MEDICAL SERVICES INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- MEDICAL SERVICES INC (EIN 39-1536207)
- Tax period
- 2019-04-01 to 2020-03-31
- Filed
- 2020-11-05
- IRS object ID
- 202013109349301566
- Schema version
- 2019v5.1
- 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 L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-11-05T11:31:26-06:00 | ReturnTs |
| Tax Period End | 2020-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 227 WEST FIRST STREET SUITE 700 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 558021926 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391536207 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEDICAL SERVICES INC | BusinessNameLine1Txt |
| Business Name Line2 | D/B/A HAYWARD AREA MEMORIAL HOSPITAL | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MEDI | BusinessNameControlTxt |
| Phone | 7159344321 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11040 N STATE ROAD 77 | AddressLine1Txt |
| City | HAYWARD | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 548436391 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LUKE BEIRL | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Phone | 7159344321 | PhoneNum |
| Signature | 2020-10-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JULIE BOYER | PreparerPersonNm |
| PTIN | P01278549 | PTIN |
| Phone | 2187275025 | PhoneNum |
| Preparation | 2020-10-19 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 71.13.46.40 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-10-29 | IPDt |
| IP Tm | 15:51:56 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 2AED2949E52E3F15968FB9AB12211B5144C4A110 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | LUKE BEIRL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11040 N STATE ROAD 77 | AddressLine1Txt |
| City | HAYWARD | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 548436391 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $62,076,402 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTP://HAYWARDMEMORIALHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1986 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO CONTINUOUSLY IMPROVE THE HEALTH STATUS OF THE PEOPLE OF THE HAYWARD AREA | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 445 | TotalEmployeeCnt |
| Total Volunteers | 118 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $76,742 | PYContributionsGrantsAmt |
| CY Contributions Grants | $60,566 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $51,403,912 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $60,573,976 | CYProgramServiceRevenueAmt |
| PY Investment Income | $587,262 | PYInvestmentIncomeAmt |
| CY Investment Income | $605,436 | CYInvestmentIncomeAmt |
| PY Other Revenue | $292,268 | PYOtherRevenueAmt |
| CY Other Revenue | $140,020 | CYOtherRevenueAmt |
| PY Total Revenue | $52,360,184 | PYTotalRevenueAmt |
| CY Total Revenue | $61,379,998 | 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 | $24,646,640 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $28,960,485 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $22,169,215 | PYOtherExpensesAmt |
| CY Other Expenses | $26,425,526 | CYOtherExpensesAmt |
| PY Total Expenses | $46,815,855 | PYTotalExpensesAmt |
| CY Total Expenses | $55,386,011 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,544,329 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,993,987 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $79,247,204 | TotalAssetsBOYAmt |
| Total Assets EOY | $85,483,305 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,401,784 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,395,713 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $68,845,420 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $74,087,592 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | CONTINUOUSLY IMPROVE THE HEALTH STATUS OF THE PEOPLE OF THE HAYWARD AREA | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $48,392,250 | ExpenseAmt |
| Revenue | $60,597,777 | RevenueAmt |
| Desc | HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE IS A 25-BED CRITICAL ACCESS HOSPITAL, 50 BED NURSING HOME, AND 40 APARTMENT RCAC FACILITY. THE HOSPITAL CAMPUS ALSO CONTAINS TWO ATTACHED CLINICS THAT ARE OWNED AND OPERATED BY ESSENTIA HEALTH AND NORTHLAKES COMMUNITY HEALTH CENTER. THESE CLINICS EMPLOY APPROXIMATELY 18 FULL-TIME PHYSICIANS, AND ADDITIONAL PART-TIME SPECIALTY CARE PHYSICIANS WHO DO ROUNDS AND SEE PATIENTS AT THE HOSPITAL THROUGHOUT THE MONTH. THE HOSPITAL, NURSING HOME AND ASSISTED LIVING EMPLOY CLOSE TO 463 EMPLOYEES. IN FY '19-'20 THE HOSPITAL HAD 774 INPATIENT ADMISSIONS AND 2351 IP DAYS, 522 OBSERVATION ADMISSIONS WITH 11,833 HOURS OF CARE, AND 38 TCU ADMISSIONS WITH 425 CENSUS DAYS OF CARE. THE NURSING HOME HAD 81 ADMISSIONS WITH 16,994 CENSUS DAYS, AND THE ASSISTED LIVING HAD 13,892 RESIDENT DAYS WITH AN AVERAGE MONTHLY CENSUS OF 37.96 FOR THE FISCAL YEAR WITH 40 TOTAL APARTMENTS. THE EMERGENCY ROOM IS STAFFED BY A PHYSICIAN 24/7/365 SEEING 7,240 PATIENTS. AIR AND GROUND AMBULANCES ARE AVAILABLE FOR THOSE REQUIRING A HIGHER LEVEL OF TRAUMA CARE. AS A RESULT OF A 2015 COMMUNITY HEALTH NEEDS ASSESSMENT, AN URGENT CARE WAS OPENED IN 2017. IT SERVED 5,405 PATIENTS DURING ITS THIRD FULL FISCAL YEAR OF OPERATION. THE OPERATING ROOM PERFORMED 1,090 CASES AND ENDOSCOPY PERFORMED 979 PROCEDURES. THE INCREASE IN SURGERIES IS A RESULT OF THE HOSPITAL OPENING AN ORTHOPEDICS PRACTICE IN APRIL 2018, AND A UROLOGY PRACTICE IN AUGUST 2019. THE ORTHOPEDICS PRACTICE HAD 1,488 CLINIC VISITS AND 259 SURGERIES IN ITS SECOND YEAR OF OPERATION WITH A TRANSITION OF PROVIDERS OCCURRING IN FEBRUARY 2020 - A SPORTS MEDICINE CERTIFIED ORTHOPEDIC SURGERON WAS HIRED; THE UROLOGY PRACTICE HAD 975 CLINIC VISITS AND 143 SURGERIES IN ITS FIRST PARTIAL YEAR OF OPERATION. RADIOLOGY EXAMS TOTAL 21,647, AND LAB EXAMS TOTAL 64,507 PER YEAR. HAYWARD HOSPITAL PERFORMED 132 DELIVERIES LAST YEAR WITH 264 NEWBORN DAYS. HAYWARD IS A POPULAR VACATION HOME DESTINATION AND ATTRACTS TOURISTS THROUGHOUT THE YEAR. HAYWARD IS ALSO A POPULAR RECREATIONAL AREA ATTRACTING MOUNTAIN BIKERS, SKIERS, BOATING, FISHING, AND GENERAL OUTDOOR ACTIVITIES. MEDICAL PROFESSIONALS ARE ATTRACTED TO THIS POPULAR RECREATIONAL AREA BY THE QUALITY OF LIFE THEY FIND HERE. | Desc |
| Total Program Service Expenses | $48,392,250 | 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 | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | 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 | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 41 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 445 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 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 | BRAD ZELLER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7159344245 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11040 N STATE ROAD 77 | AddressLine1Txt |
| City | HAYWARD | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54843 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| ROGER BRANHAM | |||||||||
| PHYSICIAN | 40.00 | Yes (X) | $541,425 | $0 | $15,533 | ||||
| JASON DOUGLAS | |||||||||
| DIRECTOR/PRESIDENT-REI | 1.00 | $0 | $457,712 | $49,723 | 39.00 | Yes (X) | Yes (X) | ||
| DAYLE QUIGLEY | |||||||||
| PHYSICIAN | 40.00 | Yes (X) | $414,586 | $0 | $30,234 | ||||
| PAUL TONKIN | |||||||||
| PHYSICIAN | 40.00 | Yes (X) | $401,299 | $0 | $20,496 | ||||
| LUKE BEIRL | |||||||||
| DIRECTOR/CEO-MSI | 38.00 | $314,229 | $0 | $50,700 | 2.00 | Yes (X) | Yes (X) | ||
| KENT DUMONSEAU | |||||||||
| CFO - REI | 1.00 | $0 | $280,838 | $47,795 | 39.00 | Yes (X) | |||
| MATTHEW VINCENT | |||||||||
| CRNA | 40.00 | Yes (X) | $272,556 | $0 | $52,684 | ||||
| JULIE BOE | |||||||||
| CRNA | 40.00 | Yes (X) | $255,046 | $0 | $50,888 | ||||
| BRAD ZELLER | |||||||||
| VP SUPPORT SERVICES | 38.00 | $198,640 | $0 | $45,805 | 2.00 | Yes (X) | |||
| HEATHER SHEEHAN | |||||||||
| VP SENIOR SERVICES | 39.00 | $196,018 | $0 | $47,376 | 1.00 | Yes (X) | |||
| AINDREA LINDSAY | |||||||||
| VP PATIENT CARE | 38.00 | $157,202 | $0 | $39,051 | 2.00 | Yes (X) | |||
| RICH HOBAN | |||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||||
| JASON OLSEN | |||||||||
| FORMER DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||||
| BRENT KELLEY DO | |||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||||
| JOHN GARRETT | |||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||||
| AMY BEILKE | |||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||||
| DEVON DANNEN MD | |||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||||
| HARRY MALCOLM MD | |||||||||
| SECRETARY | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | Yes (X) | ||
| KAREN GUSTAFSON | |||||||||
| TREASURER | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | Yes (X) | ||
| JAMES MILLER | |||||||||
| VICE CHAIR | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | Yes (X) | ||
| BARBARA KOERPEL-DUFFY | |||||||||
| CHAIR | 1.00 | $0 | $0 | $0 | 2.00 | Yes (X) | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,751,001 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $738,550 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $450,285 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | 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 |
|---|---|---|---|---|---|
| REGIONAL ENTERPRISES INC | |||||
| 1615 MAPLE LANE | ASHLAND | WI | 54806 | PRO FEES/RENT | $2,924,597 |
| WAPITI MEDICAL GROUP-WOOD RIVER LLC | |||||
| 107 FLYNN DRIVE STE 600 | MILBANK | SD | 57252 | ER SERVICES | $1,790,534 |
| MEDICAL SOLUTIONS | |||||
| 1010 N 102ND STREET STE 300 | OMAHA | NE | 68114 | LOCUM STAFFING; ER, MED SURG, PT, OB, OR | $677,709 |
| MARKET & JOHNSON | |||||
| 2350 GALLOWAY STREET PO BOX 630 | EAU CLAIRE | WI | 54702 | CONTRACTOR FOR BUILDING PROJECTS | $670,246 |
| BWBR | |||||
| 380 ST PETER STREET SUITE 600 | SAINT PAUL | MN | 55102 | ARCHITECT FIRM FOR BUILDING PROJECTS | $616,916 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 16 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $60,566 | AllOtherContributionsAmt |
| Noncash Contributions | $10,282 | NoncashContributionsAmt |
| Total Contributions | $60,566 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| HOSPITAL | 621500 | $55,464,526 | $55,464,526 |
| NURSING HOME | 623000 | $3,324,126 | $3,324,126 |
| ASSISTED LIVING | 623000 | $1,773,856 | $1,773,856 |
| DIABETES | 621500 | $11,468 | $11,468 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $60,573,976 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $602,739 | TotalRevenueColumnAmt |
| Exclusion | $602,739 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $14,768 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $31,530 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$16,762 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$16,762 | TotalRevenueColumnAmt |
| Exclusion | -$16,762 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $603,352 | SecuritiesAmt |
| Other | $64,219 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $583,884 | SecuritiesAmt |
| Other | $80,990 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $19,468 | SecuritiesAmt |
| Other | -$16,771 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,697 | TotalRevenueColumnAmt |
| Exclusion | $2,697 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| CAFETERIA | 900099 | $80,127 | $80,127 | |
| GIFT SHOP | 900099 | $52,854 | $52,854 | |
| MISCELLANEOUS | 900099 | $23,801 | $23,801 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $156,782 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $61,379,998 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $60,597,777 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $721,655 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,033,126 | TotalAmt |
| Management And General | $1,033,126 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,864,526 | TotalAmt |
| Program Services | $19,825,398 | ProgramServicesAmt |
| Management And General | $1,039,128 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $706,639 | TotalAmt |
| Program Services | $674,343 | ProgramServicesAmt |
| Management And General | $32,296 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,905,170 | TotalAmt |
| Program Services | $4,594,523 | ProgramServicesAmt |
| Management And General | $310,647 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,451,024 | TotalAmt |
| Program Services | $1,323,607 | ProgramServicesAmt |
| Management And General | $127,417 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $164,529 | TotalAmt |
| Management And General | $164,529 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,411 | TotalAmt |
| Management And General | $77,411 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,470 | TotalAmt |
| Management And General | $3,470 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,497,678 | TotalAmt |
| Program Services | $3,162,681 | ProgramServicesAmt |
| Management And General | $334,997 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $151,094 | TotalAmt |
| Program Services | $3,116 | ProgramServicesAmt |
| Management And General | $147,978 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $973,705 | TotalAmt |
| Program Services | $712,042 | ProgramServicesAmt |
| Management And General | $261,663 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,173,251 | TotalAmt |
| Management And General | $2,173,251 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $878,738 | TotalAmt |
| Program Services | $830,404 | ProgramServicesAmt |
| Management And General | $48,334 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $277,463 | TotalAmt |
| Program Services | $212,064 | ProgramServicesAmt |
| Management And General | $65,399 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $220,977 | TotalAmt |
| Program Services | $198,879 | ProgramServicesAmt |
| Management And General | $22,098 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,287,126 | TotalAmt |
| Program Services | $2,958,413 | ProgramServicesAmt |
| Management And General | $328,713 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $139,495 | TotalAmt |
| Management And General | $139,495 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DRUGS | $5,820,161 | $5,820,161 | |
| MEDICAL SUPPLIES | $3,166,910 | $3,166,308 | $602 |
| IMPLICIT PRICE CONCESSI | $2,665,872 | $2,665,872 | |
| REPAIRS & MAINTENANCE | $1,445,897 | $1,413,051 | $32,846 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,481,749 | TotalAmt |
| Program Services | $831,388 | ProgramServicesAmt |
| Management And General | $650,361 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,386,011 | TotalAmt |
| Program Services | $48,392,250 | ProgramServicesAmt |
| Management And General | $6,993,761 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,133 | BOYAmt |
| EOY | $68,413 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,234,565 | BOYAmt |
| EOY | $30,877,695 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,450,025 | BOYAmt |
| EOY | $9,601,036 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,405,313 | BOYAmt |
| EOY | $1,785,474 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $363,567 | BOYAmt |
| EOY | $707,579 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $60,329,028 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $32,207,723 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,136,251 | BOYAmt |
| EOY | $28,121,305 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,434,174 | BOYAmt |
| EOY | $6,674,363 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,179,176 | BOYAmt |
| EOY | $7,647,440 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $79,247,204 | BOYAmt |
| EOY | $85,483,305 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,749,899 | BOYAmt |
| EOY | $5,884,404 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,651,885 | BOYAmt |
| EOY | $5,511,309 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,401,784 | BOYAmt |
| EOY | $11,395,713 | 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 | $68,845,420 | BOYAmt |
| EOY | $74,087,592 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,845,420 | BOYAmt |
| EOY | $74,087,592 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $79,247,204 | BOYAmt |
| EOY | $85,483,305 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $5,993,987 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$751,815 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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 | $3,470 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,470 | 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 | HAYWARD AREA MEMORIAL HOSPITAL AND WATER'S EDGE PAY DUES TO CERTAIN ORGANIZATIONS RELATED TO THE INDUSTRY WHICH HAVE LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $45,799 | OtherCostOrOtherBasisAmt |
| Book Value | $45,799 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $40,010,732 | OtherCostOrOtherBasisAmt |
| Depreciation | $21,776,530 | DepreciationAmt |
| Book Value | $18,234,202 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,910,479 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,168,913 | DepreciationAmt |
| Book Value | $4,741,566 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,362,018 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,262,280 | DepreciationAmt |
| Book Value | $5,099,738 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $28,121,305 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MUTUAL FUNDS | Desc |
| Book Value | $6,674,363 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $6,674,363 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ASSETS LIMITED AS TO USE | Desc |
| Book Value | $7,647,440 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $7,647,440 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $58,010,612 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$751,815 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$2,665,872 | OtherRevenueAmt |
| Revenue Not Reported | -$3,417,687 | RevenueNotReportedAmt |
| Revenue Subtotal | $61,428,299 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$48,301 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$48,301 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $61,379,998 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $52,768,440 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $48,301 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $48,301 | ExpensesNotReportedAmt |
| Expenses Subtotal | $52,720,139 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $2,665,872 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $2,665,872 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $55,386,011 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE COMPANY IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES. NONPROFIT ORGANIZATIONS MAY BECOME SUBJECT TO INCOME TAXES IF QUALIFICATION AS A TAX-EXEMPT ENTITY CHANGES, IF UNRELATED BUSINESS INCOME IS GENERATED AND IN CERTAIN OTHER INSTANCES. NONPROFIT ORGANIZATIONS ARE REQUIRED TO ASSESS THE CERTAINTY OF THEIR TAX POSITIONS RELATED TO THESE MATTERS AND, IN SOME CASES, RECORD LIABILITIES FOR POTENTIAL TAXES, INTEREST AND PENALTIES ACCOMPANIED BY FOOTNOTE DISCLOSURES. THE COMPANY HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE THE ACCRUAL OF AN INCOME TAX PROVISION. GENERALLY, THE COMPANY IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL OR STATE TAX AUTHORITIES FOR YEARS BEFORE 2017. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | IMPLICIT PRICE CONCESSIONS -2,665,872. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | RENTAL EXPENSES -31,530. LOSS ON SALE OF FIXED ASSETS -16,771. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 31,530. LOSS ON SALE OF FIXED ASSETS 16,771. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | IMPLICIT PRICE CONCESSIONS 2,665,872. |
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 |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $358,251 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $358,251 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00680 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,343,863 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,080,545 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,263,318 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06190 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,702,114 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,080,545 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,621,569 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06870 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $67,610 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $67,610 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,947,337 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,788,633 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,158,704 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07890 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $55,904 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $55,904 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,070,851 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,788,633 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,282,218 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08130 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,772,965 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,869,178 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,903,787 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,105 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,190 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,915 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,105 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,190 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,915 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,665,872 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $17,448,152 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $17,862,659 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$414,507 | 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 | HAYWARD AREA MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11040 N STATE ROAD 77 | AddressLine1Txt |
| City | HAYWARD | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54843 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| State License | 1040 | 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 | HAYWARD AREA 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 | 0 | 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 PART V, PAGE 8 | 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 PART V, PAGE 8 | 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 | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| 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 |
| 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 Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| HAYWARD AREA MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: IN EARLY 2018, HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE AND SAWYER COUNTY PUBLIC HEALTH DEPARTMENT BEGAN AN ASSESSMENT PROCESS TO DETERMINE THE TOP HEALTH CONCERNS OF THE CITIZENS THAT LIVE IN THE COMMUNITIES SERVED BY HAYWARD AREA MEMORIAL HOSPITAL. SEVERAL MEETINGS TOOK PLACE WITH PARTICIPATION FROM A VARIETY OF AGENCIES AND COMMUNITY LEADERS. AT EACH MEETING DATA WAS PRESENTED AND INFORMATION WAS GATHERED FROM THOSE IN ATTENDANCE. SURVEY QUESTIONS WERE DRAFTED BASED ON THE GOALS OF WISCONSIN'S HEALTHIEST WISCONSIN 2020 PLAN. THE ONLINE SURVEY TOOL WAS DISTRIBUTED THROUGHOUT THE FOLLOWING COMMUNITIES: CLAM LAKE, CABLE, COUDERAY, DRUMMOND, EXELAND, GORDON, GRAND VIEW, HAYWARD, LAKE NEBAGAMON, MINONG, OJIBWA, RADISSON, BARNES, SPRINGBROOK, STONE LAKE, TREGO AND WINTER. ONLINE SURVEYS WERE DISTRIBUTED VIA EMAIL, USING TARGETED SOCIAL MEDIA CHANNELS AND LINKED TO THE HOSPITAL'S WEBSITE. PAPER COPIES OF THE SURVEY WERE ALSO MADE AVAILABLE IN THE FRONT ENTRANCES OF THE HAYWARD AREA MEMORIAL HOSPITAL AND WATER'S EDGE, AT THE SAWYER COUNTY HEALTH DEPARTMENT AND THE HAYWARD PUBLIC LIBRARY. A TOTAL OF 547 COMMUNITY MEMBERS PARTICIPATED IN THE SURVEY; SHARING THEIR GREATEST COMMUNITY HEALTH CONCERNS. COMMUNITY HEALTH NEEDS ASSESSMENT ATTENDEES INCLUDE:CAROL ANDERSON, NORTHLAKES COMMUNITY CLINIC-HAYWARDLISA ANDERSON, HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE LORI BALTRUSIS, SAWYER COUNTY-UW EXTENSIONLUKE BEIRL, HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE JESSICA BJORK, SAWYER COUNTY HEALTH & HUMAN SERVICESALICIA CARLSON, SAWYER COUNTY HEALTH & HUMAN SERVICESNICOLE CROSBY, WINTER SCHOOLSJEANINE CONNELL, LCO COMMUNITY HEALTH CENTERBRYAN DEYO, SAWYER COUNTY SHERIFF'S DEPARTMENTKORTNEY DRAKE, NORTHLAKES COMMUNITY CLINICSABRINA DUNLAP, NORTHLAKES COMMUNITY CLINIC-HAYWARDJANE FLYGSTAD, MARSHFIELD CLINIC HEALTH SYSTEMROSE GOKEE, LCO COMMUNITY HEALTH CENTERPAUL GRAHOVAC, SAWYER COUNTY HEALTH & HUMAN SERVICESARIGA GRIGORYAN, SAWYER COUNTY-UW EXTENSIONTIM GULLINGSRUD, HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE LAURA HAMMEREL, HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE LINDA HAND, SENIOR RESOURCE CENTERSANDY HARM, HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE BARBARA KOERPEL-DUFFY, HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGEKAILEE KOFAL, ESSENTIA HEALTH-HAYWARDELLEN KWIATKOWSKI, NORTHLAKES COMMUNITY CLINICMELINDA LAMBERT, LCO COMMUNITY HEALTH CENTERCAROLYNN WHEELOCK-MASHLAN, HAYWARD COMMUNITY SCHOOL DISTRICT CANDI MCCONNELL, HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE CHERIE MORGAN, HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE KATHY MULLALLY, NORTHWEST CONNECTION FAMILY RESOURCE CENTER ANGELA NIMSGREN, SAWYER COUNTY HEALTH & HUMAN SERVICESCRAIG OLSON, HAYWARD COMMUNITY SCHOOL DISTRICTLAURI PERLICK, AGING & DISABILITY RESOURCE CENTER OF THE NORTHAND SAWYER COUNTY ADULT PROTECTIVE SERVICESJACKIE SAARI, HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGEPAT SANCHEZ, SAWYER COUNTY EMERGENCY MANAGEMENTNATE SCHWEITZER, LCO TRIBAL POLICE DEPARTMENTHEATHER SHEEHAN, HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE EILEEN SIMAK, SAWYER COUNTY HEALTH & HUMAN SERVICESJACKIE STRAND, NORTHWEST CONNECTION FAMILY RESOURCE CENTER KRISTIN UPANOT, NORTHLAKES COMMUNITY CLINICSKY VAN ROSSUM, GREATER WISCONSIN AGENCY ON AGING RESOURCES BARBARA WICKSTROM, HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE JT WOHLING, CITY OF HAYWARD POLICE DEPARTMENTLISA WYDRA, SAWYER COUNTY & LCO FOODWISECHAR YAGLE, SAWYER COUNTY HEALTH & HUMAN SERVICESSHEILA YOUNG, SAWYER COUNTY HOUSINGBRAD ZELLER, HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE |
| HAYWARD AREA MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: COMMUNITY OUTREACH BEGAN ON MARCH 8, 2018, BY BRINGING A VARIETY OF HEALTHCARE AND COMMUNITY LEADERS TOGETHER TO DEFINE AND RANK COMMUNITY HEALTH NEEDS; ADDITIONAL OUTREACH TOOK PLACE ON APRIL 19, 2018. DATA WAS PRESENTED BY SAWYER COUNTY PUBLIC HEALTH DEPARTMENT, SAWYER COUNTY HEALTH AND HUMAN SERVICES, HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE, SAWYER COUNTY SENIOR RESOURCE CENTER AND THE GREATER WISCONSIN AGENCY ON AGING RESOURCES.SEE THE DESCRIPTION FOR PART V, SECTION B, LINE 5 FOR THE LIST OF COMMUNITY HEALTH NEEDS ASSESSMENT ATTENDEES. |
| HAYWARD AREA MEMORIAL HOSPITAL | PART V, SECTION B, LINE 7D: HAMH DID A SOCIAL MEDIA POST AS WELL AS GAVE PAPER COPIES OF THE REPORT TO THE PARTNERING ORGANIZATIONS THAT IT WORKED ON THE CHNA WITH, FOR AVAILABILITY AT THEIR LOCATIONS. |
| HAYWARD AREA MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: COMMUNITY HEALTH NEEDS ASSESSMENT WORK FOR OUR FY 2020-2022 COMMUNITY HEALTH IMPROVEMENT PLAN BEGAN IN EARLY 2018 AND COMMENCED THROUGH YEAR 2019 WITH IMPLEMENTATION STRATEGY BEING APPROVED BY THE HAMH BOARD OF DIRECTORS AT ITS 2/27/19 MEETING. THIS IMPLEMENTATION STRATEGY WILL HAVE THE FOLLOWING THREE AREAS OF FOCUS/GOALS WITH WORK BEGINNING APRIL 1, 2019 AND ENDING MARCH 31, 2022 (FY 2020-2022 FOR HAMH). WE WILL REPORT EACH YEAR OF PROGRESS TOWARD THESE GOALS ON OUR FUTURE FORM 990S. PRIORITY 1 - MENTAL HEALTHCHAMPION: PAUL GRAHOVAC, DIRECTOR OF SAWYER COUNTY HEALTH & HUMAN SERVICESPROGRESS - FISCAL YEAR 2020:GOAL 1: IMPROVE THE COMMUNITY CRISIS RESPONSE. DEVELOP A COMPREHENSIVE COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE PLAN WHICH INCLUDES DECISION MAKING POINTS FOR THOSE WHO RESPOND TO THE CRISIS. - INITIAL CONVERSATIONS BETWEEN SAWYER COUNTY PUBLIC HEALTH AND HAYWARD AREA MEMORIAL HOSPITAL TO DISCUSS WHAT PROGRAMS THE HOSPITAL MAY BE ABLE TO OFFER. - FOCUS ON BRINGING COUNTY LAW ENFORCEMENT GROUPS TOGETHER TO CLARIFY ROLES AND INCREASE UNDERSTANDING OF COMMUNITY RESOURCES. MEETINGS HELD AT HAYWARD AREA MEMORIAL HOSPITAL WITH REPRESENTATION FROM THE HOSPITAL EMERGENCY DEPARTMENT, HOSPITAL ADMINISTRATION AND SAWYER COUNTY HEALTH AND HUMAN SERVICES. LAW ENFORCEMENT ENTITIES ATTENDING INCLUDE SAWYER COUNTY SHERIFF'S DEPARTMENT, CITY OF HAYWARD POLICE, TOWN OF HAYWARD POLICE AND LAC COURTE OREILLES LAW ENFORCEMENT. - IN DECEMBER 2019, CORE GROUP OF HAYWARD HEALTH CRISIS PROFESSIONALS WAS IDENTIFIED TO RESPOND AND ASSIST THOSE IN NEED. - SIGNIFICANT IMPROVEMENTS IN COMMUNICATION CHANNELS BETWEEN ALL AGENCIES HAVE BEEN REPORTED WITH GREATER COLLABORATION AND IMPROVED RESPONSE TO THE SERVE THE NEEDS OF THE COMMUNITY. GROUP WILL CONTINUE TO HOLD MONTHLY MEETINGS. GOAL 2: EDUCATE, INFORM AND SHARE BEHAVIOR HEALTH RESOURCES WITH COMMUNITY AND AGENCIES. CREATE A MENTAL HEALTH RESOURCE GUIDE SIMILAR TO MENTAL HEALTH TASK FORCE OF POLK COUNTY HTTP://MENTALHEALTHPOLK.ORG- WORK ON THIS GOAL HAS NOT BEGUN. PRIORITY 2 - OVER AGE 60 YEARSCHAMPION: HEATHER SHEEHAN, VICE PRESIDENT OF SENIOR SERVICES, HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGEPROGRESS - FISCAL YEAR 2020:GOAL 1: PROMOTE HEALTHY AGING. DEVELOP AND MARKET MASTER COMMUNITY EDUCATION CALENDAR. MEASURE ATTENDANCE AT LISTED EVENTS. - PROJECT DEFERRED. - HAMHWE LAUNCHED NEW WEBSITE IN FALL 2019 AND INCLUDED CALENDAR FEATURE THAT CAN BE UTILIZED TO DEVELOP ONLINE COMMUNITY CALENDAR. GOAL 2: IMPROVE CARE TRANSITIONS. WORK WITH THE CARE TRANSITIONS TASK FORCE, WHICH INCLUDE COMMUNITY ORGANIZATIONS AND AGENCIES, TO REDUCE HOSPITAL READMISSION RATES.- GROUP MEETINGS ARE FACILITATED BY A HAMHWE REPRESENTATIVE AND OCCUR QUARTERLY. HAMHWE PRESENTS READMISSION RATE DATA AND PRESENTS CONCERNS AND CHALLENGES THEY ARE EXPERIENCING. PARTICIPATING AGENCIES ALSO SHARE WHAT THEIR CLIENTS ARE EXPERIENCING AND SOLUTIONS AND OPPORTUNITIES FROM COMMUNITY RESOURCES ARE DISCUSSED. - PARTICIPATING AGENCIES INCLUDE LOCAL SENIOR LIVING FACILITIES INCLUDING LONG TERM CARE, ASSISTED LIVING AND INDEPENDENT LIVING. INCLUSA, HOME HEALTH AGENCIES, REGIONAL HOSPICE SERVICES AND HAMHWE SOCIAL SERVICES ALSO ATTEND. GOAL 3: DEVELOP SAFETY AND CRISIS RESPONSE PLAN FOR THOSE WITH DEMENTIA. IMPLEMENT THE "PURPLE TUBE PROJECT AND WORK WITH THE MENTAL HEALTH PRIORITY GROUP TO INCORPORATE OVER 60 AGE GROUP INTO THE COMMUNITY CRISIS RESPONSE PLAN. MEASURE THE NUMBER OF TUBES IN HOMES. - THE GOAL OF THE PURPLE TUBE PROJECT IS TO ASSIST FAMILIES AND FIRST RESPONDERS BY PROVIDING INFORMATION WHICH MAY BE HELPFUL IN THE EVENT OF A MEDICAL OR BEHAVIORAL EMERGENCY FOR THOSE SUFFERING FROM DEMENTIA. - THE PURPLE TUBE PROJECT WAS INITIATED BY HAMHWE. EDUCATION WAS PROVIDED TO LOCAL AGENCIES INCLUDING: LCO ELDER SERVICES, AGING AND DISABILITY RESOURCE CENTER OF THE NORTH, LCO HEALTH CARE CENTER, SAWYER COUNTY SHERIFF'S DEPARTMENT, CITY OF HAYWARD POLICE, INCLUSA, LCO TRIBAL POLICE AND SENIOR RESOURCE CENTER. - HAMHWE DEVELOPED ALL PROMOTIONAL MATERIAL INCLUDING A BROCHURE, PRESS RELEASE, RADIO ANNOUNCEMENTS AND DISTRIBUTION BAGS FOR MATERIALS. COST OF MATERIALS WAS $175. - NOVEMBER 13, 2019, KICKOFF EVENT AT THE SENIOR CENTER FOR THE PURPLE TUBE PROJECT AND THE FIRST PURPLE TUBE WAS PLACED IN A HOME IN DECEMBER 2019. - ADRC AND INCLUSA ARE PROVIDING THEIR ELIGIBLE MEMBERS WITH TUBES. THEIR SUPPORT AND COLLABORATION WITH ALL AGENCIES HAS BEEN VERY HELPFUL BECAUSE OF THEIR PRE-ESTABLISHED RELATIONSHIPS WITH THEIR MEMBERS AND THE REGULAR VISITS TO THOSE MEMBER'S HOMES. GOAL 4: ASSESS OPPORTUNITIES RELATED TO CHRONIC DISEASE MANAGEMENT. WORK WITH AREA PHYSICIANS AND HEALTHCARE PROFESSIONALS TO DETERMINE HOW WE CAN HELP PATIENTS MANAGE CHRONIC DISEASES. - DEFERRED TO 2021. PRIORITY 3 - SUBSTANCE ABUSECHAMPIONS: EILEEN SIMAK, SAWYER COUNTY HEALTH OFFICER PROGRESS - FISCAL YEAR 2020:GOAL 1: PREVENTION - ESTABLISH REPRESENTATION FOR EACH OF THE TWELVE COMMUNITY SECTORS ON THE SAWYER COUNTY LCO JOINT PREVENTION PROGRAMMING COALITION. - AN ACTIVE GROUP, WHICH MEETS MONTHLY, HAS BEEN ESTABLISHED. ORGANIZATIONS REPRESENTED INCLUDE SAWYER COUNTY HEALTH AND HUMAN SERVICES, HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE, LAC COURTE OREILLES/SAWYER COUNTY DRUG ENDANGERED CHILDREN, LAC COURTE OREILLES SCHOOL, WINTER SCHOOLS, AL-ANON, CONGRESSMAN DUFFY'S OFFICE AND THE GREATER HAYWARD MINISTERIAL ASSOCIATION. - COMMUNITY ANTI-VAPING PRESENTATIONS HELD APRIL 1, 2019 AND OCTOBER 24, 2019 WORKING WITH AMERICAN LUNG ASSOCIATION, HAMHWE, SAWYER COUNTY PUBLIC HEALTH, HAYWARD COMMUNITY SCHOOL DISTRICT, LCO, MARSHFIELD CLINIC AND NORTHWEST WI TOBACCO-FREE COALITION. PLANS TO PROVIDE AN ADDITIONAL THREE PRESENTATIONS IN 2020. - 'FATAL VISION' PRESENTATIONS HELD IN THE HAYWARD & WINTER SCHOOLS FOR 75 MIDDLE SCHOOL STUDENTS BY 12/31/19. 'FATAL VISION' USES GOOGLES TO SIMULATE ALCOHOL IMPAIRMENT AND EDUCATES PARTICIPANTS ABOUT THE CONSEQUENCES OF IMPAIRMENT. THE GOGGLES ARE USED AS A PREVENTATIVE METHOD TO CHANGE ATTITUDES AND REDUCE DRUNK DRIVING BEHAVIOR.- COMMUNITY EVENT FOR AREA BUSINESSES ON ADDICTION HELD MAY 2019.- HAMH BEGAN OFFERING NITROUS OXIDE AS AN ALTERNATIVE TO PAIN MANAGEMENT DURING CHILDBIRTH IN APRIL 2019.- HAMH SUPPORTED SAFE & SOBER ADVERTISING CAMPAIGN ON WHSM - INVESTMENT $150 - 30 - :30 SECOND COMMERCIALS (CHRISTMAS EVE-NEW YEAR'S EVE 2019)GOAL 2: TREATMENT - REDUCE THE STIGMA OF ADDICTION BY IMPLEMENTING A MINIMUM OF THREE COMMUNITY EDUCATION INITIATIVES.- IN DECEMBER 2019, HAMH EMERGENCY DEPARTMENT BEGAN PARTNERING WITH LAC COURTE TRIBAL OFFICIALS TO IMPROVE PLANS TO HELP PEOPLE ONCE THEY ARE IDENTIFIED AS NEEDING TREATMENT SUPPORT. GOAL 3: RECOVERY - WORK WITH THE COMMUNITY TO CREATE A MINIMUM OF ONE RECOVERY FRIENDLY PRACTICE. - RESEARCHING POSSIBLE PILOT PROGRAMS THAT COULD BE IMPLEMENTED TO HELP BUSINESSES WORK WITH EMPLOYEES WHO ARE IN RECOVERY. - ALTERNATIVE TO OPIOIDS (ALTO) PROGRAM IMPLEMENTED BY HAMH IN FEBRUARY 2019 AND CONTINUED THROUGHOUT THE CALENDAR YEAR. FROM FEBRUARY 2019 TO JULY 2019 A 15% REDUCTION IN OPIOID DISTRIBUTION WAS RECORDED AT HAMH.- IN NOVEMBER 2019, HAMH BEGAN OFFERING SUBOXONE AND SUBUTEX, DRUGS USED TO TREAT THOSE ADDICTED TO OPIOIDS, WAS MADE AVAILABLE FOR OBSTETRIC PATIENTS IN NOVEMBER 2019. - HAMHWE SPONSORED THE FOLLOWING RECOVERY SUPPORT GROUPS AND PROGRAMS: - WEEKLY AA MEETINGS HELD AT HAMH EACH THURSDAY EVENING. - CELEBRATE RECOVERY DINNERS HELD THE THIRD TUESDAY OF EVERY MONTH AT THE WESLEYAN CHURCH. HAMHWE STAFF PROVIDE VOLUNTEER SUPPORT AND DESSERT FOR THE DINNERS AND MEETING. - SOBRIETY FRIDAY EVENTS HELD AT LAC COURTE OREILLES TRIBAL CENTER THE FIRST FRIDAY OR EVERY MONTH JANUARY-MAY AND SEPTEMBER-DECEMBER. SPONSORSHIP INCLUDES VOLUNTEER SUPPORT, DINNER AND DOOR PRIZES. COST OF DINNER AND DOOR PRIZES WAS $2,876.COMMUNITY HEALTH NEEDS NOT ADDRESED:THE COMMUNITY HEALTH IMPROVEMENT PLAN COMMITTEE IDENTIFIED SEVERAL OTHER HEALTH CONCERNS PREVALENT IN OUR COMMUNITIES WHICH INCLUDED, BUT WERE NOT LIMITED TO: NUTRITION AND HEALTHY FOODS, PHYSICAL ACTIVITY, INJURY AND VIOLENCE PREVENTION, HEALTHY GROWTH AND DEVELOPMENT, TOBACCO USE AND EXPOSURE, COMMUNICABLE DISEASES, ETC.STAKEHOLDERS WERE ASKED TO RANK THESE HEALTH CONCERNS BY PRIORITY, AND WHILE ALL ARE IMPORTANT AND DEMAND TO BE ACKNOWLEDGED, THE COMMITTEE DECIDED TO USE AVAILABLE RESOURCES IN THE MOST EFFICIENT WAY POSSIBLE. THIS MEANT PRIORITIZING THREE ISSUES FOR THE GREATEST IMPACT, RATHER THAN TRYING TO DO A LITTLE IN EACH AREA. |
| PART V, LINE 16A, FAP WEBSITE: | HTTP://HAYWARDMEMORIALHOSPITAL.COM/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE-POLICY/ |
| PART V, LINE 16B, FAP APPLICATION FORM WEBSITE: | HTTPS://HAYWARDMEMORIALHOSPITAL.COM/WP-LIB/WP-CONTENT/UPLOADS/2019/09/FINANCIAL-ASST.-APPLICATION.PDF |
| PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY: | HTTPS://HAYWARDMEMORIALHOSPITAL.COM/WP-LIB/WP-CONTENT/UPLOADS/2020/03/2020-HAMH-FAP-PLAIN-LANGUAGE-SUMMARY-FANCY.PDF |
| PART V, LINE 7A, CHNA - HOSPITAL'S WEBSITE: | HTTPS://HAYWARDMEMORIALHOSPITAL.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ |
| PART V, LINE 10, IMPLEMENTATION PLAN WEBSITE: | HTTPS://HAYWARDMEMORIALHOSPITAL.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - WATER'S EDGE | ||||
| 11040 N STATE ROAD 77 | HAYWARD | WI | 54843 | NURSING HOME |
| 2 - WATER'S EDGE | ||||
| 11040 N STATE ROAD 77 | HAYWARD | WI | 54843 | ASSISTED LIVING FACILITY |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED MEDICARE COST REPORT. |
| PART I, LINE 7G: | SUBSIDIZED HEALTH SERVICES INCLUDE RESPIRATORY THERAPY, REHAB SERVICES, DIABETES EDUCATION, EMERGENCY, OBSERVATION BEDS, AND NURSING HOME. |
| PART I, LN 7 COL(F): | IMPLICIT PRICE CONCESSIONS FROM FINANCIAL STATEMENTS IS $2,665,872. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | MANY PROGRAMS HAVE BEEN DESIGNED TO HELP PATIENTS OF THE COMMUNITY. BREASTFEEDING AND CHILD BIRTH EDUCATION, BLOOD DRIVES, PREGNANCY AND INFANT CARE CLASSES, LIFELINE, DIABETES SUPPORT GROUPS, IN-KIND MEETINGS, ACLS CLASSES, LACTATION SUPPORT GROUPS, STEPPING ON CLASSES, PALS CLASSES, NRP CLASS, ALSO COURSE AND PAIN SUPPORT GROUPS ARE EXAMPLES OF THE COMMUNITY ACTIVITIES HAYWARD HOSPITAL IS CURRENTLY INVOLVED IN. IN ADDITION, COMMUNITY BENEFIT OPERATIONS THAT THE HOSPITAL IS INVOLVED WITH INCLUDE THE BIRKIE MEDICAL TEAM, COMMUNITY WIDE HUMAN TRAFFICKING LECTURE, COMMUNITY PICNIC AND COMMUNITY SUPPERS. THE ACTIVITIES HAVE BEEN REPORTED ON SCHEDULE H, PART I, LINE 7E.WORKFORCE DEVELOPMENT - HAMH PURCHASED A LARGE, MULTI-ROOM HOME IN DECEMBER 2018 TO HOUSE MEDICAL STUDENTS AND LOCUM PROVIDERS WITH THE INTENT TO ATTRACT MEDICAL STUDENTS TO COME TO HAYWARD FOR THEIR RESIDENCY AND SEEK EMPLOYMENT IN THE HAYWARD AREA AFTER GRADUATION. |
| PART III, LINE 2: | IN MAY 2014, THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ISSUED A NEW STANDARD RELATED TO REVENUE RECOGNITION. THE COMPANY ADOPTED THE NEW STANDARD EFFECTIVE APRIL 1, 2019, USING THE MODIFIED RETROSPECTIVE METHOD. THE ADOPTION OF THE NEW STANDARD DID NOT HAVE AN IMPACT ON THE RECOGNITION OF NET REVENUES FOR ANY PERIODS PRIOR TO ADOPTION. THE MOST SIGNIFICANT IMPACT OF ADOPTING THE NEW STANDARD IS TO THE PRESENTATION OF THE STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS, WHERE THE "PROVISION FOR UNCOLLECTIBLE ACCOUNTS" IS NO LONGER PRESENTED AS A SEPARATE LINE ITEM AND "REVENUES" ARE PRESENTED NET OF ESTIMATED EXPLICIT AND IMPLICIT PRICE CONCESSION REVENUE DEDUCTIONS. THE COMPANY ALSO ELIMINATED THE RELATED PRESENTATION OF "ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS" ON THE BALANCE SHEET AS A RESULT OF THE ADOPTION OF THE NEW STANDARD.REVENUES GENERALLY RELATE TO CONTRACTS WITH PATIENTS IN WHICH THE PERFORMANCE OBLIGATIONS ARE TO PROVIDE HEALTH CARE SERVICES TO THE PATIENTS. REVENUES ARE RECORDED DURING THE PERIOD THE PERFORMANCE OBLIGATIONS TO PROVIDE HEALTH CARE SERVICES ARE SATISFIED. THE COMPANY'S PERFORMANCE OBLIGATIONS FOR INPATIENT SERVICES ARE GENERALLY SATISFIED OVER PERIODS THAT AVERAGE APPROXIMATELY THREE DAYS, AND REVENUES ARE RECOGNIZED BASED ON CHARGES INCURRED IN RELATION TO TOTAL EXPECTED CHARGES. PERFORMANCE OBLIGATIONS FOR OUTPATIENT SERVICES ARE GENERALLY SATISFIED OVER A PERIOD OF LESS THAN ONE DAY.REVENUES ARE BASED UPON THE ESTIMATED AMOUNTS THE COMPANY EXPECTS TO BE ENTITLED TO RECEIVE FROM PATIENTS, INCLUDING PAYMENTS MADE BY THIRD-PARTY PAYORS ON BEHALF OF PATIENTS. ESTIMATES OF CONTRACTUAL ALLOWANCES UNDER MANAGED CARE AND COMMERCIAL INSURANCE PLANS ARE BASED UPON THE PAYMENT TERMS SPECIFIED IN THE RELATED CONTRACTUAL AGREEMENTS. REVENUES RELATED TO UNINSURED PATIENTS AND UNINSURED COPAYMENTS AND DEDUCTIBLE AMOUNTS FOR PATIENTS WHO HAVE HEALTH CARE COVERAGE MAY HAVE DISCOUNTS APPLIED (UNINSURED DISCOUNTS AND CONTRACTUAL DISCOUNTS). THE COMPANY ALSO RECORDS ESTIMATED IMPLICIT PRICE CONCESSIONS (BASED PRIMARILY ON HISTORICAL COLLECTION EXPERIENCE) RELATED TO UNINSURED ACCOUNTS TO RECORD SELF-PAY REVENUES AT THE ESTIMATED AMOUNTS THE COMPANY EXPECTS TO COLLECT.UNDER THE PROVISIONS OF ACCOUNTING STANDARDS UPDATE (ASU) NO. 2014-09, WHICH WAS ADOPTED APRIL 1, 2019, WHEN THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME, THE RIGHT IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH THE COMPANY HAS THE UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS FOR RETROACTIVE ADJUSTMENTS ARE RECEIVABLES IF THE COMPANY'S RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. FOR PATIENT ACCOUNTS RECEIVABLE SUBSEQUENT TO THE ADOPTION OF ASU 2014-09, THE ESTIMATED UNCOLLECTIBLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT ACCOUNTS RECEIVABLE RATHER THAN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE COMPANY DETERMINES THIS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH CERTAIN CLASSES OF PATIENTS USING A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT TO ACCOUNT FOR PATIENT CONTRACTS AS COLLECTIVE GROUPS RATHER THAN INDIVIDUALLY. THE FINANCIAL STATEMENT EFFECTS OF USING THIS PRACTICAL EXPEDIENT ARE NOT MATERIALLY DIFFERENT FROM AN INDIVIDUAL CONTRACT APPROACH.THE PRIMARY COLLECTIONS RISKS RELATE TO UNINSURED PATIENT ACCOUNTS, INCLUDING PATIENT ACCOUNTS FOR WHICH THE PRIMARY INSURANCE CARRIER HAS PAID THE AMOUNTS COVERED BY THE APPLICABLE AGREEMENT, BUT THE PATIENT RESPONSIBILITY AMOUNTS (DEDUCTIBLES AND COPAYMENTS) REMAIN OUTSTANDING. IMPLICIT PRICE CONCESSIONS RELATE PRIMARILY TO AMOUNTS DUE DIRECTLY FROM PATIENTS. ESTIMATED IMPLICIT PRICE CONCESSIONS ARE RECORDED FOR ALL UNINSURED ACCOUNTS, REGARDLESS OF THE AGING OF THOSE ACCOUNTS. ACCOUNTS ARE WRITTEN OFF WHEN ALL REASONABLE INTERNAL AND EXTERNAL COLLECTION EFFORTS HAVE BEEN PERFORMED. |
| PART III, LINE 3: | AT HAYWARD AREA MEMORIAL HOSPITAL, IMPLICIT PRICE CONCESSIONS ARE CONSIDERED THE UNWILLINGNESS TO PAY, WHILE CHARITY CARE AND FREE CARE ARE INABILITY TO PAY. |
| PART III, LINE 4: | SEE FOOTNOTE 1 ON PAGE 9 OF THE AUDITED FINANCIAL STATEMENTS |
| PART III, LINE 8: | THE COSTING METHODOLOGY USED IN DETERMINING THE MEDICARE ALLOWABLE COST REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6:THE HOSPITAL FOLLOWED MEDICARE'S PRESCRIBED METHODS OF DETERMINING COSTS PAYABLE UNDER TITLE XVIII (MEDICARE) IN COMPLETING ITS ANNUAL MEDICARE COST REPORT (COST REPORT) USING DATA AVAILABLE FROM THE INSTITUTION'S BASIC ACCOUNTS, AS USUALLY MAINTAINED, TO ARRIVE AT EQUITABLE AND PROPER PAYMENT FOR SERVICES. THE COST REPORT WAS COMPLETED USING THE HOSPITAL'S TRIAL BALANCE OF EXPENSES, AS WELL AS OTHER STATISTICAL AND FINANCIAL RECORDS MAINTAINED BY THE HOSPITAL. AS REQUIRED BY MEDICARE REGULATIONS, CERTAIN RECLASSIFICATIONS AND ADJUSTMENTS TO COSTS WERE INCLUDED IN THE COST REPORT TO DETERMINE MEDICARE ALLOWABLE COSTS.AFTER MEDICARE ALLOWABLE COSTS ARE DETERMINED, THE COST REPORT PROVIDES FOR THE STEP DOWN METHOD OF COST FINDING. THIS METHOD PROVIDES FOR ALLOCATING THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS, WHICH UTILIZE THE SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. AFTER ALL COSTS OF THE GENERAL SERVICE COST CENTERS HAVE BEEN ALLOCATED TO THE REMAINING COST CENTERS, THE TOTAL COSTS OF THESE REMAINING COST CENTERS ARE FURTHER DISTRIBUTED TO THE DEPARTMENTAL CLASSIFICATION TO WHICH THEY PERTAIN, E.G., HOSPITAL GENERAL INPATIENT ROUTINE, SUBPROVIDER, ANCILLARY, ETC.AFTER THE STEP-DOWN PROCESS, THE COST REPORT PROVIDES FOR THE APPORTIONMENT OF COSTS TO THE MEDICARE PROGRAM BASED ON A NUMBER OF DIFFERENT METHODOLOGIES INCLUDING PER PATIENT DAY, PER VISIT, AND PERCENTAGE OF CHARGES, AS MOST PREVALENT. MEDICARE COSTS AS DETERMINED BY THE COST REPORT METHODOLOGIES DESCRIBED PREVIOUSLY WERE UTILIZED TO COMPLETE THE APPLICABLE MEDICARE ALLOWABLE COSTS OF CARE FOR SCHEDULE H (FORM 990) PART III SECTION B LINE 6. |
| PART III, LINE 9B: | HAYWARD AREA MEMORIAL HOSPITAL'S BILLING AND COLLECTION POLICY STATES:A. SUBJECT TO COMPLIANCE WITH THE PROVISIONS OF THIS POLICY, HAMH MAY TAKE ANY AND ALL LEGAL ACTIONS, INCLUDING EXTRAORDINARY COLLECTION ACTIONS, TO OBTAIN PAYMENT FOR MEDICAL SERVICES PROVIDED.B. ALL PATIENTS WILL BE OFFERED A PLAIN LANGUAGE SUMMARY (APPENDIX A) AND AN APPLICATION FORM (APPENDIX B) FOR FINANCIAL ASSISTANCE UNDER THE FAP AS PART OF THE DISCHARGE OR INTAKE PROCESS FROM A HOSPITAL.C. AT LEAST THREE SEPARATE STATEMENTS FOR COLLECTION OF SELF-PAY ACCOUNTS SHALL BE MAILED OR EMAILED TO THE LAST KNOWN ADDRESS OF EACH RESPONSIBLE INDIVIDUAL(S); PROVIDED, HOWEVER, THAT NO ADDITIONAL STATEMENTS NEED BE SENT AFTER A RESPONSIBLE INDIVIDUAL(S) SUBMITS A COMPLETE APPLICATION FOR FINANCIAL ASSISTANCE UNDER THE FAP OR HAS PAID IN-FULL. AT LEAST 60 DAYS SHALL HAVE ELAPSED BETWEEN THE FIRST AND LAST OF THE REQUIRED THREE MAILINGS. IT IS THE RESPONSIBLE INDIVIDUAL(S) OBLIGATION TO PROVIDE A CORRECT MAILING ADDRESS AT THE TIME OF SERVICE OR UPON MOVING. IF AN ACCOUNT DOES NOT HAVE A VALID ADDRESS, THE DETERMINATION FOR "REASONABLE EFFORT" WILL HAVE BEEN MADE. ALL SINGLE PATIENT ACCOUNT STATEMENTS OF SELF-PAY ACCOUNTS WILL INCLUDE BUT NOT LIMITED TO:1. AN ACCURATE SUMMARY OF THE HOSPITAL SERVICES COVERED BY THE STATEMENT;2. THE CHARGES FOR SUCH SERVICES;3. THE AMOUNT REQUIRED TO BE PAID BY THE RESPONSIBLE INDIVIDUAL(S) (OR, IF SUCH AMOUNT IS NOT KNOWN, A GOOD FAITH ESTIMATE OF SUCH AMOUNT AS OF THE DATE OF THE INITIAL STATEMENT); AND4. A CONSPICUOUS WRITTEN NOTICE THAT NOTIFIES AND INFORMS THE RESPONSIBLE INDIVIDUAL(S) ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE HOSPITAL FAP INCLUDING THE TELEPHONE NUMBER OF THE DEPARTMENT AND DIRECT WEBSITE ADDRESS WHERE COPIES OF DOCUMENTS MAY BE OBTAINED.D. AT LEAST ONE OF THE STATEMENTS MAILED OR EMAILED WILL INCLUDE WRITTEN NOTICE THAT INFORMS THE RESPONSIBLE INDIVIDUAL(S) ABOUT THE ECAS THAT ARE INTENDED TO BE TAKEN IF THE RESPONSIBLE INDIVIDUAL(S) DOES NOT APPLY FOR FINANCIAL ASSISTANCE UNDER THE FAP OR PAY THE AMOUNT DUE BY THE BILLING DEADLINE. SUCH STATEMENT MUST BE PROVIDED TO THE RESPONSIBLE INDIVIDUAL(S) AT LEAST 30 DAYS BEFORE THE DEADLINE SPECIFIED IN THE STATEMENT. A PLAIN LANGUAGE SUMMARY WILL ACCOMPANY THIS STATEMENT. IT IS THE RESPONSIBLE INDIVIDUAL(S) OBLIGATION TO PROVIDE A CORRECT MAILING ADDRESS AT THE TIME OF SERVICE OR UPON MOVING. IF AN ACCOUNT DOES NOT HAVE A VALID ADDRESS,THE DETERMINATION FOR "REASONABLE EFFORT" WILL HAVE BEEN MADE.E. RESPONSIBLE INDIVIDUAL(S) PROPENSITY TO PAY WILL BE SCORED BASED ON THAT ASSESSMENT OF THE RESPONSIBLE INDIVIDUAL(S) LIKELIHOOD TO PAY AND DOLLAR AMOUNT OF THE SELF-PAY ACCOUNT.F. HAMH OFFERS PAYMENT PLANS THAT BEAR NO INTEREST.G. PRIOR TO INITIATION OF ANY ECAS, AN ORAL ATTEMPT WILL BE MADE TO CONTACT RESPONSIBLE INDIVIDUAL(S) BY TELEPHONE AT THE LAST KNOWN TELEPHONE NUMBER, IF ANY, AT LEAST ONCE DURING THE SERIES OF MAILED OR EMAILED STATEMENTS IF THE ACCOUNT REMAINS UNPAID. DURING ALL CONVERSATIONS, THE PATIENT OR RESPONSIBLE INDIVIDUAL(S) WILL BE INFORMED ABOUT THE FINANCIAL ASSISTANCE THAT MAY BE AVAILABLE UNDER THE FAP.H. ECAS MAY BE COMMENCED AS FOLLOWS:1. IF ANY RESPONSIBLE INDIVIDUAL(S) FAIL TO APPLY FOR FINANCIAL ASSISTANCE UNDER THE FAP BY 120 DAYS AFTER THE FIRST POST DISCHARGE STATEMENT, AND THE RESPONSIBLE PARTIES HAVE RECEIVED A STATEMENT WITH A BILLING DEADLINE DESCRIBED IN SECTION III.E ABOVE, THEN HAMH OR COLLECTION AGENCY MAY INITIATE ECAS.2. IF ANY RESPONSIBLE INDIVIDUAL(S) SUBMITS AN INCOMPLETE APPLICATION FOR FINANCIAL ASSISTANCE UNDER THE FAP PRIOR TO THE APPLICATION DEADLINE, THEN ECAS MAY NOT BE INITIATED UNTIL AFTER EACH OF THE FOLLOWING STEPS HAS BEEN COMPLETED:A. PFS PROVIDES THE RESPONSIBLE INDIVIDUAL(S) WITH A WRITTEN NOTICE THAT DESCRIBES THE ADDITIONAL INFORMATION ORDOCUMENTATION REQUIRED UNDER THE FAP IN ORDER TO COMPLETE THE APPLICATION FOR FINANCIAL ASSISTANCE, WHICH NOTICE WILL INCLUDE A COPY OF THE PLAIN LANGUAGE SUMMARY.B. PFS PROVIDES THE RESPONSIBLE INDIVIDUAL(S) WITH AT LEAST 30 DAYS' PRIOR WRITTEN NOTICE OF THE ECAS THAT HAMH ORCOLLECTION AGENCY MAY INITIATE AGAINST THE RESPONSIBLE INDIVIDUAL(S) IF THE FAP APPLICATION IS NOT COMPLETED OR PAYMENT IS NOT MADE; PROVIDED, HOWEVER, THAT THE COMPLETION DEADLINE FOR PAYMENT MAY NOT BE SET PRIOR TO 120 DAYS AFTER THE FIRST POST DISCHARGE STATEMENT.C. IF THE RESPONSIBLE INDIVIDUAL(S) WHO HAS SUBMITTED THE INCOMPLETE APPLICATION COMPLETES THE APPLICATION FOR FINANCIAL ASSISTANCE, AND PFS DETERMINES DEFINITIVELY THAT THE RESPONSIBLE INDIVIDUAL(S) IS INELIGIBLE FOR ANY FINANCIAL ASSISTANCE UNDER THE FAP, HAMH WILL INFORM THE RESPONSIBLE INDIVIDUAL(S) IN WRITING THE DENIAL AND INCLUDE A 30 DAYS' PRIOR WRITTEN NOTICE OF THE ECAS THAT HAMH OR COLLECTION AGENCY MAY INITIATE AGAINST THE RESPONSIBLE INDIVIDUAL(S); PROVIDED, HOWEVER, THAT THE BILLING DEADLINE MAY NOT BE SET PRIOR TO 120 DAYS AFTER THE FIRST POST DISCHARGE STATEMENT.D. IF THE RESPONSIBLE INDIVIDUAL(S) WHO HAS SUBMITTED THE INCOMPLETE APPLICATION FAILS TO COMPLETE THE APPLICATION BY THE COMPLETION DEADLINE SET IN THE NOTICE PROVIDED PURSUANT TO SECTION III.G.3.B ABOVE, THEN ECAS MAY BE INITIATED.E. IF AN APPLICATION, COMPLETE OR INCOMPLETE, FOR FINANCIAL ASSISTANCE UNDER THE FAP IS SUBMITTED BY A RESPONSIBLEINDIVIDUAL(S), AT ANY TIME PRIOR TO THE APPLICATION DEADLINE, HAMH WILL SUSPEND ECAS WHILE SUCH FINANCIAL ASSISTANCE APPLICATION IS PENDING.I. AFTER THE COMMENCEMENT OF ECAS IS PERMITTED UNDER SECTION III.G ABOVE, COLLECTION AGENCIES SHALL BE AUTHORIZED TO REPORT UNPAID ACCOUNTS TO CREDIT AGENCIES, AND TO FILE JUDICIAL OR LEGAL ACTION, GARNISHMENT, OBTAIN JUDGMENT LIENS AND EXECUTE UPON SUCH JUDGMENT LIENS USING LAWFUL MEANS OF COLLECTION; PROVIDED, HOWEVER, THAT PRIOR APPROVAL OF PFS SHALL BE REQUIRED BEFORE INITIAL LAWSUITS MAY BE INITIATED. HAMH AND EXTERNAL COLLECTION AGENCIES MAY ALSO TAKE ANY AND ALL LEGAL OTHER ACTIONS INCLUDING BUT NOT LIMITED TO TELEPHONE CALLS, EMAILS, TEXTS, MAILING NOTICES, AND SKIP TRACING TO OBTAIN PAYMENT FOR MEDICAL SERVICES PROVIDED.IV. POLICY AVAILABILITYCONTACT OUR BUSINESS OFFICE AT 715-934-4267 FOR INFORMATION REGARDING ELIGIBILITY OR THE PROGRAMS THAT MAY BE AVAILABLE TO YOU, TO REQUEST A COPY OF THE FAP, FAP APPLICATION FORM, OR COLLECTION POLICY TO BE MAILED TO YOU, OR IF YOU NEED A COPY OF THE FAP, FAP APPLICATION FORM, OR COLLECTION POLICY TRANSLATED TO SPANISH. FULL DISCLOSURE OF THE FAP, FAP APPLICATION FORM, OR COLLECTION POLICY MAY BE FOUND AT WWW.HAYWARDMEMORIALHOSPITAL.COM/FINANCIAL-SERVICES/ . A PAPER COPY OF OUR FAP, FAP APPLICATION FORM, OR COLLECTION POLICY CAN BE OBTAINED AT OUR FACILITY LOCATED AT 11040N STATE RD. 77, HAYWARD, WI 54843 AT THE REGISTRATION DESK.PATIENTS REQUEST ASSISTANCE AND AT THAT POINT RECEIVE THE DOCUMENTS TO APPLY FOR CHARITY CARE. MEDICAL SERVICES, INC DOES POST A LARGE SIGN IN THE LOBBY THAT STATES "THIS HEALTH CARE FACILITY IS REQUIRED TO GIVE A REASONABLE AMOUNT OF ITS SERVICES FREE OR AT A REDUCED CHARGE TO PERSONS WHO CANNOT AFFORD TO PAY FOR MEDICAL CARE. IF YOU ARE NOT ABLE TO PAY FOR ALL OR PART OF THE CARE YOU NEED, PLEASE CONTACT THE ADMISSIONS OR BUSINESS OFFICE OF THIS FACILITY AND ASK ABOUT THE AVAILABILITY OF SUCH CARE". THIS SIGN IS PLACED IN A LOCATION THAT ALL PATIENTS CAN SEE AND ASK FOR DOCUMENTS TO COMPLETE TO START THE CHARITY CARE APPLICATION PROCESS. COMMUNITY CARE INFORMATION IS ALSO INCLUDED IN ALL ADMISSION FOLDERS AND ALL ROOMS HAVE INFORMATIONAL BINDERS WITH CHARITY CARE INFORMATION. OUR FINANCIAL ASSISTANCE POLICY IS ALSO AVAILABLE ON OUR WEBSITE ALONG WITH THE APPLICATION. |
| PART VI, LINE 2: | NEEDS ASSESSMENT:FACILITY STAFF PARTICIPATE IN THE COMMUNITY NEEDS ASSESSMENT PROCESS WITH THE SAWYER COUNTY HEALTH DEPARTMENT, COMMUNITY HEALTH CLINICS, ASSISTED LIVING FACILITY, AND PHYSICIANS FROM THE COMMUNITY. FOLLOWING THE COMPLETION OF THE ASSESSMENT, VARIOUS WORK GROUPS ARE CONVENED. APPROPRIATE STAFF MEMBERS FROM THE FACILITY THEN WORK WITH COMMUNITY MEMBERS TO DEVELOP PROGRAMS AND APPROACHES TO ADDRESS THE IDENTIFIED HEALTH ISSUES. SOME EXAMPLES INCLUDE ABUSE OF PRESCRIPTION DRUGS, SEXUAL ABUSE PREVENTION PROGRAMS, UNDERAGE ALCOHOL USE, TRANSPORT ISSUES, TELEHEALTH, PATIENT ADVOCACY PROGRAM, AND REDUCED COST CLINIC. |
| PART VI, LINE 3: | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:ALL PATIENTS ARE BILLED THE SAME, HOWEVER, IF A PATIENT BECOMES DELINQUENT ON A BILL, A LETTER IS SENT TO THE PATIENT ASKING THAT THE PATIENT CONTACT PATIENT FINANCIAL SERVICES FOR ASSISTANCE. PATIENTS HAVE THE OPTION TO DISCUSS PAYMENT OPTIONS WITH PATIENT FINANCIAL SERVICES AND POSSIBLE ELIGIBILITY FOR CHARITY CARE. |
| PART VI, LINE 4: | COMMUNITY INFORMATION:HAYWARD WISCONSIN IS LOCATED IN NORTHERN WISCONSIN AND CONSISTS OF A HIGH MEDICARE AND MEDICAID POPULATION. THE MEDICARE AND MEDICAID POPULATION ACCOUNTS FOR 69% OF THE HOSPITAL'S GROSS REVENUES AND 50% OF ITS NET PATIENT SERVICE REVENUES. HAYWARD IS CONSIDERED A SUMMER VACATION DESTINATION THAT BRINGS LARGE CROWDS DURING THE SUMMER MONTHS. THE EMERGENCY DEPARTMENT SERVES A LARGE NUMBER OF PATIENTS THAT RANGE FROM COMMERCIAL INSURANCE, MEDICARE, MEDICAID, IHS (INDIAN HEALTH SERVICES), ETC. HAYWARD HOSPITAL IS FOCUSED ON PROVIDING HIGH QUALITY HEALTHCARE IN A RURAL LOCATION. MANY SERVICES ARE PROVIDED BY HAYWARD HOSPITAL, ALLOWING LESS PATIENT TRAVEL AT A TIME WHEN THE PATIENT IS LIKELY NOT FEELING WELL. THE HAYWARD COMMUNITY IS AN AGING POPULATION AND WE RECOGNIZE THAT NEED AND HAVE COMMITTED MILLIONS OF DOLLARS INTO SERVICES FOR THE OLDER POPULATION. WE BELIEVE HAYWARD HOSPITAL PROVIDES EXCEPTIONAL CARE IN A RURAL LOCATION. |
| PART VI, LINE 5: | PROMOTION OF COMMUNITY HEALTH:OPEN MEDICAL STAFF. COMMUNITY CALL PROGRAM FOR MEDICAL STAFF. LOCAL COMMUNITY BOARD WITH 11 VOTING MEMBERS. NONPROFIT STATUS WITH PROFITS (IF ANY) USED FOR ADDITIONAL SERVICES, CAPITAL PURCHASES SUCH AS A CT SCANNER, LAB EQUIPMENT, ELECTRONIC HEALTH RECORD, IMPROVED INPATIENT SERVICES, OB PROGRAM, CONTINUED EDUCATION FOR ALL STAFF, GROWING SENIOR SERVICES PROGRAM AND A FOCUS ON THE NEEDS OF THE COMMUNITY. |
| PART VI, LINE 6: | AFFILIATED HEALTH CARE SYSTEM:MEDICAL SERVICES, INC. IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROGER BRANHAM | ||||||||||||||
| PHYSICIAN | $529,627 | $0 | $5,000 | $0 | $6,798 | $0 | $14,000 | $0 | $1,533 | $0 | $556,958 | $0 | $0 | $0 |
| JASON DOUGLAS | ||||||||||||||
| DIRECTOR/PRESIDENT-REI | $0 | $419,226 | $0 | $37,856 | $0 | $630 | $0 | $14,000 | $0 | $35,723 | $0 | $507,435 | $0 | $0 |
| DAYLE QUIGLEY | ||||||||||||||
| PHYSICIAN | $312,185 | $0 | $0 | $0 | $102,401 | $0 | $14,000 | $0 | $16,234 | $0 | $444,820 | $0 | $0 | $0 |
| PAUL TONKIN | ||||||||||||||
| PHYSICIAN | $401,179 | $0 | $0 | $0 | $120 | $0 | $0 | $0 | $20,496 | $0 | $421,795 | $0 | $0 | $0 |
| LUKE BEIRL | ||||||||||||||
| DIRECTOR/CEO-MSI | $288,505 | $0 | $25,523 | $0 | $201 | $0 | $13,837 | $0 | $36,863 | $0 | $364,929 | $0 | $0 | $0 |
| KENT DUMONSEAU | ||||||||||||||
| CFO - REI | $0 | $256,491 | $0 | $24,001 | $0 | $346 | $0 | $12,819 | $0 | $34,976 | $0 | $328,633 | $0 | $0 |
| MATTHEW VINCENT | ||||||||||||||
| CRNA | $272,381 | $0 | $0 | $0 | $175 | $0 | $12,112 | $0 | $40,572 | $0 | $325,240 | $0 | $0 | $0 |
| JULIE BOE | ||||||||||||||
| CRNA | $254,601 | $0 | $0 | $0 | $445 | $0 | $12,726 | $0 | $38,162 | $0 | $305,934 | $0 | $0 | $0 |
| BRAD ZELLER | ||||||||||||||
| VP SUPPORT SERVICES | $174,406 | $0 | $24,023 | $0 | $211 | $0 | $7,940 | $0 | $37,865 | $0 | $244,445 | $0 | $0 | $0 |
| HEATHER SHEEHAN | ||||||||||||||
| VP SENIOR SERVICES | $171,855 | $0 | $24,023 | $0 | $140 | $0 | $8,883 | $0 | $38,493 | $0 | $243,394 | $0 | $0 | $0 |
| AINDREA LINDSAY | ||||||||||||||
| VP PATIENT CARE | $157,074 | $0 | $0 | $0 | $128 | $0 | $940 | $0 | $38,111 | $0 | $196,253 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4A | FormAndLineReferenceDesc |
| Explanation | FORMER ED MEDICAL DIRECTOR/PHYSICIAN DR. DAYLE QUIGLEY'S EMPLOYMENT ENDED ON OCTOBER 31, 2019. SHE RECEIVED A PAYMENT OF $101,240, LESS WITHHOLDING, IN A LUMP SUM, EQUIVALENT TO 36 12-HOUR SHIFTS AT $195 PER HOUR PLUS $17,000. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| SARAH DUMONSEAU | |||
| FAMILY MEMBER OF OFFICER KENT DUMONSEAU | $116,796 | EMPLOYMENT | 0 |
| HALEY STELLMACHER | |||
| FAMILY MEMBER OF OFFICER LUKE BEIRL | $84,560 | EMPLOYMENT | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | REGIONAL ENTERPRISES, INC. IS THE SOLE CORPORATE MEMBER OF MEDICAL SERVICES, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE PRESIDENT OF REI SHALL BE AN EX OFFICIO MEMBER OF THE MSI BOARD WITH FULL VOTING PRIVILEGES. |
| FORM 990, PART VI, SECTION A, LINE 7B | AS THE SOLE MEMBER OF MEDICAL SERVICES, INC., REGIONAL ENTERPRISES, INC. HAS THE FOLLOWING RESERVE POWERS: A. TO MAKE, AMEND, OR REPEAL MSI'S BYLAWS AND ARTICLES OF INCORPORATION. B. TO APPROVE ANY CHANGE IN MSI'S PHILOSOPHY, MISSION OR VISION STATEMENTS, AND APPROVE THE LONG-RANGE GOALS AND STRATEGIC PLAN FOR MSI. C. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGET. D. TO APPROVE ALL BUILDING PROGRAMS THAT EXCEED $500,000 IN VALUE. E. TO SELECT AND RETAIN AN INDEPENDENT AUDITING FIRM. F. TO APPOVE THE PURCHASE, SALE, LEASE, DISPOSITION, OR ALIENATION OF ANY REAL PROPERTY OWNED BY MSI. ANY SUCH ACTION SHALL BE JOINTLY APPROVED BY THE BOARD OF DIRECTORS OF MEMORIAL MEDICAL CENTER OF ASHLAND, WISCONSIN. G. TO APPROVE ANY PLAN OF DISSOLUTION OR MERGER, CONSOLIDATION, ACQUISITION OR DISPOSITION OF REAL PROPERTY OR RELOCATION OF THE FACILITIES OF MSI. ANY SUCH ACTION SHALL BE JOINTLY APPROVED BY THE BOARD OF DIRECTORS OF MEMORIAL MEDICAL CENTER OF ASHLAND, WISCONSIN. H. TO AUTHORIZE THE PRESIDENT OF REI TO RECOMMEND TO THE BOARD OF MSI, THE INDIVIDUAL WHO WILL SERVE AS THE CHIEF EXECUTIVE OFFICER FOR MSI, SUBJECT TO RATIFICATION BY THE MSI BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FINANCE AND ACCOUNTING TEAM REVIEW THE 990 PRIOR TO FILING TO CONFIRM ACCURACY OF INFORMATION. THE 990 IS REVIEWED BY THE BOARD OF DIRECTORS BEFORE IT IS FILED. IF ANY CHANGES ARE MADE, A FINAL COPY OF THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH DIRECTOR AND OFFICER SHALL DISCLOSE TO THE BOARD OF DIRECTORS, OR TO THE OTHER MEMBERS OF ANY COMMITTEE CONSIDERING A PROPOSED BUSINESS TRANSACTION OR ARRANGEMENT, THE EXISTENCE AND NATURE OF ANY FINANCIAL INTEREST SUCH PERSON OR A MEMBER OF SUCH PERSON'S FAMILY MAY HAVE WITH RESPECT TO SUCH PROPOSED TRANSACTION OR ARRANGEMENT. EACH DIRECTOR AND PRINCIPAL OFFICER SHALL PROMPTLY MAKE DISCLOSURES AS MAY BE NECESSARY TO KEEP THE BOARD OR COMMITTEE FULLY APPRISED OF SUCH PERSON'S FINANCIAL INTERESTS. DISCLOSURE SHALL ALSO BE ACCOMPLISHED ON AN ANNUAL BASIS BY HAVING EACH DIRECTOR AND PRINCIPAL OFFICER EXECUTE AND DELIVER TO MSI A CERTIFICATE REGARDING CONFLICTS OF INTEREST. IF ANY DIRECTOR OR PRINCIPAL OFFICER DISCLOSES A POTENTIAL FINANCIAL INTEREST TO THE BOARD OF DIRECTORS OR ANY COMMITTEE REGARDING A PROPOSED TRANSACTION OR ARRANGEMENT, THE BOARD OR COMMITTEE SHALL FIRST DETERMINE WHETHER THE PROPOSED TRANSACTION OR ARRANGEMENT COULD BE CONSIDERED AN INSIDER TRANSACTION. IF THE BOARD OR COMMITTEE IS CERTAIN THAT THE TRANSACTION OR ARRANGEMENT WILL NOT INVOLVE AN INSIDER, THE INTERESTED PERSON SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE FINANCIAL INTEREST IS DISCUSSED. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. IF IT IS DETERMINED NO CONFLICT EXISTS, THE INTERESTED PERSON MAY REJOIN THE MEETING AND PARTICIPATE IN THE DISCUSSIONS AND ACTIONS REGARDING THIS AGENDA ITEM. THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER MSI CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN MSI'S BEST INTEREST AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO MSI. IF THE BOARD OR COMMITTEE BELIEVES AN ALTERNATE TRANSACTION COULD BE CONSIDERED THAT WOULD BE MORE ADVANTAGEOUS TO MSI, THE CHAIRPERSON OF THE BOARD OR COMMITTEE SHALL APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION. FURTHER ACTION BY THE BOARD OR COMMITTEE SHALL BE TABLED UNTIL SUCH TIME AS THE DISINTERESTED PERSON HAS BEEN ABLE TO REPORT HIS OR HER FINDINGS TO THE APPROPRIATE GOVERNING BODY. THE BOARD OR COMMITTEE SHALL NOT APPROVE ANY TRANSACTION OR ARRANGEMENT THAT IS NOT IN THE BEST INTERESTS OF MSI AND THAT IS NOT FAIR AND REASONABLE TO MSI. ONCE DISCUSSION AND/OR ACTION REGARDING THE AGENDA ITEM RELATING TO THE DIRECTOR'S FINANCIAL INTEREST HAS BEEN COMPLETED, THE INTERESTED PERSON MAY REJOIN THE BOARD OR COMMITTEE MEETING. IF THE TRANSACTION OR ARRANGEMENT INVOLVES OR MAY INVOLVE AN INSIDER, THE BOARD OR COMMITTEE SHALL FOLLOW THE PROCEDURES ABOVE AND THE INSIDER SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE INSIDER TRANSACTION IS DISCUSSED. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE WHETHER THE TRANSACTION OR ARRANGEMENT UNDER CONSIDERATION COULD CONSTITUTE AN INSIDER TRANSACTION. AS PART OF THIS CONSIDERATION, THE BOARD OR COMMITTEE SHALL ALSO CONSIDER WHETHER THEIR ACTION COULD BE CONSTRUED TO BE AN EXCESS BENEFIT TRANSACTION SUBJECT TO INTERMEDIATE SANCTIONS. IN DETERMINING WHETHER A TRANSACTION OR ARRANGEMENT IS AN EXCESS BENEFIT TRANSACTION, THE BOARD OR COMMITTEE CONSIDERING THE TRANSACTION OR ARRANGEMENT SHOULD REVIEW APPROPRIATE DATA AS TO COMPARABILITY (SUCH AS COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS IN THE REGION, NATIONAL COMPENSATION STUDIES, COMPETING OFFERS RECEIVED BY THE INSIDER, ASSET APPRAISALS OR RENTAL ANALYSES BY QUALIFIED APPRAISERS AND OTHER INFORMATION THAT MAY BE OBTAINED ABOUT COMPARABLE AGREEMENTS, PURCHASES, SALES AND LEASES). THE BOARD OR COMMITTEE MAY RELY ON SUCH INFORMATION OR DATA PROVIDED BY MSI'S MANAGEMENT. THE BOARD OR COMMITTEE SHALL NOT APPROVE ANY TRANSACTION OR ARRANGEMENT THAT IS AN EXCESS BENEFIT TRANSACTION. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A DIRECTOR OR PRINCIPAL OFFICER HAS FAILED TO DISCLOSE A FINANCIAL INTEREST, IT SHALL INFORM THE DIRECTOR OR PRINCIPAL OFFICER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE DIRECTOR OR PRINCIPAL OFFICER AN OPPORTUNITY TO EXPLAIN WHY DISCLOSURE WAS NOT MADE. IF, AFTER HEARING THE RESPONSE OF THE DIRECTOR OR PRINCIPAL OFFICER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE DIRECTOR HAS IN FACT FAILED TO DISCLOSE A FINANCIAL INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND/OR CORRECTIVE ACTION, WHICH MAY INCLUDE, BUT NOT BE LIMITED TO: SUSPENSION OF VOTING RIGHTS, RECISION OF ANY AGREEMENTS, AND TERMINATION OF DIRECTOR OR OFFICER STATUS. |
| FORM 990, PART VI, SECTION B, LINE 15 | HR WILL RESEARCH SALARY DATA FOR OUR REGION AND PROVIDE ADMINISTRATION WITH A TYPICAL COMPENSATION RANGE. DIFFICULT POSITIONS TO FILL, DEMANDS OF THE POSITION, EXPERIENCE, EDUCATION, PAST WORK HISTORY, AND REFERENCES ARE ALL TAKEN INTO CONSIDERATION WHEN DETERMINING COMPENSATION. UPDATES TO THE RANGES ARE PUT INTO PLACE AROUND APRIL OR MAY EACH YEAR, IF CHANGES OCCURRED. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE BY REQUEST FROM THE PUBLIC RELATIONS DIRECTOR FOR THE SAME PERIOD OF DISCLOSURE SET FORTH IN SECTION 6104(D). THE GOVERNING DOCUMENTS ARE CONFIDENTIAL AND NOT AVAILABLE TO THE PUBLIC. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MEMORIAL MEDICAL CENTER INC | |||||||||||
| 1615 MAPLE LANE | ASHLAND | WI | 54806 | 237013497 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | REGIONAL ENTERPRISES INC | 0 | |
| REGIONAL ENTERPRISES INC | |||||||||||
| 1615 MAPLE LANE | ASHLAND | WI | 54806 | 391555837 | SUPPORT | WI | 501(C)(3) | LINE 10 | 0 | N/A | |
| REI MEDICAL CLINICS INC | |||||||||||
| 1615 MAPLE LANE | ASHLAND | WI | 54806 | 391701306 | SUPPORT | WI | 501(C)(3) | LINE 12A, I | REGIONAL ENTERPRISES INC | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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