LADD MEMORIAL HOSPITAL: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- LADD MEMORIAL HOSPITAL (EIN 39-0773970)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-10
- IRS object ID
- 202133149349300443
- Schema version
- 2020v4.1
- 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 K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-10T07:41:20-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | 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 | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390773970 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LADD MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LADD | BusinessNameControlTxt |
| Phone | 7152942111 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2600 65TH AVENUE PO BOX 218 | AddressLine1Txt |
| City | OSCEOLA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54020 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MATTHEW FORGE | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7152942111 | PhoneNum |
| Signature | 2021-11-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MATTHEW | PersonFirstNm |
| Person Last | FORGE | 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 | 2021-11-09 | 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 | 2020 | 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 | OSCEOLA MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MATTHEW FORGE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2600 65TH AVENUE PO BOX 218 | AddressLine1Txt |
| City | OSCEOLA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54020 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $42,476,734 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MYOMC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1947 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO INSPIRE AND IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY THROUGH HOME-TOWN CUSTOMER SERVICE, QUALITY AND STRATEGIC PARTNERSHIPS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 316 | TotalEmployeeCnt |
| Total Volunteers | 34 | TotalVolunteersCnt |
| Total Gross UBI | $2,005,246 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $326,033 | PYContributionsGrantsAmt |
| CY Contributions Grants | $599,075 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $38,185,765 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $40,651,408 | CYProgramServiceRevenueAmt |
| PY Investment Income | $113,567 | PYInvestmentIncomeAmt |
| CY Investment Income | $48,956 | CYInvestmentIncomeAmt |
| PY Other Revenue | $519,011 | PYOtherRevenueAmt |
| CY Other Revenue | $399,903 | CYOtherRevenueAmt |
| PY Total Revenue | $39,144,376 | PYTotalRevenueAmt |
| CY Total Revenue | $41,699,342 | 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 | $16,282,762 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $16,727,677 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $170,596 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $22,416,270 | PYOtherExpensesAmt |
| CY Other Expenses | $24,220,887 | CYOtherExpensesAmt |
| PY Total Expenses | $38,699,032 | PYTotalExpensesAmt |
| CY Total Expenses | $40,948,564 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $445,344 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $750,778 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $38,495,361 | TotalAssetsBOYAmt |
| Total Assets EOY | $46,005,640 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $17,934,790 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $24,701,894 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $20,560,571 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $21,303,746 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO INSPIRE AND IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY THROUGH HOME-TOWN CUSTOMER SERVICE, QUALITY AND STRATEGIC PARTNERSHIPS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $33,350,588 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $38,646,162 | RevenueAmt |
| Desc | DURING 2020, LADD MEMORIAL HOSPITAL PROVIDED INPATIENT, OUTPATIENT, AND CLINICAL CARE SERVICES TO THE RESIDENTS OF THE GREATER OSCEOLA AREA, REGARDLESS OF ABILITY TO PAY.INPATIENT SERVICES WERE PROVIDED TO 434 PATIENTS AND TOTALED 1463 DAYS OF SERVICE. INPATIENT SERVICES INCLUDED GENERAL MEDICINE, SURGERY, PEDIATRIC, AND OBSTETRIC.OUTPATIENT SERVICES INCLUDED 2830 EMERGENCY ROOM VISITS, AND 1294 OP SURGERIES. CLINICAL CARE SERVICES INCLUDED 21,512 CLINIC VISITS, 7,281 WALK IN VISITS, TOTALING 28,793. | Desc |
| Total Program Service Expenses | $33,350,588 | 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 | 0 | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 22 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 316 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | 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 | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KIM ERICSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7152942111 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2600 65TH AVENUE PO BOX 218 | AddressLine1Txt |
| City | OSCEOLA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54020 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt |
|---|---|---|---|---|---|---|---|---|
| MARYBETH GUSTAFSON | ||||||||
| PHARMACIST | 40.00 | Yes (X) | $159,594 | $0 | $33,795 | |||
| COBY SOMSEN | ||||||||
| NURSE PRACTITONER | 36.00 | Yes (X) | $138,248 | $0 | $5,745 | |||
| NATALIA CROPPER | ||||||||
| NURSE PRACTITONER | 36.00 | Yes (X) | $104,528 | $0 | $28,952 | |||
| TOM HECHT | ||||||||
| EXECUTIVE OF FOUNDATION | 40.00 | Yes (X) | $101,390 | $0 | $23,828 | |||
| RACHEL JOHNSON-HIMES | ||||||||
| PHARMACIST | 40.00 | Yes (X) | $114,166 | $0 | $4,298 | |||
| MATT FORGE | ||||||||
| CEO | 40.00 | $246,155 | $0 | $18,670 | Yes (X) | |||
| KIM ERICSON | ||||||||
| CFO | 40.00 | $180,205 | $0 | $18,897 | Yes (X) | |||
| MISTY CHARLIER | ||||||||
| CAO | 40.00 | $153,851 | $0 | $36,794 | Yes (X) | |||
| RACHEL ZIMMER | ||||||||
| CNO | 40.00 | $128,576 | $0 | $5,331 | Yes (X) | |||
| ANNE MARIE PUESHNER | ||||||||
| CHAIRPERSON | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| PETER MANSHIP | ||||||||
| VICE-CHAIRPERSON | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| DEBORAH PETERS | ||||||||
| SECRETARY | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| JOHN CLARK | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| MARK ERICKSON | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| KIERSTEN JUSTINGER | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | 0.50 | ||
| GREG KUMLIEN DC | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| TYLER SCHMIDTZ | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| ERIK SEVERSON MD | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| AMANDA TREMBREULL MD | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,326,713 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $176,310 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | 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 |
|---|---|---|---|---|---|
| HEALTHPARTNERS | |||||
| MAIL STOP 21109A | ST PAUL | MN | 55164 | PHYSICIANS | $5,194,111 |
| NATIONAL GOVERNMENT SERVICES | |||||
| PO BOX 809199 | CHICAGO | IL | 606809199 | CONTRACTED SERVICES | $2,717,208 |
| MARSHFIELD LABS | |||||
| 1000 NORTH OAK AVENUE | MARSHFIELD | WI | 54449 | LABORATORY SERVICES | $944,104 |
| JOHNSON & JOHNSON | |||||
| 5972 COLLECTIONS CENTER DRIVE | CHICAGO | IL | 60693 | SURGICAL IMPLANTS | $877,427 |
| CMDI | |||||
| PO BOX 158 | MILACA | MN | 56353 | DIAGNOSTIC IMAGING | $751,892 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 22 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $131,468 | RelatedOrganizationsAmt |
| Government Grants | $350,133 | GovernmentGrantsAmt |
| All Other Contributions | $117,474 | AllOtherContributionsAmt |
| Total Contributions | $599,075 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT SERVICE REV | 621990 | $40,497,075 | $38,491,829 | $2,005,246 |
| FITNESS CENTER | 713940 | $154,333 | $154,333 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $40,651,408 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $42,095 | TotalRevenueColumnAmt |
| Exclusion | $42,095 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $784,253 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $750,027 | SecuritiesAmt |
| Other | $27,365 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $34,226 | SecuritiesAmt |
| Other | -$27,365 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,861 | TotalRevenueColumnAmt |
| Exclusion | $6,861 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | GIFT SHOP | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $46,736 | TotalRevenueColumnAmt |
| Exclusion | $46,736 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $353,167 | TotalRevenueColumnAmt |
| Exclusion | $353,167 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $399,903 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $41,699,342 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $38,646,162 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,005,246 | UnrelatedBusinessRevenueAmt |
| Exclusion | $448,859 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $788,479 | TotalAmt |
| Management And General | $788,479 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,784,408 | TotalAmt |
| Program Services | $9,670,343 | ProgramServicesAmt |
| Management And General | $2,991,092 | ManagementAndGeneralAmt |
| Fundraising | $122,973 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $264,234 | TotalAmt |
| Program Services | $201,606 | ProgramServicesAmt |
| Management And General | $60,064 | ManagementAndGeneralAmt |
| Fundraising | $2,564 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,013,509 | TotalAmt |
| Program Services | $1,487,927 | ProgramServicesAmt |
| Management And General | $506,661 | ManagementAndGeneralAmt |
| Fundraising | $18,921 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $877,047 | TotalAmt |
| Program Services | $628,565 | ProgramServicesAmt |
| Management And General | $240,489 | ManagementAndGeneralAmt |
| Fundraising | $7,993 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,426 | TotalAmt |
| Management And General | $18,426 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,500 | TotalAmt |
| Management And General | $36,500 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,870,352 | TotalAmt |
| Program Services | $10,617,283 | ProgramServicesAmt |
| Management And General | $253,069 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,001 | TotalAmt |
| Management And General | $4,001 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $367,915 | TotalAmt |
| Program Services | $199,221 | ProgramServicesAmt |
| Management And General | $168,020 | ManagementAndGeneralAmt |
| Fundraising | $674 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,277,278 | TotalAmt |
| Program Services | $81,013 | ProgramServicesAmt |
| Management And General | $1,196,265 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $569,175 | TotalAmt |
| Program Services | $410,747 | ProgramServicesAmt |
| Management And General | $158,428 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,291 | TotalAmt |
| Program Services | $8,437 | ProgramServicesAmt |
| Management And General | $1,813 | ManagementAndGeneralAmt |
| Fundraising | $41 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $360,985 | TotalAmt |
| Program Services | $288,736 | ProgramServicesAmt |
| Management And General | $69,415 | ManagementAndGeneralAmt |
| Fundraising | $2,834 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,836,289 | TotalAmt |
| Program Services | $1,468,767 | ProgramServicesAmt |
| Management And General | $353,105 | ManagementAndGeneralAmt |
| Fundraising | $14,417 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,885 | TotalAmt |
| Management And General | $47,885 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DRUGS | $3,893,696 | $3,893,106 | $590 |
| MEDICAL SUPPLIES | $2,825,221 | $2,499,734 | $325,487 |
| BAD DEBT EXPENSE | $890,969 | $890,969 | |
| EQUIPMENT RENTAL AND MA | $665,132 | $637,289 | $27,843 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $546,772 | TotalAmt |
| Program Services | $366,845 | ProgramServicesAmt |
| Management And General | $179,748 | ManagementAndGeneralAmt |
| Fundraising | $179 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,948,564 | TotalAmt |
| Program Services | $33,350,588 | ProgramServicesAmt |
| Management And General | $7,427,380 | ManagementAndGeneralAmt |
| Fundraising | $170,596 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,024,270 | BOYAmt |
| EOY | $10,757,933 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $976,058 | BOYAmt |
| EOY | $1,879,189 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,307,524 | BOYAmt |
| EOY | $5,548,871 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $901,489 | BOYAmt |
| EOY | $1,090,998 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $99,705 | BOYAmt |
| EOY | $257,621 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $37,380,861 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $19,468,512 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,253,443 | BOYAmt |
| EOY | $17,912,349 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,489,454 | BOYAmt |
| EOY | $5,661,944 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $812,240 | BOYAmt |
| EOY | $810,688 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $631,178 | BOYAmt |
| EOY | $561,047 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,525,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,495,361 | BOYAmt |
| EOY | $46,005,640 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,464,974 | BOYAmt |
| EOY | $4,183,345 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,192 | BOYAmt |
| EOY | $2,192 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,952,968 | BOYAmt |
| EOY | $11,910,863 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,325,656 | BOYAmt |
| EOY | $1,147,898 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $190,000 | BOYAmt |
| EOY | $7,457,596 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,934,790 | BOYAmt |
| EOY | $24,701,894 | 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 | $20,560,571 | BOYAmt |
| EOY | $21,303,746 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,560,571 | BOYAmt |
| EOY | $21,303,746 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,495,361 | BOYAmt |
| EOY | $46,005,640 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $750,778 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$7,603 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | 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 | $1,095 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,095 | 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 | LADD MEMORIAL HOSPITAL 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 LADD MEMORIAL HOSPITAL THAT $1,095 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 | $1,545,900 | OtherCostOrOtherBasisAmt |
| Book Value | $1,545,900 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $27,483,282 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,395,323 | DepreciationAmt |
| Book Value | $15,087,959 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,280,042 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,073,189 | DepreciationAmt |
| Book Value | $1,206,853 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $71,637 | OtherCostOrOtherBasisAmt |
| Book Value | $71,637 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $17,912,349 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| PAYROLL PROTECTION PROGAM LOAN | $3,183,300 |
| DEFERRED PROVIDER RELIEF FUNDS | $4,274,296 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $7,457,596 | TotalLiabilityAmt |
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 |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| 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 | $142,268 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $142,268 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00350 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,075,784 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,024,534 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,051,250 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02570 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,218,052 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,024,534 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,193,518 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02920 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,258 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,258 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $33,337 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $33,337 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,416,630 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,754,539 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,662,091 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06500 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $99,884 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $99,884 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,565,109 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,755,539 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,809,570 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06850 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,783,161 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,780,073 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,003,088 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09770 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $442,964 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $221,482 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,306,538 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,180,385 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $126,153 | 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 | LADD MEMORIAL HOSPITAL INC DBA OSCEOLA MED | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2600 65TH AVENUE | AddressLine1Txt |
| City | OSCEOLA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54020 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MYOMC.ORG | WebsiteAddressTxt |
| State License | 1021 | 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 | OSCEOLA MEDICAL CENTER | 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 |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | 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 |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | 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 | 300.000000000000 | 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 |
| 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 PART V, PAGE 8 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, PAGE 8 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, PAGE 8 | 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 Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| OSCEOLA MEDICAL CENTER | PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT LEADERSHIP TEAM COLLECTED BOTH QUANTITATIVE AND QUALITATIVE SATA TO IDENTIFY THE TOP HEALTH PRIORITIES IN POLK COUNTY. METHODS USED INCLUDED A SURVEY, COMMUNITY FORUMS, A KEY PARTNER MEETING AND COMPREHENSIVE COLLECTION AND REVIEW OF SECONDARY HEALTH DATA. DATA FROM THE COMMUNITY SURVEY AND SECONDARY REVIEW WAS PRESENTED AND DICUSSED AT BOTH THE COMMUNITY FORUMS AND KEY PARTNER MEETINGS WITH VOTING CONDUCTED FOR THE TOP HEALTH PRIORITIES. PARTICIPANTS IDENTIFIED THE TOP FOUR HEALTH PRIORITIES IN POLK COUNTY AS:1. MENTAL HEALTH2. SUBSTANCE USE AND ABUSE3. NUTRITION AND PHYSICAL ACTIVITY4. ACCESS TO CARE |
| OSCEOLA MEDICAL CENTER | PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED AND A COMMUNITY HEALTH IMPROVEMENT PROCESS ("CHIP") WAS DEVELOPED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS:1. AMERY REGIONAL MEDICAL CENTER2. ST. CROIX REGIONAL MEDICAL CENTER |
| OSCEOLA MEDICAL CENTER | PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED AND CHIP DEVELOPED IN JOINT EFFORT WITH THE POLK COUNTY HEALTH DEPARTMENT. |
| OSCEOLA MEDICAL CENTER | PART V, SECTION B, LINE 7D: POLK COUNTY HEALTH DEPARTMENT |
| OSCEOLA MEDICAL CENTER | PART V, SECTION B, LINE 11: THE HOSPITAL'S WORK TOWARD MEETING STATED GOALS WERE GREATLY IMPACTED BY THE COVID-19 PANDEMIC. SOME ACTIVITIES DID OCCUR AND PANDEMIC-RELATED ACTIVITIES WERE ADDED. MENTAL HEALTH- ONGOING SCREENINGS DURING CLINIC VISITS.- PROVIDED MENTAL HEALTH TOPICS THROUGH SOCIAL MEDIA. ADDED PANDEMIC-RELATED TOPICS AND RESOURCES.- PARTNERED WITH LOCAL SCHOOL DISTRICT TO PREVENT A MENTAL HEALTH "COMMUNITY CONVERSATION".- CONTINUED DEVOTING STAFF TIME TO COUNTY AND AREA MENTAL HEALTH COMMITTEES.- PROVIDED FUNDS FOR A "SUICIDE AWARENESS WALK"- PARTNERED WITH LOCAL SCHOOL DISTRICT ON STRATEGIC PLANNING THAT WOULD, IN PART, INCLUDE MENTAL HEALTH.- PROVIDED FUNDS TO LOCAL CHAMBER FOR PANDEMIC DISASTER RELIEF.- THROUGH OUR FOUNDATION, PROVIDED FUNDS INTO THE COMMUNITY FOR MENTAL HEALTH ACTIVITIES.- WORKED ON "GET FIT FOR LIFE" WEIGHT MANAGEMENT PROGRAM FOR MENTAL HEALTH AND NUTRITION.OBESITY/NUTRITION- PROVIDED VOLUNTEERS TO FOR UNITED WAY FREE FOOD DISTRIBUTION.- THROUGH OUR FOUNDATION, PROVIDED FUNDS INTO THE COMMUNITY FOR OBESITY ACTIVITIES.- THROUGH OUR FOUNDATION, PROVIDED FUNDS CREATE FREE VIRTUAL FITNESS CLASSES.- WORKED WITH LOCAL NONPROFIT ON "PLAY AND LEARN" PROGRAM ABOUT HEALTHY EATING FOR TODDLERS.- WORKED ON "GET FIT FOR LIFE" WEIGHT MANAGEMENT PROGRAM FOR MENTAL HEALTH AND NUTRITION.- CONTINUED DEVOTING STAFF TIME TO COUNTY PUBLIC HEALTH NUTRITION AND PHYSICAL ACTIVITY COMMITTEES.- PROVIDED RESOURCES FOR FREE FRUITS AND VEGETABLES FOR CHILDREN THROUGH A POWER OF PRODUCE PROGRAM AT LOCAL FARMERS MARKET.SUBSTANCE ABUSE- THROUGH OUR FOUNDATION, PROVIDED FUNDS INTO THE COMMUNITY FOR ALCOHOL AND DRUG TREATMENT ACTIVITIES.ACCESS TO CARE- CONTINUED OFFERING AND PROMOTING WALK-IN CLINIC TO SEE PATIENTS.- HOSTED "BETTER BREATHERS CLUB" TO PROVIDE SUPPORT AND INFORMATION TO THOSE WITH BREATHING PROBLEMS.- THROUGH OUR FOUNDATION, PROVIDED EQUIPMENT FUNDS FOR LOCAL SCHOOL NURSES. - THROUGH OUR FOUNDATION, PROVIDED TECHNOLOGY FUNDS FOR VIRTUAL CLINIC VISITS. |
| OSCEOLA MEDICAL CENTER | PART V, SECTION B, LINE 13B: IN A CASE BY CASE REVIEW, OSCEOLA MEDICAL CENTER HOLDS THE RIGHT TO MAKE EXCEPTIONS TO THE GUIDELINES LISTED IN THE COMMUNITY CARE POLICY (SUCH AS BUT NOT LIMITED TO PRESUMPTIVE GRANTING) WHEN IT IS FOUND TO BE IN THE BEST INTEREST OF THE PATIENT. |
| PART V, SECTION B, LINE 7A | HTTPS://MYOMC.ORG/ABOUT/COMMUNITY |
| PART V, SECTION B, LINE 7B | HTTP://POLKUNITED.ORG/WHAT_IS_CHACHIP/CHA |
| PART V, SECTION B, LINE 10 | HTTP://POLKUNITED.ORG/WHAT_IS_CHACHIP/COMMUNITY_HEALTH_IMPROVEMENT_PLAN_CHIP |
| PART V, SECTION B, LINE 16A | HTTPS://MYOMC.ORG/INFO/PATIENTS/FINANCIAL-POLICIES |
| PART V, SECTION B, LINE 16B | HTTPS://WWW.MYOMC.ORG/INFO/PATIENTS/BILLING/137-POLICIES |
| PART V, SECTION B, LINE 16C | HTTPS://WWW.MYOMC.ORG/INFO/PATIENTS/BILLING/137-POLICIES#PLS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - OSCEOLA CLINIC | ||||
| 2600 65TH AVENUE | OSCEOLA | WI | 54020 | PROVIDER BASED CLINIC |
| 2 - CLINIC PHARMACY | ||||
| 2600 65TH AVENUE | OSCEOLA | WI | 54020 | RETAIL PHARMACY |
| 3 - SCANDIA CLINIC | ||||
| 21150 OZARK COURT NORTH | SCANDIA | MN | 55073 | FREE STANDING CLINIC (CLOSED DURING 2020) |
| 4 - WILD RIVER FITNESS CENTER | ||||
| 2630 65TH AVENUE | OSCEOLA | WI | 54020 | FITNESS CENTER |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6A: | THE COMMUNITY BENEFIT REPORT IS AVAILABLE UPON REQUEST. |
| 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 HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS 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 COSTING METHODS FOR THE FORM 990. THE COST OF COMMUNITY HEALTH IMPROVEMENT, HEALTH PROFESSIONALS EDUCATION, AND IN-KIND CONTRIBUTIONS REFLECTS THE DIRECT AND INDIRECT COSTS AS DETERMINED BY THE HOSPITAL. |
| PART I, LINE 7G: | THE COST OF SUBSIDIZED HEALTH SERVICES IS BASED ON COST ALLOCATIONS FROM THE MEDICARE COST REPORT. SERVICES INCLUDE NURSERY, OCCUPATIONAL HEALTH, CLINIC SERVICES, EMERGENCY ROOM, AND PHYSICIAN SERVICES. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | OUR HOSPITAL PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY THAT WITHOUT OUR HOSPITAL, WOULD NOT BE AVAILABLE TODAY.BEYOND INPATIENT HOSPITALIZATIONS, WE PROVIDE LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES, WALK-IN CLINIC, INFUSION SERVICES, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH AND SURGICAL SERVICES. |
| PART III, LINE 4: | ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, OSCEOLA MEDICAL CENTER ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL 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 DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, OSCEOLA MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS 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), OSCEOLA MEDICAL CENTER RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF THEIR PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE TO 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 ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. |
| PART III, LINE 8: | OSCEOLA MEDICAL CENTER HAS BEEN DESIGNATED AS A CRITICAL ACCESS HOSPITAL.THE COST-TO-CHARGE RATIOS USED TO CALCULATE THE COST OF MEDICARE SERVICES WERE TAKEN FROM THE MEDICARE COST REPORT.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: | ONCE APPROVED FOR FINANCIAL ASSISTANCE, THAT FINANCIAL ASSISTANCE IS VALID FOR ONE YEAR FROM THE APPROVAL DATE WITH FOLLOW UP VERIFICATION COMPLETED AFTER 6 MONTHS. IT IS THE PATIENT'S RESPONSIBILITY TO NOTIFY OMC IMMEDIATELY SHOULD THERE BE ANY CHANGE IN THE DETERMINING FACTORS WITHIN THE APPROVED YEAR PERIOD. |
| PART VI, LINE 2: | THE MEDICAL CENTER ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY BY WORKING WITH COUNTY AND STATE OFFICES, COMMUNICATING WITH CIVIC ORGANIZATIONS, INTERPRETING PATIENT TRENDS AND INTERPRETING FEEDBACK FROM ONE-ON-ONE PATIENT CONVERSATIONS.IN ADDITION, A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IS COMPLETED EVERY THREE YEARS. THE CHNA SOUGHT INPUT FROM DIVERSE STAKEHOLDERS, INCLUDING HEALTHCARE PROVIDERS, COMMUNITY LEADERS AND THE PUBLIC. THE ULTIMATE GOAL OF THE ASSESSMENT IS TO IDENTIFY HEALTH ISSUES AND DEVELOP STRATEGIES TO ADDRESS THE COMMUNITY'S HEALTH NEEDS. THE EFFORT INCLUDED A COMPREHENSIVE REVIEW OF HEALTH DATA, AN ANALYSIS OF REAL TIME BODY MASS INDEX DATA FROM LOCAL CLIENT PATIENT ELECTRONIC MEDICAL RECORDS AND HEALTH AND LIFESTYLE DATA FROM COMMUNITY SURVEYS. |
| PART VI, LINE 3: | OSCEOLA MEDICAL CENTER HAS INFORMATION REGARDING THE CHARITY CARE POLICY AND OTHER FINANCIAL ASSISTANCE OPTIONS AVAILABLE: 1. A DEDICATED PATIENT ADVOCACY POSITION THAT WORKS ONE ON ONE WITH PATIENTS 2. PLACED IN MAILINGS 3. PAMPHLETS USED BY THE HOSPITAL'S PROVIDERS THAT CAN BE DISTRIBUTED 4. IN PLAIN SIGHT AT EACH POINT OF REGISTRATION 6. THE FAP AND BILLING AND COLLECTION POLICIES ARE AVAILABLE AT THE OSCEOLA PUBLIC LIBRARY 5. ON THEIR WEBSITE THESE RESOURCES ARE AVAILABLE TO ENSURE THAT ALL PATIENTS FULLY UNDERSTAND ALL OPTIONS THAT ARE AVAILABLE FOR ASSISTANCE. |
| PART VI, LINE 4: | OSCEOLA MEDICAL CENTER SERVES THE CITY OF OSCEOLA, WISCONSIN, AND NEIGHBORING COMMUNITIES IN WESTERN WISCONSIN AND EASTERN MINNESOTA. THE MEDIAN INCOME IN THE SURROUNDING AREA IS APPROXIMATELY $59,994 PER YEAR. APPROXIMATELY 8.6% OF THE LOCAL POPULATION LIVES AT OR BELOW THE FEDERAL POVERTY GUIDELINES AND APPROXIMATELY 7% OF THE POPULATION DOES NOT HAVE HEALTH INSURANCE. |
| PART VI, LINE 5: | A MAJORITY OF OSCEOLA MEDICAL CENTER'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE HOSPITAL, NOR FAMILY MEMBERS THEREOF.OSCEOLA MEDICAL CENTER ALSO PROMOTES COMMUNITY HEALTH BY PROVIDING FREE HEALTH SEMINARS, OTHER CLASSES FOR A FEE, SUCH AS ATHLETIC SCREENINGS, AND FREE FITNESS VIDEOS. OSCEOLA MEDICAL CENTER IS A NON-PROFIT ORGANIZATION, AND THEREFORE ALL EARNINGS IN EXCESS OF COST ARE USED BY THE HOSPITAL TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE THROUGH THE PURPOSE OR UPGRADE OF FACILITIES AND EQUIPMENT, OR THE ADDITION OR EXPANSION OF NEEDED SERVICES. WE ALSO PROVIDED COVID TESTING AND COVID VACCINES TO THE COMMUNITY. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARYBETH GUSTAFSON | ||||||||||||||
| PHARMACIST | $159,594 | $0 | $0 | $0 | $0 | $0 | $5,123 | $0 | $28,672 | $0 | $193,389 | $0 | $0 | $0 |
| MATT FORGE | ||||||||||||||
| CEO | $246,155 | $0 | $0 | $0 | $0 | $0 | $5,440 | $0 | $13,230 | $0 | $264,825 | $0 | $0 | $0 |
| KIM ERICSON | ||||||||||||||
| CFO | $180,205 | $0 | $0 | $0 | $0 | $0 | $3,255 | $0 | $15,642 | $0 | $199,102 | $0 | $0 | $0 |
| MISTY CHARLIER | ||||||||||||||
| CAO | $153,851 | $0 | $0 | $0 | $0 | $0 | $4,504 | $0 | $32,290 | $0 | $190,645 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| VILLAGE OF OSCEOLA HOSPITAL FACILITIES REVENUE BOND | |||||||
| A | 396006338 | 2007-06-13 | $8,000,000 | REFINANCE EXISTING BONDS & CONSTRUCT NEW HOSPITAL BUILDING | 0 | 0 | 0 |
| TOWN OF OSCEOLA HOSPITAL FACILITIES REVENUE BOND | |||||||
| B | 396006044 | 2007-06-28 | $7,040,000 | CONSTRUCT NEW HOSPITAL BUILDING | 0 | 0 | 0 |
| TOWN OF FARMINGTON HOSPITAL FACILITIES REVENUE BOND | |||||||
| C | 390990620 | 2007-07-13 | $6,040,000 | CONSTRUCT NEW HOSPITAL BUILDING | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $3,295,121 | $8,000,000 | $138,545 | $4,581,314 | $3,280,141 | 2008 | Yes (1) | 0 | Yes (1) | Yes (1) |
| B | $2,934,249 | $7,040,000 | $80,850 | $6,959,150 | 2008 | 0 | 0 | Yes (1) | Yes (1) | |
| C | $2,771,887 | $6,040,000 | $65,800 | $5,974,200 | 2008 | 0 | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.01270 | 0.01270 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0.01270 | 0.01270 | 0 | 0 | 0 |
| C | 0 | 0 | 0 | 0 | 0.01270 | 0.01270 | 0 | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 |
| C | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
| C | 0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE K, PART II, LINE 11, COLUMN A: | THE AMOUNT LISTED WAS USED TO REFINANCE EXISTING DEBT. |
| SCHEDULE K, PART IV, LINE 2: | THERE IS NO REBATE BECAUSE THERE ARE NO PROCEEDS AVAILABLE FOR INVESTMENT. ALL PROCEEDS HAVE BEEN USED FOR CAPITAL EXPENDITURES. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 3, CHANGES IN PROGRAM SERVICES | OMC WAS SIGNIFICANTLY IMPACTED BY COVID 19 AND SERVICES WERE REDUCED IN SOME AREAS DUE TO CONSERVING PPE OR LACK OF VOLUME. THE SCANDIA CLINIC SHIFTED SERVICES TO THE OSCEOLA CAMPUS FROM MARCH THROUGH SEPTEMBER AND SUBSEQUENTLY THE DECISION TO CLOSE THAT LOCATION AT THE END OF 2020. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE COMPLETED FORM WAS REVIEWED AND APPROVED BY THE ADMINISTRATOR AND CHIEF FINANCIAL OFFICER BEFORE THE FORM WAS FILED. THE BOARD OF DIRECTORS FINANCE COMMITTEE MEETING AND THE FULL BOARD OF DIRECTORS RECEIVED A COPY AFTER THE RETURN WAS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY THAT IS MONITORED THROUGHOUT THE YEAR. ANNUALLY THE BOARD OF DIRECTORS MUST ATTEST TO ANY KNOWN CONFLICTS AS DEFINED BY THE POLICY. IF AT THAT TIME, OR DURING THE YEAR, A MEMBER BELIEVES THERE TO BE A CONFLICT THEY MUST DISCLOSE SUCH EXISTENCE TO THE BOARD OR COMMITTEE THAT THE OPPORTUNITY PERTAINS TO. THE REMAINING BOARD OR COMMITTEE THEN MUST DETERMINE IF A CONFLICT ACTUALLY EXISTS. IF SO, THE CONFLICTED BOARD MEMBER HAS THE ABILITY TO PRESENT TO THE BOARD ON THE MATTER BUT THEN MUST ABSTAIN FROM FURTHER DISCUSSION OR VOTING ON THE MATTER. |
| FORM 990, PART VI, SECTION B, LINE 15 | IN SETTING THE COMPENSATION OF THE CEO AND CFO, THE EXECUTIVE COMMITTEE SHALL COMPLY WITH LADD MEMORIAL HOSPITAL, INC.'S CONFLICT OF INTEREST POLICY AND, WITHOUT LIMITING THAT COMPLIANCE, WILL: (A) ACT ONLY WITH THE PARTICIPATION OF EXECUTIVE COMMITTEE MEMBERS WHO DO NOT HAVE A CONFLICT OF INTEREST CONCERNING THE MATTER, (B) WILL OBTAIN AND RELY UPON APPROPRIATE DATA AS TO COMPARABILITY, AND (C) WILL ADEQUATELY AND TIMELY DOCUMENT THE BASIS FOR ITS DETERMINATION, CONCURRENTLY WITH MAKING THAT DETERMINATION. APPROPRIATE DATA AS TO COMPARABILITY CAN INCLUDE, BUT IS NOT NECESSARILY LIMITED TO: COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR FUNCTIONALLY COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA OF THE CORPORATION; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; OR ACTUAL WRITTEN OFFERS FROM SIMILAR INSTITUTIONS COMPETING FOR THE SERVICES OF THE SAME INDIVIDUAL. ADEQUATE AND TIMELY DOCUMENTATION WILL GENERALLY BE MINUTES OR OTHER RECORDS OF THE EXECUTIVE COMMITTEE MEETING THAT STATE: THE COMPENSATION AND WHEN IT WAS APPROVED; THE EXECUTIVE COMMITTEE MEMBERS WHO WERE PRESENT AND HOW EACH VOTED; THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE EXECUTIVE COMMITTEE AND A SUMMARY OF HOW THE DATA WAS OBTAINED, AND ANY ACTION TAKEN IN SPECIFIC COMPLIANCE WITH THE MEDICAL CENTER'S CONFLICT OF INTEREST POLICY. IF THE EXECUTIVE COMMITTEE APPROVES A COMPENSATION PACKAGE FOR THE CEO OR CFO THAT IS HIGHER OR LOWER THAN THE RANGE OF COMPARABILITY DATA OBTAINED, THE BASIS FOR THE DETERMINATION OUTSIDE THE RANGE MUST BE RECORDED. MINUTES OR OTHER RECORDS OF THE EXECUTIVE COMMITTEE THAT DOCUMENT A DECISION ON CEO OR CFO COMPENSATION MUST BE PREPARED BEFORE THE LATER OF THE NEXT MEETING OF THE EXECUTIVE COMMITTEE OR 60 DAYS AFTER THE DECISION, AND MUST BE REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE WITHIN A REASONABLE PERIOD THEREAFTER. |
| FORM 990, PART VI, SECTION C, LINE 19 | LADD MEMORIAL HOSPITAL, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 7,687,163. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,687,163. ANESTHESIA SERVICES: PROGRAM SERVICE EXPENSES 724,936. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 724,936. LAB SERVICES: PROGRAM SERVICE EXPENSES 1,023,482. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,023,482. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 951,474. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 951,474. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 230,228. MANAGEMENT AND GENERAL EXPENSES 253,069. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 483,297. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSCEOLA COMMUNITY HEALTH FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2600 65TH AVENUE | AddressLine1Txt |
| City | OSCEOLA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54020 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 392029106 | EIN |
| Primary Activities | FOUNDATION | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12B, II | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| 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 | Yes (1) | 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 |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSCEOLA COMMUNITY HEALTH FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $131,468 | InvolvedAmt |
| Method Of Amount Determination | ACTUAL | MethodOfAmountDeterminationTxt |