MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC: Form 990, tax year 2021
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- Organization
- MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC (EIN 39-0944012)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-10
- IRS object ID
- 202203149349301985
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-10T09:13:04-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | 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 | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390944012 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOUNDVIEW MEMORIAL HOSPITAL & CLINICS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MOUN | BusinessNameControlTxt |
| Phone | 6083393331 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 402 WEST LAKE STREET | AddressLine1Txt |
| City | FRIENDSHIP | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53934 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | FRANK PEREZ-GUERRA | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6083393331 | PhoneNum |
| Signature | 2022-11-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | FRANK | PersonFirstNm |
| Person Last | PEREZ-GUERRA | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2022-10-30 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GUNDERSEN MOUNDVIEW HOSPITAL & CLINICS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | FRANK PEREZ-GUERRA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 402 WEST LAKE STREET | AddressLine1Txt |
| City | FRIENDSHIP | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53934 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $26,119,703 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GUNDERSENHEALTH.ORG/MOUNDVIEW | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1959 | 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 | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 172 | TotalEmployeeCnt |
| Total Volunteers | 65 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $714,119 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,946,443 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $19,640,027 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $21,792,390 | CYProgramServiceRevenueAmt |
| PY Investment Income | $99,864 | PYInvestmentIncomeAmt |
| CY Investment Income | $109,562 | CYInvestmentIncomeAmt |
| PY Other Revenue | $210,302 | PYOtherRevenueAmt |
| CY Other Revenue | $258,112 | CYOtherRevenueAmt |
| PY Total Revenue | $20,664,312 | PYTotalRevenueAmt |
| CY Total Revenue | $26,106,507 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,100 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,350 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,348,389 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,124,660 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,188,772 | PYOtherExpensesAmt |
| CY Other Expenses | $11,700,235 | CYOtherExpensesAmt |
| PY Total Expenses | $18,538,261 | PYTotalExpensesAmt |
| CY Total Expenses | $20,826,245 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,126,051 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,280,262 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,739,931 | TotalAssetsBOYAmt |
| Total Assets EOY | $21,727,345 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $9,378,738 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,036,680 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,361,193 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,690,665 | NetAssetsOrFundBalancesEOYAmt |
| Mission | WE WILL DISTINGUISH OURSELVES THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $17,643,785 | ExpenseAmt |
| Grant | $1,350 | GrantAmt |
| Revenue | $21,869,135 | RevenueAmt |
| Desc | THE HOSPITAL IS A GENERAL MEDICAL CRITICAL ACCESS HOSPITAL LICENSE FOR 25 BEDS. DURING FISCAL YEAR 2021, THE HOSPITAL HAD 565 ACUTE INPATIENT DAYS AND 569 SWING-BED DAYS. THE HOSPITAL ALSO HAD 6,196 EMERGENCY ROOM/URGENT CARE AND 10,245 CLINIC VISITS RESPECTIVELY. | Desc |
| Total Program Service Expenses | $17,643,785 | 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 | 0 | 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 | 201 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 172 | 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | 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 | 0 | 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 | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRANK PEREZ-GUERRA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6083393331 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 402 WEST LAKE STREET | AddressLine1Txt |
| City | FRIENDSHIP | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53934 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| BRYAN ERDMANN | ||||||||
| BOARD TRUSTEE | 2.50 | 40.00 | Yes (X) | $0 | $296,814 | $70,078 | ||
| STEPHANIE CARROLL | ||||||||
| BOARD TRUSTEE | 2.50 | 40.00 | Yes (X) | $0 | $298,096 | $62,139 | ||
| FRANK PEREZ-GUERRA | ||||||||
| CEO | 2.50 | 40.00 | $0 | $186,080 | $51,476 | Yes (X) | ||
| ROXANNE POTTS | ||||||||
| BOARD TRUSTEE | 2.50 | 40.00 | Yes (X) | $0 | $142,577 | $39,705 | ||
| PAUL FISCH | ||||||||
| VICE CHAIR | 2.50 | 40.00 | Yes (X) | $0 | $124,910 | $40,663 | Yes (X) | |
| DIANA BRONIEC | ||||||||
| NURSE PRACTITIONER | 40.00 | 0.00 | $153,878 | $0 | $8,391 | Yes (X) | ||
| SARAH ROSSMAN | ||||||||
| SECRETARY | 2.50 | 40.00 | Yes (X) | $0 | $131,378 | $21,262 | Yes (X) | |
| BRAD SHAW | ||||||||
| DIRECTOR | 40.00 | 0.00 | $133,157 | $0 | $3,083 | Yes (X) | ||
| MOLLY MOLL | ||||||||
| PHYSICAL THERAPIST | 40.00 | 0.00 | $107,078 | $0 | $28,141 | Yes (X) | ||
| LINDA CHARLES | ||||||||
| NURSE PRACTITIONER | 40.00 | 0.00 | $114,028 | $0 | $18,738 | Yes (X) | ||
| LORI WITTIG | ||||||||
| DIRECTOR | 40.00 | 0.00 | $122,710 | $0 | $7,473 | Yes (X) | ||
| RICHARD STERNHAGEN | ||||||||
| CHAIR | 2.50 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| RENEE SCHINDLBECK | ||||||||
| TREASURER (THRU DEC) | 2.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| KAREN MILLER | ||||||||
| BOARD TRUSTEE | 2.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JOE THEISEN | ||||||||
| BOARD TRUSTEE | 2.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $630,851 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,179,855 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $351,149 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | 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 AVENUE | LA CROSSE | WI | 54601 | ADMINISTRATIVE SERVICES | $8,534,497 |
| WEATHERBY HEALTHCARE | |||||
| PO BOX 972633 | DALLAS | TX | 753972633 | CONTRACT MD SERVICES | $622,821 |
| STAFFENCY | |||||
| 221 W COLLEGE AVE FLOOR 2 | APPLETON | WI | 54911 | CONTRACT RN/LAB SERVICES | $265,847 |
| SHC SERVICES INC | |||||
| PO BOX 677896 | DALLAS | TX | 752677896 | CONTRACT IMAGING PERSONNEL SERVICES | $245,587 |
| RITA LUEDKE | |||||
| PO BOX 32 | LOWELL | WI | 53557 | CONTRACT CRNA SERVICES | $168,095 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $3,926,899 | GovernmentGrantsAmt |
| All Other Contributions | $19,544 | AllOtherContributionsAmt |
| Total Contributions | $3,946,443 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621300 | $18,492,509 | $18,492,509 |
| PHARMACY | 446110 | $3,229,140 | $3,229,140 |
| MEDICAL BUILDING RENT | 531120 | $60,420 | $60,420 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,321 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,321 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $21,792,390 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $108,378 | TotalRevenueColumnAmt |
| Exclusion | $108,378 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $20,877 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $13,196 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $7,681 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,681 | TotalRevenueColumnAmt |
| Exclusion | $7,681 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,184 | 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 | $1,184 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,184 | TotalRevenueColumnAmt |
| Exclusion | $1,184 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| E.H.R INCENTIVE | 900099 | $76,745 | $76,745 | |
| CAFETERIA | 722514 | $17,699 | $17,699 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $155,987 | TotalRevenueColumnAmt |
| Exclusion | $155,987 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $250,431 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,106,507 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $21,869,135 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $290,929 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,350 | TotalAmt |
| Program Services | $1,350 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $237,556 | TotalAmt |
| Management And General | $237,556 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,150,652 | TotalAmt |
| Program Services | $5,996,936 | ProgramServicesAmt |
| Management And General | $1,153,716 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,435 | TotalAmt |
| Program Services | $110,648 | ProgramServicesAmt |
| Management And General | $8,787 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,094,110 | TotalAmt |
| Program Services | $885,268 | ProgramServicesAmt |
| Management And General | $208,842 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $522,907 | TotalAmt |
| Program Services | $422,489 | ProgramServicesAmt |
| Management And General | $100,418 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,342 | TotalAmt |
| Management And General | $67,342 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,550 | TotalAmt |
| Management And General | $31,550 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,619,743 | TotalAmt |
| Program Services | $5,629,293 | ProgramServicesAmt |
| Management And General | $990,450 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,128 | TotalAmt |
| Program Services | $1,040 | ProgramServicesAmt |
| Management And General | $63,088 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $438,156 | TotalAmt |
| Program Services | $323,449 | ProgramServicesAmt |
| Management And General | $114,707 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $314,789 | TotalAmt |
| Program Services | $312,682 | ProgramServicesAmt |
| Management And General | $2,107 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,381 | TotalAmt |
| Program Services | $34,121 | ProgramServicesAmt |
| Management And General | $4,260 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,750 | TotalAmt |
| Program Services | $4,171 | ProgramServicesAmt |
| Management And General | $14,579 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,460 | TotalAmt |
| Program Services | $5,814 | ProgramServicesAmt |
| Management And General | $646 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $631,316 | TotalAmt |
| Program Services | $568,184 | ProgramServicesAmt |
| Management And General | $63,132 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,205 | TotalAmt |
| Management And General | $49,205 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $2,252,691 | $2,252,691 | |
| BAD DEBT EXPENSE | $717,434 | $717,434 | |
| EQUIPMENT REPAIRS AND M | $309,313 | $306,368 | $2,945 |
| COLLECTION EXPENSE | $8,716 | $8,716 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $132,261 | TotalAmt |
| Program Services | $71,847 | ProgramServicesAmt |
| Management And General | $60,414 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,826,245 | TotalAmt |
| Program Services | $17,643,785 | ProgramServicesAmt |
| Management And General | $3,182,460 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $700 | BOYAmt |
| EOY | $1,176 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,065,743 | BOYAmt |
| EOY | $11,776,826 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,167,154 | BOYAmt |
| EOY | $2,254,866 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $208,427 | BOYAmt |
| EOY | $587,479 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $79,884 | BOYAmt |
| EOY | $106,584 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,267,721 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,711,278 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,575,746 | BOYAmt |
| EOY | $5,556,443 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $760,833 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $642,277 | BOYAmt |
| EOY | $683,138 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,739,931 | BOYAmt |
| EOY | $21,727,345 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,661,822 | BOYAmt |
| EOY | $1,063,000 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,741,453 | BOYAmt |
| EOY | $3,183 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $169,632 | BOYAmt |
| EOY | $111,687 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,805,831 | BOYAmt |
| EOY | $3,858,810 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,378,738 | BOYAmt |
| EOY | $5,036,680 | 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 | $10,785,611 | BOYAmt |
| EOY | $16,064,689 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $575,582 | BOYAmt |
| EOY | $625,976 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,361,193 | BOYAmt |
| EOY | $16,690,665 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,739,931 | BOYAmt |
| EOY | $21,727,345 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $5,280,262 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $72,828 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$23,618 | OtherChangesInNetAssetsAmt |
| 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 | 0 | FederalGrantAuditRequiredInd |
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 | $1,767 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,767 | 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 | MOUNDVIEW MEMORIAL HOSPITAL & CLINICS PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE WHA HAS NOTIFIED MOUNDVIEW MEMORIAL HOSPITAL & CLINICS THAT $1,767 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $76,500 | OtherCostOrOtherBasisAmt |
| Book Value | $76,500 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,475,389 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,016,109 | DepreciationAmt |
| Book Value | $4,459,280 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,213,894 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,346,033 | DepreciationAmt |
| Book Value | $867,861 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $501,938 | OtherCostOrOtherBasisAmt |
| Depreciation | $349,136 | DepreciationAmt |
| Book Value | $152,802 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,556,443 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| 3RD PARTY SETTLEMENTS | $1,338,768 |
| OPERATING LEASE OBLIGATIONS | $17,760 |
| DUE TO RELATED PARTY | $359,668 |
| ADVANCE COVID PAYMENTS | $2,142,614 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,858,810 | 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 | GUNDERSEN HEALTH SYSTEM HAS REVIEWED 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 2016 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 | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $236,904 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $236,904 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01140 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,711,451 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,158,817 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $552,634 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02650 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,948,355 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,158,817 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $789,538 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03790 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $135,041 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,025 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $132,016 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00630 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,707 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,707 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,947,013 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,028,812 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,918,201 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.18810 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,091,761 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,031,837 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,059,924 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.19490 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,040,116 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,190,654 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,849,462 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.23280 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $302,344 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $12,593 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,381,222 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,318,041 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $63,181 | 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 | MOUNDVIEW MEMORIAL HOSPITAL & CLINICS | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 402 WEST LAKE STREET PO BOX 40 | AddressLine1Txt |
| City | FRIENDSHIP | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53934 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.GUNDERSENHEALTH.ORG/MOUNDVIEW | WebsiteAddressTxt |
| State License | 1014 | 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 |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOUNDVIEW MEMORIAL HOSPITAL | 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 |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | 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 |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| 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 | SEE SUPPLEMENTAL INFORMATION | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE SUPPLEMENTAL INFORMATION | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE SUPPLEMENTAL INFORMATION | 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 (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MOUNDVIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: A 52 QUESTION SURVEY WAS AVAILABLE FOR COMMUNITY MEMBERS TO COMPLETE FROM JUNE 14-AUGUST 8, 2021. THE SURVEY WAS AVAILABLE ONLINE VIA SURVEY MONKEY AND SHARED THROUGH FACEBOOK AND EMAILS TO VARIOUS COMMUNITY BUSINESS, AGENCIES, COALITION MEMBERS, AND CHURCHES. PAPER COPIES WERE AVAILABLE AT HEALTH & HUMAN SERVICES, GUNDERSEN MOUNDVIEW, LIBRARIES IN ADAMS, ROME AND WI DELLS, THE COUNTY FAIR, AREA FOOD PANTRIES, FRIENDSHIP CONNECTION, AND WAS DISTRIBUTED TO THE COUNTY'S MEALS ON WHEELS RECIPIENTS. A SURVEY WAS TRANSLATED INTO SPANISH WITH COPIES SENT TO AREA FARMS THAT EMPLOY SPANISH SPEAKING WORKERS. PRESS RELEASES WERE SENT AND ADS PLACED THROUGH LOCAL MEDIA. THERE WERE 607 RESPONDENTS. TWO COMMUNITY FOCUS GROUPS WERE ALSO SCHEDULED AND ADVERTISED WITH NO ONE ATTENDING. TWO FOCUS GROUPS FOR COMMUNITY STAKEHOLDERS WERE HELD WITH TEN PARTICIPANTS. THERE WERE ALSO 23 KEY INFORMANT INTERVIEWS WITH COMMUNITY MEMBERS AND KEY STAKEHOLDERS. COMMUNITY STAKEHOLDER PARTICIPANTS INCLUDED MEDICAL PROVIDERS, SERVICE AGENCIES, SCHOOL LEADERS, COUNTY GOVERNMENT, BUSINESS LEADERS AS WELL AS MANY OTHERS WHO REPRESENTED LOW INCOME AND DISABILITY POPULATIONS. |
| MOUNDVIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6A: ASPIRUS AND SSM HEALTH CARE ST. CLARE HOSPITAL ALSO PARTICIPATED IN THE COUNTY-WIDE NEEDS ASSESSMENT HOSTED IN 2021 BY PUBLIC HEALTH. OUR NEEDS ASSESSMENT INCLUDES BRIEF INFO SPECIFIC TO US THAT IS THEN ATTACHED TO THE COUNTY-WIDE ASSESSMENT. |
| MOUNDVIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: ADAMS COUNTY HEALTH AND HUMAN SERVICES - DIVISION OF PUBLIC HEALTH AND GREAT RIVERS UNITED WAY |
| MOUNDVIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: GUNDERSEN MOUNDVIEW IS ADDRESSING IDENTIFIED HEALTH NEEDS THROUGH COUNTY AND HOSPITAL SPECIFIC IMPLEMENTATION PLANS. THE INITIAL IDENTIFICATION OF HEALTH PRIORITIES THROUGH THE ASSESSMENT ARE, OVERALL, ENCOMPASSED IN OUR FOUR HOSPITAL PRIORITY AREAS, WE WILL PARTICIPATE IN THE COUNTY PUBLIC HEALTH'S COMMUNITY ACTION TEAMS TO CONDUCT A GAP ANALYSIS, GOALS, SMART OBJECTIVES, AND A WORKPLAN FOR IDENTIFIED HEALTH NEEDS. IN ADDITION, WE HAVE ALSO SET OBJECTIVES THROUGH OUR HOSPITAL SPECIFIC IMPLEMENTATION PLAN. AN EXAMPLE IS THE HOSPITAL LED MENTORING AND GRIEF SUPPORT PROGRAMS TO HELP ADDRESS MENTAL HEALTH NEEDS. WE WILL ANNUALLY REVIEW PROGRESS ON OUR IMPLEMENTATION GOALS. |
| MOUNDVIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 13H: HOSPITAL PATIENTS NOT MEETING FINANCIAL ASSISTANCE ELIGIBILITY THRESHOLDS MAY BE ELIGIBLE FOR ASSISTANCE UNDER CIRCUMSTANCES WHEN HOSPITAL MEDICAL BILLS WOULD RESULT IN SEVERE FINANCIAL HARDSHIP. PATIENTS, OR THEIR GUARANTORS, MAY BE ELIGIBLE FOR CATASTROPHIC CARE ASSISTANCE IF THEY HAVE INCURRED OUT-OF-POCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GMV THAT EXCEED 25% OF FAMILY INCOME AND HAVE ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL THRESHOLD. |
| PART V, LINE 16A, 16B, 16C | PART V, LINE 16A, FAP WEBSITE:HTTPS://WWW.GUNDERSENHEALTH.ORG/APP/FILES/PUBLIC/FD66C1FB-C19E-4C8B-8B2F-17FADA3EE277/MOUNDVIEW%20FINANCIAL-ASSISTANCE-POLICY_7_2022.PDFPART V, LINE 16B, FAP APPLICATION WEBSITE:HTTPS://WWW.GUNDERSENHEALTH.ORG/APP/FILES/PUBLIC/9C388CFA-7D1D-4E08-8889-2458C7057388/GUNDERSEN%20FINANCIAL%20ASSISTANCE%20APPLICATION%20SYSTEMWIDE.PDFPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.GUNDERSENHEALTH.ORG/APP/FILES/PUBLIC/74503E41-12C0-4624-9F92-27AD0709FF69/FINANCIAL-ASSISTANCE-MOUNDVIEW-PLAIN-LANGUAGE-SUMMARY.PDF |
| PART V, LINE 7A | PART V, LINE 7A, HOSPITAL FACILITY'S WEBSITE:HTTPS://WWW.GUNDERSENHEALTH.ORG/APP/FILES/PUBLIC/25EB2FE9-2F2C-445C-B87C-0B48307B963D/COMMUNITY-NEEDS-ASSESSMENT-2021-MOUNDVIEW.PDF |
| PART V, LINE 10 | PART V, LINE 10, HOSPITAL'S RECENTLY ADOPTED IMPLEMENTATION STRATEGY:HTTPS://WWW.GUNDERSENHEALTH.ORG/APP/FILES/PUBLIC/A641705C-B399-45BF-9074-8A9BCF29B443/COMMUNITY-NEEDS-IMPLEMENTATION-PLAN-2022-MOUNDVIEW.PDF |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - GUNDERSEN FRIENDSHIP CLINIC | ||||
| 402 WEST LAKE STREET PO BOX 40 | FRIENDSHIP | WI | 53934 | RURAL HEALTH CLINIC |
| 2 - GUNDERSEN WESTFIELD CLINIC | ||||
| 207 NORTH PIONEER PARK ROAD | WESTFIELS | WI | 53964 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | HOSPITAL PATIENTS NOT MEETING FINANCIAL ASSISTANCE ELIGIBILITY THRESHOLDS MAY BE ELIGIBLE FOR ASSISTANCE UNDER CIRCUMSTANCES WHEN HOSPITAL MEDICAL BILLS WOULD RESULT IN SEVERE FINANCIAL HARDSHIP. PATIENTS, OR THEIR GUARANTORS, MAY BE ELIGIBLE FOR CATASTROPHIC CARE ASSISTANCE IF THEY HAVE INCURRED OUT-OF-POCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GMV THAT EXCEED 25% OF FAMILY INCOME AND HAVE ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL THRESHOLD. |
| PART I, LINE 7: | THE RATIO OF PATIENT COST TO CHARGES WAS CALCULATED BY DIVIDING HOSPITAL EXPENSES NET OF NON-PATIENT REVENUE AND IDENTIFIED COMMUNITY BENEFIT EXPENSE BY GROSS PATIENT REVENUE. THE PERCENTAGE WAS THEN MULTIPLIED BY THE GROSS REVENUES ON BAD DEBT ACCOUNTS. |
| PART I, LINE 7G: | THE ORGANIZATION OPERATES 2 RURAL HEALTH CLINICS, AN OBSERVATION ROOM AND EMERGENCY ROOM WHERE THE COSTS EXCEED THE NET PATIENT SERVICE REVENUE. THESE SERVICES WOULD NOT BE PROVIDED TO THE COMMUNITY IF NOT FOR THE LEADERSHIP OF THE HOSPITAL. THE ORGANIZATION UTILIZED THEIR COST REPORT AND OTHER INTERNAL INFORMATION TO DETERMINE THE AMOUNTS TO BE RECORDED PER WORKSHEET 6 OF THE IRS FORM SCHEDULE H INSTRUCTIONS. AMOUNTS RECORDED HERE HAVE NOT BEEN DUPLICATED IN OTHER AREAS OF THE FORM, MEDICAID, BAD DEBT, FINANCIAL ASSISTANCE HAS BEEN REMOVED FROM THE AMOUNTS REPORTED AND THESE SERVICES WERE EXCLUDED FROM THE MEDICARE SURPLUS/SHORTFALL CALCULATION. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THE HOSPITAL'S COMMUNITY BUILDING ACTIVITIES PROMOTES HEALTH OF THE COMMUNITIES IT SERVES THROUGH LOCAL ADVERTISEMENTS, INVOLVEMENT WITH CHAMBER OF COMMERCE, DEPARTMENT OF AGING AND OTHER COMMUNITY ORGANIZATIONS. THE AMOUNT OF SUPPORT IS DIFFICULT TO QUANTIFY. |
| PART III, LINE 2: | THE RATIO OF PATIENT COST TO CHARGES WAS CALCULATED BY DIVIDING HOSPITAL EXPENSES NET OF NON-PATIENT REVENUE AND IDENTIFIED COMMUNITY BENEFIT EXPENSE BY GROSS PATIENT REVENUE. THE PERCENTAGE WAS THEN MULTIPLIED BY THE GROSS REVENUES ON BAD DEBT ACCOUNTS. |
| PART III, LINE 3: | IT IS CONSIDERED COMMUNITY BENEFIT AS THE HOSPITAL IS REIMBURSED ON MEDICARE ALLOWABLE COSTS. MEDICARE ALLOWABLE COSTS ARE DEFINED BY MEDICARE. THEY DO NOT NECESSARILY CAPTURE ALL COSTS OF THE HOSPITAL PROVIDING SERVICES TO THE COMMUNITY. CONSEQUENTLY, THERE ARE COSTS NOT REIMBURSED BY EITHER PATIENT OR THE PROGRAM. |
| PART III, LINE 4: | THE CONSOLIDATED FINANCIAL STATEMENTS WHICH INCLUDE MOUNDVIEW MEMORIAL DO NOT HAVE A DETAILED FOOTNOTE DESCRIBING BAD DEBT. THE BELOW EXPLANATION HELPS EXPLAIN THE HOSPITALS APPROACH. PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, THAT REFLECTS MANAGEMENT'S BEST ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS PATIENT SERVICE REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND CURRENT STATUS OF INDIVIDUAL ACCOUNTS.IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE .EXISTS FOR PART OF THE BILL). THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON ITS EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. |
| PART III, LINE 8: | IT IS CONSIDERED COMMUNITY BENEFIT AS THE HOSPITAL IS REIMBURSED ON MEDICARE ALLOWABLE COSTS. MEDICARE ALLOWABLE COSTS ARE DEFINED BY MEDICARE. THEY DO NOT NECESSARILY CAPTURE ALL COSTS OF THE HOSPITAL PROVIDING SERVICES TO THE COMMUNITY. CONSEQUENTLY, THERE ARE COSTS NOT REIMBURSED BY EITHER PATIENT OR THE PROGRAM. |
| PART III, LINE 9B: | PATIENTS UPON REGISTRATION ARE GIVEN THE POLICY AND REQUIREMENTS TO BE ELIGIBLE FOR CHARITY CARE. THEY ARE ENCOURAGED BY A FINANCIAL ADVISOR TO REVIEW THEIR SITUATION FOR ELIGIBILITY. |
| PART VI, LINE 2: | THE HOSPITAL ANNUALLY REVIEWS THE COUNTY HEALTH RANKINGS AS WELL AS INFECTION CONTROL/COMMUNICABLE DISEASE REPORTS WITH THE PUBLIC HEALTH OFFICE. THE HOSPITAL COMPLETES SURVEILLANCE ON INFECTIOUS AND COMMUNICABLE DISEASE AND MONITORS FOR OUTBREAKS. WE COMPLETE ANNUAL RISK ASSESSMENTS ON TB AND INFECTION CONTROL ISSUES. THE HOSPITAL ALSO COMMUNICATES REGULARLY WITH PUBLIC HEALTH TO ADDRESS COMMUNITY HEALTH NEEDS AS THEY ARISE. |
| PART VI, LINE 3: | THE HOSPITAL ANNUALLY UPDATES THE AVAILABILITY OF ITS CHARITY PLAN AND QUALIFYING INCOME NEEDS TO QUALIFY ON THE HOSPITAL WEBSITE. THE EXISTENCE OF A CHARITY PLAN IS POSTED IN THE ADMITTING AREA. UPON REGISTRATION, THE PATIENT IS INFORMED OF THE HOSPITAL'S CHARITY PLAN, ELIGIBILITY, AND METHODS FOR APPLYING. ANYONE INTERESTED IN FURTHER INFORMATION IS REFERRED TO THE PATIENT ACCOUNT COORDINATOR FOR QUESTIONS AND ELIGIBILITY. THIS PERSON WORKS WITH THE PATIENT IN APPLICATION AS WELL AS EXPLORING THE POSSIBLE ELIGIBILITY OF ANY OTHER GOVERNMENT PROGRAM THAT MAY BE APPLICABLE, I.E. MEDICAID, BADGER CARE. |
| PART VI, LINE 4: | GUNDERSEN MOUNDVIEW SERVES ALL RESIDENTS OF ADAMS COUNTY (POPULATION 20,875 PER CENSUS 2021 QUICK FACTS). WE ALSO SERVE WESTFIELD AREA RESIDENTS, LOCATED IN MARQUETTE COUNTY. HOWEVER, OUR PRIMARY SERVICE AREA IS THE CENTRAL PORTION OF ADAMS COUNTY INCLUDING THE ZIP CODES OF ADAMS, FRIENDSHIP, ARKDALE AND GRAND MARSH WHICH MAKE UP OVER 76% OF OUR REVENUE. THE MAJORITY OF ADAMS COUNTY RESIDENTS ARE WHITE (93.8%) AND RETIRED (30.2% ARE AGE 65 AND OVER). THE MEDIAN HOUSEHOLD INCOME IS $46,369 WHICH IS CONSIDERABLY LOWER THAN THE STATE MEDIAN. TOURISM IS THE COUNTY'S LARGEST INDUSTRY. THE COUNTY IS MEDICALLY UNDERSERVED AND HAS RANKED IN THE BOTTOM OF THE WI COUNTY HEALTH RANKINGS IN TERMS OF HEALTH OUTCOMES AND FACTORS. |
| PART VI, LINE 5: | THE HOSPITAL PROVIDES MONETARY AND IN-KIND SUPPORT TO NUMEROUS COMMUNITY HEALTH INITIATIVES SUCH AS RECREATIONAL/WELLNESS PROGRAMS, USE OF OUR MEETING ROOMS BY AREA NONPROFITS, STAFF TIME SERVING ON THE LOCAL HEALTH BOARD AND ON NUMEROUS COMMUNITY COALITIONS, AND IMPLEMENTED NUMEROUS INITIATIVES TO ADDRESS THE COVID-19 PANDEMIC. THE HOSPITAL BOARD INCLUDES COMMUNITY MEMBERS WHO ARE UNPAID. |
| PART VI, LINE 6: | THE ORGANIZATION IS PART OF GUNDERSEN HEALTH SYSTEM. EACH AFFILIATE DEVELOPS ITS OWN NEEDS ASSESSMENT AND IMPLEMENTATION PLAN, WITH SUPPORT FROM THE SYSTEM AS NEEDED. THE SYSTEM HOLDS QUARTERLY COMMUNITY BENEFIT MEETINGS AMONG THE AFFILIATES TO REVIEW PROGRESS ON GOALS. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRYAN ERDMANN | ||||||||||||||
| BOARD TRUSTEE | $0 | $289,952 | $0 | $2,212 | $0 | $4,650 | $0 | $42,050 | $0 | $28,028 | $0 | $366,892 | $0 | $0 |
| STEPHANIE CARROLL | ||||||||||||||
| BOARD TRUSTEE | $0 | $293,496 | $0 | $4,600 | $0 | $0 | $0 | $36,302 | $0 | $25,837 | $0 | $360,235 | $0 | $0 |
| FRANK PEREZ-GUERRA | ||||||||||||||
| CEO | $0 | $181,446 | $0 | $2,047 | $0 | $2,587 | $0 | $27,188 | $0 | $24,288 | $0 | $237,556 | $0 | $0 |
| ROXANNE POTTS | ||||||||||||||
| BOARD TRUSTEE | $0 | $130,912 | $0 | $5,781 | $0 | $5,884 | $0 | $17,967 | $0 | $21,738 | $0 | $182,282 | $0 | $0 |
| PAUL FISCH | ||||||||||||||
| VICE CHAIR | $0 | $113,960 | $0 | $2,098 | $0 | $8,852 | $0 | $18,157 | $0 | $22,506 | $0 | $165,573 | $0 | $0 |
| DIANA BRONIEC | ||||||||||||||
| NURSE PRACTITIONER | $148,200 | $0 | $4,094 | $0 | $1,584 | $0 | $4,453 | $0 | $3,938 | $0 | $162,269 | $0 | $0 | $0 |
| SARAH ROSSMAN | ||||||||||||||
| SECRETARY | $0 | $128,019 | $0 | $2,558 | $0 | $801 | $0 | $18,816 | $0 | $2,446 | $0 | $152,640 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE HOSPITAL HAS A NINE MEMBER BOARD OF DIRECTORS COMPRISED OF FIVE MEMBERS FROM THE HEALTH SYSTEM AND FOUR COMMUNITY DIRECTORS CHOSEN FROM OUR LOCAL SERVICE AREA. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD OF DIRECTORS SOLICITS NOMINATIONS FROM CANDIDATES TO FILL OPEN BOARD SEATS. THE FULL BOARD THEN VOTES TO APPROVE OR DISAPPROVE THE NEW POSITION. |
| FORM 990, PART VI, SECTION A, LINE 7B | MEMBERS OF THE BOARD OF DIRECTORS MUST APPROVE ANY BYLAW CHANGES. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 IS REVIEWED BY THE CFO AND CEO PRIOR TO FILING. THE FILED 990 IS THEN SHARED WITH THE FINANCE COMMITTEE AND REVIEWED IN DETAIL . A COPY OF THE 990 IS ISSUED TO EACH MEMBER OF THE BOARD AS WELL. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY IS REVIEWED EVERY YEAR BY THE POLICY AND PROCEDURE COMMITTEE AND BY THE CEO. OFFICERS AND DIRECTORS ARE REQUIRED TO REVIEW THE POLICY AND DISCLOSE CONFLICTS. THE CEO REVIEWS THE SIGNED STATEMENTS. IF THERE IS A CONFLICT, THE CONFLICT WOULD BE DECLARED, AND THE MEMBER WOULD ABSTAIN FROM VOTING. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE HEALTH SYSTEM RELAYS ON MARKET COMPARABLE SALARY DATA TO SET THE RANGE OF COMPENSATION FOR THE CEO POSITION. THE RANGES ARE ADJUSTED AND REVIEWED ANNUALLY BY THE BOARD'S COMPENSATION COMMITTEE , WITH FINAL APPROVAL BY THE SYSTEM BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION BELIEVES THE GOVERNING DOCUMENTS AND POLICIES ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. THE AUDITED FINANCIAL STATEMENTS ARE NOW REQUIRED TO BE ATTACHED TO FORM 990. AUDITED FINANCIAL INFORMATION IS POSTED ANNUALLY ON THE HOSPITAL'S WEBSITE. |
| FORM 990, PART IX, LINE 11G | EMERGENCY ROOM SERVICE FEES: PROGRAM SERVICE EXPENSES 2,768,765. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,768,765. ANESTHESIA SERVICE FEES: PROGRAM SERVICE EXPENSES 186,609. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 186,609. LABORATORY SERVICE FEES: PROGRAM SERVICE EXPENSES 153,931. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 153,931. PHARMACY SERVICE FEES: PROGRAM SERVICE EXPENSES 11,396. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,396. FAMILY MEDICINE SERVICE FEES: PROGRAM SERVICE EXPENSES 830,649. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 830,649. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,677,943. MANAGEMENT AND GENERAL EXPENSES 990,450. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,668,393. |
| FORM 990, PART XI, LINE 9: | CHANGE IN ASSETS HELD IN POLIVKA TRUST -23,618. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (23 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| COMMUNITY HOUSING OF LA CROSSE INC | |||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391586700 | INDEPENDENT LIVING | WI | 501(C)(3) | LINE 10 | LUTHERAN REAL ESTATE HOLDING CORP | Yes (1) | |
| GUNDERSEN CLINIC LTD | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391028657 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| GUNDERSEN LUTHERAN ADMINISTRATIVE SVC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391606449 | SUPPORTING ORG | WI | 501(C)(3) | LINE 12B, II | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| GUNDERSEN LUTHERAN CREDENTIALING SVC INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391856898 | CREDENTIALING | WI | 501(C)(3) | LINE 12C, III-FI | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391866425 | SUPPORTING ORG | WI | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| GUNDERSEN LUTHERAN MEDICAL CENTER INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 390813416 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391249705 | FOUNDATION | WI | 501(C)(3) | LINE 7 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| HARMONY COMMUNITY HEALTHCARE INC | |||||||||||
| 815 MAIN AVENUE | SOUTH HARMONY | MN | 55939 | 410711606 | HEALTHCARE | MN | 501(C)(3) | LINE 10 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| LUTHERAN HOUSING OF LA CROSSE | |||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391751934 | INDEPENDENT LIVING | WI | 501(C)(3) | LINE 10 | LUTHERAN REAL ESTATE HOLDING CORP | Yes (1) | |
| LUTHERAN REAL ESTATE HOLDING CORP | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391480826 | HOUSING | WI | 501(C)(3) | LINE 12C, III-FI | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| MEMORIAL HEALTHCARE FOUNDATION OF ADAMS COUNTY INC | |||||||||||
| PO BOX 40 | FRIENDSHIP | WI | 53934 | 391775074 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | MOUNDVIEW MEMORIAL HOSPITALS AND CLINICS | Yes (1) | |
| MEMORIAL HOSPITAL OF BOSCOBEL | |||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 53805 | 390845590 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | GUNDERSENT LUTHERAN HEALTH SYSTEM | Yes (1) | |
| MEMORIAL HOSPITAL OF BOSCOBEL FOUNDATION | |||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 53805 | 391688793 | FUNDRAISING | WI | 501(C)(3) | LINE 7 | MEMORIAL HOSPITAL OF BOSCOBEL | Yes (1) | |
| PALMER LUTHERAN HEALTH CENTER INC | |||||||||||
| 112 JEFFERSON STREET | WEST UNION | IA | 52175 | 421320763 | HEALTHCARE | IA | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| PALMER MEMORIAL FOUNDATION | |||||||||||
| 112 JEFFERSON STREET | WEST UNION | IA | 52175 | 421032878 | FOUNDATION | IA | 501(C)(3) | LINE 7 | PALMER LUTHERAN HEALTH CENTER | Yes (1) | |
| SAINT ELIZABETH'S HOSPITAL OF WABASHA | |||||||||||
| 1200 GRANT BLVD WEST | WABASHA | MN | 55981 | 410693877 | HEALTHCARE | MN | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| ST JOSEPH'S HEALTH SERVICES INC | |||||||||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | 390929538 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| ST JOSEPH'S MEMORIAL FOUNDATION INC | |||||||||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | 391455787 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | ST JOSEPH'S HEALTH SERVICES | Yes (1) | |
| TRI-COUNTY MEMORIAL FOUNDATION INC | |||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 300093022 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | TRI-COUNTY MEMORIAL HOSPITAL | Yes (1) | |
| TRI-COUNTY MEMORIAL HOSPITAL | |||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 390704510 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| TRI-STATE AMBULANCE INC | |||||||||||
| 235 CAUSEWAY BOULEVARD | LA CROSSE | WI | 54603 | 391965415 | MEDICAL TRANSPORT | WI | 501(C)(3) | LINE 10 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| TRI-STATE REGIONAL AMBULANCE INC | |||||||||||
| 235 CAUSEWAY BOULEVARD | LA CROSSE | WI | 54603 | 391962965 | MEDICAL TRANSPORT | WI | 501(C)(3) | LINE 10 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
| TWEETEN LUTHERAN HEALTHCARE CENTER INC | |||||||||||
| 125 FIFTH AVENUE SE | SPRING GROVE | MN | 55974 | 411565003 | HEALTHCARE | WI | 501(C)(3) | LINE 10 | GUNDERSEN LUTHERAN HEALTH SYSTEM | Yes (1) | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| GUNDERSEN LUTHERAN ENVISION LLC | |||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 264706546 | RENEWABLE ENERGY | WI | N/A | C | Yes (1) |
| 3REALESTATE LLC | |||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | RENTAL | WI | N/A | C | Yes (1) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | 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 | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |