PRAIRIE DU CHIEN MEMORIAL HOSPITAL ASSOCIATION INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- PRAIRIE DU CHIEN MEMORIAL HOSPITAL ASSOCIATION INC (EIN 39-0926284)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-10-15
- IRS object ID
- 201242909349300519
- 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 D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-10-15T17:15:39-07:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391336685 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Rural Wisconsin Health Cooperative | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 880 Independence Lane | AddressLine1 |
| City | Sauk CIty | City |
| State | WI | State |
| ZIP Code | 53583 | 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 | 390926284 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Prairie du Chien Memorial Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PRAI | NameControl |
| Phone | 6083572000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 705 East Taylor Street | AddressLine1 |
| City | Prairie du Chien | City |
| State | WI | State |
| ZIP Code | 538212196 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | William P Sexton | Name |
| Title | CEO | Title |
| Phone | 6083572000 | Phone |
| Date Signed | 2012-10-15 | DateSigned |
| Authorize Third Party | 0 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Richard Donkle | Name |
| PTIN | P01349576 | PTIN |
| Phone | 6086432343 | Phone |
| Date Prepared | 2012-10-15 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | William P Sexton | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 705 East Taylor Street | AddressLine1 |
| City | Prairie du Chien | City |
| State | WI | State |
| ZIP Code | 538212196 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 33177106 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | http://www.pdcmh.org/ | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1957 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | Prairie du hien Memorial Hospital will deliver high quality, personalized healthcare and education, in a freindly safe environment, to educate people in every stage of life through partnerships with other regional health care providers. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 341 | TotalNbrEmployees |
| Total Nbr Volunteers | 277 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 158490 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 632988 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 16845815 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 31308643 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 292524 | InvestmentIncomePriorYear |
| Investment Income Current Year | 523184 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 287437 | OtherRevenuePriorYear |
| Other Revenue Current Year | 547319 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 17584266 | TotalRevenuePriorYear |
| Total Revenue Current Year | 33012134 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 1060 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 8390 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 9570363 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 19416672 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 84896 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 5497040 | OtherExpensePriorYear |
| Other Expenses Current Year | 10677412 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 15068463 | TotalExpensesPriorYear |
| Total Expenses Current Year | 30102474 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2515803 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2909660 | RevenuesLessExpensesCY |
| Total Assets BOY | 37592794 | TotalAssetsBOY |
| Total Assets EOY | 40717408 | TotalAssetsEOY |
| Total Liabilities BOY | 3207288 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3360849 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 34385506 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 37356559 | NetAssetsOrFundBalancesEOY |
| Mission Description | Prairie du Chien Memorial Hospital will deliver high quality, personalized healthcare and education, in a friendly safe environment, to educate people in every stage of life through partnerships with other regional health care providers. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 23437470 | Expense |
| Revenue | 28905117 | Revenue |
| Description | Routine services: Inpatient/acute services-2748 days, Hospice acute services-188 days, Skilled Swing Bed services-1196 days, Intermediate Care Serices-375 days. Outpatient services: Outpatient visits-17117 visits. Ancillary Inpatient and Outpatient services are provided to the local community who would otherwise be required to travel outside their community to obtain their health care services. In addition to the services already mentioned, Prairie du Chien Memorial provides Birthing Center, Diagnostics, 24 hour Emergency Services, Urgent Care, Extended Care, Home Oxygen, Home Medical Equipment, Lifeline, Palliative Care, Pulmonology, Podiatry, Sleep Study, Wound Care/Ostomy/Continance Care, Respite Care, Infusion Services, Outpatient Care, Laboratory Services, Medical Imaging, Rehabilitation Services, Sleep Center, Speech & Audiology, and Surgical Services. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 969882 | Expense |
| Revenue | 483138 | Revenue |
| Description | Prairie du Chien Memorial Hospital's Home Health Care Agency provides health care services to patients throughout their life span, in their place of residence under the orders of a licensed physician. A registered nurse completes an initial comprehensive assessment of the patient, family and living environment. The nurse (and if required, therapist and medical social worker) and physician develop a plan of care to meet the mutual goals as established with the patient, family, physician and other health care teammembers. As the plan is implemented, referrals are made as appropriate to the other team members and support systems. Inaddition to the above mentioned staff, the Certified Home Health Aide is able to provide assistance with needed personal care, prescribed exercise programs and other duties as directed by the nurse. In-home health services: Registered Nurses, Home Health Aides, Physical Therapy, Occupational Therapy, Speech Therapy, Medical Social Worker, Home Health visits-4381; admissions-211. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1444606 | Expense |
| Revenue | 1152594 | Revenue |
| Description | Hospice provides specially trained health care professionals working together with you, your family, and your own primary physician. Your Hospice Team consists of medical directors, registered nurses, medical social workers, home health aides, dietitians, pharmacists, pastoral care services, volunteers, therapists, and bereavement coordinators. Hospice focuses on the patient and their family: To promote a source of continuous physical, emotional, and spiritual care to the dying patient and family. To provide encouragement to live their remaining life to the fullest with dignity and obtain the highest quality of life. To support the family during and after the death of the patient's loved ones. Hospice consists of the following services: Home Care: The family is supported by the Hospice team and attending physician to care for their loved one at home. Regular visits are made by staff to assure patient and family needs are being met. Hospice is also available in nursing homes and assisted living facilities contracted with our agency within our service area. Continuous Care: In times of crisis when intense nursing care is needed for symptom management, staff will be accessible for extended periods as available. Inpatient Care: If the need arises for more acute care and/or symptom management, a patient may be admitted into their local hospital. Hospice has contracts with several hospitals in our service area. Respite Care: This type of care is available to offer caregivers relief. The patient can be admitted into their local hospital and be cared for by the nursing staff. Medicare/Medicaid covers five consecutive days of Respite Care on a non-routine basis. Hospice Home Care Days-6292 | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1352214 | Expense |
| Revenue | 767795 | Revenue |
| Description | Prairie du Chien Memorial Hospital provides 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 rural hospitals, was created and is maintained in order to provide care locally-care that without our hospital, would not be available locally. Beyond inpatient hospitalizations, we provide local access to many health services: Birthing Center, Dialysis Center, Diagnostics, 24 hour Emergency Services, Urgent Care, Extended Care, Home Health Care, Hospice, Home Oxygen, Home Medical Equipment, Personal Home services, Lifeline, Palliative Care, Home delivered meals, Pulmonology, Podiatry, Sleep Study, Wound Care/Ostomy/Continence Care, Respite Care, Infusion Services, Outpatient Care, Laboratory Services, Medical Imaging, Rehabilitation Services, Sleep Center, Speech and Audiology, Surgical Services, Family Resource Center, Crawford Abuse Resistance Effort, Independent Living, and Telehealth. Prairie du Chien Memorial Hospital provides quality medical health care regardless of race, color, age, national origin, sex, gender identity, sexual orientation, disability or ability to pay. In keeping with this hospital's commitment to serve all members of the community: Memorial Hospital provided free care and/or subsidized care. Memorial Hospital provides care to persons covered by governmental programs at below cost. Recognizing its mission to the community, services are provided to both Medicare and Medicaid patients. To the extent reimbursement is below charges, Memorial Hospital recognizes these amounts as contractual allowances in meeting its mission to the entire community. Memorial Hospital's health activities and programs help support the community. Consideration is also given where the need and/or individual's inability to pay coexists. These activities include wellness programs, community education programs, special programs for the elderly, medically underserved, screening programs and a variety of broad community support activities. Preparing and delivering 24,401 Meals on Wheels during the year December 31, 2011 to community residents who are unable to prepare a meal for themselves due to their medical condition. These meals were provided at a minimal subsidized fee. Diet counseling is provided. During the year December 31, 2011, 363 people received diet counseling. Sponsoring a weight loss program and a variety of other wellness type programs at subsidized cost. Offering a series of seminars on topics such as Parenting, Women & Heart Disease, Osteoporosis, Stress Management, Advanced Directives, and Survivors of Sexual Abuse. In addition, we provide Lamaze classes for prenatal education and an "I Can Cope Program" for cancer patients. These classes are all free or subsidized by the Hospital. Interactive video presentations were also provided for the community. Providing bereavement counseling for about 430 families of Hospice patients during the year December 31, 2011. Also offering grief support program and newsletters for families in local communities. Support groups for parents who have lost a child through miscarriage or stillbirth. Providing free newborn hearing testing. Providing community education center which coordinates clinical rotation and provides assistance to educators through our work with student nurses, unit clerk students, physical therapy students, radiology tech students, health information students, and residents. Providing CPR classes for the community. First Aid classes were provided for community members. Participation in Farm & Home Show and the Senior Expo.. Health brochures and screenings were done. We performed free oximeter screenings for the community and offere for free or reduced cost blood pressure, glucose, and cholesterol screenings. Collaborating with local school systems to provide educational programs on issues such as sex education, breast health, and providing tours of the hospital for health classes, child development classes, and others. Community benefits are also achieved through many reduced price services and free programs offered throughout the year based upon activities and services which Memorial Hospital believes will serve a bona fide community health need. These include: A variety of brochures on health and wellness are available free of charge in several locations within the hospital. A variety of brochures to educate Medicare patients, with respect to their benefits under the Medicare program. Participation in two county fairs during the year December 31, 2011 in order to foster health education in the community. Services provided include glucose, oximeter, blood pressure and cholesterol screenings. Being available to speak before community organizations on a variety of health care topics, in 2011. The Family Resource Center provides a variety of services and resources including a Toy Resource & Lending Library; a three-week "Music, Movement & Memories" series; parent education for jail inmates; babysitter training; phone consultations; family coaching; family drop-ins; family support groups; car seat installation & instruction; new parent education; CPR training; and a variety of other family focused services. FRC also tours MFL Mar MAC schools yearly to educate about the services and programs for new parents. FRC strives to pursue its goal of empowering parents to face the challenges of family life in a caring and positive way. Through education and support along with resources the ultimate goal of FRC is the prevention of child abuse and neglect. Crawford Abuse Resistance Effort (C.A.R.E.) as Sponsored by Prairie du Chien Memorial Hospital provided the following services for the year ending December 31, 2011. The goal of C.A.R.E. is to reduce and/or prevent alcohol, tobacco, and other drug use/abuse among Crawford County youth and adults using comprehensive prevention and health promotion strategies. To achieve this goal, C.A.R.E. collaborates with schools, law enforcement and community agencies to provide substance abuse prevention education and training programs for youth and adults. In 2011, 1,149 adults contributed 2,991 hours and 2,293 youth contributed 8,511 hours to planning, implementation, evaluation and/or participation in prevention and youth development programs. Additionally, approximately 380 adults and 825 youth were impacted by C.A.R.E. through some level of direct service. C.A.R.E. focuses their efforts on the implementation of environmental strategies designed to create positive community change. These strategies include alcohol/tobacco compliance checks, local policy/ordinance change and saturation/party patrols. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 1352214 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 0 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 767795 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 27204172 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | 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 | 1 | 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 | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | 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 | 25 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 341 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | 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 |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | David Breitbach | NamePerson |
| Telephone Number | 6083572405 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 705 East Taylor Street | AddressLine1 |
| City | Prairie du Chien | City |
| State | WI | State |
| ZIP Code | 538212196 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| Paul Ginkel | |||||||||
| President | 4 | X | 0 | 0 | 0 | ||||
| Charlie Connell | |||||||||
| Vice President | 2 | X | 0 | 0 | 0 | ||||
| Patrick Mulhern | |||||||||
| Secretary | 2 | X | 0 | 0 | 0 | ||||
| Lisa Esser | |||||||||
| Treasurer | 2 | X | 0 | 0 | 0 | ||||
| Gayette Grimm | |||||||||
| Board Member | 2 | X | 0 | 0 | 0 | ||||
| Rory Meisner | |||||||||
| Board Member | 2 | X | 0 | 0 | 0 | ||||
| Mattie Rademacher | |||||||||
| Board Member | 2 | X | 0 | 0 | 0 | ||||
| Alice Staples | |||||||||
| Board Member | 2 | X | 0 | 0 | 0 | ||||
| Roy C George | |||||||||
| Board Member | 2 | X | 0 | 0 | 0 | ||||
| William Sexton | |||||||||
| CEO | 40 | 425056 | 0 | 37946 | X | ||||
| David Beitbach | |||||||||
| CFO | 40 | 160975 | 0 | 36708 | X | ||||
| M C Achenbach | |||||||||
| COO | 40 | 177739 | 0 | 26064 | X | ||||
| James Gariti | |||||||||
| Physician | 47.75 | 290305 | 0 | 41037 | X | ||||
| R Timothy Fitzner | |||||||||
| Physician | 49.25 | 292150 | 0 | 39181 | X | ||||
| Khalid Ali | |||||||||
| Physician | 48.25 | 263276 | 0 | 40005 | X | ||||
| Christopher Burrows | |||||||||
| Physician | 47.50 | 278155 | 0 | 32600 | X | ||||
| Tom Wilkes | |||||||||
| Physician | 40 | 136029 | 0 | 30758 | X | ||||
| Harold W Brown | |||||||||
| Exec Director/CEO | 0 | 182487 | 0 | 0 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2206172 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 284299 | TotalOtherCompensation |
| Number Individuals GT100 K | 13 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Gundersen Clinic | |||||
| 1836 South Avenue | LaCrosse | WI | 54601 | Medical Services | 749333 |
| Prairie Anesthesia Service | |||||
| 36681 Wildernest | Prairie du Chien | WI | 53821 | Anesthesia Services | 612289 |
| Shared Medical Services | |||||
| PO Box 330 | Cottage Grove | WI | 53527 | Medical Services | 177570 |
| Monona Pharmacy | |||||
| 1118 West Center St | Monona | IA | 52159 | Pharmacy Services | 106060 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| Federated Campaigns | 0 | FederatedCampaigns |
| Membership Dues | 0 | MembershipDues |
| Fundraising Events | 0 | FundraisingEvents |
| Related Organizations | 0 | RelatedOrganizations |
| Government Grants | 204847 | GovernmentGrants |
| All Other Contributions | 428141 | AllOtherContributions |
| Noncash Contributions | 0 | NoncashContributions |
| Total Contributions | 632988 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| Inpatient & Outpatient Services | 622000 | 28905116 | 28905116 | 0 | $0 |
| Home Health Services | 621610 | 483138 | 483138 | 0 | $0 |
| Hospice Services | 624100 | 1152594 | 1152594 | 0 | $0 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 767795 | TotalRevenueColumn |
| Related Or Exempt Function Income | 767795 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 31308643 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 505270 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $505,270 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 16544 | Real |
| Personal | 0 | Personal |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 19566 | Real |
| Personal | 0 | Personal |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -3022 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -3022 | TotalRevenueColumn |
| Related Or Exempt Function Income | -3022 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 35151 | Securities |
| Other | 128169 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 16778 | Securities |
| Other | 128628 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 18373 | Securities |
| Other | -459 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17914 | TotalRevenueColumn |
| Related Or Exempt Function Income | 17914 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrbtns Rprtd Fundraising Events | 0 | CntrbtnsRprtdFundraisingEvents |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| WEE Care | 624100 | 267777 | 267777 | 0 | $0 |
| Meal Income | 622000 | 95848 | 95848 | 0 | $0 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 186716 | TotalRevenueColumn |
| Related Or Exempt Function Income | 186716 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 550341 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 33012134 | TotalRevenueColumn |
| Related Or Exempt Function Income | 31873876 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $505,270 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8390 | Total |
| Program Services | 8390 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 586031 | Total |
| Management And General | 586031 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13501338 | Total |
| Program Services | 12498515 | ProgramServices |
| Management And General | 951721 | ManagementAndGeneral |
| Fundraising | 51102 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 590220 | Total |
| Program Services | 523651 | ProgramServices |
| Management And General | 64428 | ManagementAndGeneral |
| Fundraising | 2141 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3777997 | Total |
| Program Services | 3351893 | ProgramServices |
| Management And General | 412399 | ManagementAndGeneral |
| Fundraising | 13705 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 961086 | Total |
| Program Services | 852689 | ProgramServices |
| Management And General | 104911 | ManagementAndGeneral |
| Fundraising | 3486 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34143 | Total |
| Program Services | 4035 | ProgramServices |
| Management And General | 24981 | ManagementAndGeneral |
| Fundraising | 5127 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44733 | Total |
| Management And General | 44733 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 85899 | Total |
| Management And General | 85899 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2950050 | Total |
| Program Services | 2827052 | ProgramServices |
| Management And General | 122998 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 380980 | Total |
| Program Services | 361730 | ProgramServices |
| Management And General | 19250 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 252951 | Total |
| Program Services | 245677 | ProgramServices |
| Management And General | 3798 | ManagementAndGeneral |
| Fundraising | 3476 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1235202 | Total |
| Program Services | 1235202 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 105588 | Total |
| Program Services | 40586 | ProgramServices |
| Management And General | 65002 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Contracted Expenses | 2111682 | 2056117 | 55565 | 0 |
| Bad Debts | 535951 | 535951 | 0 | 0 |
| Payments to Hospitals & Nursing Homes | 294175 | 294175 | 0 | 0 |
| Equipment Expenses | 1161373 | 1149898 | 11475 | 0 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1484685 | Total |
| Program Services | 1218611 | ProgramServices |
| Management And General | 260215 | ManagementAndGeneral |
| Fundraising | 5859 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30102474 | Total |
| Program Services | 27204172 | ProgramServices |
| Management And General | 2813406 | ManagementAndGeneral |
| Fundraising | 84896 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 250 | BOY |
| EOY | 250 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16103118 | BOY |
| EOY | 18577911 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6215189 | BOY |
| EOY | 6525118 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 835642 | BOY |
| EOY | 839336 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 975184 | BOY |
| EOY | 980311 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 126894 | BOY |
| EOY | 178855 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 23642233 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 14631645 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8907268 | BOY |
| EOY | 9010588 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4400516 | BOY |
| EOY | 4578923 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8816 | BOY |
| EOY | 8816 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19917 | BOY |
| EOY | 17300 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37592794 | BOY |
| EOY | 40717408 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2622798 | BOY |
| EOY | 2959236 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 584490 | BOY |
| EOY | 401613 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3207288 | BOY |
| EOY | 3360849 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34385506 | BOY |
| EOY | 37173827 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 182732 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34385506 | BOY |
| EOY | 37356559 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37592794 | BOY |
| EOY | 40717408 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2909660 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 61393 | ReconcilationOtherChanges |
| 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 D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 755250 | OtherCostOrOtherBasis |
| Book Value | 755250 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 9945659 | OtherCostOrOtherBasis |
| Depreciation | 5924461 | Depreciation |
| Book Value | 4021198 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 0 | Depreciation |
| Book Value | 0 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 8838890 | OtherCostOrOtherBasis |
| Depreciation | 5994031 | Depreciation |
| Book Value | 2844859 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 4102434 | OtherCostOrOtherBasis |
| Depreciation | 2713153 | Depreciation |
| Book Value | 1389281 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 9010588 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Severance Pay | Description |
| Amount | $401,613 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 401613 | TotalOfAmounts |
| Total Revenue | 33012134 | TotalRevenue |
| Total Expenses | 30102474 | TotalExpenses |
| Excess Or Deficit For Year | 2909660 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 46796 | NetUnrealizedGLOnInvestments |
| Donated Services And Facilities | 0 | DonatedServicesAndFacilities |
| Investment Expenses | 0 | InvestmentExpenses |
| Prior Period Adjustments | 0 | PriorPeriodAdjustments |
| Other | $14,597 | OtherAmount |
| Total Adjustments | 61393 | TotalAdjustments |
| Excess Or Deficit Per FS | 2971053 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 33031700 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 0 | NetUnrealizedGainsInvestments |
| Donated Srvc And Use Of Facilities | 0 | DonatedSrvcAndUseOfFacilities |
| Recoveries Of Prior Year Grants | 0 | RecoveriesOfPriorYearGrants |
| Other Revenues | 19566 | OtherRevenues |
| Revenue Not Rptd F990 | 19566 | RevenueNotRptdF990 |
| Revenue Subtotal | 33012134 | RevenueSubtotal |
| Investment Expenses Not Included | 0 | InvestmentExpensesNotIncluded |
| Other Revenues Not Included | 0 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 33012134 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 30122040 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 0 | DonatedServicesUseOfFacilities |
| Prior Year Adjustments | 0 | PriorYearAdjustments |
| Losses Reported | 0 | LossesReported |
| Other Expenses Included | 19566 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 19566 | ExpensesNotRptdF990 |
| Expenses Subtotal | 30102474 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 0 | InvestmentExpensesNotIncluded2 |
| Other Expenses Not Included | 0 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 30102474 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchD_P11_S00_L08 | Schedule D, Part XI, Line 8 | Net change in restricted contributions. |
| SchD_P12_S00_L02d | Schedule D, Part XII, Line 2d | Rental expenses included in Part VIII, Line 6b |
| SchD_P13_S00_L02d | Schedule D, Part XIII, Line 2d | Rental expenses included on Part VIII, Line 6b |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Solicitation Of Non Govt Grants | X | SolicitationOfNonGovtGrants |
| Solicitation Of Govt Grants | X | SolicitationOfGovtGrants |
| Special Fundraising Events | X | SpecialFundraisingEvents |
| Agreement Ref Fundraising | 0 | AgreementRefFundraising |
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 |
| Pcent300 | X | Pcent300 |
| 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 | 527458 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 527458 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0178 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2420462 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1706096 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 714366 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0242 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 89916 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 66978 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 22938 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0008 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 3037836 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1773074 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1264762 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0428 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 471809 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 168256 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 303553 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0103 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6173898 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4097883 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2076015 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0702 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1060 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1060 | NetCommunityBenefitExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 6646767 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4266139 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2380628 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0805 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 9684603 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6039213 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3645390 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.1233 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $535,954 | BadDebtExpenseAmount |
| Amount Attributable To | 80393 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 10577605 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 10734197 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -156592 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| 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 | Prairie du Chien Memorial Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 705 East Taylor Street | AddressLine1 |
| City | Prairie du Chien | City |
| State | WI | State |
| ZIP Code | 53821 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Prairie du Chien Memorial Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 0 | ActionsOnNonpayment |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchH_P01_S00_L06a | Schedule H, Part I, Line 6a | The Hospital prepares an annual report that includes community benefits, and that report is made available to the public. |
| SchH_P01_S00_L07 | Schedule H, Part I, Line 7 | In computing the costs for line 7a through c the cost to charge ratio derived from Worksheet 2 was utilized. In computing the costs for Line 7e through g the costs were obtained from the Medicare cost report. For Line 7i actual costs were used. |
| SchH_P03_S0A_L04 | Schedule H, Part III, Section A, Line 4 | The carrying amount of patient receivables is reduced by a valuation allowance that reflects management's estimate of amounts that will not be collected from patients and third-party payors. Management reviews patient receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision. Management also reviews accounts to determine if classification as charity care is appropriate. Our rough estimate is based on an estimate of the amount of bad debt claims returned to us by our third party collection agency due to inability to collect or bankruptcy. |
| SchH_P03_S0B_L08 | Schedule H, Part III, Section B, Line 8 | The Medicare allowable costs on Line 6 were taken from the Medicare cost report, Worksheets E, Part B, E-2, and E-3, Part V. Also included was the estimated cost of Medicare Fee for Service services. These costs were estimated based on the Medicare inpatient and outpatient cost to charge ratio. Cost related to subsidized health services reported in Part I, Line 7g were not included. Any shortfalls in Medicare reimbursement should be included as community benefit because of the additional cost the Hospital incurred as a result of onerous Medicare requirements. |
| SchH_P03_S0C_L09b | Schedule H, Part III, Section C, Line 9b | All accounts are subject to mamagement reivew prior to being turned over for outside collection. |
| SchH_P05_S0B_L13 | Schedule H, Part V, Section B, Line 13 | Applications available on hospital website and notification of the availability of discounted care is posted within patient care areas of the hospital. |
| SchH_P05_S0B_L19 | Schedule H, Part V, Section B, Line 19 | These patients were offered interest free repayment plans and where applicable were referred to the Hospital's charity care program. |
| SchH_P05_S0B_L21 | Schedule H, Part V, Section B, Line 21 | Gross charges are billed to all patients unless they meet charity care guidelines or have another contractual arrangement. A discount is given for FAP eligible patients according to the Hospital's policy and these discounts are removed from gross charges. |
| SchH_P06_S00_L02 | Schedule H, Part VI, Line 2 | In October of 2010 the Board of Directors, Hospital administration and staff met with community leaders in an open forum to discuss the heath care needs of our community. As part of this discussion we asked these community leaders to identify any unmet health care needs. In May 2011 the Hospital started a community health assessment in cooperation with Crawford and Grant Counties and Grant Regional Health Center and Soutwest Health Center. |
| SchH_P06_S00_L03 | Schedule H, Part VI, Line 3 | Patients who do not have the ability to pay all or any portion of their hospital bill are informed about family services, nursing, or patient financial services. The patient or family member is given an application for Charity Care. The patient is also directed to contact their county Department of Human Services to apply for assistance under federal, state, or local government programs. If the patient is not eligible for Medical Assistance or any other government program, they are instructed to complete and return the Hospital's Charity Care application. |
| SchH_P06_S00_L04 | Schedule H, Part VI, Line 4 | Prairie du Chien Memorial Hospital provides healthcare services to the general public in southwestern Wisconsin and northeastern Iowa. Demographically Prairie du Chien Memorial Hospital serves a rural population with an average household income in the low to median range. Prairie du Chien Memorial Hospital serves all ages but is experiencing an increase in geriatric patients. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
| No Grant More Than5000 | X | NoGrantMoreThan5000 |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SchI_P01_S00_L02 | Identifier |
| Return Reference | Schedule I, Part I, Line 2 | ReturnReference |
| Explanation | Prairie du Chien Memorial Hospital gave support to various local charitable groups with donations, none of which exceeded $1500, to further their charitable missions. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Housing Allowance Or Residence | X | HousingAllowanceOrResidence |
| Written Policy Re T And E Expenses | 0 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Harold W Brown | |||||||||||||
| 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 182487 | 0 |
| William Sexton | |||||||||||||
| 392501 | 0 | 32555 | 0 | 0 | 0 | 10500 | 0 | 27446 | 0 | 463002 | 0 | 0 | 0 |
| M C Achenbach | |||||||||||||
| 170052 | 0 | 7687 | 0 | 0 | 0 | 2402 | 0 | 23661 | 0 | 203802 | 0 | 0 | 0 |
| David Beitbach | |||||||||||||
| 145781 | 0 | 15194 | 0 | 0 | 0 | 9122 | 0 | 27585 | 0 | 197682 | 0 | 0 | 0 |
| James Gariti | |||||||||||||
| 260319 | 0 | 29986 | 0 | 0 | 0 | 10500 | 0 | 30537 | 0 | 331342 | 0 | 0 | 0 |
| R Timothy Fitzner | |||||||||||||
| 262892 | 0 | 29259 | 0 | 0 | 0 | 10500 | 0 | 28681 | 0 | 331332 | 0 | 0 | 0 |
| Khalid Ali | |||||||||||||
| 233663 | 0 | 29612 | 0 | 0 | 0 | 10500 | 0 | 29505 | 0 | 303280 | 0 | 0 | 0 |
| Christopher Burrows | |||||||||||||
| 249083 | 0 | 29072 | 0 | 0 | 0 | 10500 | 0 | 22100 | 0 | 310755 | 0 | 0 | 0 |
| Tom Wilkes | |||||||||||||
| 123497 | 0 | 12532 | 0 | 0 | 0 | 7524 | 0 | 23233 | 0 | 166786 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchJ_P01_S00_L01a | Schedule J, Part I, Line 1a | A new CEO was hired 10/01/08 and is using a hospital owned residence until his move to the area has been completed in accordance with his employment agreement. CEO compensation was grossed up to allow for the value of this housing and the related income taxes. |
| SchJ_P01_S00_L01b | Schedule J, Part I, Line 1b | There is no written policy, but was done at the direction of the hospital board of directors. |
| SchJ_P01_S00_L03 | Schedule J, Part I, Line 3 | Prairie du Chien Memorial Hospital administration utilizes the Rural WIsconsin Health Cooperative and Wisconsin Hospital Association salary surveys when determining compensation. Compensation is approved by the Board of Directors. |
| SchJ_P01_S00_L04 | Schedule J, Part I, Line 4 | Previous CEO receives payments from a nonqualified deferred compensation arrangement. |
| SchJ_P01_S00_L06 | Schedule J, Part I, Line 6 | Prairie du Chien Memorial Hospital has an historical employee incentive plan. The employee incentive plan has the following stipulations, criteria and guidelines: a.) The plan allows for employee incentive pay if the hospital has generated a gain in excess of 5% based on net patient income less interest and unrestricted contributions. b.) Employee incentive payment will not exceed 2% of gross pay based on each quarter performance. All overtime will not be included in the calculation of incentive pay. c.) Eligible employees are those on the hospital payroll as of the end of each quarter. Employees leaving employment during the quarter will not be eligible to participate. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Jane Page | |||
| Daughter of Board Member | 27407 | Employment | 0 |
| Katy Krueger | |||
| Daughter of Board Member | 63396 | Employment | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| F990_P06_S0A_L06 | Form 990, Part VI, Section A, Line 6 | Prairie du Chien Memorial is a community hospital which was organized through community membership. Members are required to pay a minimal fee to belong to Prairie du Chien Memorial Hospital Association. |
| F990_P06_S0A_L07a | Form 990, Part VI, Section A, Line 7a | Members of the Prairie du Chien Memorial Hospital Association meet annually to vote for new Board members and for bylaw changes. |
| F990_P06_S0A_L07b | Form 990, Part VI, Section A, Line 7b | Members of the Prairie du Chien Memorial Hospital Association must approve bylaw changes. |
| F990_P06_S0B_L11b | Form 990, Part VI, Section B, Line 11b | Annual IRS Form 990 is mailed to each individual member of the Board of Directors. |
| F990_P06_S0B_L12c | Form 990, Part VI, Section B, Line 12c | Appropriate staff are notified of potential conflicts of interest and monitor compliance through the year. |
| F990_P06_S0B_L15 | Form 990, Part VI, Section B, Line 15 | Prairie du Chien Memorial Hospital administration utilizes the Rural Wisconsin Health Cooperative and Wisconsin Hospital Association salary surveys when determining compensation. |
| F990_P06_S0C_L19 | Form 990, Part VI, Section C, Line 19 | Prairie du Chien Memorial Hospital uses its wesite to communicate with the public. Prairie du Chien Memorial Hospital also publishes an annual report that presents financial information, mission statement, a review of last year and a look forward. Conflict of interest statements are available on request. |
| F990_P11_S00_L05 | Form 990, Part XI, Line 5 | Unrealized gains = $46796, Net change in restricted assets = $14597 |