SARTORI MEMORIAL HOSPITAL INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
SARTORI MEMORIAL HOSPITAL INC (EIN 42-0758901)
Tax period
2016-07-01 to 2017-06-30
Filed
2018-05-14
IRS object ID
201841349349305834
Schema version
2016v3.1
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 ReturnHeader

FieldValueIRS element (for citing)
Return2018-05-14T13:32:06-05:00ReturnTs
Tax Period End2017-06-30TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2016-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN420758901EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Sartori Memorial Hospital IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% TIMOTHY HUBERInCareOfNm
Business Name ControlSARTBusinessNameControlTxt
Phone3192683000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1515 College StreetAddressLine1Txt
CityCedar FallsCityNm
State AbbreviationIAStateAbbreviationCd
ZIP50613ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTIMOTHY HUBERPersonNm
Person TitleVPF/CFOPersonTitleTxt
Phone3192727607PhoneNum
Signature2018-05-10SignatureDt
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJack DusenberyPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line13421 West Ninth StreetAddressLine1Txt
CityWaterlooCityNm
State AbbreviationIAStateAbbreviationCd
ZIP507025499ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$42,481,160GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Group Exemption0928GroupExemptionNum
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.wheatoniowa.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1954FormationYr
Legal Domicile StateIALegalDomicileStateCd
Activity Or MissionGeneral inpatient and outpatient acute health care services.ActivityOrMissionDesc
Voting Members Governing Body6VotingMembersGoverningBodyCnt
Voting Members Independent5VotingMembersIndependentCnt
Total Employee329TotalEmployeeCnt
Total Volunteers155TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$302,324PYContributionsGrantsAmt
CY Contributions Grants$245,771CYContributionsGrantsAmt
PY Program Service Revenue$39,233,016PYProgramServiceRevenueAmt
CY Program Service Revenue$41,718,895CYProgramServiceRevenueAmt
PY Investment Income-$1,943PYInvestmentIncomeAmt
CY Investment Income$14,650CYInvestmentIncomeAmt
PY Other Revenue$1,111,754PYOtherRevenueAmt
CY Other Revenue$382,652CYOtherRevenueAmt
PY Total Revenue$40,645,151PYTotalRevenueAmt
CY Total Revenue$42,361,968CYTotalRevenueAmt
PY Grants And Similar Paid$329,777PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$55,530CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$14,700,934PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$14,402,573CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$20,648,138PYOtherExpensesAmt
CY Other Expenses$23,040,068CYOtherExpensesAmt
PY Total Expenses$35,678,849PYTotalExpensesAmt
CY Total Expenses$37,498,171CYTotalExpensesAmt
PY Revenues Less Expenses$4,966,302PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$4,863,797CYRevenuesLessExpensesAmt
Total Assets BOY$17,153,476TotalAssetsBOYAmt
Total Assets EOY$17,697,472TotalAssetsEOYAmt
Total Liabilities BOY$3,006,600TotalLiabilitiesBOYAmt
Total Liabilities EOY$2,804,614TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$14,146,876NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$14,892,858NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionAS A MEMBER OF WHEATON IOWA, OUR AFFILIATES STRIVE TO LIVE OUT THE HEALING MINISTRY OF THE JUDEO-CHRISTIAN TRADITION WHILE PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTHCARE SERVICES THAT PROMOTE THE DIGNITY AND WELL BEING OF THE PATIENTS AND COMMUNITIES WE SERVE. OUR VISION IS TO BE RECOGNIZED FOR SUPERIOR HEALTHCARE SERVICE, CLINICAL EXCELLENCE, AS THE HEALTHCARE EMPLOYER OF CHOICE, AND THE PREFERRED PARTNER OF PHYSICIANS.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$36,333,852ExpenseAmt
Grant$55,530GrantAmt
Revenue$41,878,897RevenueAmt
DescWHEATON FRANCISCAN HEALTHCARE IN IOWA Wheaton Franciscan Healthcare - Iowa is a faith-based 511-bed, not-for-profit, comprehensive medical/surgical health care provider offering acute levels of medical care at Covenant Medical Center in Waterloo, Sartori Memorial Hospital in Cedar Falls, and Mercy Hospital in Oelwein. Its services in the region also include Covenant Clinic with more than 100 primary care and specialty providers; Covenant Foundation, Sartori Health Care Foundation and Mercy Hospital Foundation. Areas of excellence include cardiology, orthopedics, neurosurgery, maternity and NICU, cancer treatment, minimally invasive and Bariatric surgery. The Iowa operations have been part of a 140 year system of care sponsored by the Wheaton Franciscan Sisters, formerly incorporated in 1983. In 2016, the Wheaton Franciscan Sisters transferred their Iowa operations to Mercy Health Network, an Iowa-based health care system based out of Des Moines, Iowa. Mercy Health Network (MHN) is an integrated system of member hospitals and other health and patient care facilities united into one operating organization to improve the delivery of healthcare services to the people of Iowa and adjoining states. MHNs sponsors own and operate medical centers and other services in Clinton, Des Moines, Dubuque, Mason City, and Sioux City, and community hospitals in six other locations. In addition, MHN has 27 members who participate through contracts for management and other services. Mercy Health Network (MHN) was founded in 1998 under a joint operating agreement between two of the largest Catholic, not-for-profit health organizations in the United States: Catholic Health Initiatives, based in Englewood, Colorado, and Trinity Health, based in Livonia, Michigan. Covenant Medical Center in Waterloo, Iowa was founded in 1986 when Wheaton Franciscan Services consolidated St. Francis Hospital (founded in 1912) and Schoitz Medical Center (founded in 1904). Covenant Medical Center was located in two locations until 1991 when all acute care services were combined at one site. The other site was transformed into an assisted living center and adult services center. In 1995, Wheaton Franciscan Services Iowa region was renamed Covenant Health System and included Covenant Medical Center in Waterloo, Covenant Foundation in Waterloo, Mercy Hospital in Oelwein, N. E. Iowa Real Estate Investments and Schoitz Health Resources. Sartori Memorial Hospital became a part of Covenant Health System in 1996 when the system entered a long-term lease agreement with the City of Cedar Falls. In 2006, Covenant Health System was renamed Wheaton Franciscan Healthcare-Iowa, to reflect its continued commitment to an integrated health care delivery system for residents of Northeast Iowa. Today Wheaton Franciscan Healthcare Iowa includes Covenant Medical Center (and its unincorporated division, Covenant Clinic) and Covenant Foundation in Waterloo, Mercy Hospital in Oelwein, Sartori Memorial Hospital and Sartori Health Care Foundation in Cedar Falls, and N. E. Iowa Real Estate Investments. WHEATON FRANCISCAN HEALTHCARE IN IOWA LIST OF ENTITIES Hospitals Covenant Medical Center, Inc. Mercy Hospital of Franciscan Sisters, Inc. Sartori Memorial Hospital, Inc. Covenant Clinic, an unincorporated division of Covenant Medical Center, Inc. Patients have access to more than 100 primary and specialty care physicians, physician assistants, nurse practitioners, and other health care professionals located throughout Northeast Iowa in 24 locations. Regional Service Lines Covenant Cardiology Covenant Cancer Treatment Center Covenant Clinic Orthopedic Services Covenant Home Health Emergency Services Imaging/Radiology Services Iowa Spine and Brain Institute Midwest Institute of Advanced Laparoscopic Surgery Maternal Child Health Occupational Medicine and Wellness Covenant Retail Pharmacies Rehabilitation Services Philanthropic Foundations Covenant Foundation, Inc. Sartori Health Care Foundation, Inc. Other N.E. Iowa Real Estate Investments, Ltd. WHEATON FRANCISCAN HEALTHCARE COMMUNITY IMPACT IN IOWA / 2017 Charity Care: $4,520,613. Charity Care is defined as free or discounted health services provided to those who cannot afford to pay and who meet all criteria for financial assistance. Charity care is based on costs, not charges, and does not include bad debt. Unreimbursed Cost of Public Programs: $8,564,262. Unreimbursed cost of public programs is defined as the shortfall experienced when payments received are below the cost of treating public beneficiaries through Medicaid and other local public programs. Community Health Improvement Services: $1,364,985. Community Health Improvement Services are defined as clinical and non-clinical services designed to improve community health, which are provided to the community for free or for fees that did not cover costs. Financial Contributions: $689,939. Financial contributions are defined as contributions, including cash, non-cash items such as food, furniture, equipment, supplies, and loaned staff for volunteer and charitable purposes, made to individuals, community groups, or nonprofit organizations for charitable purposes. Health Professions Education: $3,580,190. Health professions education is defined as direct costs incurred for accredited training and education programs for physicians, nurses, allied health professionals and technicians (does not include ongoing education for staff). Community Building Activities: $31,098. Community building activities are defined as programs that, while not directly related to health care, provide opportunities to address the root causes of health problems, such as poverty, homelessness, and environmental issues. Costs for these activities include cash and in-kind donations. Community Benefit Operations: $156,481. Community benefit operations are defined as costs associated with dedicated staff and community health needs and/or assets assessment, as well as other costs associated with community benefit strategy and operations. Subsidized Health Services: $5,648,906. Subsidized health services are defined as the negative margin for clinical services that are provided despite a financial loss because of an identified community need that would need to be met by the government or another not-for-profit if it was not offered. The financial losses are so significant that negative margins remain after removing the effects of charity care, bad debt, and Medicaid shortfalls. TOTAL BENEFIT TO THE COMMUNITY FOR IOWA 2017: $24,556,474.Desc
Total Program Service Expenses$36,333,852TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesYes (true)FundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee329EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsYes (true)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (true)QuidProQuoContriDisclInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members6GoverningBodyVotingMembersCnt
Independent Voting Member5IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsYes (true)ChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonTIMOTHY HUBERPersonNm
Phone3192727607PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line13421 WEST NINTH STREETAddressLine1Txt
CityWATERLOOCityNm
State AbbreviationIAStateAbbreviationCd
ZIP507025499ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Jack Dusenbery
Director; President1.040.0Yes (X)Yes (X)$0$683,271$65,981
John Fuller
Chair as of 1/17 - Director1.01.0Yes (X)Yes (X)$0$0$0
Michael Hager
Treasurer as of 1/17-Director1.01.0Yes (X)Yes (X)$0$0$0
James Hartel MD
Secretary - Director1.01.0Yes (X)Yes (X)$0$0$0
Sue Roberts
V Chair as of 1/17 - Director1.01.0Yes (X)Yes (X)$0$0$0
Tom Strub DDS
Chair - Director through 12/161.01.0Yes (X)Yes (X)$0$0$0
Anne Hennessey DDS
Director as of 1/171.01.0Yes (X)$0$0$0
Michele Panicucci
Asst. Treas.; CFO through 4/171.040.0Yes (X)$0$423,761$68,730
Timothy Huber
Asst. Treas.; CFO as of 4/171.040.0Yes (X)$0$158,445$41,706
Mary Jo Kavalier
VP Operations40.01.0$184,873$0$60,636Yes (X)
James Lehman MD
VP Medical Affairs1.040.0$0$444,752$30,144Yes (X)
Kelly Wolf
Pharmacist40.01.0$137,079$0$11,386Yes (X)
Diane Heindl MD
Physn Employee; Former Officer1.040.0$0$203,812$20,740Yes (X)
Ryan Meyer
Admin Directr; Former Key Empl1.040.0$0$149,115$24,782Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$321,952TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,063,156TotReportableCompRltdOrgAmt
Total Other Compensation$324,105TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K2IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Emergency Practice Associates Inc
PO Box 1260WATERLOOIA507041260Physician Services$1,562,557
Xygent Inc
9961 Valley View RoadEDEN PRAIRIEMN55344Surgical Services$462,082
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
Fundraising$57,894FundraisingAmt
Related Organizations$132,288RelatedOrganizationsAmt
Government Grants$11,120GovernmentGrantsAmt
All Other Contributions$44,469AllOtherContributionsAmt
Noncash Contributions$7,173NoncashContributionsAmt
Total Contributions$245,771TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PROGRAM SERVICE REVENUE622110$16,891,638$16,891,638
MEDICARE/MEDICAID PAYMENTS622110$24,467,452$24,467,452
RENT REVENUE531120$359,805$359,805
FieldValueIRS element (for citing)
Total Program Service Revenue$41,718,895TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$14,650TotalRevenueColumnAmt
Exclusion$14,650ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$170,850RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$84,565RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$86,285RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$86,285TotalRevenueColumnAmt
Exclusion$86,285ExclusionAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$25,294FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$57,894ContriRptFundraisingEventAmt
Fundraising Direct Expenses$34,627FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column-$9,333TotalRevenueColumnAmt
Exclusion-$9,333ExclusionAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmt
ELECTRONIC HEALTH RECORD622110$160,002$160,002
GIFT SHOP453220$45,762$45,762
CAFETERIA722514$96,536$96,536

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,400TotalRevenueColumnAmt
Exclusion$3,400ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$305,700OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$42,361,968TotalRevenueColumnAmt
Related Or Exempt Func Income$41,878,897RelatedOrExemptFuncIncomeAmt
Exclusion$237,300ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$55,530TotalAmt
Program Services$55,530ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$245,509TotalAmt
Management And General$245,509ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$11,350,532TotalAmt
Program Services$11,165,913ProgramServicesAmt
Management And General$184,619ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$222,096TotalAmt
Program Services$218,484ProgramServicesAmt
Management And General$3,612ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,738,928TotalAmt
Program Services$1,710,644ProgramServicesAmt
Management And General$28,284ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$845,508TotalAmt
Program Services$834,306ProgramServicesAmt
Management And General$11,202ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$150TotalAmt
Management And General$150ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$4,416TotalAmt
Program Services$4,416ProgramServicesAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,555,400TotalAmt
Program Services$1,555,400ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$5,013TotalAmt
Program Services$5,013ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,643,133TotalAmt
Program Services$1,603,637ProgramServicesAmt
Management And General$39,496ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$838,890TotalAmt
Program Services$838,890ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$17,376TotalAmt
Program Services$15,194ProgramServicesAmt
Management And General$2,182ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$6,853TotalAmt
Program Services$6,774ProgramServicesAmt
Management And General$79ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$22,980TotalAmt
Management And General$22,980ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,055,432TotalAmt
Program Services$1,055,432ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
PURCHASED SERVICES$1,879,030$1,879,030
MEDICAL SUPPLIES$7,691,738$7,691,738
BAD DEBT EXPENSE$767,669$767,669
CORPORATE SERVICES ALLOCATION$733,864$107,658$626,206

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$6,818,124TotalAmt
Program Services$6,818,124ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$37,498,171TotalAmt
Program Services$36,333,852ProgramServicesAmt
Management And General$1,164,319ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$4,223,922BOYAmt
EOY$5,345,827EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$362,925BOYAmt
EOY$372,542EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$13,289,635LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,327,378LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$12,550,863BOYAmt
EOY$11,962,257EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$15,766BOYAmt
EOY$16,846EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$17,153,476BOYAmt
EOY$17,697,472EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,832,945BOYAmt
EOY$1,578,644EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,173,655BOYAmt
EOY$1,225,970EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,006,600BOYAmt
EOY$2,804,614EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$14,146,876BOYAmt
EOY$14,892,858EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$14,146,876BOYAmt
EOY$14,892,858EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$17,153,476BOYAmt
EOY$17,697,472EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$4,863,797ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$4,117,815OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

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)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsYes (true)GrantsOtherOrganizationsInd
Grants Other Organizations$4,416GrantsOtherOrganizationsAmt
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesfalseOtherActivitiesInd
Total Lobbying Expenditures$4,416TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule C DisclosuresFormAndLineReferenceDesc
ExplanationSchedule C Part II-B Line 1f: Sartori Memorial Hospital, Inc. has made grants to other organizations for lobbying purposes. These grants have been in the form of membership dues paid to regional and national health care organizations, where the organizations have provided Sartori Memorial Hospital, Inc. with an estimated percentage of dues payments which are used for lobbying activities.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,300,000OtherCostOrOtherBasisAmt
Book Value$4,300,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,717,943OtherCostOrOtherBasisAmt
Depreciation$138,044DepreciationAmt
Book Value$2,579,899BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,270,740OtherCostOrOtherBasisAmt
Depreciation$1,189,285DepreciationAmt
Book Value$5,081,455BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$953OtherCostOrOtherBasisAmt
Depreciation$50DepreciationAmt
Book Value$903BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$11,962,257TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescOTHER LIABILITIESDesc
Amt$1,225,970Amt
FieldValueIRS element (for citing)
Total Liability$1,225,970TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceIRS Form 990 Schedule D, Part XFormAndLineReferenceDesc
ExplanationThe Company follows the provisions of ASC Subtopic 740-10, Income Taxes - Overall. ASC Subtopic 740-10 clarifies the accounting for uncertainty in tax positions and also provides guidance on when the tax positions are recognized in an entity's financial statements and how the values of these positions are determined. As of June 30, 2017, the Company did not have a liability for unrecognized tax benefits.ExplanationTxt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1Fstvl of TreesEvent1Nm
Gross Receipts Event1$72,727GrossReceiptsEvent1Amt
Charitable Contri Event1$53,304CharitableContriEvent1Amt
Gross Revenue Event1$19,423GrossRevenueEvent1Amt
Rent Facility Costs Event1$5,829RentFacilityCostsEvent1Amt
Food And Beverage Event1$9,035FoodAndBeverageEvent1Amt
Entertainment Event1$350EntertainmentEvent1Amt
Other Direct Expenses Event1$17,943OtherDirectExpensesEvent1Amt
Event2May BreakfastEvent2Nm
Gross Receipts Event2$10,461GrossReceiptsEvent2Amt
Charitable Contri Event2$4,590CharitableContriEvent2Amt
Gross Revenue Event2$5,871GrossRevenueEvent2Amt
Rent Facility Costs Event2$420RentFacilityCostsEvent2Amt
Food And Beverage Event2$723FoodAndBeverageEvent2Amt
Other Direct Expenses Event2$327OtherDirectExpensesEvent2Amt
Other Events Total0OtherEventsTotalCnt
Gross Receipts Total$83,188GrossReceiptsTotalAmt
Charitable Contributions Tot$57,894CharitableContributionsTotAmt
Gross Revenue Total Events$25,294GrossRevenueTotalEventsAmt
Rent Fclty Costs Total Events$6,249RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$9,758FoodAndBeverageTotalEventsAmt
Entertainment Total Events$350EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events$18,270OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$34,627DirectExpenseSummaryEventsAmt
Net Income Summary-$9,333NetIncomeSummaryAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$326,105TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$326,105NetCommunityBenefitExpnsAmt
Total Expense0.00890TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,819,220TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,215,191DirectOffsettingRevenueAmt
Net Community Benefit Expns$604,029NetCommunityBenefitExpnsAmt
Total Expense0.01640TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,145,325TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,215,191DirectOffsettingRevenueAmt
Net Community Benefit Expns$930,134NetCommunityBenefitExpnsAmt
Total Expense0.02530TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$20,042TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$20,042NetCommunityBenefitExpnsAmt
Total Expense0.00050TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$150,693TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$25,647DirectOffsettingRevenueAmt
Net Community Benefit Expns$125,046NetCommunityBenefitExpnsAmt
Total Expense0.00340TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,113,996TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$988,592DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,125,404NetCommunityBenefitExpnsAmt
Total Expense0.03060TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$25,789TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$25,789NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,310,520TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,014,239DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,296,281NetCommunityBenefitExpnsAmt
Total Expense0.03520TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,455,845TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,229,430DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,226,415NetCommunityBenefitExpnsAmt
Total Expense0.06050TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$767,669BadDebtExpenseAmt
Reimbursed By Medicare$11,332,449ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$14,861,025CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$3,528,576MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

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

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Sartori Memorial Hospital IncBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1515 College StreetAddressLine1Txt
CityCedar FallsCityNm
State AbbreviationIAStateAbbreviationCd
ZIP50613ZIPCd
FieldValueIRS element (for citing)
Website Addresshttp://www.wheatoniowa.orgWebsiteAddressTxt
State License070059H (IA)StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
Facility Reporting Group1FacilityReportingGroupCd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Sartori Memorial Hospital IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
OtherYes (X)OtherInd
CHNA Conducted15CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLwheatoniowa.org - full url in narrativeOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt15ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLwheatoniowa.org - full url in narrativeStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLwheatoniowa.org-full url in narraFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLwheatoniowa.org-full url in narrativFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLwheatoniowa.org-full url inFAPSummaryOnWebsiteURLTxt
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 TranslatedYes (X)FAPTranslatedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
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 (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule H Supplemental InformationFormAndLineReferenceDesc
ExplanationSchedule H Part V Section B Line 3j: Iowas Community Health Needs Reports provide additional detailed information in response to many of the Schedule H questions on our Community Health Needs Assessments and Implementation Plans. These reports can be accessed at www.wheatoniowa.org under the About Us page or at this link: https://www.wheatoniowa.org/about-us/community-outreach-benefit. A Community Health Needs Assessment and Implementation Plan for each of the three Wheaton Iowa hospitals are available. Schedule H Part V Section B Line 5: This report was compiled by Wheaton Iowa representing both Covenant Medical Center (CMC) and Sartori Memorial Hospital (SMH) in partnership with Unity Point Health (representing Allen Hospital) and the Black Hawk County Health Department. Wheaton Iowa and Unity Point are both health care systems serving Black Hawk County and surrounding counties with three hospitals and a network of clinics. At the time of the research project, representatives from the listed entities included Amy Hetherton, Director of Marketing and Communications for Wheaton Iowa; Keyah Levy, Community Health Coordinator for Wheaton Iowa; Jim Waterbury, VP of Institutional Advancement for Unity Point Health Allen; and Bruce Meisinger, Director of Public Health for the Black Hawk County Health Department. They worked collaboratively to develop the survey, and made it available to the public online and in paper form. Publicity, websites, and emails invited the public to take the survey anytime before December 20, 2015. Paper surveys were available at the hospitals and clinics, the local food bank and other non-profit agencies. Information on how to access the link for the online survey was promoted heavily and emailed to internal and external audiences. The partners received nearly 600 electronic and paper surveys with additional efforts made to ensure a cross-section of residents completed the survey. Additionally, one-on-one interviews were conducted with local organizations and businesses (listed below) to better understand the populations they serve, and the health needs of their clients and/or employees. This information was compared to existing secondary data, including a 2015 health assessment completed by Black Hawk County Health Department. Allen Child Protection Center Allens Womens Health Big Brothers Big Sisters of NE Iowa Black Hawk County Gaming Association Black Hawk County Health Department Black Hawk Grundy Mental Health Care Initiatives Hospice Cedar Valley Friends of the Family Cedar Valley Promise Cedar Valley United Way Covenant Prenatal & Womens Health Clinic Family & Childrens Council Guernsey Charitable Foundation Hawkeye Community College Healthy Cedar Valley Coalition I-HOPE Free Clinic KWWL Martin Luther King, Jr. Center McElroy Trust Northeast Iowa Food Bank Salvation Army Success Street Inc. Together 4 Families University of Northern Iowa Waterloo Community Schools Waterloo Human Rights Commission YWCA Schedule H Part V Section B Line 6a: Our community health needs assessment was conducted in partnership with Covenant Medical Center, Allen Hospital, and the Black County Health Department. Schedule H Part V Section B Line 6b: Sartori Memorial Hospital and Covenant Medical Center, as part of Wheaton Iowa, worked with Allen Hospital, part of Unity Point, and the Black Hawk County Health Department. Schedule H Part V Section B Line 7a: https://www.wheatoniowa.org/about-us/community-outreach-benefit/community- health-needs-assessment.aspx Schedule H Part V Section B Line 10a: https://www.wheatoniowa.org/about-us/community-outreach-benefit/community- health-needs-assessment.aspx Schedule H Part V Section B Line 11: Using the CHNA completed in June 2013, the hospital developed, adopted, and worked on executing a three-year Implementation Strategy to address priority community health needs. The following summarizes how the hospital addressed priority health needs in the community. Access and Education o Coordinated a Medical Leaders Program for Hansen Elementary to provide a learning forum to generate interest in health care careers. o A Healthcare 101 video promoting the benefits of weight loss surgery in reducing comorbidities. o Care-A-Van is a free service providing safe and efficient transportation for clients who may have no other means of getting to and from medical services provided by Wheaton Iowa. Care-A-Van has operated in Cedar Falls since July of 2014 transporting patients to and from the Waterloo and Cedar Falls area to SMH and Covenant Clinic offices in Cedar Falls. Health Behaviors & Community Wellness (Obesity & Physical Inactivity) o SMH partners with the Northeast Iowa Food Bank to provide nutritious meals during the summer programs at Hansen Elementary. o A Healthcare 101 video promoting the benefits of exercising in reducing health issues. o SMH expanded its Fruit and Vegetable Voucher Program (FVVP) to provide fresh fruits and vegetables to bariatric patients who then discussed healthy eating with a dietician to receive vouchers to redeem at local farmers' markets. Mental Health Services & Education o SMH collaborated with several community agencies including Cedar Valley United Way to address the critical issues surrounding mental health, working together to advance mental health programs and services. Multiple strategies and tactics are identified, defined and will be implemented in the coming years. Cardiovascular Disease o Sponsored the American Heart Associations' Heart Walk in May 2017 providing heart education, interactive activities, etc. Cancer o SMH continued to collaborate with the Black Hawk County Tobacco and Clean Air Coalition and financially supported the creation and dissemination of Quit Kits to promote online counseling and free nicotine replacement therapy through Quit Line Iowa. The partnership provided "Ask, Assess, Refer" (2As/R) training to more than 250 health care professionals at CMC and Sartori. Although much progress has been made, SMH remains focused on the same key findings with its partners. These include: Access and Education; Healthy Behaviors and Community Wellness; Mental Health Services and Education, Cardiovascular Disease and Cancer. Based on the CHNA completed in June 2016, the hospital developed and adopted, a three-year Implementation Strategy to address the same priority community health needs. The following summarizes how the hospital will address the priority health needs in the June 2016 Implementation Strategy: Expand Access o Continue to recruit primary care providers o Expand clinic access Healthy Behaviors and Community Wellness o Improve access to healthy food, diabetes education, etc. o Provide screenings and education at community events o Partner with local government, organizations and the school system to create awareness and impact change. o Participate in educational programs centered on the effects of alcohol/drug abuse Mental Health o Continue our partnership with community leaders to develop strategies to improve local care o Promote and educate residents on the benefits of a nutritious diet and exercise to improve mental health Cardiovascular o Maximize the American Heart Association Mission: Lifeline program to ensure all emergency medical services that can transmit vital patient information from the field o Participate in the American Heart Associations ACTION Registry program to share data for high effectiveness o Continue to invest in life saving measures, as well as collaborate with various area organizations to educate and promote signs and symptoms of heart disease. Cancer o Partner with area agencies to reduce tobacco use, and promote tobacco cessation and prevention programs While our organization understands the importance of meeting all of the needs of the community, an in depth assessment was completed in which key leaders identified/confirmed the prominent needs that would be most impacted by the site. The top community health needs assessed, but will not be part of the current implementation plan are as follows: Transportation: CMC currently provides a Care-A-Van service for patients, and recently donated funds to DaVita Dialysis to help fund transportation for our patients who need daily rides to appointments. We were able to expand the Care-A-Van service in Cedar Falls during the last assessment, but are limited by the number of volunteer drivers. The organization remains engaged with local government on plans to improve the transportation infrastructure in our community. Geriatric Care: Our current care model includes geriatric services and we work with local partners to ensure ongoing care for this growing population. STI: CMC works closely with our in-house lab, and the county health department to partner with their existing programs. Dental: CMC will continue to support the Iowa Mission of Mercy when it comes back to Waterloo, but dental care will not be a top priority for CMC. Unemployment: We will contiExplanationTxt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule H Supplemental InformationFormAndLineReferenceDesc
ExplanationSchedule H Part 1 Line 6a: For Fiscal Years prior to 2017, the Annual Report that included the Hospitals community benefit information was contained in a report prepared by the former parent organization, Wheaton Franciscan Services, Inc. However, effective May 1, 2016, the Iowa region of Wheaton Franciscan Healthcare was transferred to Mercy Health Network. As a result of this transfer, the Iowa region has conducted their own audit, and prepared their own Community Benefit Reports for Fiscal 2016 and subsequent years. The Fiscal 2017 Community Benefit report entitled Moving Our Community Forward can be accessed at this link: http://wfhcia.trinity-health.org/Documents/2017%20Community%20Benefit%20Re port.pdf Schedule H Part 1 Line 7: Community Benefit amounts are reported using total actual costs per the hospitals managerial accounting system in use, which includes all patient segments including inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, Medicare HMO, uninsured, and self-pay patients. Medicare is reported using the most recently filed cost report at the time the Annual Report and related community benefit information is published. Amounts are summarized using a software application recommended by the Catholic Health Association in conjunction with the Iowa Hospital Association, because it has the ability to provide the information in a format suitable for Schedule H presentation. After the data is entered by the Site Finance Directors, its accuracy is verified by employees who are trained in community benefit reporting, and then approved by the Chief Financial Officer and the President/CEO of the Iowa organization. After amounts are verified and approved, community benefit amounts become finalized. Finally, the information is compiled with the assistance of CBISA software for presentation in IRS Forms 990 Schedule H and Statement of Program Service Accomplishments Part III. The Iowa hospital facilities are not required to report community benefit information to the State of Iowa, but do make the information readily available on certain websites, and report the information to the Iowa Hospital Association. Schedule H Part 1 Line 7 Column f: Iowa Hospitals follow guidelines established by the Catholic Health Association and the Iowa Hospital Association, who recommend that bad debt expense not be included in community benefit amounts. As a result of this applied methodology, a total amount of $767,669 has not been included in the denominator of the calculation that determines the percentages reported on Schedule H Line 7 Column f. Schedule H Part 1 Line 7g: In the Iowa region, clinic operations are included as a department of the hospital, Covenant Medical Center, Inc. Clinic operations for the Iowa clinics are included only in the community benefit reporting of charity care, government sponsored health care, and Medicare shortfall. Therefore, costs related to physician clinics are not included in subsidized health services reported on Schedule H Part I Line 7g. Schedule H Part III Section A Lines 1-3: In determining bad debt amounts, the Iowa organizations use a two-level scoring process as follows: First, for any patient account that is categorized as having no insurance, when the amount becomes 60 days overdue or greater, the patients account is reviewed for financial assistance qualification. If the patient is found to qualify for financial assistance, the necessary steps are taken to apply, and the needed adjustments are made so as to treat as charity care and not as bad debt. A similar scoring process is completed for those patients who do have insurance, but after 120 days or greater, still have not paid the patient responsibility portion. Again, these patient accounts are reviewed for financial assistance, and if they qualify, similar steps are taken to remove from bad debt. As a result of these scoring procedures, Iowas position is therefore that none of the patients resulting in uncollectible accounts would have qualified as charity care patients as this determination is made at the time of admission, or later with the timing of the scoring procedures mentioned above. Bad debt is therefore only determined for each organization at the time the amount due is truly determined to be uncollectible, after financial assistance has been determined, and after many months of collection efforts. Additionally, the organization followed guidelines established by the Catholic Health Association and the Iowa Hospital Association, who recommends that no bad debt amounts be included in community benefit amounts. For these reasons, Part III Section A Line 3 is reported at zero. Schedule H Part III Section A Line 4 Sartori Memorial Hospital, Inc. is included in the consolidated financial statements of Wheaton Franciscan Healthcare - Iowa, Inc. The following is the text of the footnote from the financial statements which addresses the allowance for doubtful accounts. This footnote can be found on page 14 of the attached consolidated financial statements. Patient's account receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectability of patient accounts receivable, the Hospitals analyze their past history and identify trends for each of their 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 doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospitals analyze contractually due amounts and provide an allowance for doubtful accounts and a provision for bad debts, if necessary. For receivables associated with patient responsibility (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 patients are screened against the Hospital's charity care policy and uninsured discount policy. Each charity care application is inspected even if a patient has insurance, as they may be underinsured and qualify for the charity care discount. For any remaining patient responsibility balance, the Hospitals record a provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. The Hospitals' allowance for uncollectible accounts for self-pay patients, which includes unisured patients and residual copayments and deductibles for which managed care has already paid, covers 65% of self-pay accounts receivable at June 30, 2017. The Hospitals do not maintain a material allowance for uncollectible accounts from third-party payors, nor did the Hospitals have significant write-offs from third-party payors. The Hospitals recognize patient service revenue associated with services provided to patients who have third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for charity care, the Hospitals recognize revenue for services provided (on the basis of discounted rates, as provided by policy). On the basis of historical experience, a portion of the Hospital's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the Hospitals record a provision for bad debts related to uninsured patients in the period the services are provided. Schedule H Part III Section B Line 6-8 Schedule H Part III Section B Line 6 reports allowable costs of care as taken from the most recently filed Medicare cost report available at the time the Community Benefit Report is published. The Medicare cost report calculates its allowable total costs based on applicable Medicare regulations. Medicare and Medicaid cost is determined using individual cost center cost-to-charge ratios. This cost to charge ratio is determined using all payer cost and all payer charges. The cost to charge ratio is applied to the actual Medicare and Medicaid charges to determine the Medicare and Medicaid cost. This organization has adopted the cost and charge practices as recommended by the Catholic Health Association and the Iowa Hospital Association, and therefore, does not count any Medicare shortfall numbers in its annual reporting of Community Benefit amounts. Schedule H Part III Section C Line 9b: Iowa organizations follow a policy that outlines all collection practices for patients who are known to qualify for government programs and for our charity care program. We make every attempt tExplanationTxt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Sartori Healthcare Foundation IncBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line13421 West 9th StAddressLine1Txt
CityWaterlooCityNm
State AbbreviationIAStateAbbreviationCd
ZIP507025499ZIPCd
FieldValueIRS element (for citing)
Recipient EIN421240996RecipientEIN
IRC Section501(c)(3)IRCSectionDesc
Cash Grant$55,530CashGrantAmt
Valuation Method UsedBookValuationMethodUsedDesc
Purpose Of GrantSupportPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule I DisclosuresFormAndLineReferenceDesc
ExplanationDonations made by Sartori Memorial Hospital, Inc. to charitable organizations are made in furtherance of the recipient organization's exempt purpose. Donations are included in community benefits in schedule H if the contribution has been formally restricted to a community benefit activity that meets the criteria to be reported on schedule H.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 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
Jack Dusenbery
Director; President$0$435,816$0$234,000$0$13,455$0$42,835$0$23,146$0$749,252$0$0
Diane Heindl MD
Physn Employee; Former Officer$0$198,408$0$4,500$0$904$0$18,890$0$1,850$0$224,552$0$0
Mary Jo Kavalier
VP Operations$154,744$0$27,332$0$2,797$0$38,067$0$22,569$0$245,509$0$0$0
James Lehman MD
VP Medical Affairs$0$332,313$0$103,700$0$8,739$0$14,506$0$15,638$0$474,896$0$0
Ryan Meyer
Admin Directr; Former Key Empl$0$135,883$0$12,099$0$1,133$0$6,160$0$18,622$0$173,897$0$0
Michele Panicucci
Asst. Treas.; CFO through 4/17$0$278,835$0$129,100$0$15,826$0$52,142$0$16,588$0$492,491$0$0
Timothy Huber
Asst. Treas.; CFO as of 4/17$0$144,205$0$13,242$0$998$0$16,386$0$25,320$0$200,151$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule J DisclosuresFormAndLineReferenceDesc
ExplanationSchedule J Part I Line 3 Sartori Memorial Hospital, Inc. is a subsidiary in the Wheaton Iowa system. Sartori Memorial Hospital, Inc.'s President/CEO is paid directly by a related entity, Covenant Medical Center, Inc. Covenant Medical Center, Inc. used the following methods to establish the compensation of Sartori Memorial Hospital, Inc.'s President/CEO: -independent compensation consultant -written employment contract -compensation survey or study, and -approval by Mercy Health Network board of directorsExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule O DisclosuresIRS Form 990 Part I Line 6 Sartori Memorial Hospital, Inc. received donated services through volunteers assisting in such areas as surgical waiting area, information desk, ambulatory surgery, medical records, engineering, occupational health, dietary, community screenings, materials, laundry, surgery, administration, human resources, public relations, wellness, and medical runner. Part V Line 1a and Part VII Section B Line 1-2 Wheaton Iowa streamlined their reporting of IRS Forms 1099-MISC so that most 1099-MISC are now reported using the FEIN number of the parent organization or of a related organization. The actual expense continues to be either paid by, or transferred to, the individual entity, which is normally a subsidiary or related organization to the organization(s) issuing the 1099. For this reason, the reader may notice on some 990's that there are top 5 independent contractors reported, but no 1099s are reported. Likewise on the 990's of the organization(s) reporting number of 1099's, there may be a disproportionate share of 1099's reported as compared with the actual expenses of the organization. IRS Form 990 Part VI Section A Line 4 The organization's bylaws were amended and restated December 1, 2016 to reflect that the corporate member of the parent of Sartori Memorial Hospital, Inc. (Wheaton Franciscan Healthcare - Iowa, Inc.) was changed on May 1, 2016 from Wheaton Franciscan Services, Inc. to Mercy Health Network, Inc. IRS Form 990 Part VI Section A Lines 6-7b Sartori Memorial Hospital, Inc. has one member which holds several reserved powers over Sartori Memorial Hospital, Inc. These reserved powers include, but are not limited to, the election of members of the governing body and election of officers, approval of certain financial expenditures in accordance with policy, and approval of budgets and strategic plans; these approvals are based on recommendations from the governing body. IRS Form 990 Part VI Section B Lines 11a and 11b Affiliates of Wheaton Iowa during the fiscal year ending June 30, 2017 used a multiple-level review process on all IRS Forms 990 to ensure accurate and timely filing for all organizations. Under the direction of the Chief Financial Officer, the Accounting Department prepares Forms 990 and any applicable 990-T and associated state filings. When complete, the return is first reviewed by a Senior-Level (or higher) associate in the Finance Department, who focuses on the income statement and balance sheet items, and schedules where transactions of this type might be reported. If discrepancies are found, the item will be corrected prior to the next step in the review process. Once cleared through Finance, the return is provided to the Tax Department of the Wheaton Iowa sponsor organization, where the Tax Director concentrates primarily on consistency of reporting between all returns, accuracy of tax related information, and explanation and understanding of any outliers. Again, any problems or questions are investigated and corrected. Depending on the level of complexity of the year in question, as well as the individual issues specific to that filing, certain returns may be selected for outside review by a public accounting firm. This decision will vary from year to year based on many factors, and sometimes outside review is not utilized at all. Also, certain schedules, such as Schedule H or Schedule J may be reviewed by committees, such as the Community Benefit Team or the Compensation Committee in selected years. The board has asked for formal presentations on various 990 topics over the years. This decision will vary from year to year, again based on many factors. Once all levels of review have been completed, a designated finance and accounting employee will schedule an appointment with the signer of the 990. The signer, the Vice President-Finance and CFO, will perform an additional, normally high level review prior to signing the return. Once signed, the return is cleared to provide to members of the Board of Directors, who at a later date but prior to efiling, are provided access to all 990's throughout their assigned region. IRS Form 990 Part VI Section B Lines 12a - 12c: Sartori Memorial Hospital, Inc. has adopted a Conflict of Interest policy which applies to all "interested persons" of Sartori Memorial Hospital, Inc. including directors, principal officers, key employees, and members of committees with Board-delegated powers. Interested persons are expected to discharge their duties in a manner the person reasonably believes to be in the best interests of Sartori Memorial Hospital, Inc. and to avoid situations involving a conflict of interest. On an annual basis, interested persons are required to complete a conflict of interest disclosure statement and to affirm their receipt of the conflict of interest policy, compliance with its requirements, and agree to notify the organization of changes impacting their annual disclosure in accordance with the policy. The annual disclosures are provided to internal Legal Counsel and the Integrity and Compliance Officer, from which Legal Counsel prepares a report for the Board Chair and CEO. A summary of potential conflicts is reviewed with the Board of Directors of Sartori Memorial Hospital, Inc. (or a delegated committee of the Board) on a yearly basis. Interested persons are required to make full disclosure to Sartori Memorial Hospital, Inc. of any financial or business interests that might result in or have the appearance of a conflict of interest. The Board of Directors of Sartori Memorial Hospital, Inc. (or a delegated committee of the Board) is responsible for the review of transactions to determine whether an actual conflict of interest exists. In the event of an actual conflict, the Board (or a delegated committee of the Board) will either avoid the conflict or appropriately scrutinize the transaction to ensure it is in the best interests of Sartori Memorial Hospital, Inc. Interested persons are required to recuse themselves from discussion and voting on matters involving a conflict of interest. The policy further addresses the proper documentation of the proceedings and potential disciplinary and corrective action for violations of the policy. The policy is available to the public upon request.
Schedule O Disclosures (cont'd)IRS Form 990 Part VI Section B Line 15a Question 15a is answered "No" because the compensation for the CEO of Sartori Memorial Hospital, Inc. is established and paid by a related entity, Covenant Medical Center, Inc. In establishing CEO compensation, Covenant Medical Center, Inc. follows a process which includes the following: Use of an independent compensation consultant and compensation study, use of a written employment contract, and review and approval by the Mercy Health Network board of directors. This process is performed annually. IRS Form 990 Part VI Section B Line 15b In establishing other officer and key employee compensation, Sartori Memorial Hospital, Inc. follows a process which includes the following: Use of an independent compensation consultant and compensation study, use of a written employment contract, and review and approval by the Covenant Medical Center, Inc. and Wheaton Franciscan Healthcare - Iowa, Inc. CEO, authorized to act on behalf of the Board with respect to certain compensation matters. This process is performed annually. IRS Form 990 Part VI Section C Line 19 Affliates of Wheaton Iowa, during the fiscal year ending June 30, 2017, provided upon request certain documents including our financial statements, conflict of interest policy, and governing documents that support our tax exempt status, including, but not limited to, articles of incorporation and bylaws. IRS Form 990 Part VII Column B Affiliates of Wheaton Iowa during the fiscal year ending June 30, 2017 operated as a controlled group of related healthcare organizations. As such, many employees who are at the Director level or above, or who are Officers and/or Directors of organizations where Wheaton has common boards and other overlaps in committee representations, spend significant time devoted to tasks not only for the filing organization, but also for related organizations. While there is no official time study tracking that is done, it is estimated that for each employee, tasks devoted to related organizations could approximate up to 80% or more of total hours. IRS Form 990 Part XI Line 9 Certain related organizations utilize receivable/payable accounts throughout the year. These intercompany balances were settled through the equity account at the end of the fiscal year to bring the receivable/payable balance to zero. For the fiscal year ended June 30, 2017 this resulted in a decrease in net assets or fund balances of $4,117,815.
FORM 990 PART IX LINE 24 - OTHER EXPENSESDESCRIPTION:PARENT COMPANY ALLOCATION TOTAL EXPENSES:6429236 PROGRAM SERVICES:6429236
FORM 990 PART IX LINE 24 - OTHER EXPENSESDESCRIPTION:MEDICAID PROVIDER TAX TOTAL EXPENSES:261022 PROGRAM SERVICES:261022
FORM 990 PART IX LINE 24 - OTHER EXPENSESDESCRIPTION:AUXILIARY TOTAL EXPENSES:45866 PROGRAM SERVICES:45866
FORM 990 PART IX LINE 24 - OTHER EXPENSESDESCRIPTION:MISCELLANEOUS TOTAL EXPENSES:31382 PROGRAM SERVICES:31382
FORM 990 PART IX LINE 24 - OTHER EXPENSESDESCRIPTION:DUES AND SUBSCRIPTIONS TOTAL EXPENSES:50618 PROGRAM SERVICES:50618

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
WF Healthcare - Iowa Inc
3421 WEST NINTH STREETWATERLOOIA50702421177001HOLDING COIA501(c)(3)12 - III-FIMHNYes (true)
Covenant Foundation Inc
3421 WEST NINTH STREETWATERLOOIA50702421295784FOUNDATIONIA501(c)(3)10COV MED CTRYes (true)
Covenant Medical Center Inc
3421 WEST NINTH STREETWATERLOOIA50702421264647HOSPITALIA501(c)(3)3WFH-IOWAYes (true)
Mercy Hospital of Fran Sisters Inc
3421 WEST NINTH STREETWATERLOOIA50702421178403HOSPITALIA501(c)(3)3WFH-IOWAYes (true)
NE Iowa Real Estate Invsts
3421 WEST NINTH STREETWATERLOOIA50702421207432HOLDING COIA501(c)(2)N/AWFH-IOWAYes (true)
Sartori Health Care Foundation Inc
3421 WEST NINTH STREETWATERLOOIA50702421240996FOUNDATIONIA501(c)(3)12 - ISARTORI HOSPYes (true)
Mercy Health Network
1111 6th AvenueDes MoinesIA50314421478417PARENTDE501(C)(3)12 - III-FINAYes (true)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (4 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
Sartori Health Care Foundation Inc
B$55,530Book value
Sartori Health Care Foundation Inc
C$132,288Book value
Wheaton Franciscan Healthcare - Iowa Inc
m$6,429,236Book value
Covenant Medical Center Inc
o$1,543,823Book value

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