MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC (EIN 39-0944012)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-09-04
- IRS object ID
- 202042489349300524
- 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 O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-09-04T11:42:15-05:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390944012 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOUNDVIEW MEMORIAL HOSPITAL & CLINICS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MOUN | BusinessNameControlTxt |
| Phone | 6083393331 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 402 WEST LAKE STREET | AddressLine1Txt |
| City | FRIENDSHIP | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53934 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | FRANK PEREZ-GUERRA | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6083393331 | PhoneNum |
| Signature | 2020-09-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2020-09-02 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 216.54.158.12 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-09-02 | IPDt |
| IP Tm | 15:35:16 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 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 | GUNDERSEN MOUNDVIEW HOSPITAL AND CLINICS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | FRANK PEREZ-GUERRA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 402 WEST LAKE STREET | AddressLine1Txt |
| City | FRIENDSHIP | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53934 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $18,807,259 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTP://WWW.GUNDERSENHEALTH.ORG/MOUNDVIEW/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1959 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | WE WILL ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES WHILE ENRICHING EVERY LIFE WE TOUCH, INCLUDING PATIENTS, FAMILIES AND STAFF. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 166 | TotalEmployeeCnt |
| Total Volunteers | 60 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $179,418 | PYContributionsGrantsAmt |
| CY Contributions Grants | $104,548 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,037,066 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $18,470,787 | CYProgramServiceRevenueAmt |
| PY Investment Income | $50,264 | PYInvestmentIncomeAmt |
| CY Investment Income | $76,067 | CYInvestmentIncomeAmt |
| PY Other Revenue | $28,028 | PYOtherRevenueAmt |
| CY Other Revenue | $140,327 | CYOtherRevenueAmt |
| PY Total Revenue | $18,294,776 | PYTotalRevenueAmt |
| CY Total Revenue | $18,791,729 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,250 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,686,974 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,952,679 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,110,087 | PYOtherExpensesAmt |
| CY Other Expenses | $9,318,108 | CYOtherExpensesAmt |
| PY Total Expenses | $18,797,061 | PYTotalExpensesAmt |
| CY Total Expenses | $18,272,037 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$502,285 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $519,692 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $14,211,453 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,862,094 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,541,149 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,650,365 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,670,304 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,211,729 | NetAssetsOrFundBalancesEOYAmt |
| Mission | WE WILL DISTINGUISH OURSELVES THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $15,007,847 | ExpenseAmt |
| Grant | $1,250 | GrantAmt |
| Revenue | $18,493,153 | RevenueAmt |
| Desc | THE HOSPITAL IS A GENERAL MEDICAL CRITICAL ACCESS HOSPITAL LICENSED FOR 25 BEDS. DURING FISCAL YEAR 2019, THE HOSPITAL HAD 440 ACUTE INPATIENT DAYS AND 280 MEDICARE SKILL NURSING DAYS (SWING BED). THE HOSPITAL ALSO HAD 6,129 EMERGENCY ROOM / URGENT CARE VISITS. | Desc |
| Total Program Service Expenses | $15,007,847 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 212 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 166 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRANK PEREZ-GUERRA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6083393331 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 402 WEST LAKE STREET | AddressLine1Txt |
| City | FRIENDSHIP | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53934 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| BARBARA ALBRECHT | ||||||||
| BOARD MEMBER (THRU DECEMBER) | 2.50 | Yes (X) | $0 | $0 | $0 | |||
| MICHAEL CUMMINGS | ||||||||
| BOARD MEMBER | 2.50 | Yes (X) | $0 | $0 | $0 | |||
| BRYAN ERDMANN | ||||||||
| BOARD MEMBER | 2.50 | Yes (X) | $0 | $267,981 | $64,725 | |||
| MICHAEL O'NEILL | ||||||||
| BOARD MEMBER (THRU DECEMBER) | 2.50 | Yes (X) | $0 | $183,236 | $47,528 | |||
| ROXANNE POTTS | ||||||||
| BOARD MEMBER | 2.50 | Yes (X) | $0 | $124,384 | $35,652 | |||
| KRAIG SCHUSTER | ||||||||
| BOARD MEMBER | 2.50 | Yes (X) | $0 | $0 | $0 | |||
| RICHARD STERNHAGEN | ||||||||
| CHAIR | 2.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| PAUL FISCH | ||||||||
| VICE-CHAIR | 2.50 | Yes (X) | $0 | $108,816 | $37,498 | Yes (X) | ||
| SARAH ROSSMAN | ||||||||
| SECRETARY | 2.50 | Yes (X) | $0 | $120,590 | $22,454 | Yes (X) | ||
| RENEE SCHINDLBECK | ||||||||
| TREASURER | 2.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| FRANK PEREZ GUERRA | ||||||||
| CEO | 40.00 | $0 | $171,861 | $13,054 | Yes (X) | 1.00 | ||
| SHERYL OBERNBERGER | ||||||||
| NURSE PRACTITIONER | 40.00 | $167,651 | $0 | $37,396 | Yes (X) | |||
| DIANA BRONIEC | ||||||||
| DIRECTOR | 40.00 | $141,670 | $0 | $7,430 | Yes (X) | |||
| BRONWYN DILLEY | ||||||||
| NURSE PRACTITIONER | 40.00 | $145,388 | $0 | $28,066 | Yes (X) | |||
| LINDA CHARLES | ||||||||
| NURSE PRACTITIONER | 40.00 | $128,469 | $0 | $18,900 | Yes (X) | |||
| JUDY NOWICKI | ||||||||
| DIRECTOR | 40.00 | $116,257 | $0 | $17,623 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $699,435 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $976,868 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $330,326 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | 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 |
|---|---|---|---|---|---|
| EMCARE PHYSICIAN SERVICES INC | |||||
| 7032 COLLECTION CENTER DRIVE | CHICAGO | IL | 60693 | ER PHYSICIAN COVERAGE | $2,122,041 |
| GUNDERSEN HEALTH SYSTEM | |||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | ADMINISTRATIVE AND CLINICAL SERVICES | $1,495,821 |
| TOTALMED STAFFING INC | |||||
| 221 W COLLEGE AVE - FLOOR 2 | APPLETON | WI | 549115759 | CONTRACT NURSING SERVICES | $283,596 |
| FIRST REFLECTIONS INC | |||||
| 228 N PINE STREET | ADAMS | WI | 53910 | CRNA SERVICES | $217,878 |
| SHARED IMAGING SERVICES | |||||
| PO BOX 88450 | MILWAUKEE | WI | 532880450 | NUCLEAR MEDICINE/EKG TESTING SERVICES | $145,022 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 17 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $75,766 | RelatedOrganizationsAmt |
| Government Grants | $15,360 | GovernmentGrantsAmt |
| All Other Contributions | $13,422 | AllOtherContributionsAmt |
| Total Contributions | $104,548 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621300 | $18,390,267 | $18,390,267 |
| MEDICAL BUILDING RENT | 531120 | $68,772 | $68,772 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,748 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,748 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $18,470,787 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $72,303 | TotalRevenueColumnAmt |
| Exclusion | $72,303 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $23,764 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $15,530 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $8,234 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,234 | TotalRevenueColumnAmt |
| Exclusion | $8,234 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,764 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,764 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,764 | TotalRevenueColumnAmt |
| Exclusion | $3,764 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | E.H.R INCENTIVE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $22,366 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $22,366 | RelatedOrExemptFuncIncomeAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $109,727 | TotalRevenueColumnAmt |
| Exclusion | $109,727 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $132,093 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,791,729 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,493,153 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $194,028 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,250 | TotalAmt |
| Program Services | $1,250 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $184,915 | TotalAmt |
| Management And General | $184,915 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,913,248 | TotalAmt |
| Program Services | $5,647,276 | ProgramServicesAmt |
| Management And General | $1,265,972 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $133,875 | TotalAmt |
| Program Services | $108,861 | ProgramServicesAmt |
| Management And General | $25,014 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,203,228 | TotalAmt |
| Program Services | $910,730 | ProgramServicesAmt |
| Management And General | $292,498 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $517,413 | TotalAmt |
| Program Services | $413,602 | ProgramServicesAmt |
| Management And General | $103,811 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,323 | TotalAmt |
| Management And General | $31,323 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,300 | TotalAmt |
| Management And General | $49,300 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,832,752 | TotalAmt |
| Program Services | $4,156,563 | ProgramServicesAmt |
| Management And General | $676,189 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,642 | TotalAmt |
| Program Services | $850 | ProgramServicesAmt |
| Management And General | $65,792 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $523,107 | TotalAmt |
| Program Services | $397,410 | ProgramServicesAmt |
| Management And General | $125,697 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $651 | TotalAmt |
| Program Services | $651 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $304,218 | TotalAmt |
| Program Services | $269,355 | ProgramServicesAmt |
| Management And General | $34,863 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,095 | TotalAmt |
| Program Services | $25,555 | ProgramServicesAmt |
| Management And General | $10,540 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,850 | TotalAmt |
| Program Services | $29,375 | ProgramServicesAmt |
| Management And General | $16,475 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $153,633 | TotalAmt |
| Program Services | $137,755 | ProgramServicesAmt |
| Management And General | $15,878 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $749,259 | TotalAmt |
| Program Services | $662,336 | ProgramServicesAmt |
| Management And General | $86,923 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,059 | TotalAmt |
| Management And General | $50,059 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $1,072,009 | $1,072,009 | |
| MEDICAL SUPPLIES | $911,094 | $910,596 | $498 |
| REPAIRS & MAINTENANCE | $281,796 | $238,875 | $42,921 |
| COLLECTION EXPENSE | $118,550 | $118,550 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,770 | TotalAmt |
| Program Services | $24,798 | ProgramServicesAmt |
| Management And General | $66,972 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,272,037 | TotalAmt |
| Program Services | $15,007,847 | ProgramServicesAmt |
| Management And General | $3,264,190 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $700 | BOYAmt |
| EOY | $700 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,699,910 | BOYAmt |
| EOY | $2,954,609 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,016,239 | BOYAmt |
| EOY | $2,237,422 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $279,249 | BOYAmt |
| EOY | $241,475 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,744 | BOYAmt |
| EOY | $214,447 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $7,488,616 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,403,285 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,362,175 | BOYAmt |
| EOY | $6,085,331 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,800,436 | BOYAmt |
| EOY | $1,128,110 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,211,453 | BOYAmt |
| EOY | $12,862,094 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,545,124 | BOYAmt |
| EOY | $1,749,773 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,250 | BOYAmt |
| EOY | $3,090 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,099,561 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $871,214 | BOYAmt |
| EOY | $1,866,561 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $30,941 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,541,149 | BOYAmt |
| EOY | $3,650,365 | 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 | $8,139,868 | BOYAmt |
| EOY | $8,659,560 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $530,436 | BOYAmt |
| EOY | $552,169 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,670,304 | BOYAmt |
| EOY | $9,211,729 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,211,453 | BOYAmt |
| EOY | $12,862,094 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $519,692 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $21,733 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $1,492 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,492 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | MOUNDVIEW MEMORIAL HOSPITAL & CLINICS PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE WHA HAS NOTIFIED MOUNDVIEW MEMORIAL HOSPITAL & CLINICS THAT $1,492 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $76,500 | OtherCostOrOtherBasisAmt |
| Book Value | $76,500 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,145,928 | OtherCostOrOtherBasisAmt |
| Depreciation | $515,291 | DepreciationAmt |
| Book Value | $4,630,637 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,822,239 | OtherCostOrOtherBasisAmt |
| Depreciation | $629,837 | DepreciationAmt |
| Book Value | $1,192,402 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $443,949 | OtherCostOrOtherBasisAmt |
| Depreciation | $258,157 | DepreciationAmt |
| Book Value | $185,792 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,085,331 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| RIGHT-OF-USE ASSETS - OPERATING LEASES | $30,941 |
| RECEIVABLE FROM THIRD PARTY PAYORS | $545,000 |
| RECEIVABLE FROM POLIVKA TRUST | $552,169 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,128,110 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OPERATING LEASE LIABILITIES | Desc |
| Amt | $30,941 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $30,941 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $53,374 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $53,374 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,828,895 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,695,414 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,133,481 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06200 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,882,269 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,695,414 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,186,855 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06490 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $186,327 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,420 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $170,907 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00940 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,845 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,845 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,746,278 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,310,324 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,435,954 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.18800 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,946,450 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,325,744 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,620,706 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.19820 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,828,719 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,021,158 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,807,561 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.26310 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $460,964 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $36,877 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,926,938 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,966,844 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$39,906 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOUNDVIEW MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 402 WEST LAKE STREET | AddressLine1Txt |
| City | FRIENDSHIP | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53934 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTPS://WWW.GUNDERSENHEALTH.ORG/MOUNDV | WebsiteAddressTxt |
| State License | 1014 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOUNDVIEW MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 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 SUPPLEMENTAL INFO | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SUPPLEMENTAL INFO | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE SUPPLEMENTAL INFORMATION | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE SUPPLEMENTAL INFORMATION | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE SUPPLEMENTAL INFORMATION | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MOUNDVIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: THE HOSPITAL COLLABORATED WITH THE ADAMS COUNTY PUBLIC HEALTH, UW EXTENSION, ADAMS COUNTY GOVERNMENT, ADAMS-FRIENDSHIP SCHOOL DISTRICT AND COMMUNITY MEMBERS TO CREATE AND CONDUCT A HEALTH SURVEY OF THE GENERAL PUBLIC IN MARCH 2016. THERE WERE 602 RESPONDENTS, MAKING IT A STATISTICALLY SIGNIFICANT SAMPLE OF THE COUNTY. THE SURVEY WAS WIDELY DISTRIBUTED VIA A SURVEY LINK SHARED THROUGH ORGANIZATION EMAIL LISTS, ORGANIZATION FACEBOOK PAGES, AREA NEWSLETTERS, NEWSPAPER AND RADIO. INDIVIDUALS WERE LIMITED TO ONE SURVEY PER EMAIL ADDRESS. PAPER SURVEYS WERE DISTRIBUTED THROUGH FOOD PANTRIES, LIBRARY, MEALS ON WHEELS, SENIOR MEAL SITES AND THE LIGHTED SCHOOL HOUSE PROGRAM TO OBTAIN INPUT FROM THOSE WITHOUT COMPUTERS AND OTHER DIFFICULT TO REACH POPULATIONS. SURVEY RESPONDENTS WERE ASKED TO RANK ISSUES THAT MAY IMPACT THEIR COMMUNITY'S HEALTH ON A SEVEN POINT SCALE AND TO NAME THEIR TOP TWO HEALTH CONCERNS. A SIMILAR SURVEY WAS DISTRIBUTED VIA EMAIL TO 43 COMMUNITY STAKEHOLDERS WHO WERE IDENTIFIED AS HAVING A BROAD, VESTED INTEREST IN THE COMMUNITY. THESE INCLUDED MEDICAL PROVIDERS AND PROFESSIONALS, SERVICE AGENCIES (INCLUDING THOSE REPRESENTING LOW INCOME AND DISABILITY POPULATIONS), SCHOOL LEADERS, COUNTY GOVERNMENT, BUSINESS LEADERS AND OTHER OFFICIALS. COMMUNITY STAKEHOLDER AND PATIENT ADVISORY COUNCIL FOCUS GROUPS WERE HELD IN 2018 TO REVIEW AND PRIORITIZE SEVEN IDENTIFIED NEEDS. |
| MOUNDVIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: WHILE THE NEEDS ASSESSMENT IS SPECIFIC TO GUNDERSEN MOUNDVIEW, THE HOSPITAL COLLABORATED WITH OTHER ORGANIZATIONS IN OBTAINING AND ANALYZING DATA INCLUDING ADAMS COUNTY HEALTH PUBLIC HEALTH AND THE BE HEALTHY ADAMS COUNTY COALITION WHICH INCLUDED REPRESENTATIVES FROM ADAMS COUNTY HEALTH AND HUMAN SERVICES, ADAMS COUNTY UW EXTENSION, ADAMS COUNTY GOVERNMENT, ADAMS-FRIENDSHIP SCHOOL DISTRIC AND COMMUNITY MEMBERS AT LARGE. |
| MOUNDVIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: GUNDERSEN MOUNDVIEW CONTINUES TO ADDRESS IDENTIFIED HEALTH NEEDS THROUGH OUR IMPLEMENTATION PLAN. "CHRONIC DISEASE AND CONDITIONS" ARE ADDRESSED BY OUR PARTICIPATION IN VARIOUS COALITIONS AND EVENTS. SOME EXAMPLES INCLUDE: BE HEALTHY ADAMS COUNTY COALITIONS - WHICH ESTABLISHES INITIATIVES TO INCREASE AND IMPROVE PHYSICAL ACTIVITY AND NUTRITION, SPONSORSHIP OF AREA FARM MARKETS TO IMPROVE ACCESS TO FRUITS/VEGETABLES, PARTICIPATING ON THE YMCA STEERING COMMITTEE WHICH IS WORKING ON THE ESTABLISHMENT OF A SATELLITE YMCA IN OUR COUNTY, ADAMS COUNTY CANCER AWARENESS TEAM PROMOTING AWARENESS OF CANCER AND RELATED SCREENINGS, AND SPONSORSHIP/PARTICIPATION IN ADAMS COUNTY SUICIDE AWARENESS COALITION. WE HAVE INCREASED OUR NUMBER OF MENTORS IN THE ELEMENTARY SCHOOL BY 45% (FROM 20 TO 29 MENTORS) OVER THE PRIOR YEAR. MENTORS HELP BUILD YOUTH RESILIENCY BY MITIGATING THE IMPACT OF ADVERSE CHILDHOOD EXPERIENCES. WE IMPLEMENTED SAFE SITTER AND HOME ALONE CLASSES TO ASSIST FAMILIES WHOSE CHILDREN ARE HOME ALONE WHILE PARENTS ARE WORKING. WE ARE IN THE PLANNING STAGES OF IMPLEMENTING A GRIEF SUPPORT GROUP - A NEED THAT WAS IDENTIFIED THROUGH COLLABORATIVE WORK WITH THE AGING DEPARTMENT. WE CONTINUE TO ADDRESS "SUBSTANCE ABUSE" THROUGH OUR SUPPORT/COLLABORATION WITH FAMILY HEALTH LA CLINICA ROCHE-A-CRI BEHAVIORAL HEALTH AND RECOVERY CENTER WHICH INCLUDES SERVING ON THEIR COMMITTEE. WE CONTINUE TO SERVE ON THE DRUG FREE COALITION AND PROMOTE DRUG TAKE BACK EVENTS. WE PROVIDE LAB SUPPORT (OVER 542 DRUG COLLECTIONS IN 2019 ALONE) TO THE COUNTY DRUG TREATMENT COURT. HEALTH CARE COST AND ACCESS" IS CONTINUALLY ADDRESSED. SEVERAL NEW SPECIALTY PROVIDERS WERE ADDED IN 2019 AND ARE NOW SEEING PATIENTS LOCALLY. WE RECRUITED A NEW NURSE PRACTITIONER TO PRIMARY CARE. THERE REMAINS A NEED TO CONTINUE RECRUITMENT IN BOTH AREAS. THROUGH SHARED RESOURCES VIA OUR AFFILIATION WITH GUNDERSEN, WE CONTINUE TO SEE COST SAVINGS THROUGHOUT OUR ORGANIZATION. WORKFORCE DEVELOPMENT" HAS BEEN ADDRESSED BY PARTICIPATING ON THE COUNTY ECONOMIC DEVELOPMENT COUNCIL, CHAMBER OF COMMERCE BOARD AND THE NEW UNIVERCITY ALLIANCE COALITION. WE PROVIDED CLINICAL ROTATIONS/INTERNSHIP OPPORTUNITIES TO 15 STUDENTS IN 2019. WE CONTINUE TO PROVIDE EDUCATION AND TUITION REIMBURSEMENT PROGRAMS FOR OUR STAFF. |
| MOUNDVIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 13H: HOSPITAL PATIENTS NOT MEETING FINANCIAL ASSISTANCE ELIGIBILITY THRESHOLDS MAY BE ELIGIBLE FOR ASSISTANCE UNDER CIRCUMSTANCES WHEN HOSPITAL MEDICAL BILLS WOULD RESULT IN SEVERE FINANCIAL HARDSHIP. PATIENTS, OR THEIR GUARANTORS, MAY BE ELIGIBLE FOR CATASTROPHIC CARE ASSISTANCE IF THEY HAVE INCURRED OUT-OF-POCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GMV THAT EXCEED 25% OF FAMILY INCOME AND HAVE ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL THRESHOLD. |
| PART V, LINE 16A, 16B, 16C | PART V, LINE 16A, FAP WEBSITE:HTTPS://WWW.GUNDERSENHEALTH.ORG/APP/FILES/PUBLIC/8939/FINANCIAL-ASSISTANCE-MOUNDVIEW-FAP-FINANCIAL-ASSISTANCE-POLICY.PDFPART V, LINE 16B, FAP APPLICATION WEBSITE:HTTPS://WWW.GUNDERSENHEALTH.ORG/APP/FILES/PUBLIC/8946/FINANCIAL-ASSISTANCE-ALL-LOCATIONS-FINANCIAL-ASSISTANCE-APPLICATION-ENGLISH.PDFPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.GUNDERSENHEALTH.ORG/APP/FILES/PUBLIC/8936/FINANCIAL-ASSISTANCE-MOUNDVIEW-PLAIN-LANGUAGE-SUMMARY.PDF |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - GUNDERSEN FRIENDSHIP CLINIC | ||||
| 402 WEST LAKE STREET | FRIENDSHIP | WI | 53934 | RURAL HEALTH CLINIC |
| 2 - GUNDERSEN WESTFIELD CLINIC | ||||
| 207 NORTH PIONEER PARK ROAD | WESTFIELD | WI | 53964 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE RATIO OF PATIENT COST TO CHARGES WAS CALCULATED BY DIVIDING HOSPITAL EXPENSES NET OF NON-PATIENT REVENUE AND IDENTIFIED COMMUNITY BENEFIT EXPENSE BY GROSS PATIENT REVENUE. |
| PART I, LINE 7G: | THE ORGANIZATION OPERATES 2 RURAL HEALTH CLINICS, AN OBSERVATION ROOM AND EMERGENCY ROOM WHERE THE COSTS EXCEED THE NET PATIENT SERVICE REVENUE. THESE SERVICES WOULD NOT BE PROVIDED TO THE COMMUNITY IF NOT FOR THE LEADERSHIP OF THE HOSPITAL. THE ORGANIZATION UTILIZED THEIR COST REPORT AND OTHER INTERNAL INFORMATION TO DETERMINE THE AMOUNTS TO BE RECORDED PER WORKSHEET 6 OF THE IRS FORM SCHEDULE H INSTRUCTIONS. AMOUNTS RECORDED HERE HAVE NOT BEEN DUPLICATED IN OTHER AREAS OF THE FORM, MEDICAID, BAD DEBT, FINANCIAL ASSISTANCE HAS BEEN REMOVED FROM THE AMOUNTS REPORTED AND THESE SERVICES WERE EXCLUDED FROM THE MEDICARE SURPLUS/SHORTFALL CALCULATION. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THE HOSPITAL'S COMMUNITY BUILDING ACTIVITIES PROMOTES HEALTH OF THE COMMUNITIES IT SERVES THROUGH LOCAL ADVERTISEMENTS, INVOLVEMENT WITH CHAMBER OF COMMERCE, DEPARTMENT OF AGING AND OTHER COMMUNITY ORGANIZATIONS. THE AMOUNT OF SUPPORT IS DIFFICULT TO QUANTIFY. |
| PART III, LINE 2: | THE RATIO OF PATIENT COST TO CHARGES WAS CALCULATED BY DIVIDING HOSPITAL EXPENSES NET OF NON-PATIENT REVENUE AND IDENTIFIED COMMUNITY BENEFIT EXPENSE BY GROSS PATIENT REVENUE. THE PERCENTAGE WAS THEN MULTIPLIED BY THE GROSS REVENUES ON BAD DEBT ACCOUNTS. |
| PART III, LINE 3: | IT IS CONSIDERED COMMUNITY BENEFIT AS THE HOSPITAL IS REIMBURSED ON MEDICARE ALLOWABLE COSTS. MEDICARE ALLOWABLE COSTS ARE DEFINED BY MEDICARE. THEY DO NOT NECESSARILY CAPTURE ALL COSTS OF THE HOSPITAL PROVIDING SERVICES TO THE COMMUNITY. CONSEQUENTLY, THERE ARE COSTS NOT REIMBURSED BY EITHER PATIENT OR THE PROGRAM. |
| PART III, LINE 4: | PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, THAT REFLECTS MANAGEMENT'S BEST ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS PATIENT SERVICE REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND CURRENT STATUS OF INDIVIDUAL ACCOUNTS.IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. |
| PART III, LINE 8: | IT IS CONSIDERED COMMUNITY BENEFIT AS THE HOSPITAL IS REIMBURSED ON MEDICARE ALLOWABLE COSTS. MEDICARE ALLOWABLE COSTS ARE DEFINED BY MEDICARE. THEY DO NOT NECESSARILY CAPTURE ALL COSTS OF THE HOSPITAL PROVIDING SERVICES TO THE COMMUNITY. CONSEQUENTLY, THERE ARE COSTS NOT REIMBURSED BY EITHER PATIENT OR THE PROGRAM. THE COST METHODOLOGY USED TO DETERMINE MEDICARE ALLOWABLE COSTS IS A STEP-DOWN ALLOCATION OF COSTS FROM NON-REVENUE AREAS TO REVENUE AREAS. THIS ALLOCATION IS DONE FOLLOWING MEDICARE RULES AND REGULATIONS. |
| PART III, LINE 9B: | PATIENTS UPON REGISTRATION ARE GIVEN THE POLICY AND REQUIREMENTS TO BE ELIGIBLE FOR CHARITY CARE. THEY ARE ENCOURAGED BY A FINANCIAL ADVISOR TO REVIEW THEIR SITUATION FOR ELIGIBILITY. |
| PART VI, LINE 2: | THE HOSPITAL COLLECTS, REVIEWS AND ANALYZES LOCAL, REGIONAL AND STATE DATA SOURCES IN CONJUNCTION WITH THE LOCAL PUBLIC HEALTH DEPARTMENT TO ASSESS SPECIFIC UNMET COMMUNITY NEEDS. THIS DATA INCLUDES SURVEYS OF THE GENERAL COMMUNITY AS WELL AS COMMUNITY STAKEHOLDERS WITH A BROAD, VESTED INTEREST IN THE COMMUNITY. IT ALSO INCLUDES TWO FOCUS GROUP SESSIONS OF COMMUNITY STAKEHOLDERS AND THE HOSPITAL'S PATIENT ADVISORY COUNCIL TO REVIEW AND HELP PRIORITIZE HEALTH NEEDS. THE HOSPITAL ANNUALLY REVIEWS THE COUNTY HEALTH RANKINGS AS WELL AS INFECTION CONTROL/COMMUNICABLE DISEASE REPORTS WITH THE PUBLIC HEALTH OFFICE. |
| PART VI, LINE 3: | THE HOSPITAL ANNUALLY UPDATES THE AVAILABILITY OF ITS CHARITY PLAN AND QUALIFYING INCOME NEEDS TO QUALIFY ON THE HOSPITAL WEBSITE. THE EXISTENCE OF A CHARITY PLAN IS POSTED IN THE ADMITTING AREA. UPON REGISTRATION, THE PATIENT IS INFORMED OF THE HOSPITAL'S CHARITY PLAN, ELIGIBILITY AND METHODS FOR APPLYING. ANYONE INTERESTED IN FURTHER INFORMATION IS REFERRED TO THE PATIENT ACCOUNT COORDINATOR FOR QUESTIONS AND ELIGIBILITY. THIS PERSON WORKS WITH THE PATIENT IN APPLICATION AS WELL AS EXPLORING THE POSSIBLE ELIGIBILITY OF ANY OTHER GOVERNMENT PROGRAM THAT MAY BE APPLICABLE. IE MEDICAID, BADGER CARE. |
| PART VI, LINE 4: | THE ORGANIZATION SERVES ALL OF ADAMS COUNTY WISCONSIN (POPULATION APPROXIMATELY 19,973). ITS PRIMARY SERVICE AREA IS WITHIN THE CENTER OF THE COUNTY, BORDERED BY HWY 82 SOUTH, COUNTY C NORTH. THE COUNTY'S POVERTY RATE IS 13.9% HIGHER THAN THE STATE AVERAGE. OVER 70% OF STUDENTS ENROLLED IN THE SCHOOL DISTRICT ARE ELIGIBLE FOR FREE LUNCH. THE PERCENTAGE OF THOSE AGED 65 YEARS AND OVER IS 28% IS SIGNIFICANTLY HIGHER THAN THE STATE AND IS PROJECTED TO STEADILY INCREASE TO GREATER THAN 35% BY 2040. THERE IS A LOWER LEVEL OF COLLEGE EDUCATED RESIDENTS THAN STATE AVERAGES. |
| PART VI, LINE 5: | THE HOSPITAL WORKS WITH LOCAL PUBLIC HEALTH AND COMMUNITY SERVICE ORGANIZATIONS TO COORDINATE AND/OR PROVIDE SPONSORSHIP FUNDS TO SUPPORT COMMUNITY HEALTH PROGRAMS TO MEET THE NEEDS OF THE LOCAL COMMUNITY. THE HOSPITAL PROVIDES INKIND SUPPORT INCLUDING THE USE OF OUR MEETING ROOMS BY NONPROFIT GROUPS, DONATION OF EQUIPMENT/FURNITURE TO HABITAT FOR HUMANITY AND STAFF WHO SERVE ON NUMEROUS COMMUNITY COALITIONS AND HEALTH BOARDS. THE HOSPITAL BOARD INCLUDES COMMUNITY MEMBERS WHO ARE UNPAID. THE HOSPITAL ALSO PROVIDES SPONSORSHIPS OF EVENTS/PROGRAMS THAT HAVE HEALTH/WELLNESS EDUCATION BUILT INTO THEM. |
| PART VI, LINE 6: | THE ORGANIZATION IS PART OF GUNDERSEN HEALTH SYSTEM. EACH AFFILIATE DEVELOPS ITS OWN NEEDS ASSESSMENT AND IMPLEMENTATION PLAN, WITH SUPPORT FROM THE SYSTEM AS NEEDED. THE SYSTEM HOLDS QUARTERLY COMMUNITY BENEFIT MEETINGS AMONG THE AFFILIATES TO REVIEW PROGRESS ON GOALS. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRYAN ERDMANN | ||||||||||||||
| BOARD MEMBER | $0 | $265,097 | $0 | $500 | $0 | $2,384 | $0 | $39,331 | $0 | $25,394 | $0 | $332,706 | $0 | $0 |
| MICHAEL O'NEILL | ||||||||||||||
| BOARD MEMBER (THRU DECEMBER) | $0 | $180,943 | $0 | $500 | $0 | $1,793 | $0 | $26,732 | $0 | $20,796 | $0 | $230,764 | $0 | $0 |
| ROXANNE POTTS | ||||||||||||||
| BOARD MEMBER | $0 | $119,311 | $0 | $0 | $0 | $5,073 | $0 | $15,891 | $0 | $19,761 | $0 | $160,036 | $0 | $0 |
| FRANK PEREZ GUERRA | ||||||||||||||
| CEO | $0 | $168,946 | $0 | $500 | $0 | $2,415 | $0 | $7,000 | $0 | $6,054 | $0 | $184,915 | $0 | $0 |
| SHERYL OBERNBERGER | ||||||||||||||
| NURSE PRACTITIONER | $137,840 | $0 | $28,779 | $0 | $1,032 | $0 | $5,274 | $0 | $32,122 | $0 | $205,047 | $0 | $0 | $0 |
| BRONWYN DILLEY | ||||||||||||||
| NURSE PRACTITIONER | $127,795 | $0 | $8,072 | $0 | $9,521 | $0 | $4,130 | $0 | $23,936 | $0 | $173,454 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | ANY PERSON OVER THE AGE OF EIGHTEEN YEARS WHO IS A RESIDENT OF ADAMS COUNTY MAY BE A MEMBER OF THE CORPORATION. MEMBERSHIP MAY BE ATTAINED BY ANY SUCH PERSON WHO SHALL AGREE IN WRITING TO BECOME A MEMBER OF THIS CORPORATION BY SUBSCRIBING TO A MEMBERSHIP LIST OF SAID CORPORATION. ANNUAL MEMBERSHIPS WILL BE IN EFFECT FROM JULY 1ST TO JUNE 30TH OF EACH FISCAL YEAR. |
| FORM 990, PART VI, SECTION A, LINE 7A | EACH PERSON WHO WAS A MEMBER IN GOOD STANDING AS OF THE PREVIOUS JUNE 30TH IS ENTITLED TO ONE VOTE FOR EACH SEAT OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | MEMBERS OF THE ORGANIZATION MUST APPROVE BYLAW CHANGES. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 IS REVIEWED BY THE CEO PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY IS REVIEWED EVERY YEAR BY THE POLICY AND PROCEDURE COMMITTEE AND BY THE CEO. OFFICERS AND DIRECTORS ARE REQUIRED TO REVIEW THE POLICY AND DISCLOSE CONFLICTS. THE CEO REVIEWS THE SIGNED STATEMENTS. IF THERE IS A CONFLICT, THE CONFLICT WOULD BE DECLARED AND THE MEMBER WOULD ABSTAIN FROM VOTING. |
| FORM 990, PART VI, SECTION B, LINE 15A | CEO COMPENSATION IS BASED ON DIRECT NEGOTIATIONS BETWEEN THE BOARD MEMBERS WITHOUT CONFLICT AND THE INDIVIDUAL UTILIZING CURRENT RELEVANT MARKET SURVEYS AS A GUIDE WITH THE LANGUAGE OF CONTRACT GIVEN TO MMHC ATTORNEYS FOR REVIEW AND COMMENTS. SUBSEQUENT MODIFICATIONS ARE PERFORMANCE BASED AND MARKET DRIVEN. FOR OTHER OFFICERS AND KEY EMPLOYEES, THE CEO DETERMINES SALARY BASED ON THE MARKET, EXPERIENCE AND INDUSTRY SURVEY GUIDES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION BELIEVES THE GOVERNING DOCUMENTS, AND POLICIES ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. THE AUDITED FINANCIAL STATEMENTS ARE NOW REQUIRED TO BE ATTACHED TO FORM 990. AUDITED FINANCIAL INFORMATION IS POSTED ANNUALLY ON THE HOSPITAL'S WEBSITE. |
| FORM 990, PART IX, LINE 11G | EMERGENCY ROOM SERVICE FEES: PROGRAM SERVICE EXPENSES 1,874,940. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,874,940. ANESTHESIA SERVICE FEES: PROGRAM SERVICE EXPENSES 224,278. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 224,278. LABORATORY SERVICE FEES: PROGRAM SERVICE EXPENSES 331,333. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 331,333. PHARMACY SERVICE FEES: PROGRAM SERVICE EXPENSES 49,557. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,557. FAMILY MEDICINE SERVICE FEES: PROGRAM SERVICE EXPENSES 609,823. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 609,823. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,066,632. MANAGEMENT AND GENERAL EXPENSES 676,189. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,742,821. |
| FORM 990, PART XI, LINE 9: | CHANGE IN ASSETS HELD IN POLIVKA TRUST 21,733. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (22 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391866425 | SUPPORTING ORG | WI | 501(C)(3) | LINE 12B, II | N/A | 0 | |
| GUNDERSEN LUTHERAN MEDICAL CENTER INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 390813416 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM | |
| GUNDERSEN CLINIC LTD | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391028657 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM | |
| GUNDERSEN LUTHERAN ADMINISTRATIVE SVC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391606449 | SUPPORTING ORG | WI | 501(C)(3) | LINE 12B, II | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM | |
| GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391249705 | FOUNDATION | WI | 501(C)(3) | LINE 7 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM | |
| GUNDERSEN LUTHERAN CREDENTIALING SVC INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391856898 | CREDENTIALING | WI | 501(C)(3) | LINE 12C, III-FI | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM | |
| TRI-COUNTY MEMORIAL HOSPITAL | |||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 390704510 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM | |
| HARMONY COMMUNITY HEALTHCARE INC | |||||||||||
| 815 MAIN AVENUE | SOUTH HARMONY | MN | 55939 | 410711606 | HEALTHCARE | MN | 501(C)(3) | LINE 10 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM | |
| TWEETEN LUTHERAN HEALTHCARE CENTER INC | |||||||||||
| 125 FIFTH AVENUE SE | SPRING GROVE | MN | 55974 | 411565003 | HEALTHCARE | WI | 501(C)(3) | LINE 10 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM | |
| TRI-STATE AMBULANCE INC | |||||||||||
| 235 CAUSEWAY BOULEVARD | LA CROSSE | WI | 54603 | 391965415 | MEDICAL TRANSPORT | WI | 501(C)(3) | LINE 10 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM | |
| TRI-STATE REGIONAL AMBULANCE INC | |||||||||||
| 235 CAUSEWAY BOULEVARD | LA CROSSE | WI | 54603 | 391962965 | MEDICAL TRANSPORT | WI | 501(C)(3) | LINE 10 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM | |
| LUTHERAN REAL ESTATE HOLDING CORP | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391480826 | HOUSING | WI | 501(C)(3) | LINE 12C, III-FI | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM | |
| COMMUNITY HOUSING OF LA CROSSE INC | |||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391586700 | INDEPENDENT LIVING | WI | 501(C)(3) | LINE 10 | Yes (1) | LUTHERAN REAL ESTATE HOLDING CORP | |
| LUTHERAN HOUSING OF LA CROSSE | |||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391751934 | INDEPENDENT LIVING | WI | 501(C)(3) | LINE 10 | Yes (1) | LUTHERAN REAL ESTATE HOLDING CORP | |
| ST JOSEPH'S HEALTH SERVICES INC | |||||||||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | 390929538 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM | |
| ST JOSEPH'S MEMORIAL FOUNDATION INC | |||||||||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | 391455787 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | Yes (1) | ST JOSEPH'S HEALTH SERVICES | |
| TRI-COUNTY MEMORIAL FOUNDATION INC | |||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 300093022 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | Yes (1) | TRI-COUNTY MEMORIAL HOSPITAL | |
| MEMORIAL HOSPITAL OF BOSCOBEL | |||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 53805 | 390845590 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSENT LUTHERAN HEALTH SYSTEM | |
| MEMORIAL HOSPITAL OF BOSCOBEL FOUNDATION | |||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 53805 | 391688793 | FUNDRAISING | WI | 501(C)(3) | LINE 7 | Yes (1) | MEMORIAL HOSPITAL OF BOSCOBEL | |
| PALMER LUTHERAN HEALTH CENTER INC | |||||||||||
| 112 JEFFERSON STREET | WEST UNION | IA | 52175 | 421320763 | HEALTHCARE | IA | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEM | |
| PALMER MEMORIAL FOUNDATION | |||||||||||
| 112 JEFFERSON STREET | WEST UNION | IA | 52175 | 421032878 | FOUNDATION | IA | 501(C)(3) | LINE 7 | Yes (1) | PALMER LUTHERAN HEALTH CENTER | |
| MEMORIAL HEALTHCARE FOUNDATION OF ADAMS COUNTY INC | |||||||||||
| PO BOX 40 | FRIENDSHIP | WI | 53934 | 391775074 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | Yes (1) | MOUNDVIEW MEMORIAL HOSPITALS AND CLINICS | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| DEGEN BERGLUND INC | |||||||||
| 1709 LOSEY BOULEVARD SOUTH | LA CROSSE | WI | 54601 | 390971110 | RETAIL PHARMACY | WI | N/A | C | Yes (1) |
| GUNDERSEN LUTHERAN ENVISION LLC | |||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 264706546 | RENEWABLE ENERGY | WI | N/A | C | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |