CUMBERLAND MEMORIAL HOSPITAL INC: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- CUMBERLAND MEMORIAL HOSPITAL INC (EIN 39-0831153)
- Tax period
- 2018-07-01 to 2019-06-30
- Filed
- 2020-04-04
- IRS object ID
- 202010959349300506
- Schema version
- 2018v3.1
- 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 G
- Schedule H
- Schedule J
- Schedule K
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-04-04T10:37:19-05:00 | ReturnTs |
| Tax Period End | 2019-06-30 | 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 | 2018-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390831153 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CUMBERLAND MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Business Name Line2 | D/B/A CUMBERLAND HEALTHCARE | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CUMB | BusinessNameControlTxt |
| Phone | 7158222741 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1110 7TH AVENUE | AddressLine1Txt |
| City | CUMBERLAND | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54829 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL GUTSCH | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7158222741 | PhoneNum |
| Signature | 2020-04-03 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2020-04-03 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 71.13.38.61 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-04-03 | IPDt |
| IP Tm | 10:56:54 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MICHAEL GUTSCH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1110 7TH AVENUE | AddressLine1Txt |
| City | CUMBERLAND | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54829 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $25,090,625 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CUMBERLANDHEALTHCARE.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1955 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE EXCEPTIONAL QUALITY CARE, EVERY STEP OF THE WAY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 269 | TotalEmployeeCnt |
| Total Volunteers | 98 | TotalVolunteersCnt |
| Total Gross UBI | $32,710 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$9,404 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $91,730 | PYContributionsGrantsAmt |
| CY Contributions Grants | $59,568 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $26,555,380 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $24,969,040 | CYProgramServiceRevenueAmt |
| PY Investment Income | $72,996 | PYInvestmentIncomeAmt |
| CY Investment Income | $41,594 | CYInvestmentIncomeAmt |
| PY Other Revenue | $16,951 | PYOtherRevenueAmt |
| CY Other Revenue | $2,904 | CYOtherRevenueAmt |
| PY Total Revenue | $26,737,057 | PYTotalRevenueAmt |
| CY Total Revenue | $25,073,106 | 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 | $14,296,683 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $14,674,818 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,330,192 | PYOtherExpensesAmt |
| CY Other Expenses | $10,817,182 | CYOtherExpensesAmt |
| PY Total Expenses | $25,626,875 | PYTotalExpensesAmt |
| CY Total Expenses | $25,492,000 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,110,182 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$418,894 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,675,038 | TotalAssetsBOYAmt |
| Total Assets EOY | $20,452,067 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,842,473 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,925,814 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $14,832,565 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,526,253 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO BE AN INDEPENDENT, COMMUNITY-BASED HEALTH SYSTEM DEDICATED TO PROVIDING EXCEPTIONAL QUALITY CARE, EVERY STEP OF THE WAY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $20,592,553 | ExpenseAmt |
| Revenue | $24,880,281 | RevenueAmt |
| Desc | CUMBERLAND MEMORIAL HOSPITAL D/B/A CUMBERLAND HEALTHCARE (THE ORGANIZATION") IS AN INDEPENDENT, NONPROFIT, COMMUNITY-BASED RESIDENTIAL FACILITY THAT SERVES NORTHWEST WISCONSIN. THE ORGANIZATION OPERATES A HOSPITAL (CUMBERLAND MEMORIAL HOSPITAL) AND TWO CLINICS (LOCATED IN CUMBERLAND AND TURTLE LAKE). CUMBERLAND MEMORIAL HOSPITAL BECAME A CRITICAL ACCESS HOSPITAL ON AUGUST 19, 2005, LICENSED FOR 25 ACUTE CARE BEDS, INCLUDING 3 IN THE BIRTHPLACE. SERVICES INCLUDE, BUT ARE NOT LIMITED TO, THERAPY, WOUND CARE, CHEMOTHERAPY, OBSTETRICS, AND GENERAL SURGERY. DURING FISCAL YEAR 2019, ACUTE CARE DAYS TOTALED 1,249, SWING BED DAYS TOTALED 875, AND NEWBORN DAYS TOTALED 54. THE ORGANIZATION PROVIDED 23 INPATIENT AND 274 OUTPATIENT SURGERIES ALONG WITH 287 SCOPE PROCEDURES. THERE WERE ALSO 2,576 EMERGENCY ROOM VISITS. CUMBERLAND CLINIC TOTAL VISITS WERE 16,652 AND TURTLE LAKE WERE 3,588. | Desc |
| Total Program Service Expenses | $20,592,553 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 0 | 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 | 36 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 269 | 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 | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANGIE MARTENS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7158222741 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1110 7TH AVENUE | AddressLine1Txt |
| City | CUMBERLAND | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54829 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| JOSEPH LESCHISIN | |||||||
| TRUSTEE | 1.00 | Yes (X) | $1,800 | $0 | $0 | ||
| THOMAS LINGEN MD | |||||||
| TRUSTEE | 1.00 | Yes (X) | $2,000 | $0 | $0 | ||
| JENNIFER TURCOTT | |||||||
| TRUSTEE | 1.00 | Yes (X) | $2,000 | $0 | $0 | ||
| MATT GORES | |||||||
| CHAIRPERSON | 1.00 | Yes (X) | $2,725 | $0 | $0 | ||
| CANDACE COTONE | |||||||
| VICE CHAIR | 1.00 | Yes (X) | $2,000 | $0 | $0 | Yes (X) | |
| MARTIN PETERS | |||||||
| TREASURER | 1.00 | Yes (X) | $2,000 | $0 | $0 | Yes (X) | |
| ANN HENDRICKS | |||||||
| SECRETARY | 1.00 | Yes (X) | $3,025 | $0 | $0 | Yes (X) | |
| MICHAEL GUTSCH | |||||||
| CEO | 40.00 | $257,054 | $0 | $41,422 | Yes (X) | ||
| ANGIE MARTENS | |||||||
| CFO | 40.00 | $144,152 | $0 | $7,930 | Yes (X) | ||
| GARY DEGERMAN | |||||||
| PHYSICIAN | 40.00 | $248,984 | $0 | $41,180 | Yes (X) | ||
| DONALD FULLERTON | |||||||
| CRNA | 20.00 | $234,436 | $0 | $50,866 | Yes (X) | ||
| STEFANIE RINEHARDT | |||||||
| CRNA | 20.00 | $153,372 | $0 | $42,361 | Yes (X) | ||
| BENJAMIN BRENNA | |||||||
| DIRECTOR OF REHAB | 40.00 | $141,759 | $0 | $44,635 | Yes (X) | ||
| ROBERT LINDBERG | |||||||
| COO | 40.00 | $139,421 | $0 | $33,428 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,334,728 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $261,822 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 16 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CUMBERLAND CLINIC | |||||
| 1110 7TH AVENUE | CUMBERLAND | WI | 54829 | PHYSICIAN SERVICES | $1,945,270 |
| SHARED MEDICAL TECH | |||||
| 2020 W NEWTON ST | RICE LAKE | WI | 54868 | US, NUC MED, MRI | $418,295 |
| MEDICAL SOLUTIONS | |||||
| 1010N 102ND ST SUITE 300 | OMAHA | NE | 68114 | POOL STAFF | $141,538 |
| XTEND HEALTHCARE | |||||
| 90 VOLUNTEER DRIVE SUITE 150 | HENDERSONVILLE | TN | 37075 | FOLLOW UP BILLING/LEGACY SYSTEM | $133,367 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $22,748 | FundraisingAmt |
| All Other Contributions | $36,820 | AllOtherContributionsAmt |
| Total Contributions | $59,568 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621990 | $24,590,424 | $24,590,424 |
| NURSING HOME REVENUE | 623000 | $210,000 | $210,000 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $168,616 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $79,857 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $32,710 | UnrelatedBusinessRevenueAmt |
| Exclusion | $56,049 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $24,969,040 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,821 | TotalRevenueColumnAmt |
| Exclusion | $47,821 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,733 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $7,960 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$6,227 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$6,227 | TotalRevenueColumnAmt |
| Exclusion | -$6,227 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $12,463 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $22,748 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $9,559 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,904 | TotalRevenueColumnAmt |
| Exclusion | $2,904 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,073,106 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,880,281 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $32,710 | UnrelatedBusinessRevenueAmt |
| Exclusion | $100,547 | 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 | $469,000 | TotalAmt |
| Program Services | $3,150 | ProgramServicesAmt |
| Management And General | $465,850 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,663,408 | TotalAmt |
| Program Services | $9,239,023 | ProgramServicesAmt |
| Management And General | $1,424,385 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $235,408 | TotalAmt |
| Program Services | $206,583 | ProgramServicesAmt |
| Management And General | $28,825 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,529,284 | TotalAmt |
| Program Services | $2,119,676 | ProgramServicesAmt |
| Management And General | $409,608 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $777,718 | TotalAmt |
| Program Services | $644,635 | ProgramServicesAmt |
| Management And General | $133,083 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,468 | TotalAmt |
| Management And General | $42,468 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,154 | TotalAmt |
| Management And General | $61,154 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,854,656 | TotalAmt |
| Program Services | $4,118,839 | ProgramServicesAmt |
| Management And General | $735,817 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,369 | TotalAmt |
| Program Services | $1,700 | ProgramServicesAmt |
| Management And General | $117,669 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $569,303 | TotalAmt |
| Program Services | $433,072 | ProgramServicesAmt |
| Management And General | $136,231 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $849,041 | TotalAmt |
| Management And General | $849,041 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $424,923 | TotalAmt |
| Program Services | $390,975 | ProgramServicesAmt |
| Management And General | $33,948 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,074 | TotalAmt |
| Program Services | $38,735 | ProgramServicesAmt |
| Management And General | $17,339 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,148,886 | TotalAmt |
| Program Services | $899,442 | ProgramServicesAmt |
| Management And General | $249,444 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,838 | TotalAmt |
| Management And General | $109,838 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $898,717 | $898,717 | |
| PHARMACEUTICALS | $748,510 | $748,510 | |
| PROVISION FOR BAD DEBTS | $348,329 | $348,329 | |
| REPAIRS & MAINTENACE | $245,031 | $227,882 | $17,149 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $340,883 | TotalAmt |
| Program Services | $273,285 | ProgramServicesAmt |
| Management And General | $67,598 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,492,000 | TotalAmt |
| Program Services | $20,592,553 | ProgramServicesAmt |
| Management And General | $4,899,447 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,118,393 | BOYAmt |
| EOY | $399,084 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,784,979 | BOYAmt |
| EOY | $936,634 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,649,838 | BOYAmt |
| EOY | $5,613,828 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $88,693 | BOYAmt |
| EOY | $66,191 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $462,046 | BOYAmt |
| EOY | $581,220 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,346 | BOYAmt |
| EOY | $75,829 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $27,447,350 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $17,952,640 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,836,744 | BOYAmt |
| EOY | $9,494,710 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,582,999 | BOYAmt |
| EOY | $3,167,832 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $100,000 | BOYAmt |
| EOY | $116,739 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,675,038 | BOYAmt |
| EOY | $20,452,067 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,182,131 | BOYAmt |
| EOY | $2,357,662 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,500 | BOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,916,120 | BOYAmt |
| EOY | $1,654,298 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,034,990 | BOYAmt |
| EOY | $1,680,500 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $691,732 | BOYAmt |
| EOY | $233,354 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,842,473 | BOYAmt |
| EOY | $5,925,814 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,832,565 | BOYAmt |
| EOY | $14,526,253 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,832,565 | BOYAmt |
| EOY | $14,526,253 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,675,038 | BOYAmt |
| EOY | $20,452,067 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$418,894 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $112,582 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | 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 | $3,492 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,492 | 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 | CUMBERLAND MEMORIAL HOSPITAL (THE ORGANIZATION") 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. A PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. THE ORGANIZATION IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE ORGANIZATION PAYS MEMBERSHIP FEES TO THE RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO DOES PROVIDE ANALYSIS ON CURRENT HEALTH CARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTH CARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. A PORTION OF THE FEES PAID BY THE ORGANIZATION IN FY2017 WERE RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTH CARE ENVIRONMENT IN THE STATE OF WISCONSIN. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $956,803 | OtherCostOrOtherBasisAmt |
| Book Value | $956,803 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,885,335 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,711,764 | DepreciationAmt |
| Book Value | $4,173,571 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,733,385 | OtherCostOrOtherBasisAmt |
| Depreciation | $102,554 | DepreciationAmt |
| Book Value | $1,630,831 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,178,385 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,138,322 | DepreciationAmt |
| Book Value | $2,040,063 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $693,442 | OtherCostOrOtherBasisAmt |
| Book Value | $693,442 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,494,710 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| CAPITAL LEASE OBLIGATIONS | $191,615 |
| THIRD-PARTY PAYABLES | $41,739 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $233,354 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $24,734,336 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $9,559 | OtherRevenueAmt |
| Revenue Not Reported | $9,559 | RevenueNotReportedAmt |
| Revenue Subtotal | $24,724,777 | RevenueSubtotalAmt |
| Other Revenues Not Included | $348,329 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $348,329 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $25,073,106 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $25,153,230 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $9,559 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $9,559 | ExpensesNotReportedAmt |
| Expenses Subtotal | $25,143,671 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $348,329 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $348,329 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $25,492,000 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE ORGANIZATION IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SIMILAR STATE OF WISCONSIN TAX LAWS. THE ORGANIZATION IS ALSO ENGAGED, TO A LIMITED EXTENT, IN CERTAIN ACTIVITIES SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME (UBI). UBI IS NOT SIGNIFICANT. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EVENT 9,559. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS NET AGAINST REVENUE 348,329. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EVENT 9,559. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS NET AGAINST REVENUE 348,329. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF OUTING | Event1Nm |
| Gross Receipts Event1 | $23,180 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $19,748 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $3,432 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $600 | CashPrizesEvent1Amt |
| Food And Beverage Event1 | $4,210 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $370 | OtherDirectExpensesEvent1Amt |
| Event2 | PROGRESSIVE DINNER | Event2Nm |
| Gross Receipts Event2 | $12,031 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $3,000 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $9,031 | GrossRevenueEvent2Amt |
| Rent Facility Costs Event2 | $175 | RentFacilityCostsEvent2Amt |
| Food And Beverage Event2 | $3,898 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $306 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $35,211 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $22,748 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $12,463 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $600 | CashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $175 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $8,108 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $676 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $9,559 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $2,904 | NetIncomeSummaryAmt |
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 |
| Percent100 | Yes (X) | Percent100Ind |
| 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 | $69,593 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $69,593 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00280 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,522,576 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,194,137 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,328,439 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05280 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,592,169 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,194,137 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,398,032 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05560 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $81,259 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $81,259 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00320 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $48,070 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $48,070 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,482,479 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,670,692 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,811,787 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07210 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,572 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,572 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,615,380 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,670,692 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,944,688 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07730 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,207,549 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,864,829 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,342,720 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13290 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,504 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,504 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,504 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,504 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $195,064 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $39,013 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,761,806 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,814,032 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$52,226 | 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 | CUMBERLAND MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1110 7TH AVENUE | AddressLine1Txt |
| City | CUMBERLAND | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54829 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | SEE SCHEDULE H PART V SUPPLEMENTAL | WebsiteAddressTxt |
| State License | 1058 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | AMBULANCE SERVICE; RURAL HEALTH CLINICS | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CUMBERLAND 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 | 18 | 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 SCHEDULE H PART V SUPPLEMENTAL | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SCHEDULE H PART V SUPPLEMENTAL | 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 | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE SCHEDULE H PART V SUPPLEMENTAL | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE SCHEDULE H PART V SUPPLEMENTAL | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SCH H PART V SUPPLEMENTAL | 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 |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| 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 |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CUMBERLAND MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: THE 2018 CHNA WAS COMPLETED THROUGH THRIVE BARRON COUNTY, WHICH BRINGS ALL LOCAL COMPETING HEALTHCARE SYSTEMS TOGETHER AND THE BARRON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES. OVER 800 SURVEYS WERE SENT OUT ELECTRONICALLY AND IN-PERSON TO BARRON COUNTY RESIDENTS ASKING THEM ABOUT WHAT THEY THOUGHT OUR TOP HEALTH CONCERNS WERE. ONCE THE VOTES WERE TALLIED, THE THRIVE BARRON COUNTY STEERING COMMITTEE MET TO DETERMINE THE HEALTH CONCERNS MOVING FORWARD. THERE WAS ALSO A PUBLIC FORUM AND PRESENTATIONS HELD IN SEPTEMBER FOR THE PUBLIC TO ATTEND AND BECOME INFORMED OF HEALTH CONCERNS AND VOICE ANY CONCERNS THEY HAD. |
| CUMBERLAND MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6A: 2018 CHNA WAS DONE WITH THE FOLLOWING FACILITIES; AMERY REGIONAL MEDICAL CENTER, BARRON COUNTY AGING & DISABILITY RESOURCE CENTER, CUMBERLAND MEMORIAL HOSPITAL, MAYO CLINIC HEALTH SYSTEM AND MARSHFIELD CLINIC HEALTH SYSTEM, BARRON COUNTY PUBLIC HEALTH. |
| CUMBERLAND MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: CUMBERLAND MEMORIAL HOSPITAL WORKED WITH BARRON COUNTY PUBLIC HEALTH (BARRON, WI) TO IDENTIFY AND PRIORITIZE HEALTH NEEDS. |
| CUMBERLAND MEMORIAL HOSPITAL | PART V, SECTION B, LINE 7D: SENT TO THRIVE AT BARRON COUNTY AND THEY ALSO DISTRIBUTE AND HAVE THEM AVAILABLE |
| CUMBERLAND MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: BARRON COUNTY HAS CREATED A GROUP CALLED THRIVE BARRON COUNTY, WHICH IS MADE UP OF HEALTHCARE FACILITIES IN THE COUNTY, INCLUDING CUMBERLAND MEMORIAL HOSPITAL. TOGETHER THRIVE BARRON COUNTY CONDUCTED A CHNA AND SINCE THEN EACH YEAR A NEW ASSESSMENT WAS DONE. IN 2018, THE TOP THREE HEALTH CONCERNS WERE ALCOHOL, TOBACCO AND OTHER DRUG ABUSE (ATODA), MENTAL HEALTH AND CHRONIC DISEASE. GROUPS CALLED CHATS (COMMUNITY HEALTH ACTION TEAMS) WERE FORMED TO ADDRESS THE NEEDS IDENTIFIED AND SINCE 2012 HAVE BEEN WORKING TO BETTER SERVE THE NEEDS OF THE COUNTY RESIDENTS. ADDITIONALLY, CUMBERLAND MEMORIAL HOSPITAL ANNUALLY HOLDS THE "KNOW YOUR NUMBERS" HEALTH FAIR WHICH PROVIDES FREE SCREENINGS TO AREA RESIDENTS THAT COULD POTENTIALLY ADDRESS MAJOR MEDICAL CONCERNS.AS WITH ALL HEALTHCARE ORGANIZATIONS, ADEQUATE RESOURCES ARE NOT AVAILABLE TO ADDRESS EVERY UNMET HEALTH NEED IN THE COMMUNITIES CUMBERLAND MEMORIAL HOSPITAL SERVES. THERE WERE ITEMS IDENTIFIED IN THE CHNA WHICH WERE NOT ADDRESSED, HOWEVER, ALL ITEMS WERE CONSIDERED IF A NEED WAS BROUGHT TO THE ATTENTION OF THE STEERING COMMITTEE DURING THE INFORMATION GATHERING PHASE OF THE CHNA PROCESS. SEVERAL OF THE ITEMS WHICH WERE NOT ADDRESSED PRIMARILY WERE NOT ADDRESSED DUE TO THE FINANCIAL CONSTRAINT OF PROVIDING A NEW SERVICE FOR A LIMITED POPULATION OF PEOPLE. OVER THE NEXT THREE YEARS, CUMBERLAND MEMORIAL HOSPITAL WILL CONTINUE TO PLAY A LEADING ROLE IN ADDRESSING THE HEALTH NEEDS OF THOSE WITHIN THE COMMUNITY, CONGRUENT WITH THE HOSPITAL'S MISSION. |
| CUMBERLAND MEMORIAL HOSPITAL | PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE THROUGH THE BUSINESS OFFICE STAFF. PATIENTS ARE ENCOURAGED TO CONTACT A FINANCIAL COUNSELOR FOR FURTHER INFORMATION ON THE FINANCIAL ASSISTANCE POLICY. THE HOSPITAL'S WEBSITE ALSO ENCOURAGES PATIENTS TO INQUIRE ABOUT THE FINANCIAL ASSISTANCE POLICY. |
| PART V, LINE 7A: | HOSPITAL FACILITIES WEBSITE: CUMBERLANDHEALTHCARE.COM/PATIENTS-VISITORS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ |
| PART V, LINE 10A: | HOSPITAL FACILITY'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY IS POSTED ON THEIR WEBSITE: CUMBERLANDHEALTHCARE.COM/PATIENTS-VISITORS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ |
| PART V, LINE 16A, B, C: | THE FAP WAS WIDELY AVAILABLE ON A WEBSITE: HTTPS://CUMBERLANDHEALTHCARE.COM/PATIENTS-VISITORS/PATIENT-FINANCIAL-SERVICES/THE FAP APPLICATION FORM WAS WIDELY AVAILABLE ON A WEBSITE: HTTPS://CUMBERLANDHEALTHCARE.COM/PATIENTS-VISITORS/PATIENT-FINANCIAL-SERVICES/A PLAIN LANGUAGE SUMMARY OF THE FAP WAS WIDELY AVAILABLE ON A WEBSITE: HTTPS://CUMBERLANDHEALTHCARE.COM/PATIENTS-VISITORS/PATIENT-FINANCIAL-SERVICES/ |
| 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 |
|---|---|---|---|---|
| 2 - CUMBERLAND HEALTHCARE MEDICAL CLINIC | ||||
| 1110 7TH AVENUE | CUMBERLAND | WI | 54829 | RURAL HEALTH CLINIC |
| 4 - CUMBERLAND HEALTHCARE TURTLE LAKE CENTER | ||||
| 632 US HWY 8 | TURTLE LAKE | WI | 54889 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST HOSPITAL REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. THE COSTING METHODOLOGY USED IS BASED ON MEDICARE COST REPORTING METHODS. |
| PART I, LINE 7G: | THE COST OF SUBSIDIZED SERVICES IS BASED ON COST ALLOCATIONS FROM THE MEDICARE COST REPORT. ALLOWABLE COSTS ARE ASSIGNED DIRECTLY TO DEPARTMENTS THROUGHOUT THE YEAR AND THEN THE COST REPORT USES THE ALLOCATION METHODOLOGY TO ASSIGN ALL OTHER COSTS TO CALCULATE SERVICE LINE COSTS. SUBSIDIZED HEALTH SERVICES INCLUDED THE CLINICS AND THE EMERGENCY ROOM DEPARTMENT. THESE SERVICES ARE UNAVAILABLE TO MEMBERS OF THE COMMUNITY OTHER THAN THROUGH CUMBERLAND MEMORIAL HOSPITAL. IT HAS BEEN THE GOAL OF CUMBERLAND MEMORIAL HOSPITAL TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 348,329. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | CUMBERLAND MEMORIAL HOSPITAL PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE HOSPITAL BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. SEE PART 1, LINE 7 FOR THE CALCULATED COST OF PROVIDING COMMUNITY SERVICES. CUMBERLAND MEMORIAL HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY HEALTH SERVICES: AMBULANCE SERVICES, BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES & URGENT CARE, EXTENDED CARE, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH, AND SURGICAL SERVICES. |
| PART III, LINE 2: | THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO PROVIDES DISCOUNTS TO ELIGIBLE UNINSURED OR UNDERINSURED PATIENTS UNDER ITS CHARITABLE CARE POLICY. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED OR UNDERINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. |
| PART III, LINE 3: | MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES PATIENTS ARE UNABLE TO COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE HOSPITAL PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS, A SMALL AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE. |
| PART III, LINE 4: | PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY: 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 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, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE AMOUNTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET BEEN PAID, OR FOR PAYORS AND PATIENTS 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 ON THE BASIS OF ITS PAST 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 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: | CUMBERLAND MEMORIAL HOSPITAL IS DESIGNATED A CRITICAL ACCESS HOSPITAL AND AS SUCH A PORTION OF ITS REVENUE IS PAID UNDER A COST REIMBURSEMENT SYSTEM. BASED ON THE INSTRUCTIONS, THE TOTAL MEDICARE REVENUE SHOWN ON THIS FORM 990 INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE THAT IS ACTUALLY RECEIVED BY THE HOSPITAL FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE DO NOT INCLUDE PHYSICIAN AND MID-LEVEL PRACTITIONER SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT CUMBERLAND MEMORIAL HOSPITAL OR AMBULANCE SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT METHODOLOGY AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY AND AMBULANCE SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT CUMBERLAND MEMORIAL HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREA OF CUMBERLAND, WISCONSIN. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST TO CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN AND MID-LEVEL PRACTITIONER SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES. 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 HEALTH CARE 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: | UNDER THE HOSPITAL'S COLLECTION AND CHARITABLE CARE POLICIES, CUMBERLAND MEMORIAL HOSPITAL MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE HOSPITAL'S CHARITABLE CARE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE. ALL INPATIENT SELF-PAY ADMISSIONS ARE SCREENED BY THE HOSPITAL'S FINANCIAL COUNSELOR TO ALLOW THESE PATIENTS THE ABILITY TO COMPLETE THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL, DEPENDING UPON THE PATIENT'S CONDITION, THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPELTE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION. DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICES AS WELL AS THE CHARITY AND COMMUNITY CARE PROGRAM TO ALLOW PATENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. INCLUDED IN THE POLICY, IT IS ALSO NOTED THAT THE HOSPITAL RESERVES THE RIGHT TO MAKE OR GRANT ADDITIONAL CHARITY CARE ON A CASE-BY-CASE BASIS. |
| PART VI, LINE 2: | THE HOSPITAL ASSESSES THE NEEDS OF THE COMMUNITY THROUGH SURVEYS AND BY RECOGNIZING WHY CERTAIN PATIENTS ARE REFERRED OUT OF THE AREA. THE HOSPITAL THEN ATTEMPTS TO GET SPECIALISTS IN THE IDENTIFIED AREAS INTO THE HOSPITAL TO SEE PATIENTS AND MEET THEIR NEEDS. JULY 2015 WE OPENED AN ONCOLOGY UNIT AFTER RECOGNIZING A NEED AND WANT FOR PATIENTS TO RECEIVE TREATMENT CLOSE TO HOME. WE ALSO RECOGNIZE A GROWING NEED FOR DIABETIC EDUCATION. BECAUSE THE RECOGNIZED NEED FOR MENTAL HEALTH, WE HIRED A MENTAL HEALTH COUNSELOR AT THE END OF THE FY16. SMOKING CESSATION CLASSES HAVE ALSO BEEN HELD THROUGHOUT THE YEAR. IN FY 2017 DIABETIC EDUCATION CLASSES WERE ADDED. LOOKING TO ADD ENT SPECIALIST SO WE CAN SERVE THAT NEED AND PATIENTS DON'T HAVE TO TRAVEL OUT OF THE AREA. WE LOOK FOR OPPORTUNITIES TO WORK WITH THE SCHOOL AND SERVE THE NEEDS TO STUDENTS AND BRING SERVICES TO THEM RATHER THAN THEIR PARENTS HAVING TO LEAVE THEIR JOBS TO BRING STUDENTS TO APPOINTMENTS AT OUR FACILITY. WE ARE LOOKING TO EXPAND OUR MENTAL HEALTH SERVICES AND HAVE JUST HIRED A PSYCH NP. WE ARE WORKING TO OFFER TELEHEALTH SERVICES. |
| PART VI, LINE 3: | IF A PATIENT IS IDENTIFIED AS UNINSURED, HOSPITAL STAFF WORKS WITH THE PATIENT OR THEIR FAMILY TO DETERMINE IF THEY ARE ELIGIBLE FOR ANY TYPE OF GOVERNMENT PROGRAMS OR QUALIFY FOR THE HOSPITAL'S CHARITY CARE PROGRAM. ASSISTANCE INFORMATION IS ALSO PUBLICIZED ON OUR WEBSITE |
| PART VI, LINE 4: | THE HOSPITAL SERVES THE COMMUNITIES OF CUMBERLAND, TURTLE LAKE, AND ALMENA, WI AND SURROUNDING COMMUNITIES WITHIN A 20 MILE RADIUS. THERE ARE THREE OTHER HOSPITALS LOCATED IN THE RURAL AREA THAT THE ORGANIZATION SERVES. WE ALSO HAVE A SATELLITE CLINIC IN TURTLE LAKE WHICH OFFERS FAMILY PRACTICE AND REHAB SERVICES |
| PART VI, LINE 5: | A MAJORITY OF OUR ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. OUR ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. WE ALSO PARTICIPATE IN COMMUNITY HEALTH FAIRS AND PROVIDE SERVICE AT SPORTING EVENTS. SURPLUS FUNDS ARE INVESTED BACK INTO THE FACILITY AND ITS EQUIPMENT TO ENSURE THE NEEDED SERVICES ARE CONTINUED TO BE PROVIDED IN THIS COMMUNITY. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL GUTSCH | ||||||||||||||
| CEO | $218,619 | $0 | $30,301 | $0 | $8,134 | $0 | $7,829 | $0 | $33,593 | $0 | $298,476 | $0 | $0 | $0 |
| ANGIE MARTENS | ||||||||||||||
| CFO | $138,214 | $0 | $5,938 | $0 | $0 | $0 | $5,767 | $0 | $2,163 | $0 | $152,082 | $0 | $0 | $0 |
| GARY DEGERMAN | ||||||||||||||
| PHYSICIAN | $248,984 | $0 | $0 | $0 | $0 | $0 | $7,587 | $0 | $33,593 | $0 | $290,164 | $0 | $0 | $0 |
| DONALD FULLERTON | ||||||||||||||
| CRNA | $234,436 | $0 | $0 | $0 | $0 | $0 | $9,813 | $0 | $41,053 | $0 | $285,302 | $0 | $0 | $0 |
| STEFANIE RINEHARDT | ||||||||||||||
| CRNA | $153,372 | $0 | $0 | $0 | $0 | $0 | $1,412 | $0 | $40,949 | $0 | $195,733 | $0 | $0 | $0 |
| BENJAMIN BRENNA | ||||||||||||||
| DIRECTOR OF REHAB | $132,394 | $0 | $4,086 | $0 | $5,279 | $0 | $4,550 | $0 | $40,085 | $0 | $186,394 | $0 | $0 | $0 |
| ROBERT LINDBERG | ||||||||||||||
| COO | $133,083 | $0 | $6,338 | $0 | $0 | $0 | $0 | $0 | $33,428 | $0 | $172,849 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 391337855 | BondIssuerEIN |
| Bond Issued | 2014-10-28 | BondIssuedDt |
| Issue Price | $2,925,000 | IssuePriceAmt |
| Purpose | REFUND PRIOR ISSUE | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,200,000 | RetiredAmt |
| Total Proceeds | $2,925,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $58,500 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $352,739 | CapitalExpendituresAmt |
| Other Spent Proceeds | $2,513,761 | OtherSpentProceedsAmt |
| Substantial Completion | 2009 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | Yes (1) | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE RETURN IS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND A FINAL DRAFT IS GIVEN TO THE BOARD MEMBERS OF CUMBERLAND MEMORIAL HOSPITAL. UPON APPROVAL FROM THE BOARD MEMBERS, THE RETURN IS FILED WITH THE INTERNAL REVENUE SERVICE (IRS). |
| FORM 990, PART VI, SECTION B, LINE 12C | CUMBERLAND MEMORIAL HOSPITAL REQUIRES ITS BOARD MEMBERS TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. OFFICERS AND KEY EMPLOYEES OF CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. SIGN A CODE OF CONDUCT STATEMENT. IN THE CODE OF CONDUCT STATEMENT IT MENTIONS THE CONFLICT OF INTEREST. ANY PERSON THAT BELIEVES TO HAVE A CONFLICT SHOULD DISCLOSE AS A MATTER OF RECORD TO THE BOARD ON AN ANNUAL BASIS OR AS THE INTEREST DEVELOPS AND BEFORE IT IS CONSUMMATED. ANY DIRECTOR HAVING A CONFLICT MAY NOT VOTE OR USE PERSONAL INFLUENCE ON THE MATTER. THE DIRECTOR CAN STATE THEIR POSITION ON THE MATTER BEFORE ABSTAINING FROM VOTE. |
| FORM 990, PART VI, SECTION B, LINE 15 | EXECUTIVE SALARIES ARE SET ANNUALLY CONSIDERING COMPENSATION LEVELS AT SIMILARLY SITUATED ORGANIZATIONS (TYPICALLY NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS IN SIMILAR REVENUE CATEGORIES). THE BOARD OF DIRECTORS IS RESPONSIBLE FOR SETTING THE SALARY OF THE CEO AND CFO BASED ON THEIR JOB PERFORMANCE. THE BOARD RELIES UPON COMPARABILITY DATA DEVELOPED BY OUTSIDE CONSULTANTS TO SUPPORT ITS DECISION MAKING PROCESS AND TO ENSURE COMPETITIVE SALARY LEVELS. ALL OTHER NON-UNION WAGES ARE REVIEWED SEMI-ANNUALLY IN COMPARISON TO THE RURAL WISCONSIN HEALTH COOPERATIVE WAGE SURVEY. THIS WAGE SURVEY INCLUDES WAGE DATA OF 27 RURAL HEALTH CARE ORGANIZATIONS. THE GOAL OF THE ORGANIZATION IS TO REMAIN WITHIN THE WAGE SURVEY AVERAGES, BASED ON YEARS OF SERVICE TO BE COMPETITIVE WITH SIMILAR ORGANIZATIONS. |
| FORM 990, PART VI, SECTION C, LINE 19 | CUMBERLAND MEMORIAL HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 846,306. MANAGEMENT AND GENERAL EXPENSES 735,817. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,582,123. CONTRACTED ER PHYSICIANS: PROGRAM SERVICE EXPENSES 858,221. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 858,221. CONTRACTED - PHARMACY: PROGRAM SERVICE EXPENSES 611,016. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 611,016. CONTRACTED RADIOLOGY/NUCLEAR MEDICINE SERVICES: PROGRAM SERVICE EXPENSES 414,101. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 414,101. CONTRACTED NURSING SERVICES: PROGRAM SERVICE EXPENSES 206,824. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 206,824. CONTRACTED PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,182,371. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,182,371. |
| FORM 990, PART XII, LINE 2C, AUDIT OVERSIGHT: | CUMBERLAND MEMORIAL HOSPITAL'S ENTIRE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THE AUDITED FINANCIAL STATEMENTS ARE REVIEWED BY THE BOARD OF DIRECTORS ANNUALLY AND ANY QUESTIONS OR CONCERNS REGARDING THE STATEMENTS ARE ADDRESSED BY THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
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