ST JOSEPHS HEALTH SERVICES INC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- ST JOSEPHS HEALTH SERVICES INC (EIN 39-0929538)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-10-31
- IRS object ID
- 202313049349301906
- Schema version
- 2022v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-10-31T11:59:29-05:00 | ReturnTs |
| Tax Period End | 2022-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390929538 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST JOSEPH'S HEALTH SERVICES INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STJO | BusinessNameControlTxt |
| Phone | 6084898000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 527 400 WATER AVENUE | AddressLine1Txt |
| City | HILLSBORO | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54634 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBIN NELSON | PersonNm |
| Person Title | FINANCE ADMINISTRATOR | PersonTitleTxt |
| Phone | 6084898000 | PhoneNum |
| Signature | 2023-10-27 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | ROBIN | PersonFirstNm |
| Person Last | NELSON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2023-10-17 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GUNDERSEN ST JOSEPH'S HOSPITAL AND CLINICS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ROBIN NELSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 527 400 WATER AVENUE | AddressLine1Txt |
| City | HILLSBORO | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54634 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $37,108,668 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GUNDERSENHEALTH.ORG/ST-JOSEPHS | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1949 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | WE WILL ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES WHILE ENRICHING EVERY LIFE WE TOUCH, INCLUDING PATIENTS, FAMILIES, AND STAFF. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 228 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,763,788 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,855,323 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $32,548,429 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $35,082,962 | CYProgramServiceRevenueAmt |
| PY Investment Income | $11,211 | PYInvestmentIncomeAmt |
| CY Investment Income | $41,673 | CYInvestmentIncomeAmt |
| PY Other Revenue | $449,753 | PYOtherRevenueAmt |
| CY Other Revenue | $128,710 | CYOtherRevenueAmt |
| PY Total Revenue | $34,773,181 | PYTotalRevenueAmt |
| CY Total Revenue | $37,108,668 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $16,205,219 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $17,585,276 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $13,384,510 | PYOtherExpensesAmt |
| CY Other Expenses | $14,007,456 | CYOtherExpensesAmt |
| PY Total Expenses | $29,589,729 | PYTotalExpensesAmt |
| CY Total Expenses | $31,592,732 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,183,452 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,515,936 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $60,670,818 | TotalAssetsBOYAmt |
| Total Assets EOY | $60,769,251 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $31,287,406 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $26,336,821 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $29,383,412 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $34,432,430 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WE WILL DISTINGUISH OURSELVES THROUGH PATIENT CARE, EDUCATION, RESEARCH AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $22,135,177 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $29,342,913 | RevenueAmt |
| Desc | ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY HEALTH CARE SERVICES AND OTHER FINANCIAL SUPPORT THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED, AMONG OTHER MATTERS, TO ENHANCE THE HEALTH OF THE COMMUNITY INCLUDING THE HEALTH OF LOW INCOME PATIENTS. THE ORGANIZATION OPERATES A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING ACUTE CARE SERVICES TO THE HILLSBORO, WISCONSIN AREA. INPATIENT SERVICES INCLUDE ACUTE CARE FOR MEDICAL, SURGICAL, SWING BED, AND HOSPICE PATIENTS. ST. JOSEPH'S HEALTH SERVICES, INC. ALSO PROVIDES DIAGNOSTIC SERVICES TO PATIENTS, SUCH AS X-RAY, LAB, AND THERAPY SERVICES. THE HOSPITAL HAD 1,554 TOTAL INPATIENT DAYS DURING THE FISCAL YEAR. OF THOSE PATIENT DAYS 585 WERE RELATED TO ACUTE INPATIENT SERVICES AND 969 DAYS OF CARE PROVIDED TO HOSPICE AND SWING BED PATIENTS. THE HOSPITAL'S SWING BED PROGRAM PROVIDES CARE TO PATIENTS NEEDING EITHER SKILLED NURSING OR REHABILITATIVE PROGRAMS IN THE HOSPITAL SETTING. THE SWING BED PROGRAM IS A VITAL SERVICE TO THE COMMUNITY AS THERE CURRENTLY IS NO SKILLED NURSING FACILITY IN HILLSBORO, WISCONSIN, AND THIS PROGRAM ALLOWS MANY PATIENTS THE OPPORTUNITY TO BE CARED FOR IN THEIR COMMUNITY.ST. JOSEPH'S HEALTH SERVICES ALSO PROVIDES VARIOUS OUTPATIENT SERVICES INCLUDING EMERGENCY AND URGENT CARE SERVICES; DIAGNOSTIC PROCEDURES, SUCH AS X-RAYS, CT SCANS, MRI'S, AND LABORATORY TESTING; SURGICAL PROCEDURES; AND THERAPY PROGRAMS INCLUDING PHYSICAL, OCCUPATIONAL, SPEECH, AND RESPIRATORY THERAPY SERVICES ARE AMONG THE MANY SERVICES PROVIDED BY THE HOSPITAL.ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY WITH MINIMAL OR NO CHARGE. IN ADDITION, ST. JOSEPH'S IS A PROVIDER UNDER THE WISCONSIN MEDICAID PROGRAM. UNDER THIS PROGRAM, THE ORGANIZATION IS LEGALLY BOUND TO ACCEPT THE AMOUNT DETERMINED BY THE STATE AS PAYMENT IN FULL FOR EACH PATIENT'S CHARGES. (SEE ADDITIONAL INFORMATION ON THE COST OF PROVIDING THESE SERVICES INCLUDED IN SCHEDULE H OF THE FORM 990.)ST. JOSEPH'S PROVIDES THE MEALS FOR THE SENIOR MEAL SITE COMMUNITY MEMBERS. THESE MEALS ARE DELIVERED TO THE MEMBERS HOME. WE OFFERS ADULT FITNESS IN OUR REHABILITATION GYM, HOME MONITORING EQUIPMENT SO PATIENT'S CAN SAFELY GO HOME TO RECOVER. ST. JOSEPH'S IS VERY INVOLVED IN THE CARE OF THE SCHOOL AGE CHILDREN IN OUR SERVICE AREA. THROUGH CONTRACTS WITH THE AREA SCHOOLS WE PROVIDE THEM WITH NURSES, ATHLETIC TRAINERS, SOCIAL WORKER, AND BEHAVIORAL HEALTH THERAPISTS. WE PROVIDE ALL THE TRAINING, CME, AND EDUCATION TO SUPPORT THESE PROVIDERS IN THE SCHOOL SYSTEM. CHANGES TO THE PROGRAM: THE HOSPITAL ADDED PAIN MANAGEMENT SERVICES 1 DAY/MONTH - UROLOGY SERVICES OFFERED 3 DAYS/MONTH - CHIROPRACTIC SERVICES OFFERED 2 DAYS/WEEK - VASCULAR SURGERY SERVICES OFFERED 1 DAY/MONTHDUE TO RESTRICTIONS DURING COVID WE HAD TO TEMPORARILY SUSPEND OUR COMMUNITY OUTREACH EVENTS. MANY OF THE COVID RESTRICTIONS HAVE BEEN LIFTED NOW IN THE HEALTH CARE INDUSTRY SO WE ARE STARTING UP THOSE PROGRAMS AGAIN INCLUDING, STRONG BODIES, CRP TRAINING, ADVANCED DIRECTIVES SEMINARS, SCRUB CLUB FOR MIDDLE SCHOOL STUDENTS, BLOOD DRIVES, EMPLOYEE EVENTS TO INCREASE VITALITY AT WORK, EDUCATIONAL VAPING ASSEMBLIES FOR LOCAL SCHOOLS, CAREER DAYS, ETC. WE ARE ADDING MORE AND MORE EVENTS IN THE COMMUNITY TO ADDRESS THE HEALTH OF OUR COMMUNITY. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,324,451 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $5,732,597 | RevenueAmt |
| Desc | ST. JOSEPH'S HEALTH SERVICES, INC. ALSO OPERATES THREE CLINICS LOCATED IN HILLSBORO, ELROY, AND WONEWOC, WISCONSIN. DURING THE FISCAL YEAR THESE THREE CLINICS PROVIDED A TOTAL OF 15,990 VISITS TO PATIENTS. ALL THREE OF THE CLINICS ARE DESIGNATED RURAL HEALTH CLINICS BY THE MEDICARE AND MEDICAID PROGRAMS AND AS SUCH BY DEFINITION ARE LOCATED IN DESIGNATED RURAL AND UNDERSERVED AREAS OF THE COUNTRY BY HEALTH CARE PRACTITIONERS. THESE CLINICS PROVIDE CARE TO A LARGE PORTION OF MEDICARE AND MEDICAID BENEFICIARIES WHO WITHOUT ACCESS TO CARE LOCALLY WOULD BE REQUIRED TO TRAVEL FURTHER DISTANCES FOR QUALITY HEALTHCARE. PATIENTS OF THE CLINICS ARE ALSO ELIGIBLE TO QUALIFY UNDER ST. JOSEPH'S HEALTH SERVICES FINANCIAL ASSISTANCE POLICY AS IT IS THE GOAL OF THE ORGANIZATION TO PROVIDE QUALITY HEALTHCARE TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $26,459,628 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 60 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 228 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Other | Yes (X) | OtherInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROBIN NELSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6084898000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 527 400 WATER AVENUE | AddressLine1Txt |
| City | HILLSBORO | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54634 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| MIKE MCKEE | ||||||||
| SECRETARY | 0.80 | 40.00 | Yes (X) | Yes (X) | $0 | $270,756 | $67,960 | |
| KRISTIE MCCOIC | ||||||||
| ADMINISTRATOR | 50.00 | Yes (X) | $0 | $178,958 | $50,605 | |||
| SCOTT LARSON | ||||||||
| PHARMACIST | 50.00 | $204,844 | $0 | $22,311 | Yes (X) | |||
| DANA MEYERS | ||||||||
| BOARD DIRECTOR | 0.80 | Yes (X) | $0 | $174,669 | $48,086 | |||
| RACHEL ALBRECHT MBA | ||||||||
| TREASURER/ADMIN DIRECTOR (THRU NOV) | 0.80 | 40.00 | Yes (X) | Yes (X) | $0 | $151,435 | $46,902 | |
| ROBIN NELSON | ||||||||
| FINANCE ADMINISTRATOR | 50.00 | Yes (X) | $0 | $143,981 | $46,533 | |||
| CHRIS SHANNON | ||||||||
| NURSE | 50.00 | $128,839 | $0 | $43,666 | Yes (X) | |||
| CALEB VANDEHEI | ||||||||
| NURSE | 50.00 | $134,452 | $0 | $34,147 | Yes (X) | |||
| DENISE KROES | ||||||||
| NURSE | 50.00 | $139,100 | $0 | $27,017 | Yes (X) | |||
| JESSICA THOMPSON | ||||||||
| NURSE PRACTITIONER | 50.00 | $127,823 | $0 | $34,408 | Yes (X) | |||
| STACIE CHRISTENSEN | ||||||||
| BOARD DIRECTOR | 0.80 | Yes (X) | $0 | $111,515 | $40,276 | |||
| THEA FRONK | ||||||||
| DIRECTOR OF IP SERVICES | 50.00 | Yes (X) | $102,552 | $0 | $41,729 | |||
| HOLLY BOISON | ||||||||
| BOARD DIRECTOR | 0.80 | Yes (X) | $0 | $100,712 | $37,947 | |||
| ASHLEY THAYER | ||||||||
| DIRECTOR OF OP SERVICES | 50.00 | Yes (X) | $119,521 | $0 | $7,811 | |||
| JIM MLSNA | ||||||||
| CHAIR | 0.80 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| ANN BRADNAU HYNEK | ||||||||
| VICE CHAIR | 0.80 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| NATALIE ADAMS | ||||||||
| BOARD DIRECTOR | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| KATHY KLOCK | ||||||||
| BOARD DIRECTOR (THRU MAY) | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| MIKE RORAFF | ||||||||
| BOARD DIRECTOR | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $957,131 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,132,026 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $549,398 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| GUNDERSEN HEALTH SYSTEM | |||||
| 1900 SOUTH AVE | LA CROSSE | WI | 54601 | HEALTH & ADMIN SERVICES | $7,117,836 |
| CD SMITH CONSTRUCTION INC | |||||
| PO BOX 1006 | FOND DU LAC | WI | 54936 | CONSTRUCTION | $662,837 |
| KRISTINE LADIKA | |||||
| 27349 COUNTY HWY V | WONEWOC | WI | 53968 | CRNA SERVICES | $547,808 |
| WIESER BROTHERS INC | |||||
| 200 TWILITE STREET | LACRESCENT | MN | 55947 | CONSTRUCTION | $435,855 |
| SHARED IMAGING SERVICES | |||||
| 944 WATER ST | SAUK CITY | WI | 53583 | ULTRASOUND & NUCLEAR MEDICINE SERVICES | $173,993 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $420,600 | RelatedOrganizationsAmt |
| Government Grants | $1,434,723 | GovernmentGrantsAmt |
| Total Contributions | $1,855,323 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621400 | $27,686,574 | $27,686,574 |
| PHARMACY REVENUE | 456110 | $7,337,476 | $7,337,476 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $58,912 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $51,460 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $7,452 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $35,082,962 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,173 | TotalRevenueColumnAmt |
| Exclusion | $39,173 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,500 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,500 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,500 | TotalRevenueColumnAmt |
| Exclusion | $2,500 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| DIETARY/CAFETERIA | 722514 | $127,350 | $127,350 |
| INSURANCE PROCEEDS | 900099 | $1,000 | $1,000 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $360 | TotalRevenueColumnAmt |
| Exclusion | $360 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $128,710 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $37,108,668 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35,075,510 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $177,835 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $271,228 | TotalAmt |
| Management And General | $271,228 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,779,876 | TotalAmt |
| Program Services | $11,945,942 | ProgramServicesAmt |
| Management And General | $1,833,934 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $338,555 | TotalAmt |
| Program Services | $296,258 | ProgramServicesAmt |
| Management And General | $42,297 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,394,959 | TotalAmt |
| Program Services | $2,077,811 | ProgramServicesAmt |
| Management And General | $317,148 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $800,658 | TotalAmt |
| Program Services | $652,809 | ProgramServicesAmt |
| Management And General | $147,849 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,153,476 | TotalAmt |
| Management And General | $1,153,476 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,200 | TotalAmt |
| Management And General | $18,200 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,828,942 | TotalAmt |
| Program Services | $2,735,664 | ProgramServicesAmt |
| Management And General | $93,278 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,578 | TotalAmt |
| Management And General | $68,578 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $702,716 | TotalAmt |
| Program Services | $415,122 | ProgramServicesAmt |
| Management And General | $287,594 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,532 | TotalAmt |
| Program Services | $3,532 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $327,857 | TotalAmt |
| Program Services | $317,909 | ProgramServicesAmt |
| Management And General | $9,948 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,758 | TotalAmt |
| Program Services | $26,423 | ProgramServicesAmt |
| Management And General | $9,335 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,276 | TotalAmt |
| Program Services | $22,101 | ProgramServicesAmt |
| Management And General | $14,175 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $812,217 | TotalAmt |
| Program Services | $649,774 | ProgramServicesAmt |
| Management And General | $162,443 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,465,882 | TotalAmt |
| Program Services | $1,972,706 | ProgramServicesAmt |
| Management And General | $493,176 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,158 | TotalAmt |
| Management And General | $77,158 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PHARMACY EXPENSE | $1,722,459 | $1,722,459 | |
| PROVISION FOR BAD DEBTS | $1,501,408 | $1,501,408 | |
| MEDICAL SUPPLIES | $1,388,142 | $1,387,795 | $347 |
| REPAIRS AND MAINTENANCE | $620,855 | $620,744 | $111 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $244,000 | TotalAmt |
| Program Services | $111,171 | ProgramServicesAmt |
| Management And General | $132,829 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,592,732 | TotalAmt |
| Program Services | $26,459,628 | ProgramServicesAmt |
| Management And General | $5,133,104 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,150 | BOYAmt |
| EOY | $1,150 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,612,012 | BOYAmt |
| EOY | $21,533,624 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,147,826 | BOYAmt |
| EOY | $4,713,021 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $492,820 | BOYAmt |
| EOY | $497,789 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $338,499 | BOYAmt |
| EOY | $231,160 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $41,810,739 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,900,390 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,800,266 | BOYAmt |
| EOY | $32,910,349 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $107,623 | BOYAmt |
| EOY | $107,851 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,170,622 | BOYAmt |
| EOY | $774,307 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,670,818 | BOYAmt |
| EOY | $60,769,251 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,343,987 | BOYAmt |
| EOY | $1,774,648 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $55,493 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,370,481 | BOYAmt |
| EOY | $23,718,141 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,572,938 | BOYAmt |
| EOY | $788,539 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,287,406 | BOYAmt |
| EOY | $26,336,821 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,025,778 | BOYAmt |
| EOY | $33,709,831 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $357,634 | BOYAmt |
| EOY | $722,599 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,383,412 | BOYAmt |
| EOY | $34,432,430 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,670,818 | BOYAmt |
| EOY | $60,769,251 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $5,515,936 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$466,918 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $4,416 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,416 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | ST. JOSEPH'S HEALTH SERVICES, INC. PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA) AND THE AMERICAN HOSPITAL ASSOCIATION (AHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING, HOWEVER, A PORTION OF THE ANNUAL DUES PAID TO THE WHA WAS USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. ST. JOSEPH'S HEALTH SERVICES, INC. IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE ORGANIZATION PAYS MEMBERSHIP FEES TO THE RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO PROVIDES AN ANALYSIS OF CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND IMPROVE HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. THESE EFFORTS ALSO INCLUDE LOBBYING ON THE PART OF MEMBER ORGANIZATIONS. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,203,574 | OtherCostOrOtherBasisAmt |
| Book Value | $1,203,574 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $31,820,020 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,754,250 | DepreciationAmt |
| Book Value | $27,065,770 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,608,985 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,136,230 | DepreciationAmt |
| Book Value | $3,472,755 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,178,160 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,910 | DepreciationAmt |
| Book Value | $1,168,250 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $32,910,349 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| 3RD PARTY SETTLEMENTS PAYABLE | $621,279 |
| DUE FROM GLAS | $118,864 |
| ASSET RETIREMENT OBLIGATION | $48,396 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $788,539 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE SYSTEM HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS. THE SYSTEM'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR 2018 AND PRIOR YEARS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | 0 | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $468,377 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $468,377 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01480 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,750,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,312,269 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,437,731 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04550 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,218,377 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,312,269 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,906,108 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06030 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $103,368 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $39,414 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $63,954 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $38,835 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $38,835 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,862,830 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,147,653 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,715,177 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.21260 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,515 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,515 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,011,548 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,187,067 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,824,481 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.21600 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $21,229,925 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,499,336 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,730,589 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.27630 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,625 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,625 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,625 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,625 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $776,776 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $388,388 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,488,265 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,637,579 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$149,314 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST JOSEPH'S HEALTH SERVICES INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 527 400 WATER AVENUE | AddressLine1Txt |
| City | HILLSBORO | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54634 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTP://WWW.GUNDERSENHEALTH.ORG/ST-JOSE | WebsiteAddressTxt |
| State License | 1005 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | PROVIDER BASED PHYSICIAN CLINICS | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST JOSEPH'S HEALTH SERVICES INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SUPPLEMENTAL INFORMATION | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | SEE SUPPLEMENTAL INFORMATION | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SUPPLEMENTAL INFORMATION | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ST. JOSEPH'S HEALTH SERVICES, INC. | PART V, SECTION B, LINE 5: IN PREPARING THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), ST. JOSEPH'S HEALTH SERVICES, INC. GATHERED INFORMATION IN THREE WAYS:- A RANDOM HOUSEHOLD SURVEY- CONVENIENCE SAMPLING OF IDENTIFIED GROUPS- AN ANALYSIS OF COUNTY HEALTH RANKINGS DATA- INPUT FROM COUNTY STAKEHOLDERS. |
| ST. JOSEPH'S HEALTH SERVICES, INC. | PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS:- TRI-COUNTY MEMORIAL HOSPITAL- GUNDERSEN LUTHERAN HEALTH CENTER- MAYO CLINIC HEALTH SYSTEM- TOMAH MEMORIAL HOSPITAL- VERNON MEMORIAL HEALTHCARE |
| ST. JOSEPH'S HEALTH SERVICES, INC. | PART V, SECTION B, LINE 6B: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER ORGANIZATIONS:- GREAT RIVERS UNITED WAY- LA CROSSE COMMUNITY FOUNDATION- LA CROSSE COUNTY HEALTH DEPARTMENT- MONROE COUNTY HEALTH DEPARTMENT- VERNON COUNTY HEALTH DEPARTMENT- TREMPEALEAU COUNTY HEALTH DEPARTMENT- HOUSTON COUNTY PUBLIC HEALTH DEPARTMENT |
| ST. JOSEPH'S HEALTH SERVICES, INC. | PART V, SECTION B, LINE 11: 1. MENTAL HEALTHA. CONTINUED EXPANSION AND DEVELOPMENT OF OUR SCHOOL-BASED BEHAVIORAL HEALTH PROGRAM. HAVE SECURED MULTIPLE GRANTS TO COVER THE COST OF RECRUITMENT AND STAFFING.B. FOCUSED OUR MARKETING EFFORTS ON PUSHING THE IMPORTANCE OF THE LITTLE THINGS THAT MAKE US HEALTHY (HAVING CONNECTIONS, DINING WITH FRIENDS, DANCING WITH THE KIDS)2. POVERTY/LIVABLE WAGES/SOCIOECONOMIC DISPARITIESA. FOUNDING MEMBER OF HILLSBORO CHAMBER OF COMMERCE.B. ESTABLISHED OUR HUNGERCARE PROGRAM TO PROVIDE FREE BOXES OF FOOD TO COMMUNITY MEMBERS WHO ARE FOOD INSECURE.C. WORKING ON THE DEVELOPMENT OF A SCHOOL-BASED SNACK CLOSET PROGRAM TO PROVIDE OUR YOUTH WITH CONSISTENT ACCESS TO HEALTHY SNACKS DURING SCHOOL.D. PROMOTION OF FINANCIAL ASSISTANCE PROGRAM.3. CHILDCAREA. PARTICIPATING IN THE PARTNER-UP PROGRAM. B. PROVIDED GRANT WRITING SUPPORT TO A LOCAL COMMUNITY GROUP LOOKING TO BUILD A NEW DAYCARE.4. SAFE & AFFORDABLE HOUSINGA. CONTINUED TO COLLABORATE WITH LOCAL COUNTY HEALTH DEPARTMENTS TO EXPAND ACCESS TO THEIR WELL WATER AND RADON TESTING PROGRAMS.5. MOBILITY & TRANSPORTATION ACCESSA. WE DO NOT HAVE AN OFFICIAL PLAN TO ADDRESS THIS NEED AS IT IS NOT IN OUR AREA OF EXPERTISE BUT IT IS IMPACTING THE ABILITY FOR PATIENTS TO MAKE APPOINTMENTS. WE HAVE BEGUN TO EXPLORE THE ISSUE BUT IT IS COMPLEX AND THERE ARE LIMITING FACTORS INCLUDING STAFFING, COSTS, LIABILITY AND INSURANCE.THE FULL REPORT AND PLAN IS ACCESSIBLE HERE: HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/22471 |
| PART V, SECTION B LINE 7A: | HTTPS://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/PART V, SECTION B LINE 7B:HTTPS://WWW.GREATRIVERSUNITEDWAY.ORG/OUR-WORK/COMMUNITY-NEEDS-ASSESSMENT/PART V, SECTION B LINE 10:HTTPS://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - ST JOSEPH'S HEALTH SERVICES-HILLSBORO | ||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | PHYSICIAN CLINIC |
| 2 - ST JOSEPH'S HEALTH SERVICES-ELROY | ||||
| 1705 OMAHA STREET | ELROY | WI | 53929 | PHYSICIAN CLINIC |
| 3 - ST JOSEPH'S HEALTH SERVICES-WONEWOC | ||||
| 301 RAILROAD STREET | WONEWOC | WI | 53968 | PHYSICIAN CLINIC |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | CATASTROPHIC CARE ASSISTANCE:FINANCIAL ASSISTANCE PROVIDED TO ELIGIBLE PATIENTS WITH ANNUALIZED FAMILY INCOMES IN EXCESS OF 400% OF THE FEDERAL POVERTY LEVEL, AND ASSETS OF LESS THAN THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL, AND FINANCIAL OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS IN EXCESS OF 25% OF THE FAMILY INCOME.DISCOUNTED CARE:FINANCIAL ASSISTANCE THAT PROVIDES A DISCOUNT, FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS, BASED ON A SLIDING SCALE, FOR ELIGIBLE PATIENTS, OR PATIENT GUARANTORS, WITH ANNUALIZED FAMILY INCOMES BETWEEN 200-400% OF THE FEDERAL POVERTY LEVEL AND ASSETS AT OR BELOW SIX TIMES THE FEDERAL. POVERTY LEVEL.1. FAMILY INCOME ABOVE 200% FPL BUT EQUAL TO OR LESS THAN 225% FPL ARE ELIGIBLE TO RECEIVE A 80% DISCOUNT ON THE PATIENT BALANCE DUE.2. FAMILY INCOME ABOVE 225% FPL BUT EQUAL TO OR LESS THAN 250% FPL ARE ELIGIBLE TO RECEIVE A 60% POLICY DISCOUNT ON THE PATIENT BALANCE DUE.3. FAMILY INCOME ABOVE 250% FPL BUT EQUAL TO OR LESS THAN 275% FPL ARE ELIGIBLE TO RECEIVE A 40% DISCOUNT ON THE PATIENT BALANCE DUE.4. FAMILY INCOME ABOVE 275% FPL BUT EQUAL TO OR LESS THAN 400% FPL ARE ELIGIBLE TO RECEIVE A 20% DISCOUNT ON THE PATIENT BALANCE DUE.FREE CARE:A 100% WAIVER OF PATIENT FINANCIAL OBLIGATION FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS FOR ELIGIBLE PATIENTS, OR THEIR GUARANTORS, WITH ANNUALIZED FAMILY INCOMES AT OR BELOW 200% OF THE FPL WITH ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL. UNINSURED DISCOUNT:PATIENTS WITH NO THIRD-PARTY COVERAGE WILL BE PROVIDED AN UNINSURED DISCOUNT, FOR ELIGIBLE SERVICES PROVIDED BY GHS UNDER THIS POLICY, AT THE TIME THAT THE UNDISCOUNTED CHARGES ARE RENDERED. SERVICES NOT ELIGIBLE FOR FINANCIAL ASSISTANCE INCLUDE THE FOLLOWING:1. ELECTIVE PROCEDURES NOT MEDICALLY NECESSARY, AS WELL AS SERVICES TYPICALLY, NOT COVERED BY MEDICARE OR DEFINED BY MEDICARE OR OTHER HEALTH INSURANCE COVERAGE AS NOT MEDICALLY NECESSARY.2. LASIK SURGERY, CHIROPRACTIC CARE, FERTILITY SERVICES, CONTACTS/GLASSES, COSMETIC SURGERY/PLASTIC SERVICES, HEARING AIDS, ORTHODONTICS, DENTAL SERVICES.3. SERVICES RECEIVED FROM CARE PROVIDERS NOT EMPLOYED BY GHS (E.G. PRIVATE AND/OR NON-GHS MEDICAL OR PHYSICIAN PROFESSIONALS, AMBULANCE TRANSPORT, ETC.). PATIENTS ARE ENCOURAGED TO CONTACT THESE PROVIDERS DIRECTLY TO INQUIRE INTO ANY AVAILABLE ASSISTANCE AND TO MAKE PAYMENT ARRANGEMENTS. SEE APPENDIX 3 FOR FULL LISTING OF PROVIDERS NOT COVERED UNDER THIS POLICY.4. DEDUCTIBLES AND COINSURANCE ASSOCIATED WITH MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS OUT-OF-NETWORK AS DEFINED BY THEIR INSURERS |
| PART I, LINE 7: | THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE ORGANIZATION'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. |
| PART I, LINE 7G: | SUBSIDIZED HEALTH SERVICES AT ST. JOSEPH'S HEALTH SERVICES, INC. INCLUDE THE OPERATION OF THE INPATIENT UNIT, EMERGENCY ROOM, AND RURAL HEALTH CLINICS. THE HOSPITAL AND CLINICS ARE OPERATED TO PROVIDE SUPPORT TO THE COMMUNITY BY PROVIDING HOSPITALIZATION, EMERGENCY, AND CLINICAL SERVICES TO THE SURROUNDING RURAL AREAS, WHICH WOULD OTHERWISE BE UNDERSERVED. IT IS THE GOAL OF ST. JOSEPH'S HEALTH SERVICES, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. THE COSTING METHOD FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED IN THE HOSPITAL'S MEDICARE COST REPORT WHICH PROVIDES FOR A DIRECT ALLOCATION OF EXPENSES AS WELL AS PROVIDING THE SAME DATA TO THE MEDICARE PROGRAM AS WELL AS TO THE IRS FOR 990 PURPOSES. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE ORGANIZATION BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT BENEFIT WHICH IS NOT QUANTIFIED. ST. JOSEPH'S HEALTH SERVICES, INC., LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY SERVICES INCLUDING, BUT NOT LIMITED TO: DIAGNOSTICS, EMERGENCY SERVICES, INFUSION SERVICES, SWING BED SERVICES, CLINICAL SERVICES, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH PATHOLOGY, SURGICAL SERVICES, AND WOMEN'S SERVICES. |
| PART III, LINE 2: | THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. |
| PART III, LINE 3: | MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. |
| PART III, LINE 4: | THE ORGANIZATION IS PART OF THE GUNDERSEN HEALTH SYSTEM'S CONSOLIDATED AUDIT IN WHICH THE FOOTNOTE THAT DISCUSSES THE BAD DEBT (IMPLICIT PRICE CONCESSIONS) EXPENSE IS LOCATED IN FOOTNOTE #2, PAGES 10, 11, 18 AND 19. |
| PART III, LINE 8: | THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H TO THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUE DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE ORGANIZATION AS WELL AS ANESTHESIA PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, AND REVENUE FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN PROFESSIONAL SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENTS AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT, AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE).WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. |
| PART III, LINE 9B: | THE ORGANIZATION FOLLOWS GUNDERSEN HEALTH SYSTEM'S GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED. |
| PART VI, LINE 2: | THE HOSPITAL REVIEWS THE UTILIZATION OF SERVICES THAT ARE CURRENTLY AVAILABLE AT THE HOSPITAL. AN EVALUATION OF THE AREA DEMOGRAPHIC IS USED TO DETERMINE WHAT NEW SERVICES MAYBE APPROPRIATE TO PROVIDE. |
| PART VI, LINE 3: | FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE AT ALL CHECK IN AREAS OF OUR HOSPITAL AND CLINICS. INFORMATION IS INCLUDED WITH THE BILLING STATEMENT. AVAILABLE ON THE HOSPITAL'S WEBSITE, OR BY CALLING THE PATIENT ACCOUNTS DEPARTMENT. |
| PART VI, LINE 4: | WE HAVE A 30 MILE SERVICE THAT INCLUDES THE SEVERAL COUNTIES, VERNON, SAUK, MONROE, JUNEAU AND RICHLAND. OUR PATIENT POPULATION IS MADE UP LARGELY OF MEDICARE & MEDICAID PATIENTS. |
| PART VI, LINE 5: | DRIVE THROUGH VACCINATION CLINICS WERE HELD IN EACH OF OUR LOCAL COMMUNITIES, HILLSBORO, ELROY, AND WONEWOC TO FACILITATE EASY ACCESS FOR FLU AND COVID VACCINES. WE PROVIDE THE MEALS FOR THE COMMUNITY MEMBERS SIGNED UP FOR THE MEAL SITE. |
| PART VI, LINE 6: | THROUGH THE HOSPITAL'S AFFILIATION WITH GUNDERSEN HEALTH SYSTEM SPECIALTY CARE SERVICES ARE PROVIDED AT OUR HILLSBORO LOCATION BRINGING CARE TO OUR LOCAL PATIENTS CLOSE TO HOME. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MIKE MCKEE | ||||||||||||||
| SECRETARY | $0 | $270,131 | $0 | $625 | $0 | $0 | $0 | $40,054 | $0 | $27,906 | $0 | $338,716 | $0 | $0 |
| KRISTIE MCCOIC | ||||||||||||||
| ADMINISTRATOR | $0 | $175,546 | $0 | $903 | $0 | $2,509 | $0 | $26,361 | $0 | $24,244 | $0 | $229,563 | $0 | $0 |
| SCOTT LARSON | ||||||||||||||
| PHARMACIST | $198,287 | $0 | $6,142 | $0 | $415 | $0 | $8,244 | $0 | $14,067 | $0 | $227,155 | $0 | $0 | $0 |
| DANA MEYERS | ||||||||||||||
| BOARD DIRECTOR | $0 | $154,752 | $0 | $14,527 | $0 | $5,390 | $0 | $25,614 | $0 | $22,472 | $0 | $222,755 | $0 | $0 |
| RACHEL ALBRECHT MBA | ||||||||||||||
| TREASURER/ADMIN DIRECTOR (THRU NOV) | $0 | $141,471 | $0 | $289 | $0 | $9,675 | $0 | $22,658 | $0 | $24,244 | $0 | $198,337 | $0 | $0 |
| ROBIN NELSON | ||||||||||||||
| FINANCE ADMINISTRATOR | $0 | $143,842 | $0 | $139 | $0 | $0 | $0 | $21,713 | $0 | $24,820 | $0 | $190,514 | $0 | $0 |
| CHRIS SHANNON | ||||||||||||||
| NURSE | $100,402 | $0 | $24,625 | $0 | $3,812 | $0 | $5,495 | $0 | $38,171 | $0 | $172,505 | $0 | $0 | $0 |
| CALEB VANDEHEI | ||||||||||||||
| NURSE | $104,711 | $0 | $29,741 | $0 | $0 | $0 | $5,559 | $0 | $28,588 | $0 | $168,599 | $0 | $0 | $0 |
| DENISE KROES | ||||||||||||||
| NURSE | $126,916 | $0 | $12,184 | $0 | $0 | $0 | $5,703 | $0 | $21,314 | $0 | $166,117 | $0 | $0 | $0 |
| JESSICA THOMPSON | ||||||||||||||
| NURSE PRACTITIONER | $111,838 | $0 | $883 | $0 | $15,102 | $0 | $4,357 | $0 | $30,051 | $0 | $162,231 | $0 | $0 | $0 |
| STACIE CHRISTENSEN | ||||||||||||||
| BOARD DIRECTOR | $0 | $110,831 | $0 | $684 | $0 | $0 | $0 | $16,767 | $0 | $23,509 | $0 | $151,791 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART 1, LINE 3 | FormAndLineReferenceDesc |
| Explanation | A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY, AND -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PLEASE REFER TO THE FORM 990, PART VI, LINE 15A DISCLOSURE IN SCHEDULE O FOR ADDITIONAL DETAILS ON HOW COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| ANGIE NOVY | |||
| SISTER OF OFFICER | $42,921 | SALARY | 0 |
| DORIS SKEMP | |||
| MOTHER OF OFFICER | $10,580 | SALARY | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 2 | PAIN MANAGEMENT SERVICES 1 DAY/MONTH - UROLOGY SERVICES OFFERED 3 DAYS/MONTH - CHIROPRACTIC SERVICES OFFERED 2 DAYS/WEEK - VASCULAR SURGERY SERVICES OFFERED 1 DAY/MONTH |
| FORM 990, PART III, LINE 3 | DUE TO RESTRICTIONS DURING COVID WE HAD TO TEMPORARILY SUSPEND OUR COMMUNITY OUTREACH EVENTS. MANY OF THE COVID RESTRICTIONS HAVE BEEN LIFTED NOW IN THE HEALTH CARE INDUSTRY SO WE ARE STARTING UP THOSE PROGRAMS AGAIN INCLUDING, STRONG BODIES, CRP TRAINING, ADVANCED DIRECTIVES SEMINARS, SCRUB CLUB FOR MIDDLE SCHOOL STUDENTS, BLOOD DRIVES, EMPLOYEE EVENTS TO INCREASE VITALITY AT WORK, EDUCATIONAL VAPING ASSEMBLIES FOR LOCAL SCHOOLS, CAREER DAYS, ETC. WE ARE ADDING MORE AND MORE EVENTS IN THE COMMUNITY TO ADDRESS THE HEALTH OF OUR COMMUNITY. |
| FORM 990, PART VI, SECTION A, LINE 4 | GUNDERSEN AND BELLIN HEALTH SYSTEMS, INC. (BELLIN), EACH A WISCONSIN NONPROFIT, NON-STOCK CORPORATION, ENTERED INTO A COMBINATION AGREEMENT DATED JULY 29, 2022 (THE AGREEMENT), TO ALIGN THEIR RESPECTIVE OPERATIONS AND TO FORM A SINGLE NONPROFIT HEALTH SYSTEM THROUGH THE CREATION OF BELLIN GUNDERSEN HEALTH SYSTEM, INC., A WISCONSIN NONPROFIT, NON-STOCK CORPORATION (BELLIN GUNDERSEN). ON DECEMBER 1, 2022, UPON CONSUMMATION OF THE ALIGNMENT OF THE TWO SYSTEMS (THE AFFILIATION), BELLIN GUNDERSEN BECAME THE SOLE CORPORATE MEMBER OF BOTH BELLIN AND GUNDERSEN. BELLIN AND GUNDERSEN AND THEIR RESPECTIVE AFFILIATES ARE EXPECTED TO MAINTAIN THEIR RESPECTIVE CORPORATE EXISTENCE. IN DECEMBER 2022, THE BYLAWS OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. WERE AMENDED AND RESTATED TO UPDATE THE SOLE CORPORATE MEMBER TO BELLIN GUNDERSEN HEALTH SYSTEM, INC. THE BYLAWS WERE ALSO UPDATED TO SPECIFY THE POWERS RETAINED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. THE CHIEF EXECUTIVE OFFICER OF BELLIN GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. RETAINS AUTHORITY TO APPROVE ANY SIGNIFICANT CHANGES TO THE CORPORATION. SUBJECT TO THE RESERVED POWERS SPECIFIED IN THE BYLAWS, THE AFFAIRS OF THE CORPORATION SHALL BE MANAGED BY ITS BOARD OF TRUSTEES. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ARTICLES OF INCORPORATION OF ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES FOR ONE MEMBER OF THE CORPORATION. THE SOLE MEMBER OF ST. JOSEPH'S HEALTH SERVICES, INC. IS GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | AS THE SOLE MEMBER AND UNDER THE TERMS OF THE AFFILIATION AGREEMENT, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY APPOINT, REMOVE, OR ELECT CERTAIN OFFICERS AND/OR MEMBERS OF THE BOARD OF DIRECTORS OF ST. JOSEPH'S HEALTH SERVICES, INC. GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY APPOINT FIVE MEMBERS OF THE BOARD OF DIRECTORS OF ST. JOSEPH'S HEALTH SERVICES, INC. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., HAS THE FOLLOWING RESERVE RIGHTS OF APPROVAL: THE INCURRENCE OF DEBT (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS OR DEBT INCLUDED IN APPROVED BUDGETS) AND THE GRANT OF ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND DIRECT EXECUTION OF ANY DOCUMENTS AND THE TAKING OF ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; AND THE ANNUAL OPERATING BUDGET AND CAPITAL EXPENDITURES. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 RETURN IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND THEN REVIEWED BY THE ORGANIZATION'S MANAGEMENT. A FINAL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO SUBMISSION. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY OF ST. JOSEPH'S HEALTH SERVICES, INC. REQUIRES ALL OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, AND HIGHEST-COMPENSATED EMPLOYEES TO COMPLETE ITS ANNUAL DISCLOSURE QUESTIONNAIRE. THESE QUESTIONNAIRES ARE THEN REVIEWED BY THE BOARD OF DIRECTORS, NOTING ANY RELATIONSHIPS THAT COULD POTENTIALLY CREATE A CONFLICT OF INTEREST. ALL NOTED CONFLICTS ARE DISCLOSED ANNUALLY TO THE BOARD AND ANY MEMBERS OF THE BOARD WITH CONFLICTS ARE ASKED TO ABSTAIN FROM VOTING ON THOSE ISSUES. THE ORGANIZATION ALSO NOTES AND DOCUMENTS IF ANY BUSINESS OWNED BY BOARD MEMBERS OR EMPLOYEES DO BUSINESS WITH THE ORGANIZATION TO ENSURE THAT COMPETITIVE BIDS ARE SOUGHT FOR SERVICES. |
| FORM 990, PART VI, SECTION B, LINE 15 | FOR THE PURPOSES OF DETERMINING COMPENSATION, ST. JOSEPH'S HEALTH SERVICES, INC. RELIED ON IT'S AFFILIATED ORGANIZATION, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. GUNDERSON LUTHERAN HEALTH SYSTEM, INC. USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION SURVEY OR STUDY, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION CURRENTLY DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. FORM 990 IS MADE AVAILABLE TO THE PUBLIC AT ITS MAIN BUSINESS OFFICE DURING NORMAL BUSINESS HOURS. FORM 990 INCLUDES MUCH OF THE INFORMATION CONTAINED WITHIN THE ORGANIZATION'S GOVERNING DOCUMENTS. CONFLICTS OF INTEREST ARE ALSO NOTED ON FORM 990. THE AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC AS THEY ARE REQUIRED TO BE ATTACHED TO THE FORM 990. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN UNRESTRICTED NET ASSETS OF FOUNDATION -466,918. |
| FORM 990, PART IV, LINE 12B AND PART XII, LINE 2: | THE ORGANIZATION WAS INCLUDED IN A SHORT YEAR CONSOLIDATED AUDIT FOR THE 11-MONTH PERIOD JANUARY 1, 2022 THROUGH NOVEMBER 30, 2022. THE ANSWERS FOR PART IV, LINE 12B AND PART XII, LINES 2A-2C HAVE BEEN ANSWERED YES EVEN THOUGH THE FORM 990 COVERS THE 12-MONTH PERIOD JANUARY 1, 2022 THROUGH DECEMBER 31, 2022. THE REASON FOR THIS CHANGE IS DUE TO A MERGER WITH THE BELLIN GUNDERSEN HEALTH SYSTEM. THE ACTIVITY OF DECEMBER 2022 WILL BE INCLUDED IN A CONSOLIDATED AUDIT FOR THE PERIODS OF DECEMBER 2022 - SEPTEMBER 2023 AS ALL THE RELATED PARTIES LISTED IN SCHEDULE R WILL BE TRANSITIONING TO THAT YEAR END. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (29 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BELLIN GUNDERSEN HEALTH SYSTEM INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 920504278 | PARENT | WI | 501(C)(3) | LINE 12B, II | N/A | 0 | |
| BELLIN HEALTH SYSTEMS INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391512904 | SUPPORT OF HEALTHCARE ORGANIZATIONS | WI | 501(C)(3) | LINE 12B, II | Yes (1) | BELLIN GUNDERSEN HEALTH SYSTEMS INC | |
| BELLIN COLLEGE INC | |||||||||||
| 3201 EATON ROAD | GREEN BAY | WI | 54311 | 391620530 | NURSING AND RADIOLOGIC SCIENCE COLLEGE | WI | 501(C)(3) | LINE 2 | Yes (1) | BELLIN HEALTH SYSTEMS INC | |
| LAKE MICHIGAN HEALTH SERVICES INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391512903 | SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL | WI | 501(C)(3) | LINE 12B, II | Yes (1) | BELLIN HEALTH SYSTEMS INC | |
| THE BELLIN HEALTH FOUNDATION INC | |||||||||||
| PO BOX 23400 | GREEN BAY | WI | 54301 | 391809171 | FOUNDATION | WI | 501(C)(3) | LINE 7 | Yes (1) | BELLIN HEALTH SYSTEMS INC | |
| BELLIN PSYCHIATRIC CENTER INC | |||||||||||
| PO BOX 23725 | GREEN BAY | WI | 54305 | 391657627 | PSYCHIATRIC HOSPITAL | WI | 501(C)(3) | LINE 3 | Yes (1) | BELLIN HEALTH SYSTEMS INC | |
| BELLIN MEMORIAL HOSPITAL INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 390884478 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | Yes (1) | BELLIN HEALTH SYSTEMS INC | |
| OCONTO HOSPITAL & MEDICAL CENTER INC | |||||||||||
| 820 ARBUTUS AVENUE | OCONTO | WI | 54153 | 061745397 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | Yes (1) | BELLIN MEMORIAL HOSPITAL INC | |
| GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391866425 | SUPPORTING ORGANIZATION | WI | 501(C)(3) | LINE 12B, II | Yes (1) | BELLIN GUNDERSEN HEALTH SYSTEMS INC | |
| GUNDERSEN LUTHERAN MEDICAL CENTER INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 390813416 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |
| GUNDERSEN CLINIC LTD | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391028657 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |
| GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391606449 | SUPPORTING ORGANIZATION | WI | 501(C)(3) | LINE 12B, II | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |
| GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391249705 | FOUNDATION | WI | 501(C)(3) | LINE 7 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |
| GUNDERSEN LUTHERAN CREDENTIALING SERVICES INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391856898 | CREDENTIALING SERVICE | WI | 501(C)(3) | LINE 12C, III-FI | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |
| HARMONY COMMUNITY HEALTHCARE INC | |||||||||||
| 815 MAIN AVENUE S | HARMONY | MN | 55939 | 410711606 | HEALTH CARE | MN | 501(C)(3) | LINE 10 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |
| TWEETEN LUTHERAN HEALTHCARE CENTER INC | |||||||||||
| 125 FIFTH AVENUE SE | SPRING GROVE | MN | 55974 | 411565003 | HEALTH CARE | MN | 501(C)(3) | LINE 10 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |
| TRI-STATE AMBULANCE INC | |||||||||||
| 235 CAUSEWAY BLVD | LA CROSSE | WI | 54601 | 391965415 | MEDICAL TRANSPORTATION | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |
| TRI-STATE REGIONAL AMBULANCE INC | |||||||||||
| 235 CAUSEWAY BLVD | LA CROSSE | WI | 54603 | 391962965 | MEDICAL TRANSPORTATION | WI | 501(C)(3) | LINE 11 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |
| LUTHERAN REAL ESTATE HOLDING CORP | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391480826 | HOUSING | WI | 501(C)(3) | LINE 12C, III-FI | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |
| COMMUNITY HOUSING OF LA CROSSE INC | |||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391586700 | INDEPENDENT LIVING | WI | 501(C)(3) | LINE 10 | Yes (1) | LUTHERAN REAL ESTATE HOLDING CORP | |
| LUTHERAN HOUSING OF LA CROSSE INC | |||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391751934 | INDEPENDENT LIVING | WI | 501(C)(3) | LINE 10 | Yes (1) | LUTHERAN REAL ESTATE HOLDING CORP | |
| ST JOSEPH'S MEMORIAL FOUNDATION INC | |||||||||||
| 400 WATER AVE | HILLSBORO | WI | 54634 | 391455787 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | Yes (1) | ST JOSEPH'S HEALTH SERVICES INC | |
| TRI-COUNTY MEMORIAL HOSPITAL INC | |||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 390704510 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |
| TRI-COUNTY MEMORIAL FOUNDATION INC | |||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 300093022 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | Yes (1) | TRI-COUNTY MEMORIAL HOSPITAL INC | |
| MEMORIAL HOSPITAL OF BOSCOBEL | |||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 53805 | 390845590 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |
| PALMER LUTHERAN HEALTH CENTER | |||||||||||
| 112 JEFFERSON STREET | WEST UNION | IA | 52175 | 421320763 | HEALTH CARE | IA | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |
| MEMORIAL HEALTHCARE FOUNDATION INC | |||||||||||
| PO BOX 40 | FRIENDSHIP | WI | 53934 | 391775074 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | Yes (1) | MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC | |
| MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC | |||||||||||
| 402 W LAKE STREET | FRIENDSHIP | WI | 53934 | 390944012 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |
| SAINT ELIZABETH'S HOSPITAL OF WABASHA | |||||||||||
| 1200 GRANT BLVD WEST | WABASHA | MN | 55981 | 410693877 | HEALTH CARE | MN | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| BEL-REGIONAL HOME MEDICAL INC | |||||||||
| 617 S ROOSEVELT | GREEN BAY | WI | 54301 | 391504766 | DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS | WI | N/A | C | 0 |
| BELLIN INVESTMENTS INC | |||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391564939 | OTHER | WI | N/A | C | 0 |
| GUNDERSEN ENVISION LLC | |||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 264706546 | RENEWABLE ENERGY | WI | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST JOSEPH'S MEMORIAL FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $420,600 | InvolvedAmt |
| Method Of Amount Determination | CASH | MethodOfAmountDeterminationTxt |
Comments