FURP.ORG / PUBLIC DATA EXPLORER

LADD MEMORIAL HOSPITAL: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
LADD MEMORIAL HOSPITAL (EIN 39-0773970)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-08-03
IRS object ID
201832159349300018
Schema version
2017v2.3
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 ReturnHeader

FieldValueIRS element (for citing)
Return2018-08-03T09:23:56-05:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN390758449PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line14890 OWEN AYRES COURT SUITE 200AddressLine1Txt
CityEAU CLAIRECityNm
State AbbreviationWIStateAbbreviationCd
ZIP54701ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN390773970EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1LADD MEMORIAL HOSPITAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlLADDBusinessNameControlTxt
Phone7152942111PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12600 65TH AVENUE PO BOX 218AddressLine1Txt
CityOSCEOLACityNm
State AbbreviationWIStateAbbreviationCd
ZIP54020ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMICHAEL DEFOEPersonNm
Person TitleCFOPersonTitleTxt
Phone7152944519PhoneNum
Signature2018-08-02SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonHOLLY POKRANDT CPAPreparerPersonNm
PTINP00449155PTIN
Phone7158323407PhoneNum
Preparation2018-08-02PreparationDt
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1OSCEOLA MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerMICHAEL DEFOEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12600 65TH AVENUE PO BOX 218AddressLine1Txt
CityOSCEOLACityNm
State AbbreviationWIStateAbbreviationCd
ZIP54020ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$34,766,919GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MYOMC.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1947FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionSERVING AS THE CATALYST TO CREATE A HEALTHIER COMMUNITY.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee269TotalEmployeeCnt
Total Volunteers40TotalVolunteersCnt
Total Gross UBI$1,720,530TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$10,056NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$688,488PYContributionsGrantsAmt
CY Contributions Grants$101,319CYContributionsGrantsAmt
PY Program Service Revenue$34,017,832PYProgramServiceRevenueAmt
CY Program Service Revenue$34,526,880CYProgramServiceRevenueAmt
PY Investment Income$78,128PYInvestmentIncomeAmt
CY Investment Income$96,362CYInvestmentIncomeAmt
PY Other Revenue$53,631PYOtherRevenueAmt
CY Other Revenue$42,358CYOtherRevenueAmt
PY Total Revenue$34,838,079PYTotalRevenueAmt
CY Total Revenue$34,766,919CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$14,801,176PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$14,424,553CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$178,024CYTotalFundraisingExpenseAmt
PY Other Expenses$19,433,744PYOtherExpensesAmt
CY Other Expenses$19,813,456CYOtherExpensesAmt
PY Total Expenses$34,234,920PYTotalExpensesAmt
CY Total Expenses$34,238,009CYTotalExpensesAmt
PY Revenues Less Expenses$603,159PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$528,910CYRevenuesLessExpensesAmt
Total Assets BOY$43,467,486TotalAssetsBOYAmt
Total Assets EOY$43,017,472TotalAssetsEOYAmt
Total Liabilities BOY$21,432,894TotalLiabilitiesBOYAmt
Total Liabilities EOY$20,409,242TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$22,034,592NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$22,608,230NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO INSPIRE AND IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY THROUGH HOME-TOWN CUSTOMER SERVICE, QUALITY AND STRATEGIC PARTNERSHIPS.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$30,293,852ExpenseAmt
Revenue$32,409,842RevenueAmt
DescDURING 2017, LADD MEMORIAL HOSPITAL PROVIDED INPATIENT, OUTPATIENT, AND CLINICAL CARE SERVICES TO THE RESIDENTS OF THE GREATER OSCEOLA AREA, REGARDLESS OF ABILITY TO PAY. INPATIENT SERVICES WERE PROVIDED TO 605 PATIENTS AND TOTALED 1,791 DAYS OF SERVICE. INPATIENT SERVICES INCLUDED GENERAL MEDICINE, SURGERY, PEDIATRIC, OBSTETRIC, NEWBORN AND SWINGBED CARE. OUTPATIENT SERVICES INCLUDED 3192 EMERGENCY ROOM VISITS; 3,756 RADIOLOGY PROCEDURES; 984 ONCOLOGY VISITS AND 527 SURGERIES, AS WELL AS 1504 PHYSICAL THERAPY VISITS, 2,948 ACC VISITS, 7,028 URGENT CARE VISITS AND VARIOUS OTHER HOSPITAL SERVICES. CLINICAL CARE SERVICES INCLUDED 18,174 CLINIC VISITS, 3,579 NURSE VISITS, TOTALING 21,753 VISITS.Desc
Total Program Service Expenses$30,293,852TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document38IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee269EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is FldMNStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MICHAEL DEFOEBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7152944519PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12600 65TH AVENUEAddressLine1Txt
CityOSCEOLACityNm
State AbbreviationWIStateAbbreviationCd
ZIP54020ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
ANNE MARIE PUESHNER
SECRETARY1.00Yes (X)Yes (X)$0$0$0
TYLER SCHMIDTZ
BOARD MEMBER1.00Yes (X)$0$0$0
TOM KLUGOW
BOARD MEMBER1.00Yes (X)$0$0$0
PETER MANSHIP
BOARD MEMBER1.00Yes (X)$0$0$0
AL HOGEN
CHAIRPERSON1.00Yes (X)Yes (X)$0$0$0
GREG ISAACSON
VICE-CHAIRPERSON1.00Yes (X)Yes (X)$0$0$0
TOM HUAGE DDS
BOARD MEMBER1.00Yes (X)$0$0$0
EDWARD MAUCH DO
BOARD MEMBER1.00Yes (X)$0$0$0
JOHN CLARK
BOARD MEMBER (NON-VOTING)1.00Yes (X)$0$0$0
AMANDA TREMBREULL MD
BOARD MEMBER1.00Yes (X)$0$0$0
RENE MILNER MD
CHIEF MEDICAL OFFICER1.00Yes (X)$0$0$0
MICHAEL DEFOE BEGINNING 82017
CFO40.00Yes (X)$52,808$0$7,916
TOM GESKERMANN
CEO40.00Yes (X)$165,133$0$31,706
HEATHER LUNDSTROM UNTIL 62017
CFO40.00Yes (X)$71,439$0$9,432
AMY ERICKSON
DIRECTOR OF OUTPATIENT SERVICES40.00$116,720$0$15,836Yes (X)
RACHEL ZIMMER
HOSPITAL DIRECTOR40.00$104,534$0$4,300Yes (X)
PAM BLOMSTRAND
PHARMACIST40.00$147,555$0$30,566Yes (X)
MARYBETH GUSTAFSON
PHARMACIST40.00$132,149$0$28,087Yes (X)
RACHEL JOHNSON-HIMES
PHARMACIST40.00$131,005$0$2,537Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$921,343TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$130,380TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K6IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
HEALTHPARTNERS GROUP HEALTH INC
MAIL STOP 21109AST PAULMN55164PHYSICIANS$5,046,334
CENTRAL MINNESOTA DIAGNOSTIC INC
PO BOX 158MILACAMN56353DIAGNOSTIC IMAGING$899,764
MARSHFIELD LABS
1000 NORTH OAK AVENUEMARSHFIELDWI54449LABORATORY SERVICES$552,196
RIVER VALLEY ANESTHESIA INC
PO BOX 118NEW RICHMONDWI54017ANESTHESIOLOGY SERVICES$457,381
CPSI
PO BOX 850309MOBILEAL36685ELECTRONIC HEALTH RECORDS$234,990
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K6CntrctRcvdGreaterThan100KCnt
Related Organizations$57,618RelatedOrganizationsAmt
Government Grants$25,500GovernmentGrantsAmt
All Other Contributions$18,201AllOtherContributionsAmt
Total Contributions$101,319TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
NET PATIENT SERVICE REV621990$33,779,520$32,058,990$1,720,530
FITNESS CENTER713940$418,320$418,320
GIFT SHOP621990$55,778$55,778

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$273,262TotalRevenueColumnAmt
Exclusion$273,262ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$34,526,880TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$83,862TotalRevenueColumnAmt
Exclusion$83,862ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$42,358RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$42,358RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$42,358TotalRevenueColumnAmt
Exclusion$42,358ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$12,500OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$12,500OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$12,500TotalRevenueColumnAmt
Exclusion$12,500ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$34,766,919TotalRevenueColumnAmt
Related Or Exempt Func Income$32,477,310RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$1,720,530UnrelatedBusinessRevenueAmt
Exclusion$467,760ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$277,710TotalAmt
Management And General$277,710ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$11,389,612TotalAmt
Program Services$9,203,959ProgramServicesAmt
Management And General$2,039,112ManagementAndGeneralAmt
Fundraising$146,541FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$234,111TotalAmt
Program Services$189,072ProgramServicesAmt
Management And General$42,019ManagementAndGeneralAmt
Fundraising$3,020FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,366,559TotalAmt
Program Services$2,258,869ProgramServicesAmt
Management And General$98,521ManagementAndGeneralAmt
Fundraising$9,169FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$156,561TotalAmt
Program Services$124,146ProgramServicesAmt
Management And General$30,271ManagementAndGeneralAmt
Fundraising$2,144FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$8,362TotalAmt
Management And General$8,362ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$67,200TotalAmt
Management And General$67,200ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$8,894,702TotalAmt
Program Services$8,183,120ProgramServicesAmt
Management And General$701,528ManagementAndGeneralAmt
Fundraising$10,054FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$40,545TotalAmt
Management And General$40,545ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$572,190TotalAmt
Program Services$233,312ProgramServicesAmt
Management And General$331,782ManagementAndGeneralAmt
Fundraising$7,096FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$4,640TotalAmt
Management And General$4,640ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,151,818TotalAmt
Program Services$1,151,818ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$18,311TotalAmt
Program Services$23ProgramServicesAmt
Management And General$18,288ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,730,150TotalAmt
Program Services$1,730,150ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$40,204TotalAmt
Management And General$40,204ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
MEDICAL SUPPLIES/EQUIPM$6,230,393$6,230,393
PROVISION FOR BAD DEBT$663,540$663,540
FOOD EXPENSE$195,072$195,072
HOSPITAL ASSESSMENT$96,000$96,000

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$100,329TotalAmt
Program Services$34,378ProgramServicesAmt
Management And General$65,951ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$34,238,009TotalAmt
Program Services$30,293,852ProgramServicesAmt
Management And General$3,766,133ManagementAndGeneralAmt
Fundraising$178,024FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$7,886,846BOYAmt
EOY$8,051,146EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$5,949,634BOYAmt
EOY$6,613,193EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$4,156,525BOYAmt
EOY$4,123,916EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$841,805BOYAmt
EOY$865,844EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$112,345BOYAmt
EOY$77,445EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$38,112,815LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$16,550,538LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$22,778,802BOYAmt
EOY$21,562,277EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$401,689BOYAmt
EOY$401,765EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$701,308BOYAmt
EOY$701,308EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$638,532BOYAmt
EOY$620,578EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$43,467,486BOYAmt
EOY$43,017,472EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,729,136BOYAmt
EOY$3,132,252EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$40,000BOYAmt
EOY$20,000EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$15,810,700BOYAmt
EOY$14,969,006EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$1,623,058BOYAmt
EOY$1,477,984EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$230,000BOYAmt
EOY$810,000EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$21,432,894BOYAmt
EOY$20,409,242EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$22,034,592BOYAmt
EOY$22,608,230EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$22,034,592BOYAmt
EOY$22,608,230EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$43,467,486BOYAmt
EOY$43,017,472EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$528,910ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$44,728NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$987OtherActivitiesAmt
Total Lobbying Expenditures$987TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationLADD MEMORIAL HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE WHA HAS NOTIFIED LADD MEMORIAL HOSPITAL THAT $987 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

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,547,047OtherCostOrOtherBasisAmt
Book Value$1,547,047BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$27,037,255OtherCostOrOtherBasisAmt
Depreciation$9,375,674DepreciationAmt
Book Value$17,661,581BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$9,407,326OtherCostOrOtherBasisAmt
Depreciation$7,174,864DepreciationAmt
Book Value$2,232,462BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$121,187OtherCostOrOtherBasisAmt
Book Value$121,187BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$21,562,277TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescAMOUNTS PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAMSDesc
Amt$810,000Amt
FieldValueIRS element (for citing)
Total Liability$810,000TotalLiabilityAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$224,375TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$224,375NetCommunityBenefitExpnsAmt
Total Expense0.00660TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,336,497TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,251,774DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,084,723NetCommunityBenefitExpnsAmt
Total Expense0.03170TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,560,872TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,251,774DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,309,098NetCommunityBenefitExpnsAmt
Total Expense0.03830TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$80,443TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$8,590DirectOffsettingRevenueAmt
Net Community Benefit Expns$71,853NetCommunityBenefitExpnsAmt
Total Expense0.00210TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$51,742TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$51,742NetCommunityBenefitExpnsAmt
Total Expense0.00150TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$8,510,140TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,988,772DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,521,368NetCommunityBenefitExpnsAmt
Total Expense0.07360TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$19,733TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$19,733NetCommunityBenefitExpnsAmt
Total Expense0.00060TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$8,662,058TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,997,362DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,664,696NetCommunityBenefitExpnsAmt
Total Expense0.07780TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$12,222,930TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$8,249,136DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,973,794NetCommunityBenefitExpnsAmt
Total Expense0.11610TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$663,540BadDebtExpenseAmt
Bad Debt Expense Attributable$165,885BadDebtExpenseAttributableAmt
Reimbursed By Medicare$9,741,581ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$9,793,301CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$51,720MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1LADD MEMORIAL HOSPITAL INC DBA OSCEOLA MEDBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line12600 65TH AVENUEAddressLine1Txt
CityOSCEOLACityNm
State AbbreviationWIStateAbbreviationCd
ZIP54020ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.MYOMC.ORGWebsiteAddressTxt
State License1021StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1OSCEOLA MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLHTTP://WWW.MYOMC.ORG/ABOUT/COMMUNITYOwnWebsiteURLTxt
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLHTTPS://WWW.HEALTHYPOLKCOUNTY.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENTOtherWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt16ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLHTTPS://WWW.HEALTHYPOLKCOUNTY.COM/HEALTHY-POLK-COUNTY-2020StrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLHTTPS://WWW.MYOMC.ORG/INFO/PATIENTS/BILLING/137-POLICIESFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLHTTPS://WWW.MYOMC.ORG/INFO/PATIENTS/BILLING/137-POLICIESFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLHTTPS://WWW.MYOMC.ORG/INFO/PATIENTS/BILLING/137-POLICIESFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicaid Medcr PrvtYes (X)LookBackMedicaidMedcrPrvtInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
OSCEOLA MEDICAL CENTERPART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) SOUGHT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED INCLUDING HEALTHCARE PROVIDERS, COMMUNITY LEADERS, AND THE PUBLIC. A COUNTY WIDE SURVEY OF THE HEALTH OF POLK COUNTY RESIDENTS WAS MADE AVAILABLE AT ALL OF THE LOCAL MEDICAL CENTERS AND THE HEALTH DEPARTMENT, AS WELL AS ADVERTISED IN THE LOCAL NEWSPAPERS AND POSTED ON ALL FOUR OF THE PARTNERS ORGANIZATION'S WEBSITES (650 RESPONDENTS).IN ADDITION TO THE AFOREMENTIONED SURVEY, FOUR COMMUNITY FORUMS WERE SPONSORED IN BALSAM LAKE, ST. CROIX FALLS, AMERY AND OSCEOLA. THE COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE HEALTH FOCUS AREAS. IN ADDITION, A PARTNER MEETING WAS HELD IN APRIL TARGETING KEY ORGANIZATIONS AND STAKEHOLDERS AS WELL AS LOCAL HEALTH-RELATED COALITION REPRESENTATIVES. AT EACH OF THESE VENUES, ATTENDEES HAD THE OPPORTUNITY TO PROVIDE INPUT ON THE TOP HEALTH FOCUS AREAS.THE FINAL TOP HEALTH FOCUS AREAS SELECTED BY PARTICIPANTS IN THE CHNA PROCESS WERE:1. MENTAL HEALTH2. SUBSTANCE ABUSE3. ACCESS TO CARE4. OBESITY
OSCEOLA MEDICAL CENTERPART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED AND A COMMUNITY HEALTH IMPROVEMENT PROCESS ("CHIP") WAS DEVELOPED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS:1. AMERY REGIONAL MEDICAL CENTER2. ST. CROIX REGIONAL MEDICAL CENTER
OSCEOLA MEDICAL CENTERPART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED AND CHIP DEVELOPED IN JOINT EFFORT WITH THE POLK COUNTY HEALTH DEPARTMENT.
OSCEOLA MEDICAL CENTERPART V, SECTION B, LINE 11: THE HOSPITAL IS ADDRESSING THE MOST SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AS FOLLOWS:MENTAL HEALTH - 1. THE HOSPITAL ASSISTED THE COUNTY MENTAL HEALTH TASK FORCE WITH UPDATING ITS LIST OF LOCAL MENTAL HEALTH RESOURCES LIST AND DISTRIBUTING IT WIDELY IN THE COMMUNITY. POLK COUNTY RESIDENTS WILL NOW HAVE KNOWLEDGE OF AND EASY ACCESS TO AN ANNUALLY UPDATED MENTAL HEALTH SERVICES DIRECTORY.2. AN ASSESSMENT, REFERRAL AND FOLLOW UP PROTOCOL WAS DEVELOPED FOR THE SCHOOL SYSTEM FOR STUDENTS AT HIGH RISK OF SUICIDE. THE HOSPITAL PROVIDED STAFF MEMBERSHIP ON THE TASK FORCE, AND ITS FOUNDATION, THE OSCEOLA COMMUNITY HEALTH FOUNDATION (OCHF), PROVIDED GRANT MONEY. THE HOSPITAL ALSO FUNDED A COUNSELOR IN THE OSCEOLA SCHOOL DISTRICT. THROUGH A GRANT BY OCHF, THE HEALTHY BEGINNINGS PROJECT IN THE COUNTY OFFERED STUDENT THERAPY SERVICES BOTH ONSITE IN THE SCHOOLS AND AT HOME VISITS.3. THE HOSPITAL PARTICIPATED IN THE COUNTY WIDE "BEHIND THE DOOR" CAMPAIGN THAT CALLS FOR MOUNTING AWARENESS POSTERS WITH REFERRAL INFORMATION ON THE BACKSIDES OF PUBLIC DOORS (I.E. BATHROOMS). THIS CAMPAIGN PROMOTES AWARENESS OF SUICIDE AS A PREVENTABLE PUBLIC HEALTH PROBLEM.4. ALL CLINICAL PROVIDERS AT THE HOSPITAL PROVIDE SCREENING FOR DEPRESSION AT ALL PATIENT ENCOUNTERS.5. AN AWARENESS OF THE IMPORTANCE OF PROTECTIVE BEHAVIORS TO COMBAT BULLYING PROVIDED THROUGH A HOSPITAL PROVIDED COUNSELOR IN THE OSCEOLA SCHOOL DISTRICT.IN ADDITION, THE HOSPITAL OFFERED MENTAL HEALTH INFORMATION AS PART OF A FREE WOMEN'S NIGHT HEALTH EXPO. THE MENTAL HEALTH TASK FORCE SECURED AN OTTO BREMER FOUNDATION GRANT TO DEVELOP A DEPRESSION SCREENING PROGRAM IMPLEMENTED 2015-2016.OBESITY - THE HOSPITAL AND ITS COMMUNITY HEALTH PARTNERS ADDRESSED THE OBESITY ISSUE AS FOLLOWS:1. PURSUED DEVELOPMENT OF THE BEST PRACTICE SCHOOL WELLNESS PROGRAMS.2. THROUGH OCHF, HELPED FACILIATE FUNDRAISING FOR A FOOD AND VEGETABLE COMPONENT TO AN EXISTING "BACK PACK" PROGRAM IN OSCEOLA THAT PROVIDES SUPPLEMENTAL FOOD FOR FREE AND REDUCED MEALS FAMILIES FOR WEEKEND USE. THROUGH THE HOSPITAL'S FITNESS CENTER, OFFERED "FIT FOR LIFE" FITNESS WEIGHT LOSS CLASSES, AND YOUTH PROGRAMS THAT FEATURED NUTRITION, FITNESS AND WELLNESS.3. THE HOSPITAL IS PROMOTING COUNTY WIDE RECREATIONAL RESOURCES AND CLUBS. THE FREE, JEFF MEYER PUBLIC FITNESS TRAIL CONTINUES TO ACCOMMODATE FITNESS AND WELLNESS NEEDS IN THE COMMUNITY. THROUGH OCHF, A GRANT WAS PROVIDED TO THE LOCAL "GROW OSCEOLA" GROUP TO PROMOTE FITNESS THROUGH TRAIL USE IN THE OSCEOLA AREA. A RESOURCE BROCHURE DETAILING SCHOOL OBESITY PREVENTION PROGRAMS WAS CREATED AND DISTRIBUTED.4. THROUGH OUR FITNESS CENTER, PARTICIPATED IN A "POWER UP" FITNESS AND NUTRITION EVENT IN THE OSCEOLA SCHOOL DISTRICT TO SUPPORT IMPLEMENTATION OF BEST PRACTICE PROGRAMS TO INCREASE PHYSICAL ACTIVITY AT SCHOOL AND IN THE COMMUNITY.5. THE HOSPITAL IS IDENTIFYING, SUPPORTING, AND PURSUING POLICIES THAT WILL HELP WORKSITES STRENGTHEN THEIR WELLNESS PROGRAMS. THROUGH OUR OCCUPATIONAL HEALTH DEPARTMENT, THE HOSPITAL PROVIDED HEALTH FAIRS AND RELATED OPPORTUNITIES TO ADDRESS WORKSITE WELLNESS PROGRAMS. THE HOSPITAL WORKED WITH OUTSIDE PARTNERS TO PROMOTE WEIGHT LOSS AND HEALTHY LIVING INTO WORKSITES THROUGH INVOGOR-8, A WELLNESS PROGRAM SERIES. A WORKSITE WELLNESS TOOLKIT TRAINING SCHEDULE WAS DEVELOPED FOR BUSINESSES IN POLK COUNTY AND IMPLEMENTED IN 2015.6. ALL CLINICAL PROVIDERS AT THE HOSPITAL PROVIDE SCREENING TO ADDRESS WEIGHT AND OBESITY ISSUES AT ALL PATIENT ENCOUNTERS.7. THROUGH OUR OCCUPATIONAL HEALTH DEPARTMENT, WORKED WITH ONE AREA INDUSTRY TO PROVIDE BREASTFEEDING AVAILABILITY ON SITE.8. THE HOSPITAL AND OCHF FUND AND HOST SUCCESS BY 6, A UNITED WAY PROGRAM THAT PROVIDES PHYSICAL, EMOTIONAL AND DEVELOPMENT GROWTH TO CHILDREN UNDER SIX AND THEIR PARENTS. 9. WITHIN ITS FREE MONTHLY HEALTH SEMINAR SERIES, THE HOSPITAL OFFERED THE FOLLOWING SEMINARS - NUTRITIOUS FREEZER MEAL PLANNING, LIFELONG WEIGHT LOSS, AND MANAGING DIABETES THROUGH NUTRITION AND EXERCISE.10. PARTNERED WITH A LOCAL TRAILS COALITION TO ORGANIZE AND SPONSOR FREE "DOC WALKS" ON AREA TRAILS. UNHEALTHY ALCOHOL USE - THE HOSPITAL AND ITS COMMUNITY HEALTH PARTNERS ADDRESSED UNHEALTHY ALCOHOL USE THROUGH STAFF TIME, RESOURCES, AND FUNDING AS FOLLOWS:1. COMMUNITY AWARENESS AROUND DRIVING WHILE INTOXICATED WILL BE INCREASED BY A PUBLIC AWARENESS CAMPAIGN. DATA COLLECTED OF OPERATING WHILE INTOXICATED ON UNDERAGE DRINKING CITATIONS GATHERED FROM SHERIFF'S DEPARTMENT AND LOCAL MUNICIPALITIES WILL BE USED IN THIS PUBLIC AWARENESS CAMPAIGN.2. INITIATIVES TO REDUCE UNDERAGE ALCOHOL USE INCLUDE AWARENESS PROVIDED AS PART OF HOSPITAL PROVIDED COUNSELOR IN THE OSCEOLA SCHOOL DISTRICT. 3. THE HEALTH DEPARTMENT SECURED A PARENTS WHO HOST GRANT. THE GOAL OF THIS CAMPAIGN IS TO REDUCE ACCESS TO ALCOHOL BY MINORS AT A MINIMUM OF TWO COMMUNITY EVENTS.4. AS PART OF THE HOSPITAL PROVIDED COUNSELOR SERVICES IN THE OSCEOLA SCHOOL DISTRICT, INCREASE ACCESS TO COUNSELING SERVICES FOR ADOLESCENTS WITH UNDERAGE DRINKING VIOLATIONS AND ADOLESCENTS WHOSE PARENTS ARE CONCERNED ABOUT UNDERAGE DRINKING BEHAVIORS.5. INCREASE COMMUNITY AWARENESS AROUND BINGE DRINKING THROUGH COMPANY HEALTH FAIRS.6. ALL CLINICAL PROVIDERS AT THE HOSPITAL PROVIDE SCREENING TO ADDRESS ALCOHOL USE AT ALL PATIENT ENCOUNTERS.IN ADDITION, A POLK COUNTY GUIDE TO ALCOHOL COMPLIANCE CHECKS CONTINUES TO BE DISTRIBUTED, AND A COMMUNITY HEALTH IN ACTION GRANT SECURED FOCUSING ON BEST PRACTICES FOR CHANGING UNHEALTHY ALCOHOL PRACTICES IN COMMUNITIES.
OSCEOLA MEDICAL CENTERPART V, SECTION B, LINE 13B: IN A CASE BY CASE REVIEW, OSCEOLA MEDICAL CENTER HOLDS THE RIGHT TO MAKE EXCEPTIONS TO THE GUIDELINES LISTED IN THE COMMUNITY CARE POLICY (SUCH AS BUT NOT LIMITED TO PRESUMPTIVE GRANTING) WHEN IT IS FOUND TO BE IN THE BEST INTEREST OF THE PATIENT.
FieldValueIRS element (for citing)
Facility4FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - OSCEOLA CLINIC
2600 65TH AVENUEOSCEOLAWI54020PROVIDER BASED CLINIC
2 - CLINIC PHARMACY
2600 65TH AVENUEOSCEOLAWI54020RETAIL PHARMACY
3 - SCANDIA CLINIC
21150 OZARK COURT NORTHSCANDIAMN55073FREE STANDING CLINIC
4 - WILD RIVER FITNESS CENTER
2630 65TH AVENUEOSCEOLAWI54020FITNESS CENTER

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 6A:THE COMMUNITY BENEFIT REPORT IS AVAILABLE UPON REQUEST.
PART I, LINE 7:THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS COSTING METHODS FOR THE FORM 990. THE COST OF COMMUNITY HEALTH IMPROVEMENT, HEALTH PROFESSIONALS EDUCATION, AND IN-KIND CONTRIBUTIONS REFLECTS THE DIRECT AND INDIRECT COSTS AS DETERMINED BY THE HOSPITAL.
PART I, LINE 7G:THE COST OF SUBSIDIZED HEALTH SERVICES IS BASED ON COST ALLOCATIONS FROM THE MEDICARE COST REPORT. SERVICES INCLUDE NURSERY, MASSAGE THERAPY, OCCUPATIONAL HEALTH, CLINIC SERVICES, EMERGENCY ROOM, AND PHYSICIAN SERVICES.
PART II, COMMUNITY BUILDING ACTIVITIES:WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S 'COMMUNITY BENEFIT,' THIS IS A WORK IN PROGRESS. OUR HOSPITAL PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY-CARE THAT WITHOUT OUR HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY.BEYOND INPATIENT HOSPITALIZATIONS, WE PROVIDE LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES & URGENT CARE, INFUSION SERVICES, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH, AND SURGICAL SERVICES.
PART III, LINE 4:ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, OSCEOLA MEDICAL CENTER ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, OSCEOLA MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), OSCEOLA MEDICAL CENTER RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF THEIR PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE TO OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE.
PART III, LINE 8:OSCEOLA MEDICAL CENTER HAS BEEN DESIGNATED AS A CRITICAL ACCESS HOSPITAL BUT DID RECOGNIZE A SHORTFALL FROM THE MEDICARE PROGRAM DUE TO SEQUESTRATION ADJUSTMENTS TO AMOUNTS PAID.THE COST-TO-CHARGE RATIOS USED TO CALCULATE THE COST OF MEDICARE SERVICES WERE TAKEN FROM THE MEDICARE COST REPORT.WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.
PART III, LINE 9B:ONCE APPROVED FOR FINANCIAL ASSISTANCE, THAT FINANCIAL ASSISTANCE IS VALID FOR ONE YEAR FROM THE APPROVAL DATE WITH FOLLOW UP VERIFICATION COMPLETED AFTER 6 MONTHS. IT IS THE PATIENT'S RESPONSIBILITY TO NOTIFY OMC IMMEDIATELY SHOULD THERE BE ANY CHANGE IN THE DETERMINING FACTORS WITHIN THE APPROVED YEAR PERIOD.
PART VI, LINE 2:THE MEDICAL CENTER ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY BY WORKING WITH COUNTY AND STATE OFFICES, COMMUNICATING WITH CIVIC ORGANIZATIONS, AND INTERPRETING FEEDBACK FROM ONE-ON-ONE CONVERSATIONS WITH PATIENTS. IN ADDITION, A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IS COMPLETED EVERY THREE YEARS. THE CHNA SOUGHT INPUT FROM DIVERSE STAKEHOLDERS, INCLUDING HEALTHCARE PROVIDERS, COMMUNITY LEADERS, AND THE PUBLIC. THE ULTIMATE GOAL OF THE ASSESSMENT IS TO IDENTIFY HEALTH ISSUES AND DEVELOP STRATEGIES TO ADDRESS THE COMMUNITY'S HEALTH NEEDS. THIS EFFORT INCLUDED A COMPREHENSIVE REVIEW OF HEALTH DATA, AN ANALYSIS OF REAL TIME BODY MASS INDEX DATA FROM LOCAL CLIENT PATIENT ELECTRONIC MEDICAL RECORDS AND HEALTH AND LIFESTYLE DATA FROM COMMUNITY SURVEYS.
PART VI, LINE 3:OSCEOLA MEDICAL CENTER HAS INFORMATION REGARDING THE CHARITY CARE POLICY AND OTHER FINANCIAL ASSISTANCE OPTIONS AVAILABLE:1. ON THEIR WEBSITE2. PLACED IN MAILINGS3. PAMPHLETS USED BY THE HOSPITAL'S PROVIDERS THAT CAN BE DISTRIBUTED4. A DEDICATED PATIENT ADVOCATE POSITION THAT WORKS ONE ON ONE WITH PATIENTS 5. IN PLAIN SIGHT AT EACH POINT OF REGISTRATIONTHESE RESOURCES ARE AVAILABLE TO ENSURE THAT ALL PATIENTS FULLY UNDERSTAND ALL OPTIONS THAT ARE AVAILABLE FOR ASSISTANCE.
PART VI, LINE 4:OSCEOLA MEDICAL CENTER SERVES THE CITY OF OSCEOLA WISCONSIN AND NEIGHBORING COMMUNITIES IN WESTERN WISCONSIN AND EASTERN MINNESOTA. THE MEDIAN INCOME IN THE SURROUNDING AREA IS APPROXIMATELY $50,000 PER YEAR. APPROXIMATELY 11% OF THE LOCAL POPULATION LIVES AT OR BELOW THE FEDERAL PROPERTY GUIDELINES AND APPROXIMATELY 18% OF POLK COUNTY'S RESIDENTS RECEIVE SOME TYPE OF ASSISTANCE FROM THE STATE OF WISCONSIN.
PART VI, LINE 5:A MAJORITY OF OSCEOLA MEDICAL CENTER'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE HOSPITAL, NOR FAMILY MEMBERS THEREOF.OSCEOLA MEDICAL CENTER ALSO PROMOTES COMMUNITY HEALTH BY PROVIDING FREE HEALTH SEMINARS, FREE BABY & ME CLASSES, AND OTHER CLASSES FOR A FEE SUCH AS ATHLETIC SCREENINGS AND PREDIABETES CLASSES. OSCEOLA MEDICAL CENTER IS A NON-PROFIT ORGANIZATION, AND THEREFORE ALL EARNINGS IN EXCESS OF COST ARE USED BY THE HOSPITAL TO IMPROVE THE HEALTHCARE OF THE PEOPLE THEY SERVE THROUGH THE PURCHASE OR UPGRADE OF FACILITIES AND EQUIPMENT, OR THE ADDITION OR EXPANSION OF NEEDED SERVICES.
PART VI, LINE 7, REPORTS FILED WITH STATESWI

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
TOM GESKERMANN
CEO$165,133$0$0$0$0$0$5,253$0$26,453$0$196,839$0$0$0
PAM BLOMSTRAND
PHARMACIST$147,555$0$0$0$0$0$3,946$0$26,620$0$178,121$0$0$0
MARYBETH GUSTAFSON
PHARMACIST$132,149$0$0$0$0$0$4,193$0$23,894$0$160,236$0$0$0

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
VILLAGE OF OSCEOLA HOSPITAL FACILITIES REVENUE BOND
A3960063382007-06-13$8,000,000REFINANCE EXISTING BONDS & CONSTRUCT NEW HOSPITAL BUILDING000
TOWN OF OSCEOLA HOSPITAL FACILITIES REVENUE BOND
B3960060442007-06-28$7,040,000CONSTRUCT NEW HOSPITAL BUILDING000
TOWN OF FARMINGTON HOSPITAL FACILITIES REVENUE BOND
C3909906202007-07-13$6,040,000CONSTRUCT NEW HOSPITAL BUILDING000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtTotal ProceedsTotalProceedsAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCapital ExpendituresCapitalExpendituresAmtOther Spent ProceedsOtherSpentProceedsAmtSubstantial CompletionSubstantialCompletionYrCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintInd
A$2,105,895$8,000,000$138,545$4,581,314$3,280,1412008Yes (1)0Yes (1)Yes (1)
B$1,866,468$7,040,000$80,850$6,959,150200800Yes (1)Yes (1)
C$1,923,216$6,040,000$65,800$5,974,200200800Yes (1)Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndPrivate Bus Concerning UBIPrivateBusConcerningUBIPctTotal Private Business UseTotalPrivateBusinessUsePctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A00000.003900.00390000
B00000.003900.00390000
C00000.003900.00390000

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A000000000
B000000000
C000000000

Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
A0
B0
C0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE K, PART II, LINE 11, COLUMN A:THE AMOUNT LISTED WAS USED TO REFINANCE EXISTING DEBT.
SCHEDULE K, PART IV, LINE 2:THERE IS NO REBATE BECAUSE THERE ARE NO PROCEEDS AVAILABLE FOR INVESTMENT. ALL PROCEEDS HAVE BEEN USED FOR CAPITAL EXPENDITURES.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BTHE COMPLETED FORM WAS REVIEWED AND APPROVED BY THE ADMINISTRATOR AND CHIEF FINANCIAL OFFICER BEFORE THE FORM WAS FILED. THE BOARD OF DIRECTORS FINANCE COMMITTEE MEETING AND THE FULL BOARD OF DIRECTORS RECEIVED A COPY AFTER THE RETURN WAS FILED.
FORM 990, PART VI, SECTION B, LINE 12CEACH KEY EMPLOYEE, DIRECTOR, AND OFFICER SIGNS STATEMENT EACH YEAR DURING THEIR ANNUAL REVIEW. PERIODIC EDUCATION IS DONE THROUGH INTERNAL COMMUNICATION.
FORM 990, PART VI, SECTION B, LINE 15IN SETTING THE COMPENSATION OF THE CEO AND CFO, THE EXECUTIVE COMMITTEE SHALL COMPLY WITH LADD MEMORIAL HOSPITAL, INC.'S CONFLICT OF INTEREST POLICY AND, WITHOUT LIMITING THAT COMPLIANCE, WILL: (A) ACT ONLY WITH THE PARTICIPATION OF EXECUTIVE COMMITTEE MEMBERS WHO DO NOT HAVE A CONFLICT OF INTEREST CONCERNING THE MATTER, (B) WILL OBTAIN AND RELY UPON APPROPRIATE DATA AS TO COMPARABILITY, AND (C) WILL ADEQUATELY AND TIMELY DOCUMENT THE BASIS FOR ITS DETERMINATION, CONCURRENTLY WITH MAKING THAT DETERMINATION. APPROPRIATE DATA AS TO COMPARABILITY CAN INCLUDE, BUT IS NOT NECESSARILY LIMITED TO: COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR FUNCTIONALLY COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA OF THE CORPORATION; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; OR ACTUAL WRITTEN OFFERS FROM SIMILAR INSTITUTIONS COMPETING FOR THE SERVICES OF THE SAME INDIVIDUAL. ADEQUATE AND TIMELY DOCUMENTATION WILL GENERALLY BE MINUTES OR OTHER RECORDS OF THE EXECUTIVE COMMITTEE MEETING THAT STATE: THE COMPENSATION AND WHEN IT WAS APPROVED; THE EXECUTIVE COMMITTEE MEMBERS WHO WERE PRESENT AND HOW EACH VOTED; THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE EXECUTIVE COMMITTEE AND A SUMMARY OF HOW THE DATA WAS OBTAINED, AND ANY ACTION TAKEN IN SPECIFIC COMPLIANCE WITH THE MEDICAL CENTER'S CONFLICT OF INTEREST POLICY. IF THE EXECUTIVE COMMITTEE APPROVES A COMPENSATION PACKAGE FOR THE CEO OR CFO THAT IS HIGHER OR LOWER THAN THE RANGE OF COMPARABILITY DATA OBTAINED, THE BASIS FOR THE DETERMINATION OUTSIDE THE RANGE MUST BE RECORDED. MINUTES OR OTHER RECORDS OF THE EXECUTIVE COMMITTEE THAT DOCUMENT A DECISION ON CEO OR CFO COMPENSATION MUST BE PREPARED BEFORE THE LATER OF THE NEXT MEETING OF THE EXECUTIVE COMMITTEE OR 60 DAYS AFTER THE DECISION, AND MUST BE REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE WITHIN A REASONABLE PERIOD THEREAFTER.
FORM 990, PART VI, SECTION C, LINE 19LADD MEMORIAL HOSPITAL, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11GPHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 5,250,256. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,250,256. ANESTHESIA SERVICES: PROGRAM SERVICE EXPENSES 552,196. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 552,196. LAB SERVICES: PROGRAM SERVICE EXPENSES 587,118. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 587,118. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 1,127,182. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,127,182. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 666,368. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 10,054. TOTAL EXPENSES 676,422. ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 496,469. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 496,469. DATA PROCESSING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 205,059. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 205,059.
FORM 990, PART XII, LINE 2C: OVERSIGHT OF AUDITTHE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE SELECTION OF AN INDEPENDENT AUDITOR AND MANAGEMENT OVERSEES THE AUDIT PROCESS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1OSCEOLA COMMUNITY HEALTH FOUNDATION INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line12600 65TH AVENUEAddressLine1Txt
CityOSCEOLACityNm
State AbbreviationWIStateAbbreviationCd
ZIP54020ZIPCd
FieldValueIRS element (for citing)
EIN392029106EIN
Primary ActivitiesFOUNDATIONPrimaryActivitiesTxt
Legal Domicile StateWILegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 12B, IIPublicCharityStatusTxt
Direct Controlling NAN/ADirectControllingNACd
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd