. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. | FORM 990, PART XI, LINE 2B-2C |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (7 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 | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| AFFINITY HEALTH SYSTEM | |||||||||||
| 1570 MIDWAY PL | MENASHA | WI | 54952 | 391568866 | SUPPORT RELATED HEALTHCARE ORGRANIZATIONS | IL | 501(C)(3) | 3 | N/A | 0 | |
| MERCY MEDICAL CENTER OF OSHKOSH INC | |||||||||||
| 500 S OAKWOOD | OSHKOSH | WI | 54904 | 390806268 | HEALTH CARE SERVICES | WI | 501(C)(3) | 3 | 0 | AFFINITY HEALTH SYSTEMS INC | |
| NETWORK HEALTH SYSTEM INC | |||||||||||
| 1570 MIDWAY PL | MENASHA | WI | 54952 | 391127163 | CLINICAL HEALTHCARE SERVICES | WI | 501(C)(3) | 3 | 0 | AFFINITY HEALTH SYSTEMS INC | |
| ST ELIZABETH HOSPITAL FOUNDATION | |||||||||||
| 1506 SOUTH ONEIDA STREET | APPLETON | WI | 54915 | 391256677 | RAISE FUNDS IN SUPPORT OF ST.ELIZABETH HOSPITAL AND RELATEDENTITIES | WI | 501(C)(3) | 7 | 0 | AFFINITY HEALTH SYSTEMS INC | |
| CALUMET MEDICAL CENTER INC | |||||||||||
| 614 MEMORIAL DRIVE | CHILTON | WI | 53014 | 390905385 | HOSPITAL | WI | 501(C)(3) | 3 | 0 | AFFINITY HEALTH SYSTEMS INC | |
| MERCY HEALTH FOUNDATION INC | |||||||||||
| PO BOX 3370 | OSHKOSH | WI | 54903 | 237140261 | PUBLIC WELFARE THROUGH COMMUNITY HEALTH DEVELOPMENT | WI | 501(C)(3) | 9 | 0 | AFFINITY HEALTH SYSTEMS INC | |
| WEATON FRANCISCAN SERVICES INC | |||||||||||
| 26 W171 ROOSEVELT ROAD | WHEATON | IL | 60187 | 363262111 | SUPPORT RELATED HEALTHCARE ORGRANIZATIONS | IL | 501(C)(3) | 11A-1 | N/A | 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 (2 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 |
| 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 | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 1 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | 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 | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | 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 | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |