SARTORI MEMORIAL HOSPITAL INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- SARTORI MEMORIAL HOSPITAL INC (EIN 42-0758901)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-12
- IRS object ID
- 201701329349300735
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule N
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-12T08:08:37-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420758901 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sartori Memorial Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % TIMOTHY HUBER | InCareOfNm |
| Business Name Control | SART | BusinessNameControlTxt |
| Phone | 3192683000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 515 College Street | AddressLine1Txt |
| City | Cedar Falls | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50613 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIMOTHY HUBER | PersonNm |
| Person Title | VPF/CFO | PersonTitleTxt |
| Phone | 3192727607 | PhoneNum |
| Signature | 2017-05-15 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Jack Dusenbery | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3421 West Ninth Street | AddressLine1Txt |
| City | Waterloo | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 507025499 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $40,788,716 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.wheatoniowa.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1954 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | General inpatient and outpatient acute health care services. | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 332 | TotalEmployeeCnt |
| Total Volunteers | 6 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $572,574 | PYContributionsGrantsAmt |
| CY Contributions Grants | $302,324 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $37,494,356 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $39,233,016 | CYProgramServiceRevenueAmt |
| PY Investment Income | $15,412 | PYInvestmentIncomeAmt |
| CY Investment Income | -$1,943 | CYInvestmentIncomeAmt |
| PY Other Revenue | $720,894 | PYOtherRevenueAmt |
| CY Other Revenue | $1,111,754 | CYOtherRevenueAmt |
| PY Total Revenue | $38,803,236 | PYTotalRevenueAmt |
| CY Total Revenue | $40,645,151 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $400,557 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $329,777 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $13,544,220 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $14,700,934 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $19,395,282 | PYOtherExpensesAmt |
| CY Other Expenses | $20,648,138 | CYOtherExpensesAmt |
| PY Total Expenses | $33,340,059 | PYTotalExpensesAmt |
| CY Total Expenses | $35,678,849 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,463,177 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,966,302 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,345,292 | TotalAssetsBOYAmt |
| Total Assets EOY | $17,153,476 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,725,007 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,006,600 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $12,620,285 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,146,876 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | AS A MEMBER OF WHEATON FRANCISCAN HEALTHCARE, OUR AFFILIATES STRIVE TO LIVE OUT THE HEALING MINISTRY OF THE JESUS 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 Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $31,795,398 | ExpenseAmt |
| Grant | $329,777 | GrantAmt |
| Revenue | $40,073,418 | RevenueAmt |
| Desc | WHEATON 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 107 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 1993, Franciscan Ministries transformed the former Schoitz Hospital building into Ridgeway Place, which provides housing for independent elderly residents. 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 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 / 2016 Charity Care: $4,055,181. 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: $9,624,030. 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: $1,330,818. 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: $881,134. 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: $2,451,656. 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: $30,112. 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: $97,755. 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: $4,515,072. 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 2016: $22,985,756. | Desc |
| Total Program Service Expenses | $31,795,398 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | Yes (true) | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 332 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (true) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIMOTHY HUBER | PersonNm |
| Phone | 3192727607 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3421 WEST NINTH STREET | AddressLine1Txt |
| City | WATERLOO | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 507025499 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Jack Dusenbery | ||||||||||
| President - Director | 1.0 | 40.0 | Yes (X) | Yes (X) | $0 | $637,518 | $90,879 | |||
| Nick Evens | ||||||||||
| Chair - Director | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| John Fuller | ||||||||||
| V Chair / Treasurer - Director | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Michael Hager | ||||||||||
| Director | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||||
| James Hartel MD | ||||||||||
| Secretary - Director | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Sue Roberts | ||||||||||
| Treasurer - Director | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Tom Strub DDS | ||||||||||
| Chair - Director | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Michele Panicucci | ||||||||||
| Asst. Treas. | 1.0 | 40.0 | Yes (X) | $0 | $401,585 | $110,060 | ||||
| Phyllis Doulaveris | ||||||||||
| Sr VP and Chief Nursing Office | 1.0 | 40.0 | $0 | $237,738 | $26,367 | Yes (X) | ||||
| Mary Jo Kavalier | ||||||||||
| VP Operations | 1.0 | 40.0 | $176,711 | $14,404 | $33,011 | Yes (X) | ||||
| James Lehman MD | ||||||||||
| VP Medical Affairs | 1.0 | 40.0 | $0 | $433,483 | $29,468 | Yes (X) | ||||
| Ryan Meyer | ||||||||||
| Admin Director | 1.0 | 40.0 | $0 | $150,538 | $26,088 | Yes (X) | ||||
| Kathryn Eisenman | ||||||||||
| OR Facilitator | 40.0 | 1.0 | $102,361 | $0 | $9,384 | Yes (X) | ||||
| Kelly Wolf | ||||||||||
| Pharmacist | 40.0 | 1.0 | $136,633 | $0 | $11,679 | Yes (X) | ||||
| Diane Heindl MD | ||||||||||
| Physician | 1.0 | 40.0 | $0 | $226,799 | $22,258 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $415,705 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,102,065 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $359,194 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Emergency Practice Associates Inc | |||||
| PO Box 1260 | WATERLOO | IA | 507041260 | Physician Services | $1,402,388 |
| Xygent Inc | |||||
| 9961 Valley View Road | EDEN PRAIRIE | MN | 55344 | Surgical Services | $389,534 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $72,577 | FundraisingAmt |
| Related Organizations | $183,666 | RelatedOrganizationsAmt |
| All Other Contributions | $46,081 | AllOtherContributionsAmt |
| Noncash Contributions | $3,723 | NoncashContributionsAmt |
| Total Contributions | $302,324 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PROGRAM SERVICE REVENUE | 900099 | $14,606,980 | $14,606,980 |
| MEDICARE/MEDICAID PAYMENTS | 900099 | $24,265,824 | $24,265,824 |
| RENT REVENUE | 900002 | $360,212 | $360,212 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $39,233,016 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,253 | TotalRevenueColumnAmt |
| Exclusion | $22,253 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $157,600 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $78,856 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $78,744 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $78,744 | TotalRevenueColumnAmt |
| Exclusion | $78,744 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $24,196 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$24,196 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$24,196 | TotalRevenueColumnAmt |
| Exclusion | -$24,196 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $18,993 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $72,577 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $40,513 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$21,520 | TotalRevenueColumnAmt |
| Exclusion | -$21,520 | ExclusionAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| ELECTRONIC HEALTH RECORD | 900099 | $840,402 | $840,402 | |
| GIFT SHOP | 453220 | $46,619 | $46,619 | |
| CAFETERIA | 722514 | $101,768 | $101,768 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $65,741 | TotalRevenueColumnAmt |
| Exclusion | $65,741 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,054,530 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $40,645,151 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $40,073,418 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $269,409 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $329,777 | TotalAmt |
| Program Services | $329,777 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $207,124 | TotalAmt |
| Management And General | $207,124 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,925,403 | TotalAmt |
| Program Services | $10,739,961 | ProgramServicesAmt |
| Management And General | $185,442 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,183,121 | TotalAmt |
| Program Services | $1,172,996 | ProgramServicesAmt |
| Management And General | $10,125 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,563,277 | TotalAmt |
| Program Services | $1,529,267 | ProgramServicesAmt |
| Management And General | $34,010 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $822,009 | TotalAmt |
| Program Services | $809,846 | ProgramServicesAmt |
| Management And General | $12,163 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,333 | TotalAmt |
| Program Services | $4,333 | ProgramServicesAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,510,909 | TotalAmt |
| Program Services | $1,510,909 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,536 | TotalAmt |
| Program Services | $5,536 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,511,353 | TotalAmt |
| Program Services | $1,473,821 | ProgramServicesAmt |
| Management And General | $37,532 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $802,128 | TotalAmt |
| Program Services | $802,128 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,516 | TotalAmt |
| Program Services | $13,708 | ProgramServicesAmt |
| Management And General | $1,808 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,737 | TotalAmt |
| Program Services | $13,098 | ProgramServicesAmt |
| Management And General | $639 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,980 | TotalAmt |
| Management And General | $22,980 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,367,559 | TotalAmt |
| Program Services | $1,367,411 | ProgramServicesAmt |
| Management And General | $148 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PURCHASED SERVICES | $1,741,319 | $1,741,319 | |
| MEDICAL SUPPLIES | $6,670,744 | $6,670,744 | |
| BAD DEBT EXPENSE | $644,522 | $644,522 | |
| CORPORATE SERVICES ALLOCATION | $3,951,107 | $579,627 | $3,371,480 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,386,395 | TotalAmt |
| Program Services | $2,386,395 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,678,849 | TotalAmt |
| Program Services | $31,795,398 | ProgramServicesAmt |
| Management And General | $3,883,451 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,993,985 | BOYAmt |
| EOY | $4,223,922 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $361,835 | BOYAmt |
| EOY | $362,925 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $12,699,983 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $149,120 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,970,761 | BOYAmt |
| EOY | $12,550,863 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,711 | BOYAmt |
| EOY | $15,766 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,345,292 | BOYAmt |
| EOY | $17,153,476 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,588,306 | BOYAmt |
| EOY | $1,832,945 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,136,701 | BOYAmt |
| EOY | $1,173,655 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,725,007 | BOYAmt |
| EOY | $3,006,600 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,620,285 | BOYAmt |
| EOY | $14,146,876 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,620,285 | BOYAmt |
| EOY | $14,146,876 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,345,292 | BOYAmt |
| EOY | $17,153,476 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $4,966,302 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$3,439,711 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $4,333 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $0 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,333 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule C Disclosures | FormAndLineReferenceDesc |
| Explanation | Schedule C Part II-B Line 1i: Wheaton Franciscan Healthcare was part of a controlled group of healthcare organizations through late in the fiscal year, when most of the entities were transferred to new parent organizations. These entities were related through these respective dates, through a common parent organization, Wheaton Franciscan Services, Inc. Certain entities within this controlled group engaged in limited lobbying activities that benefited each organization collectively. For calendar year 2015, Wheaton Franciscan Healthcare employed two individuals whose responsibilities included oversight and management of lobbying activities for these organizations the Senior Vice President of Strategic Initiatives and the Director of Government Relations and Advocacy . The Senior Vice President provided strategic oversight for the department and participated in visits with key elected officials when appropriate. The Director provides on-the-ground support, served as the first point of contact for elected officials, and executed on legislative lobbying activities that supported the strategic interests of the organization. These lobbying activities approximated 50% of total annual salary for the Director and no more than 20% for the Senior Vice President. A benefits factor of 25% was added, and the total was allocated amongst the organizations that received the benefit of these services. The lobbying activities included advocacy efforts related to public policy proposals such as: changes to Medicare and Medicaid funding; federal or state legislation that may impact the organization; participating in and coordinating visits with elected officials at all levels of government (local, state and federal); mobilizing grassroots efforts on behalf of the organization on issues of interest; coordinating advocacy activities in conjunction with relevant trade associations; and providing internal awareness on specific state related legislative issues when the need arises. The portion of direct expenses related to annual employee business travel to Washington DC or other locations, in order to lobby for issues important to healthcare providers and patients, have been included if applicable. Finally, any trade association dues containing a percentage portion allocable to lobbying activities, has been identified, and added or estimated as appropriate. Sartori Hospital, Inc. #42-0758901 $4,333 | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,300,000 | OtherCostOrOtherBasisAmt |
| Book Value | $4,300,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,717,943 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,272 | DepreciationAmt |
| Book Value | $2,702,671 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,681,087 | OtherCostOrOtherBasisAmt |
| Depreciation | $133,846 | DepreciationAmt |
| Book Value | $5,547,241 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $953 | OtherCostOrOtherBasisAmt |
| Depreciation | $2 | DepreciationAmt |
| Book Value | $951 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,550,863 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO/FROM THIRD PARTY PAYORS | $1 |
| OTHER LIABILITIES | $1,173,654 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,173,655 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | IRS Form 990 Schedule D, Part X | FormAndLineReferenceDesc |
| Explanation | The 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, 2016, the Company did not have a liability for unrecognized tax benefits. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Fstvl of Trees | Event1Nm |
| Gross Receipts Event1 | $83,867 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $68,726 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $15,141 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $5,775 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $12,214 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $275 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $21,831 | OtherDirectExpensesEvent1Amt |
| Event2 | May Breakfast | Event2Nm |
| Gross Receipts Event2 | $7,703 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $3,851 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $3,852 | GrossRevenueEvent2Amt |
| Rent Facility Costs Event2 | $418 | RentFacilityCostsEvent2Amt |
| Other Events Total | 0 | OtherEventsTotalCnt |
| Gross Receipts Total | $91,570 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $72,577 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $18,993 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $6,193 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $12,214 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $275 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $21,831 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $40,513 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$21,520 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $369,976 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $369,976 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01060 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,089,684 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,885,236 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $204,448 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00580 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,459,660 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,885,236 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $574,424 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01640 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,720 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $20,720 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $444,550 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $30,364 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $414,186 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01180 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,685,158 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $897,236 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $787,922 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02250 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,360 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $26,360 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,176,788 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $927,600 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,249,188 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03570 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,636,448 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,812,836 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,823,612 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05210 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,085 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $379 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,706 | NetCommunityBenefitExpnsAmt |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,085 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $379 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,706 | NetCommunityBenefitExpnsAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $644,522 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $12,148,304 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $14,502,004 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,353,700 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sartori Memorial Hospital Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 515 College Street | AddressLine1Txt |
| City | Cedar Falls | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50613 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | http://www.wheatoniowa.org | WebsiteAddressTxt |
| State License | 070059H (IA) | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Facility Reporting Group | 1 | FacilityReportingGroupCd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sartori Memorial Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | wheatoniowa.org - full url in narrative | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | wheatoniowa.org - full url in narrative | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | wheatoniowa.org-full url in narra | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | wheatoniowa.org-full url in narrativ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | wheatoniowa.org-full url in | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule H Supplemental Information | FormAndLineReferenceDesc |
| Explanation | Schedule 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 directly accessed at the following websites: Please go to www.wheatoniowa.org and select About Us, then Community Benefit Report, then select Community Health Needs Assessment on the left. For each of the 3 Iowa Hospitals, a Community Health Needs Assessment and Implementation Plan are available. Schedule H Part V Section B Line 5: This report was compiled by Wheaton Iowa (representing both CMC and 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 residents with three hospitals and a network of clinics. Representatives from the listed entities include 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. The worked collaboratively to develop the survey, and made it available to the public online and in paper form. The public was invited through publicity, websites, and mass emailing efforts on behalf of the partners, community chamber organizations, etc., to take the survey December 1-20, 2015. Paper surveys were made 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. Nearly 600 electronic and paper surveys were collected with additional efforts made to ensure a cross-section of residents completed the survey. Information was also collected through one-on-one interviews 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: Covenant Medical Center and Sartori Memorial Hospital, as part of Wheaton Franciscan Healthcare-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/webres/File/community-benefit-report/Sartori%2 0CHNA%20and%20IP%20Board%20Approved.pdf Schedule H Part V Section B Line 10a: https://www.wheatoniowa.org/webres/File/community-benefit-report/CHNA%20Sa rtori%202015.pdf 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 Healthcare 101 is an online educational program created and provided by Wheaton Iowa, and feature topics such as but not limited to: solutions for joint pain (hip & knee), Early Heart Attack Care (EHAC), consequences/risks of not vaccinating, benefits of fitness, and dietary needs/ good nutrition. These videos are meant to provide additional education to patients and families, allowing them to access these topics via our website. 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 partnered with the University of Northern Iowa Healthy Campus Coalition to provide drinking safety education. Mental Health Services & Education o SMH collaborated with the University of Northern Iowa to start a conversation surrounding mental health by providing free access to author/speaker Kevin Hansen, as well as free copies of Secret Regrets: You are not alone Cardiovascular Disease o SMH has improved cardiovascular monitoring and communication systems in the field through enhanced technology for patients in transport to SMH Emergency Department through the purchase, installation, and use of the EKG systems in emergency vehicles. As of FY16, all SMH ambulance crews were able to produce and transmit filed EKGs to the hospital. Cancer o SMH collaborated 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 also 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 will remain focused on the same key findings with its partners. These will include: Access and Education; Health 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-V-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 drives. The organization remains engaged with local government on plans to improve the transportation infrastructure in our community. Geriatric Care: These services are already integrated into our current care model, 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 denta | ExplanationTxt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule H Supplemental Information | FormAndLineReferenceDesc |
| Explanation | Schedule H Part 1 Line 6a: The Annual Report that includes the Hospitals community benefit information is normally 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 conducted their own audit, and prepared their own Community Benefit Report for Fiscal 2016 entitled Empowering People for Healthier Communities. This Community Benefit report can be accessed at: https://www.wheatoniowa.org/webres/File/community-benefit-report/2016%20Co mmunity%20Benefit%20Report.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 $644,522 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 1-4: 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 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 to assist the patient in enrolling in government insurance plans or our own charity care program allowing for free or discounted care. If the patient does not qualify for any type of aid or charity care, declines to establish a reasonable payment plan or pay the liability, the patient will be moved into a bad debt status, and the account is sent to a collection agency. This does not occur before the patient has received several notices and a final written warning. Please also see Schedule H Part III Section A Lines 1-4 narrative response. Schedule H Part V Section A and Section C: Affiliates of the Iowa region have defined and reported hospital facilities to include only those bricks and mortar buildings that actually have inpatient beds, in addition to meeting all other criteria under Iowa state law required for hospital licensing. Although there may be other facilities within our system built to hospital specifications, performing hospital-based billing, and conforming to other hospital standards under state law, until there is further guidance from the IRS, these facilities have been reported in Section C, due to their lack of having state certified inpatient beds. Schedule H Part VI Line 2: Iowa assesses the needs of the communities it serves by reviewing admission and discharge data, analyzing information from the community health departments and other community leaders, and by aligning our services with the Healthy People 2020 and other current year initiatives. The Iowa hospital organizations complete a Community Health Needs Assessment and Implementation Plan every three years. Please reference Schedule H Part V Section B Lines 1-12 for additional information. Schedule H Part VI Line 3: Iowa provides its patients with several opportunities to gain knowledge and awareness of its Community Care (Charity Care/Financial Assistance) program. Notices regarding the availability of financial assistance are displayed in highly visible locations where there is a significant volume of inpatient or outpatient traffic such as: patient admitting and registration areas in both inpatient and outpatient settings, physician offices, and emergency departments. Additionally, brochures describing the policy are available upon request in the same locations and on Iowas website. The policy is also discussed at the time of registration or pre-registration, upon admission, and again at discharge for all inpatient procedures. Schedule H Part VI Line 4: Please see detailed information provided at Schedule H Part V Section B Lines 1-12 and Part VI Line 5 Schedule H Part VI Line 5 Theresa Sartori was not a Wheaton Franciscan Sister, but it is often said her life of community service was synonymous with the Sisters Mission. A native of Baden, Germany, she came to the United States in 1857 and eventually settled in Cedar Falls, Iowa. For 40 years she served as president of the Ladies Aid Society, her churchs community service organization. She assisted the sick and homebound throughout Cedar Falls, served as a member of the Womens Relief Corp, and founded the Cedar Falls Womans Club. Upon her death in 1901, Theresas husband arranged for a hospital to be built in her name. The ho | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Valuation Method UsedValuationMethodUsedDesc | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| Sartori Healthcare Foundation Inc | ||||||||
| 3421 West 9th St | Waterloo | IA | 507025499 | 421240996 | 501(c)(3) | $58,276 | Book | Support |
| OSF Services Inc | ||||||||
| PO Box 667 | Wheaton | IL | 601870667 | 391471463 | 501(c)(3) | $271,501 | Book | Provide support |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule I Disclosures | FormAndLineReferenceDesc |
| Explanation | Wheaton Franciscan Healthcare maintains files and records to manage the decision-making and award process for organizations that it provides community sponsorship dollars to. Decisions are made by a Community Sponsorship Committee with leaders who hold positions in Diversity, Strategic Planning, Mission Services, Marketing and Philanthropy. The Committee generally strives to sponsor organizations that have missions that align with the mission, vision and values of Wheaton Franciscan Healthcare. The committee also looks for certain other criteria when deciding which organizations will receive contributions, including but not limited to supporting healthcare related activities within the Southeast Wisconsin, Iowa, and Illinois markets, supporting programming that work to further diversity and cultural competency, aligning with other WFH business relationships or service lines, supporting student academic achievement or workforce development initiatives, and finally, supporting environmental "green" initiatives. Leaders periodically meet with representatives of sponsored organizations to discuss objectives including how dollars will be spent. Additionally, Wheaton Franciscan Healthcare may, at a later date, ask for documentation in order to monitor that funds were spent for their intended purpose. Currently, confirmation letters are sent to sponsored organizations when award dollars are given, that confirm the dollar amount awarded and the intended purpose, with a request that the recipient acknowledge receipt of the funds in written correspondence. Files are maintained in the Organizational Change and Leadership Performance Department to include copies of letters of request, award and denial letters, additional documentation if requested, along with acknowledgement receipts from sponsored organizations. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Phyllis Doulaveris | ||||||||||||||
| Sr VP and Chief Nursing Office | $0 | $164,361 | $0 | $72,200 | $0 | $1,177 | $0 | $0 | $26,367 | $0 | $264,105 | $0 | $0 | |
| Jack Dusenbery | ||||||||||||||
| President - Director | $0 | $424,892 | $0 | $202,200 | $0 | $10,426 | $0 | $0 | $29,370 | $0 | $728,397 | $0 | $0 | $61,509 |
| Diane Heindl MD | ||||||||||||||
| Physician | $0 | $223,616 | $0 | $2,400 | $0 | $783 | $0 | $0 | $1,652 | $0 | $249,057 | $0 | $0 | $20,606 |
| Mary Jo Kavalier | ||||||||||||||
| VP Operations | $134,514 | $14,121 | $40,200 | $1,997 | $283 | $17,734 | $12,679 | $2,598 | $207,124 | $17,002 | $0 | $0 | ||
| James Lehman MD | ||||||||||||||
| VP Medical Affairs | $0 | $340,860 | $0 | $90,100 | $0 | $2,523 | $0 | $0 | $15,129 | $0 | $462,951 | $0 | $0 | $14,339 |
| Ryan Meyer | ||||||||||||||
| Admin Director | $0 | $139,162 | $0 | $11,130 | $0 | $246 | $0 | $0 | $18,678 | $0 | $176,626 | $0 | $0 | $7,410 |
| Michele Panicucci | ||||||||||||||
| Asst. Treas. | $0 | $274,126 | $0 | $113,500 | $0 | $13,959 | $0 | $0 | $19,380 | $0 | $511,645 | $0 | $0 | $90,680 |
Schedule N IRS990ScheduleN
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liquidation Of Assets Table | LiquidationOfAssetsTableGrp |
Disposition Of Assets Detail DispositionOfAssetsDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Assets Distri Or Expnss Paid | Net Asset Transfer | AssetsDistriOrExpnssPaidDesc |
| Distribution | 2016-05-01 | DistributionDt |
| Fair Market Value Of Asset | $16,564,363 | FairMarketValueOfAssetAmt |
| Method Of FMV Determination | Book Value | MethodOfFMVDeterminationTxt |
| EIN | 421478417 | EIN |
| Person | Mercy Health Network | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1111 6th Ave | AddressLine1Txt |
| City | Des Moines | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50314 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | 501(c)(3) | IRCSectionTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | Yes (true) | DirectorOfSuccessor2Ind |
| Employee Of Successor2 | Yes (true) | EmployeeOfSuccessor2Ind |
| Owner Of Successor2 | false | OwnerOfSuccessor2Ind |
| Receive Compensation2 | false | ReceiveCompensation2Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | IRS Form 990 Schedule N Part II Lines 2a-2b: | FormAndLineReferenceDesc |
| Explanation | Effective May 1, 2016, Wheaton Franciscan Services, Inc. transferred their membership in Wheaton Franciscan Healthcare - Iowa, Inc. and subsidiaries to Mercy Health Network, Inc. As a result of this transfer, the existing board members and officers continued to serve in their former capacity through the end of the reporting period. A reorganization is currently in process, and new boards may be formed under a new structure in the future. Additionally, all Wheaton Franciscan Healthcare senior leaders and employees were retained and transferred (job title and payroll) to Mercy Health Network. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule O Disclosures | IRS 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. IRS Form 990 Part IV Lines 12a-12b and Part XII Lines 2a-2c: Effective May 1, 2016, Iowa entities transferred their ownership interest from Wheaton Franciscan Services, Inc. to Mercy Health Network, Inc. For the year ending June 30, 2016 the system parent organization did not conduct its regular consolidated audit, therefore the Iowa region conducted their own audit, which included just the Iowa entities (and not Wheaton Franciscan Healthcare or Mercy entities). We have therefore answered NO, YES accordingly. Part V Line 1a and Part VII Section B Line 1-2 Wheaton Franciscan Healthcare 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 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 Ministries that were affiliates of Wheaton Franciscan Healthcare during the fiscal year ending June 30, 2016 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 Tax Manager, the Accounting Department prepares Forms 990, 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, where the Tax Manager 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, the Tax Manager (or the designated employee in the applicable region) will schedule an appointment with the signer of the 990. This is normally a Senior Vice President or CFO of the applicable region, who 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 leater date but prior to efiling, are provided access to all 990's throughout their assigned region via an online portal. Additionally, as a courtesy, an individual who is listed on any 990 as a reportable individual will also receive access to the portal, where they can view the 990 if they so choose, prior to it being filed with the IRS. IRS Form 990 Part VI Section B Lines 12a - 12c: The organization has a Conflict of Interest policy which states that if at any time, an officer or director become aware that the board may discuss or act upon any transaction or arrangement which may have any bearing of any kind upon, or may relate in any manner to, a financial interest of the individual, the financial interest must be disclosed. All associates of the organization must disclose a potential conflict of interest any time it arises. The disclosures are reviewed and a determination is made as to whether a conflict of interest exists and how it might be managed. Additionally, as part of an annual process, conflict of interest questionnaires are sent out to all Officers, Directors, and other individuals in key positions using software designed to capture this information. The responses are analyzed in order to determine information on potential conflicts, as well as information on business and family relationships and other disclosures required to be made on IRS Form 990. Responses to these questions are reviewed by the Vice President of Compliance and the Manager of Tax Compliance, and follow up action, if any, is documented within the software. Non-responders are reminded of their oustanding disclosure requirement automatically through the software system. Responses to questions continue to be reviewed and documented throughout this time period. Approximately 1 month prior to the filing deadline of IRS Form 990, responses to date are compiled. Any response requiring disclosure is entered into the information return. The remaining non responder names are determined, and a letter, along with the actual Conflict of Interest Policy, is sent to the Chairperson of each board. The letter lists the current non responders, as well as any Officer or Board member that has disclosed a financial interest that might pose a potential conflict of interest. Depending upon the nature of the financial interest and work done by the board, several actions may be considered - first, the board member with a financial interest would need to voluntarily excuse him or herself from the deliberations and/or voting on such a matter. If not, the board may, if necessary, etermine that the subject's financial interest was an actual conflict of interest, in which case the board member would be informed by the board Chairperson that he or she would not be allowed to vote in any such matters due to this real or perceived conflict of interest. Minutes of the board meeting would document this decision process, and reflect whatever action(s) are ultimately taken. The board chairperson is also required to discuss with non responders the repercussions of not responding, and require the board member to complete the annual conflict of interest disclosure questions before being allowed to continue in any board matters. If the board member refuses, the Chairperson has the authority to determine the appropriate action, including, but not limited to prohibiting them from participating in deliberations, preventing them from voting, and/or removing them as a board member. |
| Schedule O Disclosures (cont'd) | IRS Form 990 Part VI Section B Line 15b For the calendar year 2015, the filing organization has paid individuals who served as either Officers or Key Employees during the reporting period. These individuals have the following compensation structure: The compensation for the organization's officers and key employees who are paid by the filing organization is reviewed and approved on an annual basis, as part of the WFSI Executive Compensation Plan, by the Executive Committee of the Wheaton Franciscan Services, Inc. Board of Directors (the "Executive Committee of the WFSI Board"), an independent board, acting in a manner consistent with its conflicts of interest policy. The WFSI Board's decision is informed by an opinion on market comparable compensation data provided to the WFSI Board by an independent compensation expert. The WFSI Board maintains contemporaneous documentation of the substantiation of the deliberation and decisions it makes. IRS Form 990 Part VI Section C Line 19 Ministries that were affliates of Wheaton Franciscan Healthcare during the fiscal year ending June 30, 2016 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. During fiscal 2016, all ministries were transferred to new parent organizations and all organizations are currently working on policy review and implementation in order to adopt and streamline existing policies to those of the new parent. IRS Form 990 Part VII Column B Ministries that were affiliates of Wheaton Franciscan Healthcare during the fiscal year ending June 30, 2016 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, 2016 this resulted in an decrease in net assets or fund balances of $1,677,106. Additionally, as a result of the transfer of ownership interest from Wheaton Franciscan Services, Inc. to Mercy Health Network, Inc. effective May 1, 2016 a revaluation of fixed assets was completed to adjust the carrying amount of fixed assets to market value. For the fiscal year ended June 30, 2016 this resulted in a decrease in net assets or fund balances of $1,762,605. Disclosure Statement Related to Forms 5471 Under the constructive ownership rules of Internal Revenue Code Sections 958(a) and (b), the taxpayer is required to file Forms 5471, Information Return of US persons with respect to certain foreign corporations, as a category 4 and/or 5 filer with respect to Wheaton Franciscan Insurance Company, FEIN #98-0691609. These filing requirements are or will be satisfied through the filing of Forms 5471 with respect to the foreign corporation on the taxpayer's behalf by the US taxpayers identified below who have the same filing requirement. Taxpayer name: Wheaton Franciscan Services, Inc. Address: 26 w171 Roosevelt Road, Wheaton IL 60187 FEIN number of US Tax return with which form 5471 was filed: 36-3262111 IRS Service Center where US Tax return was or will be filed: e-filed |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (80 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Wheaton Franciscan Services Inc (3) | ||||||||||
| 26 W 171 ROOSEVELT RD | WHEATON | IL | 60187 | 363262111 | PARENT CORP | IL | 501(c)(3) | 11 - III-FI | NA | false |
| WFH - Southeast Wisconsin Inc (2) | ||||||||||
| 400 WEST RIVER WOODS PARKWAY | GLENDALE | WI | 53212 | 391568865 | HOLDING CO | IL | 501(c)(3) | 11 - III-FI | WFSI | false |
| WFH - All Saints Inc (2) | ||||||||||
| 3801 SPRING STREET | RACINE | WI | 53405 | 391264986 | HOSPITAL | WI | 501(c)(3) | 3 | WFH-SE WI | false |
| WFH - All Saints Foundation Inc (2) | ||||||||||
| 3805B SPRING STREET | RACINE | WI | 53405 | 391570877 | FOUNDATION | WI | 501(c)(3) | 11 - I (7) | WFH-AS INC | false |
| Vlntrs in Pnrshp w WFH-All Saints (2) | ||||||||||
| 3807 SPRING STREET | RACINE | WI | 53405 | 930838390 | FOUNDATION | WI | 501(c)(3) | 11 - III-NF | WFH-AS INC | false |
| WFH - Circle of Life Foundation (2) | ||||||||||
| 4300 W BROWN DEER RD STE 250 | BROWN DEER | WI | 53223 | 562426294 | FOUNDATION | WI | 501(c)(3) | 11 - I | WFH-PE | false |
| WF Home Health & Hospice Inc (2) | ||||||||||
| 3070 N 51ST ST STE 406 | MILWAUKEE | WI | 53210 | 391559428 | HOME HLTH | WI | 501(c)(3) | 3 | WFH-SE WI | false |
| WF Medical Group Inc (2) | ||||||||||
| 400 WEST RIVER WOODS PARKWAY | GLENDALE | WI | 53212 | 391791586 | MED GROUP | WI | 501(c)(3) | 3 | WFH-SE WI | false |
| WF - Elmbrook Memorial Fndn Inc (2) | ||||||||||
| 19333 WEST NORTH AVENUE | BROOKFIELD | WI | 53045 | 392028808 | FOUNDATION | WI | 501(c)(3) | 11 - I | WF INC | false |
| WF Laboratories Inc (2) | ||||||||||
| 3237 SOUTH 16TH STREET | MILWAUKEE | WI | 53215 | 391701402 | LABORATORY | WI | 501(c)(3) | 9 | WFH-SE WI | false |
| WFH - Pharmacy Ent & Fran Woods (2) | ||||||||||
| 19525 WEST NORTH AVENUE | BROOKFIELD | WI | 53005 | 391613624 | PHARMACY | WI | 501(c)(3) | 9 | WFH-SE WI | false |
| WFH - St Francis Inc (2) | ||||||||||
| 3237 SOUTH 16TH STREET | MILWAUKEE | WI | 53215 | 390907740 | HOSPITAL | WI | 501(c)(3) | 3 | WFH-SE WI | false |
| WF - St Joseph Foundation Inc (2) | ||||||||||
| 5000 WEST CHAMBERS STREET | MILWAUKEE | WI | 53210 | 391636804 | FOUNDATION | WI | 501(c)(3) | 11 - I | WF INC | false |
| Wheaton Franciscan Inc (2) | ||||||||||
| 5000 WEST CHAMBERS STREET | MILWAUKEE | WI | 53210 | 390816857 | HOSPITAL | WI | 501(c)(3) | 3 | WFH-SE WI | false |
| WFH - Fndn for St Francis & Franklin (2) | ||||||||||
| 3237 SOUTH 16TH STREET | MILWAUKEE | WI | 53215 | 320135258 | FOUNDATION | WI | 501(c)(3) | 11 - I | WFH-SFH | false |
| WFH - Elmbrook Memorial Auxiliary (2) | ||||||||||
| 19333 WEST NORTH AVENUE | BROOKFIELD | WI | 53045 | 396068950 | AUXILIARY | WI | 501(c)(3) | 11 - III-FI | WF INC | false |
| WFH - Terrace at St Francis Inc (2) | ||||||||||
| 3200 SOUTH 20TH STREET | MILWAUKEE | WI | 53215 | 391486775 | NURSING HOME | WI | 501(c)(3) | 9 | WFH-SE WI | false |
| WFH - Franklin Inc (2) | ||||||||||
| 10101 SOUTH 27TH STREET | FRANKLIN | WI | 53132 | 562592868 | HOSPITAL | WI | 501(c)(3) | 3 | WFH-SE WI | false |
| Metro Physicians Inc (2) | ||||||||||
| 400 WEST RIVER WOODS PARKWAY | GLENDALE | WI | 53212 | 943436893 | MED GROUP | WI | 501(c)(3) | 3 | WFMG | false |
| Marianjoy Inc (1) | ||||||||||
| 26 W 171 ROOSEVELT RD | WHEATON | IL | 60187 | 363483589 | HOLDING CO | IL | 501(c)(3) | 11 - III-FI | WFSI | false |
| Marianjoy Foundation Inc (1) | ||||||||||
| 26 W 171 ROOSEVELT RD | WHEATON | IL | 60187 | 352165613 | FOUNDATION | IL | 501(c)(3) | 7 | MJ HOSP | false |
| Marianjoy Rehab Center Auxiliary (1) | ||||||||||
| 26 W 171 ROOSEVELT RD | WHEATON | IL | 60187 | 363896976 | AUXILIARY | IL | 501(c)(3) | 11 - I | MJ HOSP | false |
| Marianjoy Rehab Hospital & Clinics (1) | ||||||||||
| 26 W 171 ROOSEVELT RD | WHEATON | IL | 60187 | 362680776 | REHAB HOSPITA | IL | 501(c)(3) | 3 | MARIANJOY | false |
| Rehabilitation Medicine Clinic (1) | ||||||||||
| 26 W 171 ROOSEVELT RD | WHEATON | IL | 60187 | 363236791 | MEDICAL GRP | IL | 501(c)(3) | 3 | MARIANJOY | false |
| WF Sisters Fndn (fka OSF) (3)(6) | ||||||||||
| PO Box 667 | WHEATON | IL | 601870667 | 391471463 | HOLDING CO | WI | 501(c)(3) | 11 - III-FI | WFSI | false |
| Canticle Ministries Inc (3)(7) | ||||||||||
| PO Box 667 | WHEATON | IL | 601870667 | 364091836 | HOUSING/ADVCY | IL | 501(c)(3) | 7 | OSF SVCS INC | false |
| Fran Sisters Charitable Fund of CO (3) | ||||||||||
| 2626 OSCEOLA STREET | DENVER | CO | 80212 | 840733072 | AUXILIARY | CO | 501(c)(3) | 7 | OSF SVCS INC | false |
| SET Ministry Inc (3) | ||||||||||
| 2977 NORTH 50TH STREET | MILWAUKEE | WI | 53210 | 391618277 | SOCIAL WORK | WI | 501(c)(3) | 9 | OSF SVCS INC | false |
| St Catherines Hospital Inc (3) | ||||||||||
| 9555 76TH STREET | PLEASANT PRAIRIE | WI | 53158 | 390855075 | HOSPITAL | WI | 501(c)(3) | 3 | OSF SVCS INC | false |
| UHS Inc (3)(8) | ||||||||||
| 6308 EIGHTH AVENUE | KENOSHA | WI | 53143 | 391956749 | HOSPITAL | WI | 501(c)(3) | 3 | NONE | false |
| Upendo Village NFP (3) | ||||||||||
| PO Box 667 | WHEATON | IL | 601870667 | 331007368 | HIV SUPPORT | IL | 501(c)(3) | 9 | OSF SVCS INC | false |
| WF Healthcare - Iowa Inc | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421177001 | HOLDING CO | IA | 501(c)(3) | 11 - III-FI | WFSI | false |
| Covenant Foundation Inc | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421295784 | FOUNDATION | IA | 501(c)(3) | 9 | COV MED CTR | false |
| Covenant Medical Center Inc | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421264647 | HOSPITAL | IA | 501(c)(3) | 3 | WFH-IOWA | false |
| Mercy Hospital of Fran Sisters Inc | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421178403 | HOSPITAL | IA | 501(c)(3) | 3 | WFH-IOWA | false |
| NE Iowa Real Estate Invsts | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421207432 | HOLDING CO | IA | 501(c)(2) | N/A | WFH-IOWA | false |
| Sartori Health Care Foundation Inc | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421240996 | FOUNDATION | IA | 501(c)(3) | 11 - I | SARTORI HOSP | Yes (true) |
| Mercy Health Network (4) | ||||||||||
| 1111 6th Avenue | Des Moines | IA | 50314 | 421478417 | MANAGEMENT | DE | 501(C)(3) | 11 - II | NA | false |
| Mercy Health Srvces - Iowa (4) | ||||||||||
| 1000 4TH STREET SW | MASON CITY | IA | 50401 | 311373080 | HOSPITAL | DE | 501(C)(3) | 3 | THC | false |
| Trinity Health Corporation (4) | ||||||||||
| 20555 VICTOR PARKWAY | LIVONIA | MI | 48152 | 351443425 | MANAGEMENT | IN | 501(C)(3) | 11 - II | CHI | false |
| Catholic Health Initiatives (4) | ||||||||||
| 198 Inverness Drive West | Englewood | CO | 80112 | 470617373 | SUPPORT | CO | 501(C)(3) | 9 | NA | false |
| Cath Health Initiatives-Iowa Corp (4) | ||||||||||
| 1111 6th Avenue | Des Moines | IA | 50314 | 420680448 | HEALTHCARE | IA | 501(C)(3) | 3 | CHI | false |
| Franciscan Ministries Inc (5) | ||||||||||
| 26W171 ROOSEVELT ROAD | WHEATON | IL | 601870667 | 363259684 | HOLDING CO | IL | 501(c)(3) | 11 - III-FI | WFSI | false |
| Assisi Homes - Batavia Aprtmnts (5) | ||||||||||
| 1259 EAST WILSON STREET | BATAVIA | IL | 60510 | 363914084 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| Assisi Homes - Colony Park Inc (5) | ||||||||||
| 550 EAST THORNHILL DRIVE | CAROL STREAM | IL | 60188 | 364039278 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| Assisi Homes - Cnstn House Inc (5) | ||||||||||
| 401 N CONSTITUTION DRIVE | AURORA | IL | 60506 | 364049150 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| Assisi Homes - Jefferson Court Inc (5) | ||||||||||
| 415 EAST KNAPP STREET | MILWAUKEE | WI | 53202 | 391771526 | HOUSING | WI | 501(c)(3) | 9 | FMI | false |
| Assisi Homes - Kenosha Inc (5) | ||||||||||
| 1860 27TH AVENUE | KENOSHA | WI | 53140 | 391814815 | HOUSING | WI | 501(c)(3) | 9 | FMI | false |
| Assisi Homes - Saxony Inc (5) | ||||||||||
| 1876 22ND AVENUE | KENOSHA | WI | 53140 | 391790498 | HOUSING | WI | 501(c)(3) | 9 | FMI | false |
| Assisi Homes of Gurnee Inc (5) | ||||||||||
| 3495 WEST GRAND AVENUE | GURNEE | IL | 60031 | 363942336 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| Assisi Homes of Illinois Inc (5) | ||||||||||
| 2126 WEST ROOSEVELT ROAD | WHEATON | IL | 60187 | 363803443 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| Assisi Homes of Neenah Inc (5) | ||||||||||
| 210 BYRD AVENUE | NEENAH | WI | 54946 | 363767250 | HOUSING | WI | 501(c)(3) | 9 | FMI | false |
| Canticle Place Inc (5) | ||||||||||
| 26W171 ROOSEVELT ROAD | WHEATON | IL | 601870667 | 363957850 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| Catherine Marian Housing Inc (5) | ||||||||||
| 806 SOUTH WISCONSIN AVENUE | RACINE | WI | 53403 | 391657098 | HOUSING | WI | 501(c)(3) | 9 | FMI | false |
| Clare Gardens Inc (5) | ||||||||||
| 2626 OSCEOLA STREET | DENVER | CO | 80212 | 237200039 | HOUSING | CO | 501(c)(3) | 9 | FMI | false |
| Clare of Assisi Homes - Westminster (5) | ||||||||||
| 2451 WEST 82ND PLACE | WESTMINSTER | CO | 80031 | 742740978 | HOUSING | CO | 501(c)(3) | 9 | FMI | false |
| Dayspring Villa Inc (5) | ||||||||||
| 3777 WEST 26TH AVENUE | DENVER | CO | 80211 | 363933908 | HOUSING | CO | 501(c)(3) | 9 | FMI | false |
| Francis Heights Inc (5) | ||||||||||
| 2626 OSCEOLA STREET | DENVER | CO | 80212 | 840626174 | HOUSING | CO | 501(c)(3) | 9 | FMI | false |
| Franciscan Ministries Comm Fndn (5) (25) | ||||||||||
| 26W171 ROOSEVELT ROAD | WHEATON | IL | 601870667 | 364456204 | FOUNDATION | IL | 501(c)(3) | 11 - I | FMI | false |
| Marian Housing Center Inc (5) | ||||||||||
| 4105 SPRING STREET | RACINE | WI | 53405 | 391515867 | HOUSING | WI | 501(c)(3) | 9 | FMI | false |
| Marian Park Inc (5) | ||||||||||
| 2126 WEST ROOSEVELT ROAD | WHEATON | IL | 60187 | 362750105 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| Ridgeway Place Inc (5) | ||||||||||
| 155 EAST RIDGEWAY AVENUE | WATERLOO | IA | 50702 | 421416064 | HOUSING | IA | 501(c)(3) | 9 | FMI | false |
| Villa Maria Inc (5) | ||||||||||
| 2461 WEST 82ND PLACE | WESTMINSTER | CO | 80031 | 841347868 | HOUSING | CO | 501(c)(3) | 9 | FMI | false |
| Alexandria Manor Inc (5)(9) | ||||||||||
| 600 East Jackson St Unit M-50 | Alexandria | IN | 46001 | 475177987 | HOUSING | IN | 501(c)(3) | 9 | FMI | false |
| Indianapolis Manor 1 Inc (5)(10) | ||||||||||
| 7950 Harcourt Rd | Indianapolis | IN | 46260 | 475178092 | HOUSING | IN | 501(c)(3) | 9 | FMI | false |
| Kokomo Manor Inc (5)(11) | ||||||||||
| 510 Elk Dr | Kokomo | IN | 46902 | 475189624 | HOUSING | IN | 501(c)(3) | 9 | FMI | false |
| Indianapolis Manor 2 Inc (5)(12) | ||||||||||
| 1840 Perkins Ave | Indianapolis | IN | 46203 | 475178185 | HOUSING | IN | 501(c)(3) | 9 | FMI | false |
| Paducah Ministries 1 Inc (5)(13) | ||||||||||
| 650 College Ave 77 | Paducah | KY | 42001 | 475203278 | HOUSING | KY | 501(c)(3) | 9 | FMI | false |
| Princeton Ministries 4 Inc (5)(14) | ||||||||||
| 655 Grace Court | Princeton | KY | 42445 | 475202983 | HOUSING | KY | 501(c)(3) | 9 | FMI | false |
| Richardson Ministries Inc (5)(15) | ||||||||||
| 500 Rockingham Lane | Richardson | TX | 75080 | 475202868 | HOUSING | TX | 501(c)(3) | 9 | FMI | false |
| Effingham Ministries Inc (5)(16) | ||||||||||
| 512 Hendelmeyer | Effingham | IL | 62401 | 475190275 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| Moline Ministries 1 Inc (5)(17) | ||||||||||
| 4201 22nd Street | Moline | IL | 61265 | 475216971 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| Moline Ministries 2 Inc (5)(18) | ||||||||||
| 4201 22nd Street | Moline | IL | 61265 | 475217175 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| Lake Wales Ministries Inc (5)(19) | ||||||||||
| 504 South 4th Street | Lake Wales | FL | 33853 | 475190723 | HOUSING | FL | 501(c)(3) | 9 | FMI | false |
| Pendleton Ministries 2 Inc (5)(20) | ||||||||||
| 950 Cherry St G-1 | Pendleton | SC | 29670 | 475247951 | HOUSING | SC | 501(c)(3) | 9 | FMI | false |
| Tucson Ministries Inc (5)(21) | ||||||||||
| 4131 North Western Winds Drive | Tucson | AZ | 85705 | 475239406 | HOUSING | AZ | 501(c)(3) | 9 | FMI | false |
| Phoenix Ministries 3 Inc (5)(22) | ||||||||||
| 7220 North 27th Ave | Phoenix | AZ | 85051 | 475217326 | HOUSING | AZ | 501(c)(3) | 9 | FMI | false |
| Davenport Ministries Inc (5)(23) | ||||||||||
| 7218 Hillandale Rd Apt 1 | Davenport | IA | 52806 | 475227048 | HOUSING | IA | 501(c)(3) | 9 | FMI | false |
| Villa St Clare Inc (5)(24) | ||||||||||
| 130 BYRD AVENUE | NEENAH | WI | 54946 | 391769395 | HOUSING | WI | 501(c)(3) | 9 | FMI | false |
| Assisi Homes - La Salle Manor Inc (5) | ||||||||||
| 26W171 ROOSEVELT ROAD | WHEATON | IL | 601890795 | 800623447 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Cedar Val Com HC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 999 Home Plaza | AddressLine1Txt |
| City | WATERLOO | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 261642558 | EIN |
| Primary Activities | Healthcare | PrimaryActivitiesTxt |
| Legal Domicile State | IA | LegalDomicileStateCd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Wheaton Franciscan Enterprises Inc (2) | ||||||||||||||
| 400 WEST RIVER WOODS PARKWAY | GLENDALE | WI | 53212 | 391985204 | HOLDING CO | WI | WF HOLDINGS INC | C CORP | false | |||||
| Wheaton Franciscan Holdings Inc (2) | ||||||||||||||
| 400 WEST RIVER WOODS PARKWAY | GLENDALE | WI | 53212 | 391836357 | HOLDING CO | WI | WFH-SE WI | C CORP | false | |||||
| WFMG - Sussex Inc (2) | ||||||||||||||
| 400 WEST RIVER WOODS PARKWAY | GLENDALE | WI | 53212 | 391361100 | MED GROUP | WI | WF HOLDINGS INC | C CORP | false | |||||
| Wheaton Franciscan Prov Network Inc (2) | ||||||||||||||
| 400 WEST RIVER WOODS PARKWAY | GLENDALE | WI | 53212 | 391952140 | PROVIDER CONTRACT | WI | WFH-SE WI | C CORP | false | |||||
| FMOB Condo Assoc Inc (2) | ||||||||||||||
| 400 WEST RIVER WOODS PARKWAY | GLENDALE | WI | 53212 | 341983857 | CONDO MGMT | WI | FMOB LLC | C CORP | false | |||||
| Wheaton Way Condo Owners Assoc Inc (2) | ||||||||||||||
| 10101 SOUTH 27TH STREET | FRANKLIN | WI | 53132 | 300659830 | CONDO ASSCN | WI | WFH-FRKLN | C CORP | false | |||||
| Wheaton Franciscan Insurance Company (3) | ||||||||||||||
| 980691609 | FINANCIAL | WFSI | Other | false | PO BOX 69 GT | GEORGETOWN | GRAND CAYMAN | UK | UK | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (true) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Sartori Health Care Foundation Inc | ||
| B | $58,276 | Book value |
| Sartori Health Care Foundation Inc | ||
| C | $183,666 | Book value |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule R Disclosures | FormAndLineReferenceDesc |
| Explanation | (1) Effective March 1, 2016, organizations in the Marianjoy region were transferred from Wheaton Franciscan Services, Inc. to Northwestern Memorial Healthcare, and as a result, ceased to be related as of this date. (2) Effective March 1, 2016, organizations in the Southeast Wisconsin region were transferred from Wheaton Franciscan Services, Inc. to Ascension Health, and as a result, ceased to be related as of this date. (3) Effective March 1, 2016, organizations in the Wheaton Franciscan Services, Inc. and Wheaton Franciscan Sisters Foundation, Inc. region were transferred to Wheaton Franciscan Sisters Corporation, and as a result, ceased to be related as of this date. (4) Effective May 1, 2016, organizations in the Iowa region were transferred from Wheaton Franciscan Services, Inc. to Mercy Health Network, adding new related organizations as of this date. (5) Effective May 1, 2016 with the transfer of Iowa entities to Mercy Health Network, all organizations in the Franciscan Ministries region ceased to be related as of this date. (6) Effective May 4, 2016, O.S.F. Services, Inc. changed its legal name to Wheaton Franciscan Sisters Foundation, Inc. (7) Effective June 9, 2016, Canticle Ministries, Inc. was dissolved, and as such, this will be it's final 990 and the final year it will be reported as a related organization. (8) UHS, Inc. is listed without a direct controlling entity because of the two organizations with an interest, KHMC Community Board and Wheaton Franciscan Sisters Foundation, Inc., neither can appoint a majority of the board, and since KHMC is not an entity (it is a community board), neither body "controls". (9) Alexandria Manor, Inc. was incorporated on September 25, 2015 and was granted exempt status effective February 2, 2016. (10) Indianapolis Manor 1, Inc. was incorporated on September 25, 2015 and was granted exempt status effective November 5, 2015. (11) Kokomo Manor, Inc. was incorporated on September 25, 2015 and was granted exempt status effective April 4, 2016. (12) Indianapolis Manor 2, Inc. was incorporated on September 25, 2015 and was granted exempt status effective November 5, 2015. (13) Paducah Ministries 1, Inc. was incorporated on September 25, 2015 and was granted exempt status effective April 15, 2016. (14) Princeton Ministries 4, Inc. was incorporated on September 25, 2015 and was granted exempt status effective March 21, 2016. (15) Richardson Ministries, Inc. was incorporated on September 25, 2015 and was granted exempt status effective January 15, 2016. (16) Effingham Ministries, Inc. was incorporated on September 25, 2015 and was granted exempt status effective December 21, 2015. (17) Moline Ministries 1, Inc. was incorporated on September 25, 2015 and was granted exempt status effective April 6, 2016. (18) Moline Ministries 2, Inc. was incorporated on September 25, 2015 and was granted exempt status effective March 30, 2016. (19) Lake Wales Ministries, Inc. was incorporated on September 25, 2015 and was granted exempt status effective January 7, 2016. (20) Pendleton Ministries 2, Inc. was incorporated on September 29, 2015 and was granted exempt status effective May 12, 2016. (21) Tucson Ministries, Inc. was incorporated on September 25, 2015 and was granted exempt status effective February 3, 2016. (22) Phoenix Ministries 3, Inc. was incorporated on September 25, 2015 and was granted exempt status effective March 16, 2016. (23) Davenport Ministries, Inc. was incorporated on September 29, 2015 and was granted exempt status effective January 15, 2016. (24) Effective January 31, 2016, assets of Villa St. Clare, Inc. were sold to an unrelated party, and the entity will subsequently be dissolved. (25) Effective December 22, 2016 Franciscan Ministries Community Foundation, Inc. was dissolved. | ExplanationTxt |
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