MEDICAL SERVICES INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- MEDICAL SERVICES INC (EIN 39-1536207)
- Tax period
- 2010-04-01 to 2011-03-31
- Filed
- 2011-11-09
- IRS object ID
- 201123139349300407
- 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 D
- Schedule H
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-09T09:11:14-06:00 | Timestamp |
| Tax Period End Date | 2011-03-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM MCGLADREY INC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 700 MISSABE BUILDING | AddressLine1 |
| City | DULUTH | City |
| State | MN | State |
| ZIP Code | 55802 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-04-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391536207 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEDICAL SERVICES INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MEDI | NameControl |
| Phone | 7156348911 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11040 N STATE ROAD 77 | AddressLine1 |
| City | HAYWARD | City |
| State | WI | State |
| ZIP Code | 548436391 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TIM GULLINGSRUD | Name |
| Title | CHIEF EXECUTIVE OFFICER | Title |
| Phone | 7156348911 | Phone |
| Date Signed | 2011-11-07 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MARY BETH SANTORI | Name |
| Phone | 2187278253 | Phone |
| 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 | TIM GULLINGSRUD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11040 N STATE ROAD 77 | AddressLine1 |
| City | HAYWARD | City |
| State | WI | State |
| ZIP Code | 548436391 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 32645343 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.HAMHNH.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1986 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE QUALITY HEALTH CARE TO THE PEOPLE OF HAYWARD, WI AND THE SURROUNDING AREAS | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 318 | TotalNbrEmployees |
| Total Nbr Volunteers | 120 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 64062 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 193747 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 28796479 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 31925592 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 351275 | InvestmentIncomePriorYear |
| Investment Income Current Year | 276497 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 264969 | OtherRevenuePriorYear |
| Other Revenue Current Year | 167635 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 29476785 | TotalRevenuePriorYear |
| Total Revenue Current Year | 32563471 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 16228977 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 15946296 | 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 | 12700569 | OtherExpensePriorYear |
| Other Expenses Current Year | 13724832 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 28929546 | TotalExpensesPriorYear |
| Total Expenses Current Year | 29671128 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 547239 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2892343 | RevenuesLessExpensesCY |
| Total Assets BOY | 37844672 | TotalAssetsBOY |
| Total Assets EOY | 46973734 | TotalAssetsEOY |
| Total Liabilities BOY | 15000131 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 21236850 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 22844541 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 25736884 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE QUALITY HEALTH CARE TO THE PEOPLE OF HAYWARD, WI AND THE SURROUNDING AREAS | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 25474088 | Expense |
| Revenue | 31944156 | Revenue |
| Description | OUR 25 BED CRITICAL ACCESS HOSPITAL IS FLANKED BY MEDICAL CLINICS AND A LONG TERM CARE CENTER. THERE ARE 18 FULL-TIME PHYSICIANS ON THE MEDICAL STAFF AND THE HOSPITAL AND NURSING HOME EMPLOY CLOSE TO 300 INDIVIDUALS. OUR STAFF HAS IMMEDIATE CONTACT WITH SPECIAISTS IN LARGE HOSPITALS FOR CONSULTATION.THE EMERGENCY DEPARTMENT IS STAFFED BY PHYSICIANS AND NURSES 24 HOURS-A-DAY WITH ADDITIONAL PERSONNEL AT DESIGNATED TIMES. AIR AND GROUND AMBULANCES ARE AVAILABLE FOR THOSE REQUIRING A HIGHER LEVEL OF TRAUMA CARE. HIGHLY SKILLED PHYSICIANS AND MEDICAL PROFESSIONALS FROM LARGER HOSPITALS ACROSS THE NATION ARE ATTRACTED TO THIS POPULAR RECREATIONAL AREA BY THE QUALITY OF LIFE THEY FIND HERE. | Description |
| Total Program Service Expense | 25474088 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | 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 | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 1 | 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 | 14 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 318 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | 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 | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRAD ZELLER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7159344245 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11040 N STATE ROAD 77 | AddressLine1 |
| City | HAYWARD | City |
| State | WI | State |
| ZIP Code | 54843 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| BARBARA PEICKERT | |||||||
| CEO | 40.00 | X | X | 206181 | 0 | 33155 | |
| STEVE GILLIS | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| KAREN GUSTAFSON | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| HEIDI HABEL | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| DAN HYMANS | |||||||
| DIRECTOR | 1.00 | X | 0 | 260314 | 37177 | ||
| PATRICIA JOHNSON | |||||||
| CHAIR | 1.00 | X | X | 0 | 0 | 0 | |
| BRENT KELLEY DO | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| KATHY RASMUSSEN | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| BARBARA KOERPEL-DUFFY | |||||||
| VICE CHAIR | 1.00 | X | X | 0 | 0 | 0 | |
| HARRY MALCOLM MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| DODSON THOMPSON DO | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| LES WHITEAKER | |||||||
| CFO | 40.00 | X | 0 | 185670 | 33389 | ||
| SUSAN BAUER | |||||||
| CRNA | 40.00 | 155500 | 0 | 28659 | X | ||
| SUZANNE ULMER | |||||||
| CRNA | 40.00 | 161879 | 0 | 28208 | X | ||
| ROBERT TERRY | |||||||
| CRNA | 40.00 | 149138 | 0 | 29971 | X | ||
| ALLISON FARLEY | |||||||
| PHARMACIST/DEPT HEAD | 40.00 | 117877 | 0 | 27372 | X | ||
| STEVEN KRASEAN | |||||||
| PHYSICAL THERAPIST/DEPARTM | 40.00 | 116746 | 0 | 27672 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 907321 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 445984 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 245603 | TotalOtherCompensation |
| Number Individuals GT100 K | 9 | 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 |
|---|---|---|---|---|---|
| REGIONAL ENTERPRISES INC | |||||
| 1615 MAPLE LANE | ASHLAND | WI | 54806 | PROFESSIONAL FEES/RENT | 1464724 |
| WAPITI MEDICAL GROUP | |||||
| PO BOX 92 | NEWELL | SD | 57760 | ER DOCTORS | 866661 |
| MEMORIAL MEDICAL CENTER | |||||
| 1615 MAPLE LANE | ASHLAND | WI | 54806 | PROFESSIONAL FEES | 295008 |
| IMTIAZ MOHAMED | |||||
| 1110 VALLEY DRIVE | DULUTH | MN | 55804 | ER DOCTOR | 249360 |
| DMS IMAGING | |||||
| PO BOX 86 | MINNEAPOLIS | MN | 55489 | MRI PROFESSIONAL FEES | 232359 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 10 | NumberOfContractorsGT100K |
| Government Grants | 48032 | GovernmentGrants |
| All Other Contributions | 145715 | AllOtherContributions |
| Noncash Contributions | 47900 | NoncashContributions |
| Total Contributions | 193747 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SERVICE RE | 621500 | 31863111 | 31863111 |
| DIABETES | 621500 | 34292 | 34292 |
| CAFETERIA | 722210 | 28189 | 28189 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 31925592 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 276497 | TotalRevenueColumn |
| Exclusion | $276,497 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 230943 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 81872 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 149071 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 149071 | TotalRevenueColumn |
| Exclusion | $149,071 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MISCELLANEOUS | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 18564 | TotalRevenueColumn |
| Related Or Exempt Function Income | 18564 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 18564 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 32563471 | TotalRevenueColumn |
| Related Or Exempt Function Income | 31944156 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $425,568 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 239336 | Total |
| Management And General | 239336 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11808924 | Total |
| Program Services | 10564537 | ProgramServices |
| Management And General | 1244387 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 443807 | Total |
| Program Services | 398844 | ProgramServices |
| Management And General | 44963 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2605546 | Total |
| Program Services | 2311518 | ProgramServices |
| Management And General | 294028 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 848683 | Total |
| Program Services | 746223 | ProgramServices |
| Management And General | 102460 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68259 | Total |
| Management And General | 68259 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33043 | Total |
| Management And General | 33043 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28770 | Total |
| Management And General | 28770 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7059161 | Total |
| Program Services | 6440272 | ProgramServices |
| Management And General | 618889 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1393172 | Total |
| Management And General | 1393172 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 487935 | Total |
| Program Services | 487935 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1792749 | Total |
| Program Services | 1792749 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 128254 | Total |
| Management And General | 128254 | ManagementAndGeneral |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PROVISION FOR DOUBTFUL | 2732010 | 2732010 | |
| SOCIAL SERVICES | 1479 | 1479 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29671128 | Total |
| Program Services | 25474088 | ProgramServices |
| Management And General | 4197040 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13900900 | BOY |
| EOY | 16746288 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4322934 | BOY |
| EOY | 4476858 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 306892 | BOY |
| EOY | 203333 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 655204 | BOY |
| EOY | 747232 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 273840 | BOY |
| EOY | 292311 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 38398325 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 14951874 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17677004 | BOY |
| EOY | 23446451 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 728327 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 707898 | BOY |
| EOY | 332934 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37844672 | BOY |
| EOY | 46973734 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4149083 | BOY |
| EOY | 4083689 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10851048 | BOY |
| EOY | 17153161 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15000131 | BOY |
| EOY | 21236850 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22844541 | BOY |
| EOY | 25736884 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22844541 | BOY |
| EOY | 25736884 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37844672 | BOY |
| EOY | 46973734 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 2892343 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 62299 | OtherCostOrOtherBasis |
| Book Value | 62299 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 18005561 | OtherCostOrOtherBasis |
| Depreciation | 8023099 | Depreciation |
| Book Value | 9982462 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8186497 | OtherCostOrOtherBasis |
| Depreciation | 6152659 | Depreciation |
| Book Value | 2033838 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12143968 | OtherCostOrOtherBasis |
| Depreciation | 776116 | Depreciation |
| Book Value | 11367852 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 23446451 | TotalOfBookValueLandBuildings |
| Total Revenue | 32563471 | TotalRevenue |
| Total Expenses | 29671128 | TotalExpenses |
| Excess Or Deficit For Year | 2892343 | ExcessOrDeficitForYear |
| Total Adjustments | 0 | TotalAdjustments |
| Excess Or Deficit Per FS | 2892343 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 32645343 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 81872 | OtherRevenues |
| Revenue Not Rptd F990 | 81872 | RevenueNotRptdF990 |
| Revenue Subtotal | 32563471 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 32563471 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 29753000 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 81872 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 81872 | ExpensesNotRptdF990 |
| Expenses Subtotal | 29671128 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 29671128 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE COMPANY IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES. NOT-FOR-PROFIT ORGANIZATIONS MAY BECOME SUBJECT TO INCOME TAXES IF QUALIFICATION AS A TAX-EXEMPT ENTITY CHANGES, IF UNRELATED BUSINESS INCOME IS GENERATED AND IN CERTAIN OTHER INSTANCES. NOT-FOR-PROFIT ORGANIZATIONS ARE REQUIRED TO ASSESS THE CERTAINTY OF THEIR TAX POSITIONS RELATED TO THESE MATTERS AND, IN SOME CASES, RECORD LIABILITIES FOR POTENTIAL TAXES, INTEREST AND PENALTIES ACCOMPANIED BY FOOTNOTE DISCLOSURES. THE COMPANY HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE THE ACCRUAL OF AN INCOME TAX PROVISION. GENERALLY, THE COMPANY IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE OR LOCAL TAX AUTHORITIES FOR YEARS BEFORE 2008. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 81,872. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 81,872. |
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 |
| Pcent200 D | X | Pcent200D |
| 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 | 257409 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 257409 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00960 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6774594 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5378627 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1395967 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05180 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7032003 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5378627 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1653376 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06140 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 23638 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 23638 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 182466 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 44034 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 138432 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00510 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 32154 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 32154 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00120 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 238258 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 44034 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 194224 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00720 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7270261 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5422661 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1847600 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06860 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $2,732,010 | BadDebtExpenseAmount |
| Amount Attributable To | 241050 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 9125456 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 8805494 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 319962 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 NONE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | HAYWARD AREA MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11040 N STATE ROAD 77 | AddressLine1 |
| City | HAYWARD | City |
| State | WI | State |
| ZIP Code | 54843 | 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 | HAYWARD AREA MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notified All Patients | X | NotifiedAllPatients |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Lowest Negotiated Rates | X | LowestNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| WATER'S EDGE | ||||
| 11040 N STATE ROAD 77 | HAYWARD | WI | 54843 | NURSING HOME |
| WATER'S EDGE | ||||
| 11040 N STATE ROAD 77 | HAYWARD | WI | 54843 | ASSISTED LIVING FACILITY |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7: COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED MEDICARE COST REPORT. | ||
| PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE DIABETES EDUCATION, PAIN MANAGEMENT, AND ONCOLOGY. | ||
| PART I, L7 COL(F): BAD DEBT EXPENSE FROM FINANCIAL STATEMENTS IS $2,732,010. | ||
| PART II: MANY PROGRAMS HAVE BEEN DESIGNED TO HELP PATIENTS OF THE COMMUNITY SUCH AS BREASTFEEDING EDUCATION, BLOOD DRIVES, CHILD BIRTH CLASSES, DISASTER READINESS, DIABETES EDUCATION, HEALTH FAIRS, HABITAT FOR HUMANITY, IN KIND DONATIONS AND CASH DONATIONS AS EXAMPLES OF THE COMMUNITY ACTIVITIES HAYWARD HOSPITAL IS CURRENTLY INVOLVED IN. | ||
| PART III, LINE 4: MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS AND BY USING HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS OF ACCOUNTS. PATIENT RECEIVABLES ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED WHEN RECEIVED.COSTING METHOD IS COST TO CHARGE RATIO. | ||
| PART III, LINE 8: HAYWARD AREA MEMORIAL HOSPITAL IS A CRITICAL ACCESS HOSPITAL THAT IS REIMBURSED AT 101% OF COST. THE MEDICARE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $284,099 AND ALLOWABLE COSTS OF $807,245 RESULTING IN A SHORTFALL OF $523,146. THE SHORTFALL IS THE RESULT OF UNREIMBURSED PROFESSIONAL CARE.THE HOSPITAL FOLLOWED MEDICARE'S PRESCRIBED METHODS OF DETERMINING COSTS PAYABLE UNDER TITLE XVIII (MEDICARE) IN COMPLETING ITS ANNUAL MEDICARE COST REPORT (COST REPORT) USING DATA AVAILABLE FROM THE INSTITUTION'S BASIC ACCOUNTS, AS USUALLY MAINTAINED, TO ARRIVE AT EQUITABLE AND PROPER PAYMENT FOR SERVICES. THE COST REPORT WAS COMPLETED USING THE HOSPITAL'S TRIAL BALANCE OF EXPENSES, AS WELL AS OTHER STATISTICAL AND FINANCIAL RECORDS MAINTAINED BY THE HOSPITAL. AS REQUIRED BY MEDICARE REGULATIONS, CERTAIN RECLASSIFICATIONS AND ADJUSTMENTS TO COSTS WERE INCLUDED IN THE COST REPORT TO DETERMINE MEDICARE ALLOWABLE COSTS.AFTER MEDICARE ALLOWABLE COSTS ARE DETERMINED, THE COST REPORT PROVIDES FOR THE STEP DOWN METHOD OF COST FINDING. THIS METHOD PROVIDES FOR ALLOCATING THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS, WHICH UTILIZE THE SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. AFTER ALL COSTS OF THE GENERAL SERVICE COST CENTERS HAVE BEEN ALLOCATED TO THE REMAINING COST CENTERS, THE TOTAL COSTS OF THESE REMAINING COST CENTERS ARE FURTHER DISTRIBUTED TO THE DEPARTMENTAL CLASSIFICATION TO WHICH THEY PERTAIN, E.G., HOSPITAL GENERAL INPATIENT ROUTINE, SUBPROVIDER, ANCILLARY, ETC.AFTER THE STEP-DOWN PROCESS, THE COST REPORT PROVIDES FOR THE APPORTIONMENT OF COSTS TO THE MEDICARE PROGRAM BASED ON A NUMBER OF DIFFERENT METHODOLOGIES INCLUDING PER PATIENT DAY, PER VISIT, AND PERCENTAGE OF CHARGES, AS MOST PREVALENT. MEDICARE COSTS AS DETERMINED BY THE COST REPORT METHODOLOGIES DESCRIBED PREVIOUSLY WERE UTILIZED TO COMPLETE THE APPLICABLE MEDICARE ALLOWABLE COSTS OF CARE FOR SCHEDULE H (FORM 990) PART III SECTION B LINE 6. | ||
| PART III, LINE 9B: NO, PATIENTS REQUEST ASSISTANCE AND AT THAT POINT RECEIVE THE DOCUMENTS TO APPLY FOR CHARITY CARE. MEDICAL SERVICES, INC DOES POST A LARGE SIGN IN THE LOBBY THAT STATES "THIS HEALTH CARE FACILITY IS REQUIRED TO GIVE A REASONABLE AMOUNT OF ITS SERVICES FREE OR AT A REDUCED CHARGE TO PERSONS WHO CANNOT AFFORD TO PAY FOR MEDICAL CARE. IF YOU ARE NOT ABLE TO PAY FOR ALL OR PART OF THE CARE YOU NEED, PLEASE CONTACT THE ADMISSIONS OR BUSINESS OFFICE OF THIS FACILITY AND ASK ABOUT THE AVAILABILITY OF SUCH CARE". THIS SIGN IS PLACED IN A LOCATION THAT ALL PATIENTS CAN SEE AND ASK FOR DOCUMENTS TO COMPLETE TO START THE CHARITY CARE APPLICATION PROCESS. | ||
| PART V, SECTION B, LINE 21: THE LOWEST NEGOTIATED INSURANCE RATE IS 100% OF GROSS CHARGES. | HAYWARD AREA MEMORIAL HOSPITAL | |
| PART I, LINE 6A: THE HOSPITAL FILES A COMMUNITY BENEFIT REPORT IN WI. | ||
| PART VI, LINE 2: FACILITY STAFF PARTICIPATE IN THE COMMUNITY NEEDS ASSESSMENT PROCESS WITH THE SAWYER COUNTY HEALTH DEPARTMENT. FOLLOWING THE COMPLETION OF THE ASSESSMENT, VARIOUS WORK GROUPS ARE CONVENED. APPROPRIATE STAFF MEMBERS FROM THE FACILITY THEN WORK WITH COMMUNITY MEMBERS TO DEVELOP PROGRAMS AND APPROACHES TO ADDRESS THE IDENTIFIED HEALTH ISSUES. SOME EXAMPLES INCLUDE ABUSE OF PRESCRIPTION DRUGS, SEXUAL ABUSE PREVENTION PROGRAMS AND UNDERAGE ALCOHOL USE. | ||
| PART VI, LINE 3: ALL PATIENTS ARE BILLED THE SAME, HOWEVER, IF A PATIENT BECOMES DELINQUENT ON A BILL, A LETTER IS SENT TO THE PATIENT ASKING THAT THE PATIENT CONTACT THE BUSINESS FOR ASSISTANCE WITH THE OVERDUE BILL. PATIENTS HAVE THE OPTION TO DISCUSS PAYMENT OPTIONS WITH THE BILLING OFFICE AND POSSIBLE ELIGIBILITY FOR CHARITY CARE. | ||
| PART VI, LINE 4: HAYWARD WISCONSIN IS LOCATED IN NORTHERN WISCONSIN AND CONSISTS OF A HIGH MEDICAID POPULATION. HAYWARD SERVES A HIGH MEDICAID AND HIGH MEDICARE POPULATION WITH THE TWO ACCOUNTING FOR 68% OF GROSS REVENUES AND 55% OF NET PATIENT SERVICES REVENUES. HAYWARD IS CONSIDERED A SUMMER VACATION DESTINATION THAT BRINGS LARGE CROWDS DURING THE SUMMER MONTHS. THE EMERGENCY DEPARTMENT SERVES A LARGE NUMBER OF PATIENTS THAT RANGE FROM COMMERCIAL INSURANCE, MEDICARE, MEDICAID, HIS (INDIAN HEALTH SERVICES), ETC. HAYWARD HOSPITAL IS FOCUSED ON PROVIDING HIGH QUALITY HEALTHCARE IN A RURAL LOCATION. MANY SERVICES ARE PROVIDED BY HAYWARD HOSPITAL, ALLOWING LESS PATIENT TRAVEL AT A TIME WHEN THE PATIENT IS LIKELY NOT FEELING WELL. THE HAYWARD COMMUNITY IS AN AGING POPULATION AND WE RECOGNIZE THAT NEED AND HAVE COMMITTED MILLIONS OF DOLLARS INTO SERVICES FOR THE OLDER POPULATION. WE BELIEVE HAYWARD HOSPITAL PROVIDES EXCEPTIONAL CARE IN A RURAL LOCATION. | ||
| PART VI, LINE 6: OPEN MEDICAL STAFF. COMMUNITY CALL PROGRAM FOR MEDICAL STAFF. LOCAL COMMUNITY BOARD WITH 12 VOTING MEMBERS. NONPROFIT STATUS WITH PROFITS (IF ANY) USED FOR ADDITIONAL SERVICES, CAPITAL PURCHASES SUCH AS A CT SCANNER, LAB EQUIPMENT, ELECTRONIC HEALTH RECORD, IMPROVED INPATIENT SERVICES, OB PROGRAM, CONTINUED EDUCATION FOR ALL STAFF, GROWING SENIOR SERVICES PROGRAM AND A FOCUS ON THE NEEDS OF THE COMMUNITY. | ||
| WI | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BARBARA PEICKERT | |||||||||||||
| 206181 | 0 | 0 | 0 | 0 | 0 | 9800 | 0 | 23355 | 0 | 239336 | 0 | 0 | 0 |
| DAN HYMANS | |||||||||||||
| 0 | 260314 | 0 | 0 | 0 | 0 | 0 | 11868 | 0 | 25309 | 0 | 297491 | 0 | 0 |
| LES WHITEAKER | |||||||||||||
| 0 | 185670 | 0 | 0 | 0 | 0 | 0 | 8239 | 0 | 25150 | 0 | 219059 | 0 | 0 |
| SUSAN BAUER | |||||||||||||
| 155500 | 0 | 0 | 0 | 0 | 0 | 8290 | 0 | 20369 | 0 | 184159 | 0 | 0 | 0 |
| SUZANNE ULMER | |||||||||||||
| 161879 | 0 | 0 | 0 | 0 | 0 | 7847 | 0 | 20361 | 0 | 190087 | 0 | 0 | 0 |
| ROBERT TERRY | |||||||||||||
| 149138 | 0 | 0 | 0 | 0 | 0 | 8591 | 0 | 21380 | 0 | 179109 | 0 | 0 | 0 |
Schedule M IRS990ScheduleM
Real Estate Other RealEstateOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 1 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 47900 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | TAX VALUE | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of8283 Received | 1 | NumberOf8283Received |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGifts |
| Third Parties Used | 0 | ThirdPartiesUsed |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 IS REVIEWED BY THE BOARD OF DIRECTORS BEFORE IT IS FILED. | |
| ISSUES OR CONCERNS ARE DISCUSSED AT THE COMPLIANCE COMMITTEE MEETING WITH COMPLIANCE OFFICER, COMMITTEE MEMBERS AND ADMINISTRATION. POLICIES ARE REVIEWED YEARLY AND PRESENTED TO REGULATORY COMPLIANCE COMMITTEE FOR REVIEW AND APPROVAL. | FORM 990, PART VI, SECTION B, LINE 12C | |
| HR WILL RESEARCH SALARY DATA FOR OUR REGION AND PROVIDE ADMINISTRATION WITH A TYPICAL COMPENSATION RANGE. DIFFICULT POSITIONS TO FILL, DEMANDS OF THE POSITION, EXPERIENCE, EDUCATION, PAST WORK HISTORY, AND REFERENCES ARE ALL TAKEN INTO CONSIDERATION WHEN DETERMINING COMPENSATION. | FORM 990, PART VI, SECTION B, LINE 15 | |
| A PUBLIC DISCLOSURE COPY OF THE TAX RETURN IS AVAILABLE BY REQUEST. | FORM 990, PART VI, SECTION C, LINE 18 | |
| A PUBLIC DISCLOSURE COPY OF THE TAX RETURN IS AVAILABLE BY REQUEST. ALL OTHER DOCUMENTS ARE AVAILABLE BY REQUEST FROM THE PUBLIC RELATIONS DIRECTOR, WITH THE EXCEPTION OF THE GOVERNING DOCUMENTS THAT ARE CONFIDENTIAL. | FORM 990, PART VI, SECTION C, LINE 19 | |
| ALL FINANCIAL MATTERS GO THROUGH THE FINANCE COMMITTEE. | FORM 990, PART XI, LINE 2C: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MEMORIAL MEDICAL CENTER INC | |||||||||||
| 1615 MAPLE LANE | ASHLAND | WI | 54806 | 237013497 | MEDICAL SERVICES | WI | 501(C)(3) | 170(B)(1)(A)(III) | REGIONAL ENTERPRISES INC | 0 | |
| REGIONAL ENTERPRISES INC | |||||||||||
| 1615 MAPLE LANE | ASHLAND | WI | 54806 | 391555837 | SUPPORT | WI | 501(C)(3) | 509(A)(3) | 0 | N/A | |
| REI MEDICAL CLINICS INC | |||||||||||
| 1615 MAPLE LANE | ASHLAND | WI | 54806 | 391701306 | SUPPORT | WI | 501(C)(3) | 509(A)(3) | REGIONAL ENTERPRISES INC | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |