FLAMBEAU HOSPITAL INC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
FLAMBEAU HOSPITAL INC (EIN 39-0973724)
Tax period
2015-07-01 to 2016-06-30
Filed
2017-05-15
IRS object ID
201711359349304991
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 ReturnHeader

FieldValueIRS element (for citing)
Return2017-05-15T11:33:07-05:00ReturnTs
Tax Period End2016-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN390758449PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 8010AddressLine1Txt
CityWAUSAUCityNm
State AbbreviationWIStateAbbreviationCd
ZIP544028010ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN390973724EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FLAMBEAU HOSPITAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlFLAMBusinessNameControlTxt
Phone7157622484PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line198 SHERRY AVENUEAddressLine1Txt
CityPARK FALLSCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54552ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJAMES BRAUNPersonNm
Person TitleCHIEF ADMINISTRATIVE OFFICER/CFOPersonTitleTxt
Phone7157622484PhoneNum
Signature2017-05-11SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKATHLEEN J LABRAKE CPAPreparerPersonNm
PTINP00164006PTIN
Phone7158453111PhoneNum
Preparation2017-05-11PreparationDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJAMES BRAUNPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line198 SHERRY AVENUEAddressLine1Txt
CityPARK FALLSCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54552ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$22,974,149GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressHTTP://MINISTRYHEALTH.ORG/FH/HOME.NWSWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1961FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionTO CREATE HEALTHIER COMMUNITIES WHILE IMPROVING THE HEALTH AND WELL BEING OF THE PEOPLE IN THE RURAL SETTINGS SERVED.ActivityOrMissionDesc
Voting Members Governing Body14VotingMembersGoverningBodyCnt
Voting Members Independent14VotingMembersIndependentCnt
Total Employee268TotalEmployeeCnt
Total Volunteers166TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$154,432PYContributionsGrantsAmt
CY Contributions Grants$132,383CYContributionsGrantsAmt
PY Program Service Revenue$21,861,419PYProgramServiceRevenueAmt
CY Program Service Revenue$22,793,415CYProgramServiceRevenueAmt
PY Investment Income$26,359PYInvestmentIncomeAmt
CY Investment Income$26,705CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$12,747CYOtherRevenueAmt
PY Total Revenue$22,042,210PYTotalRevenueAmt
CY Total Revenue$22,965,250CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$11,657,274PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$12,009,340CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$9,131,097PYOtherExpensesAmt
CY Other Expenses$10,080,153CYOtherExpensesAmt
PY Total Expenses$20,788,371PYTotalExpensesAmt
CY Total Expenses$22,089,493CYTotalExpensesAmt
PY Revenues Less Expenses$1,253,839PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$875,757CYRevenuesLessExpensesAmt
Total Assets BOY$15,919,928TotalAssetsBOYAmt
Total Assets EOY$16,464,599TotalAssetsEOYAmt
Total Liabilities BOY$5,248,113TotalLiabilitiesBOYAmt
Total Liabilities EOY$4,344,182TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$10,671,815NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$12,120,417NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTHE FOLLOWING OBJECTIVES PROVIDE THE DIRECTION FOR FLAMBEAU HOSPITAL IN FULFILLING ITS VISION:- TO CONTINUOUSLY IMPROVE QUALITY SERVICES TO CUSTOMERS BY BUILDING EXCELLENCE INTO EVERY ASPECT AND PROCESS OF THE HOSPITAL. CUSTOMERS INCLUDE PATIENTS AND STAFF MEMBERS. THIS EXCELLENCE DEVELOPS FROM TOTAL QUALITY IMPROVEMENT, AN ENVIRONMENT THAT ENCOURAGES EVERYONE TO CONTRIBUTE TO THE HOSPITAL'S MISSION.- TO ENCOURAGE HEALTH PROMOTION AND WELLNESS THROUGH EDUCATIONAL ACTIVITIES. WHEN FEASIBLE, THESE ACTIVITIES WILL BE PURSUED IN CONJUNCTION WITH AREA HEALTH CARE PROVIDERS.- TO COLLABORATE WITH AND PROVIDE REFERRALS TO AGENCIES PROVIDING SERVICES NOT DIRECTLY AVAILABLE AT THE HOSPITAL.- TO MAINTAIN AN OPEN RELATIONSHIP WITH THE MEDICAL AND HOSPITAL STAFF TO ENSURE EFFICIENT AND EFFECTIVE UTILIZATION OF HOSPITAL RESOURCES.- TO PROVIDE IN-SERVICE AND CONTINUING EDUCATIONAL OPPORTUNITIES FOR HEALTH CARE PERSONNEL AS A MEANS OF PROVIDING QUALITY PATIENT CARE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$16,897,423ExpenseAmt
Revenue$22,711,157RevenueAmt
DescFLAMBEAU HOSPITAL PROVIDES WELLNESS ACTIVITIES, EDUCATION AND PRIMARY HEALTHCARE SERVICES TO APPROXIMATELY 17,000 RESIDENTS IN OUR SERVICE AREA. HEALTHCARE SERVICE INCLUDES INPATIENT CARE AND SWING BED SERVICES ALONG WITH LABORATORY, RADIOLOGY, PHARMACY, REHABILITATION, SURGERY, AND OTHER OUTPATIENT SERVICES. SERVICES FOR THE YEAR ENDED JUNE 30, 2016 INCLUDED 1,737 INPATIENT DAYS, 97 SWING BED DAYS AND 27,314 OUTPATIENT REGISTRATIONS.FLAMBEAU HOME HEALTH PROVIDES HEALTH CARE SERVICES FOR HOMEBOUND PATIENTS INCLUDING PRIMARY CARE, WOUND AND INFECTION SERVICES, PERSONAL CARE SERVICES, PAIN MANAGEMENT AND OTHER MEDICAL SERVICES THAT CAN BE PROVIDED IN THE HOME. THESE SERVICES ARE PROVIDED TO THE SAME SERVICE AREA AND INCLUDED UNDUPLICATED PATIENT DAYS AND SERVICES TO PATIENTS.FLAMBEAU HOSPICE PROVIDES END OF LIFE CARE TO PATIENTS AND THEIR FAMILIES IN THEIR HOMES OR OTHER APPROPRIATE FACILITIES. ALSO PROVIDED ARE CHAPLAIN, VOLUNTEER AND BEREAVEMENT SERVICES. BEREAVEMENT SERVICES CONTINUE AFTER A PATIENT'S DEATH FOR ONE YEAR OR MORE. THESE SERVICES ARE PROVIDED TO THE SAME SERVICE AREA AND INCLUDED UNDUPLICATED PATIENT DAYS AND SERVICES TO PATIENTS.Desc
Total Program Service Expenses$16,897,423TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document52IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee268EmployeeCnt
Employment Tax Returns Filed0EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members14GoverningBodyVotingMembersCnt
Independent Voting Member14IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JAMES BRAUNBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7157622484PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line198 SHERRY AVEAddressLine1Txt
CityPARK FALLSCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54552ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
BRIAN KIEF
PRESIDENT1.00Yes (X)Yes (X)$0$0$0
TOM OLSON
CHAIRPERSON1.00Yes (X)Yes (X)$0$0$0
RICK SVEHLA
VICE CHAIRPERSON/TREASURER1.00Yes (X)Yes (X)$0$0$0
LOUAY DANIAL MD
DIRECTOR1.00Yes (X)$0$0$0
DAVE DEDA
DIRECTOR1.00Yes (X)$0$0$0
TIMOTHY LINDGREN MD
DIRECTOR1.00Yes (X)$0$0$0
CAROL MADER
DIRECTOR1.00Yes (X)$0$0$0
GAYLE STANGLE
DIRECTOR1.00Yes (X)$0$0$0
MATTHEW THOMAS MD
DIRECTOR1.00Yes (X)$0$0$0
DAVE ANDERSON
DIRECTOR1.00Yes (X)$0$0$0
JULIA RUFF
DIRECTOR1.00Yes (X)$0$0$0
SUSAN SCHMIDT
DIRECTOR1.00Yes (X)$0$0$0
ROGER STRAND
DIRECTOR1.00Yes (X)$0$0$0
JAMES BRAUN
CHIEF ADMINISTRATIVE OFFICER/CFO40.00Yes (X)$194,536$0$38,690
DAVE GRUNDSTROM
CAO RETIRED 201640.00Yes (X)$0$234,147$6,701
SARA B HILGART
PHARMACIST40.00$140,563$0$16,513Yes (X)
ELIZABETH SCHREIBER
DIRECTOR OF HEALTH CARE40.00$104,392$0$36,684Yes (X)
JANE EATON-NYMAN
DIR. OF ORGANIZATIONAL INTEGRITY40.00$130,321$0$34,697Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$569,812TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$234,147TotReportableCompRltdOrgAmt
Total Other Compensation$133,285TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K4IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
MARSHFIELD CLINIC
1000 N OAK AVENUEMARSHFIELDWI54449EKG, ADMIN, ER DOCS, LAB SVCS, MRI$2,397,233
ALEXANDER KORITTNIG
442 S 3RD AVEPARK FALLSWI54552ANESTHESIA$486,147
SHARED MEDICAL TECHNOLOGY
202 WEST NEWTON STRIB LAKEWI54868MRI AND NUCLEAR MED SERVICES$421,886
MCIS INC
1701 N FIG AVENUEMARSHFIELDWI54449INFORMATION TECHNOLOGY SERVICES$419,568
TRIMEDX LLC
5451 LAKEVIEW PARKWAY S DRIVEINDIANAPOLISIN46268EQUIPMENT MAINTENANCE$194,544
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
Related Organizations$19,979RelatedOrganizationsAmt
All Other Contributions$112,404AllOtherContributionsAmt
Total Contributions$132,383TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmt
NET PATIENT SERVICE REVENUE621110$22,239,811$22,239,811
AFFILIATED ORG RENT900099$246,705$246,705
OTHER OPERATING REVENUE621110$224,641$224,641
CAFETERIA REVENUE900099$82,258$82,258
FieldValueIRS element (for citing)
Total Program Service Revenue$22,793,415TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$26,705TotalRevenueColumnAmt
Exclusion$26,705ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$21,646FundraisingGrossIncomeAmt
Fundraising Direct Expenses$8,899FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$12,747TotalRevenueColumnAmt
Exclusion$12,747ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$22,965,250TotalRevenueColumnAmt
Related Or Exempt Func Income$22,711,157RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$121,710ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$233,226TotalAmt
Management And General$233,226ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$8,674,056TotalAmt
Program Services$7,061,941ProgramServicesAmt
Management And General$1,612,115ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$246,880TotalAmt
Program Services$202,952ProgramServicesAmt
Management And General$43,928ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,265,431TotalAmt
Program Services$1,828,376ProgramServicesAmt
Management And General$437,055ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$589,747TotalAmt
Program Services$488,681ProgramServicesAmt
Management And General$101,066ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$68,804TotalAmt
Management And General$68,804ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,594,554TotalAmt
Program Services$283,587ProgramServicesAmt
Management And General$1,310,967ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$69,870TotalAmt
Management And General$69,870ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,462,998TotalAmt
Program Services$1,440,224ProgramServicesAmt
Management And General$22,774ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$447,872TotalAmt
Program Services$378,241ProgramServicesAmt
Management And General$69,631ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$234,913TotalAmt
Program Services$160,108ProgramServicesAmt
Management And General$74,805ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,174,009TotalAmt
Program Services$1,079,418ProgramServicesAmt
Management And General$94,591ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$282,505TotalAmt
Management And General$282,505ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SERVICES$3,123,326$3,094,061$29,265
EQUIPMENT RENTAL$580,839$541,619$39,220
BAD DEBT$565,834$565,834
FOOD$125,903$103,535$22,368

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$348,726TotalAmt
Program Services$234,680ProgramServicesAmt
Management And General$114,046ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$22,089,493TotalAmt
Program Services$16,897,423ProgramServicesAmt
Management And General$5,192,070ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$6,056BOYAmt
EOY$53,428EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$4,897,867BOYAmt
EOY$6,159,341EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,779,797BOYAmt
EOY$2,471,403EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$210,637BOYAmt
EOY$197,174EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$80,776BOYAmt
EOY$65,050EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$22,903,724LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$15,911,394LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$7,551,093BOYAmt
EOY$6,992,330EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$393,702BOYAmt
EOY$525,873EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$15,919,928BOYAmt
EOY$16,464,599EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,461,987BOYAmt
EOY$1,406,967EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,695,774BOYAmt
EOY$2,820,611EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$90,352BOYAmt
EOY$116,604EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,248,113BOYAmt
EOY$4,344,182EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$9,886,238BOYAmt
EOY$11,274,724EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$785,577BOYAmt
EOY$845,693EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$10,671,815BOYAmt
EOY$12,120,417EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$15,919,928BOYAmt
EOY$16,464,599EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$875,757ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$572,845OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

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

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$3,236OtherActivitiesAmt
Total Lobbying Expenditures$3,236TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationFLAMBEAU HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE AHA AND WHA HAVE NOTIFIED FLAMBEAU HOSPITAL THAT $3,236 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$73,128OtherCostOrOtherBasisAmt
Book Value$73,128BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$14,157,799OtherCostOrOtherBasisAmt
Depreciation$9,474,950DepreciationAmt
Book Value$4,682,849BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$457,922OtherCostOrOtherBasisAmt
Depreciation$347,865DepreciationAmt
Book Value$110,057BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$8,099,435OtherCostOrOtherBasisAmt
Depreciation$6,088,579DepreciationAmt
Book Value$2,010,856BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$115,440OtherCostOrOtherBasisAmt
Book Value$115,440BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$6,992,330TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
ASBESTOS ABATEMENT LIABILITY$201,213
DEFERRED BOND ISSUANCE COSTS (OFFSET AGAINST LONG-TERM DEBT)-$84,609
FieldValueIRS element (for citing)
Total Liability$116,604TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$22,399,416TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$22,399,416RevenueSubtotalAmt
Other Revenues Not Included$565,834OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$565,834RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$22,965,250TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$21,523,659TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$21,523,659ExpensesSubtotalAmt
Other Expenses Not Included$565,834OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$565,834ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$22,089,493TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART X, LINE 2:THE HOSPITAL IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAX ON RELATED INCOME.
PART XI, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT NET AGAINST REVENUE 565,834.
PART XII, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT NET AGAINST REVENUE 565,834.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1GOLF OUTINGEvent1Nm
Gross Receipts Event1$16,116GrossReceiptsEvent1Amt
Gross Revenue Event1$16,116GrossRevenueEvent1Amt
Other Direct Expenses Event1$3,369OtherDirectExpensesEvent1Amt
Event2LIGHTS OF LOVEEvent2Nm
Gross Receipts Event2$5,530GrossReceiptsEvent2Amt
Gross Revenue Event2$5,530GrossRevenueEvent2Amt
Other Direct Expenses Event2$5,530OtherDirectExpensesEvent2Amt
Gross Receipts Total$21,646GrossReceiptsTotalAmt
Gross Revenue Total Events$21,646GrossRevenueTotalEventsAmt
Oth Direct Expnss Total Events$8,899OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$8,899DirectExpenseSummaryEventsAmt
Net Income Summary$12,747NetIncomeSummaryAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other25.000000000000FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$112,601TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$112,601NetCommunityBenefitExpnsAmt
Total Expense0.00520TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,242,824TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,521,939DirectOffsettingRevenueAmt
Net Community Benefit Expns$720,885NetCommunityBenefitExpnsAmt
Total Expense0.03350TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,355,425TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,521,939DirectOffsettingRevenueAmt
Net Community Benefit Expns$833,486NetCommunityBenefitExpnsAmt
Total Expense0.03870TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Persons Served4195PersonsServedCnt
Total Community Benefit Expns$90,314TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$90,314NetCommunityBenefitExpnsAmt
Total Expense0.00420TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served7PersonsServedCnt
Total Community Benefit Expns$28,536TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$28,536NetCommunityBenefitExpnsAmt
Total Expense0.00130TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,226,752TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,195,321DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,031,431NetCommunityBenefitExpnsAmt
Total Expense0.09440TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Persons Served9452PersonsServedCnt
Total Community Benefit Expns$112,724TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$112,724NetCommunityBenefitExpnsAmt
Total Expense0.00520TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served13654PersonsServedCnt
Total Community Benefit Expns$4,458,326TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,195,321DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,263,005NetCommunityBenefitExpnsAmt
Total Expense0.10510TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served13654PersonsServedCnt
Total Community Benefit Expns$6,813,751TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,717,260DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,096,491NetCommunityBenefitExpnsAmt
Total Expense0.14380TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,471TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,471NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Activities Or Programs157ActivitiesOrProgramsCnt
Total Community Benefit Expns$18,446TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$18,446NetCommunityBenefitExpnsAmt
Total Expense0.00090TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Activities Or Programs180ActivitiesOrProgramsCnt
Total Community Benefit Expns$2,588TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,588NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Activities Or Programs1640ActivitiesOrProgramsCnt
Total Community Benefit Expns$16,286TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$16,286NetCommunityBenefitExpnsAmt
Total Expense0.00080TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,089TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,089NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs205ActivitiesOrProgramsCnt
Total Community Benefit Expns$24,816TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$24,816NetCommunityBenefitExpnsAmt
Total Expense0.00120TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs2182ActivitiesOrProgramsCnt
Total Community Benefit Expns$65,696TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$65,696NetCommunityBenefitExpnsAmt
Total Expense0.00320TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReportedInd
Bad Debt Expense$565,834BadDebtExpenseAmt
Reimbursed By Medicare$7,952,435ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$8,336,644CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$384,209MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

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

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FLAMBEAU HOSPITAL INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line198 SHERRY AVENUEAddressLine1Txt
CityPARK FALLSCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54552ZIPCd
FieldValueIRS element (for citing)
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1FLAMBEAU HOSPITAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted15CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLHTTP://MINISTRYHEALTH.ORG/COMMUNITYBENEFITS/2016/FLAMBEAU_CHNA2016.PDFOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt15ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLHTTP://MINISTRYHEALTH.ORG/COMMUNITYBENEFITS/2016/FLAMBEAU_IMPLEMENTATIONSTRStrategyWebsiteURLTxt
Strategy AttachedYes (1)StrategyAttachedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care250.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLHTTP://MINISTRYHEALTH.ORG/FH/HOME/COMMUNITYCAREFINANCIALASSISTANCE.NWSFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLHTTP://MINISTRYHEALTH.ORG/FH/HOME/COMMUNITYCAREFINANCIALASSISTANCE.NWSFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLHTTP://MINISTRYHEALTH.ORG/FH/HOME/COMMUNITYCAREFINANCIALASSISTANCE.NWSFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Medicare RatesYes (X)MedicareRatesInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FLAMBEAU HOSPITAL, INC.PART V, SECTION B, LINE 5: FORTY COMMUNITY STAKEHOLDERS WERE ASKED TO PARTICIPATE IN THE PLANNING PROCESS. COMMUNITY HEALTH DATA WAS SENT TO ALL OF THEM TWO WEEKS EFORE THE IN-PERSON MEETING. IN REVIEWING THE DATA, THEY WERE ASKED TO COME PREPARED TO DISCUSS: ANY OUTSTANDING GAPS/NEEDS RELATED TO THE THREE CURENT HEALTH PRIORITIES, ANY EMERGING ISSUES DEMONSTRATED BY THE DATA, ANY ADDITIONAL OBSERVATIONS IN REVIEWING THE DATA. A TOTAL OF 27 INDIVIDUALS ATTENDED THE COMMUNITY HEALTH NEEDS ASSESSMENT MEETING. AFTER THE MEETING, STAKEHOLDERS PARTICIPATED IN A FACILITATED DISCUSSION ABOUT THE COMMUNITY HEALTH DATA, PROGRESS ON THE PREVIOUS PRIORITY AREAS AND ANY EMERGING NEEDS. COMMUNITY ASSETS WERE IDENTIFIED AND BASED ON THOSE ASSETS AND ADDDITIONAL CRITERIA, THE GROUPED DISCUSSED AND REACHED CONCENSUS ON THE HEALTH PRIORITIES FOR THE NEXT THREE YEAS. THOSE WHO PARTICIPATED REPRESENTED:- FLAMBEAU HOSPITAL- MARSHFIELD CLINIC- PRICE COUNTY PUBLIC HEALTH- ASPIRUS- PHILLIPS POLICE DEPARTMENT- PARK FALLS SCHOOLS- PHILLIPS SCHOOLS- PRENTICE SCHOOLS- FLAMBEAU HOME HEALTH AND HOSPICE- PRICE COUNTY HUMAN SERVICES- PHILLIPS PUBLIC LIBRARY- UW-EXENSION- TIME OUT SHELTER- COMMUNITY MEMBERS
FLAMBEAU HOSPITAL, INC.PART V, SECTION B, LINE 6B: PRICE COUNTY
FLAMBEAU HOSPITAL, INC.PART V, SECTION B, LINE 11: BASED ON THE DATA PRESENTED AND THE PRIORITIZATION PROCESS OF THE COMMUNITY STAKEHOLDERS, THE FOLLOWING PRIORITIES WERE SELECTED: AODA AND MENTAL HEALTH, CHRONIC DISEASE PREVENTION, AND NUTRITRION AND HEALTHY FOODS, AND BASED ON THE DATA AND DISCUSSION, THE HOSPITAL HAS CHOSEN TO ADDRESS AGING POPULATION.IN ADDITION TO THE ISSUES SELECTED ABOVE AS TOP PRIORITY, STAKEHOLDERS IDENTIFIED INJURY AND VIOLOENCE AS A SIGNIFICANT HEALTH ISSUES. THIS ISSUE WILL NOT BE ADDRESSED BY FLAMBEAU HOSPITAL AS A TOP PRIORITY BECAUSE IT WILL BE ADDRESSED BY OTHER ORGANIZATIONS IN THE COMMUNITY. HOWEVER, THE HOSPITAL WILL PROVIDE STRONG SUPPORT AND WILL COLLABORATE WHENEVER NEEDED WITH THE COMMUNITY EFFORTS AND THE ORGANIZATION EMBRACE (PREVIOUSLY CALLED TIME OUT) WHICH ADDRESSES THIS AREA IN OUR COMMUNITY. THE FLAMBEAU HOSPITAL IMPLEMENTATION STRATEGY IS PART OF A BROAD COMMUNITY EFFORT TO ADDRESS THE PRIORTY NEEDS IN THE COMMUNITY (AODA, MENTAL HEALTH, CHRONIC DISEASE, AND NUTRITION). ADDRESSING THESE PRIORITIES WILL BE COORDINATED BY THE PRICE COUNTY AODA/MENTAL HEALTH COALILITION AND THE HEALTH AND WELLNESS COALITION. FLAMBEAU HOSPITAL ASSOCIATES LEAD AND ACTIVELY PARTICIPATE ON THESE COALITIONS. THIS IMPLEMENTATION STRATEGY ATTACHED TO THE FORM 990 OUTLINES THE ACTIONS FLAMBEAU HOSPITAL WILL TAKE TO ADDRESS THE HEALTH NEEDS. HOWEVER, AS NOTED BELOW, MANY OF THESE STRATEGIES WILL BE IMPLEMENTED COLLABORATIVELY. RECOGNIZING THAT NO ONE ORGANIZATION IS ABLE TO EFFECT SUBSTANTIAL COMMUNITY CHANGE ALONE, THE LONG-TERM OUTCOMES IDENTIFIED IN THIS PLAN WILL BE ACHEIVED WITH MANY COMMUNITY ORGANIZATIONS WORKING TOGETHER FOR COLLECTIVE IMPACT.
FLAMBEAU HOSPITAL, INC.PART V, SECTION B, LINE 16I: FLAMBEAU HOSPITAL WILL COMMUNICATE THE FAP IN THE FOLLOWING WAYS:A. IF, DURING THE COURSE OF THE PATIENT REGISTRATION PROCESS, CARE ENCOUNTER, TREATMENT, UPON DISCHARGE OR DURING BILLING PROCESS, IT BECOMES EVIDENT THAT A PATIENT MAY NEED FINANCIAL ASSISTANCE, THE PATIENT SHALL BE REFERRED TO THE ORGANIZATION'S FAP. PATIENTS MAY BE IDENTIFIED AS NEEDING FINANCIAL ASSISTANCE AT ANY TIME DURING THE COURSE OF AN ENCOUNTER. A REFERRAL FOR CONSIDERATION OF THE FAP CAN BE INITIATED BY ANY MEMBER OF THE ORGANIZATION'S WORKFORCE, INCLUDING MEDICAL STAFF MEMBERS, WHO BECOME AWARE OF THE PATIENT'S POTENTIAL NEED FOR FINANCIAL ASSISTANCE. IN ADDITION, PATIENT'S GUARANTOR OR RESPONSIBLE PARTY MAY MAKE REQUEST FOR FAP CONSIDERATION.B. AT ADMISSIONS AND INTAKE, PATIENTS WILL BE NOTIFIED VERBALLY USING THE FOLLOWING LANGUAGE: IN THE EVENT THAT YOU ARE UNABLE TO PAY FOR THE COST OF THE CARE YOU RECEIVE, FLAMBEAU HOSPITAL OFFERS FINANCIAL ASSISTANCE. A PLAIN LANGUAGE SUMMARY WILL BE PROVIDED TO THE PATIENT.C. PUBLIC AREAS - FINANCIAL ASSISTANCE BROCHURES AND HANDOUTS WILL BE VISUALLY AVAILABLE AT FLAMBEAU HOSPITAL'S REGISTRATION AND WAITING AREAS. IF PATIENTS REQUEST ADDITIONAL INFORMATION ALL AREAS IDENTIFIED WILL HAVE THE FOLLOWING DOCUMENTS AVAILABLE: 1. FAP (COMPLETE POLICY) 2. PLAIN LANGUAGE SUMMARY 3. FAP APPLICATION 4. AMOUNT GENERALLY BILLED (AGB) POLICY 5. BILLING AND COLLECTION POLICYD. ON-LINE - A LINK TO ALL REQUIRED FAP DOCUMENTS WILL BE POSTED ON THE FRONT PAGE OF FLAMBEAU HOSPITAL'S WEBSITE: HTTP://MINISTRYHEALTH.ORG/FH/HOME.NWSE. ON BILLING STATEMENTS - EACH BILLING STATEMENT WILL INCLUDE A PLAIN LANGUAGE SUMMARY THAT DESCRIBES HOW TO ACQUIRE ADDITIONAL INFORMATION REGARDING ELIGIBILITY AND APPLICATION.F. PUBLIC RADIO AND AREA NEWSPAPERS ADS NOTIFIYING COMMUNITY MEMBERS OF THE FINANCIAL ASSISTANCE POLICY.
FLAMBEAU HOSPITAL, INC.PART V, SECTION B, LINE 22D: FOLLOWING A DETERMINATION OF ELIGIBILITY UNDER THIS FAP, A PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE WILL NOT BE CHARGED MORE FOR MEDICALLY NECESSARY CARE THAN AGB. FLAMBEAU HOSPITAL DETERMINES AGB BASED ON ALL CLAIMS PAID IN FULL TO FLAMBEAU HOSPITAL BY MEDICARE, MEDICARE ADVANTAGE, MEDICAID, MEDICAID HMO AND PRIVATE HEALTH INSURERS (INCLUDING PAYMENTS BY MEDICARE BENEFICIARIES OR INSURED INDIVIDUALS THEMSELVES), OVER A 12-MONTH PERIOD, DIVIDED BY THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS USING THE LOOK-BACK METHOD.
FLAMBEAU HOSPITAL, INC.PART V, SECTION B, LINE 24: FOLLOWING A DETERMINATION OF ELIGIBILITY UNDER THIS FAP, A PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE WILL NOT BE CHARGED MORE FOR MEDICALLY NECESSARY CARE THAN AGB. FLAMBEAU HOSPITAL DETERMINES AGB BASED ON ALL CLAIMS PAID IN FULL TO FLAMBEAU HOSPITAL BY MEDICARE, MEDICARE ADVANTAGE, MEDICAID, MEDICAID HMO AND PRIVATE HEALTH INSURERS (INCLUDING PAYMENTS BY MEDICARE BENEFICIARIES OR INSURED INDIVIDUALS THEMSELVES), OVER A 12-MONTH PERIOD, DIVIDED BY THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS USING THE LOOK-BACK METHOD.

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 7:THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITALS TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990.
PART I, LINE 7G:SUBSIDIZED HEALTH SERVICES AT FLAMBEAU HOSPITAL INCLUDE THE OPERATION OF THE EMERGENCY ROOM DEPARTMENT, AND THE COMMUNITY BASED HOSPICE AND HOMECARE PROGRAMS. THE HOSPITAL EMERGENCY DEPARTMENT OPERATES 24 HOURS PER DAY, SEVEN DAYS PER WEEK AND IS STAFFED BY A GROUP OF HIGHLY TRAINED NURSING STAFF INCLUDING REGISTERED NURSES, LICENSED PRACTICED NURSES, AND OTHER SUPPORT STAFF. MANY OF THE ADMISSIONS TO THE HOSPITAL EMERGENCY DEPARTMENT COME FROM THE COMMUNITY AND SURROUNDING AREAS. THE HOSPICE AND HOMECARE PROGRAMS ARE PROVIDED AS COMMUNITY SUPPORT SERVICES TO THE AREA OF PRICE COUNTY, WISCONSIN. ALL OF THESE SUBSIDIZED HEALTH SERVICES WORK IN SUPPORT AND COOPERATION WITH THE COMBINED EFFORTS OF FLAMBEAU HOSPITAL AND SHARE MANY SUPPORT FUNCTIONS OF THE HOSPITAL IN AN EFFORT TO PROVIDE EXCELLENT LOW COST CARE TO PATIENTS IN THEIR LOCAL COMMUNITY AND AREA. A SIGNIFICANT PAYOR FOR THESE PROGRAMS IS THE MEDICARE PROGRAM WHICH DOES NOT REIMBURSE THE HOSPITAL FOR THESE SERVICES IN ALL CASES BASED ON COST SO A SIGNIFICANT LOSS IS ABSORBED BY THE HOSPITAL TO PROVIDE THESE SERVICES TO MEMBERS OF THE COMMUNITY. IT IS THE GOAL OF FLAMBEAU HOSPITAL, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENTS ABILITY TO PAY. THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED ON THE HOSPITALS MEDICARE COST REPORT. THIS METHODOLOGY PROVIDES FOR A DIRECT ALLOCATION OF EXPENSES AS WELL AS PROVIDING THE SAME DATA TO THE MEDICARE PROGRAM AS WELL AS TO THE IRS FOR THE FORM 990 PURPOSES.
PART I, LN 7 COL(F):BAD DEBT EXPENSE IN THE AMOUNT OF $565,834 INCLUDED ON FORM 990, PART IX, LINE 25 WAS NOT INCLUDED IN TOTAL EXPENSES FOR PURPOSES OF CALCULATING COMMUNITY BENEFIT PERCENTAGES.
PART II, COMMUNITY BUILDING ACTIVITIES:WHILE THERE IS A GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITALS "COMMUNITY BENEFIT," THESE EFFORTS CONTINUE TO BE A WORK IN PROGRESS. FLAMBEAU HOSPITAL, INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE HOSPITAL BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. FLAMBEAU HOSPITAL, INC., LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: BIRTHING SERVICES, DIAGNOSTICS, EMERGENCY SERVICES & URGENT CARE, HOME CARE, HOSPICE, SWING BED SERVICES, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SLEEP CENTER, SURGICAL SERVICES, AND WOMENS SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED.
PART III, LINE 4:THE CARRYING AMOUNTS OF PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE.THE COST TO CHARGE RATIO WAS USED TO DETERMINE THE AMOUNTS REPORTED ABOVE.
PART III, LINE 8:THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H OF THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND ALSO DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE SIGNIFICANT PORTIONS OF LABORATORY, RADIOLOGY, AMBULANCE AND REHABILITATION SERVICES PROVIDED TO MEDICARE BENEFICIARIES AS WELL AS PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, ANETHESIA PROFESSIONAL SERVICES, CLINICAL PHYSICIAN PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT FLAMBEAU HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREASS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED JUNE 30, 2016 AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE.)WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING THE SERVICES TO THE ELDERLY AND DISABLES MEMBERS OF THE COMMUNITY.
PART III, LINE 9B:ONCE A PERSON IS KNOWN TO QUALIFY FOR CHARITY CARE, THE HOSPITAL WILL KEEP THAT INFORMATION ON FILE AND AUTOMATICALLY GRANT CHARITY CARE FOR UP TO A YEAR. AT THAT POINT, THE PATIENT WOULD NEED TO REAPPLY OR VERIFY THAT THEIR SITUATION HAS NOT CHANGED SIGNIFICANTLY SINCE THEIR LAST APPLICATION. CHARITY CARE IS APPLIED FIRST BEFORE ANY COLLECTION EFFORTS ARE PURSUED.
PART VI, LINE 2:PERIODIC SURVEYS OF THIS COMMUNITY ALONG WITH REVIEW OF SERVICES BEING PROVIDED FOR THE COMMUNITY AT OTHER SITES. ALSO PARTICIPATING WITH PRICE COUNTY ON THE COUNTY HEALTH ASSESSMENT AND HEALTH PLAN.
PART VI, LINE 3:INFORMATION IS POSTED IN THE FACILITY AND ALL PATIENTS WHO REGISTER AS SELF-PAY ARE CONTACTED FOR ANY ASSISTANCE NEEDS THEY MAY HAVE.
PART VI, LINE 4:FLAMBEAU HOSPITAL, INC. PROVIDES SERVICES TO RESIDENTS OF PRICE COUNTY, WI AND PORTIONS OF THREE OTHER COUNTIES. THE NEXT CLOSEST HOSPITAL IS 45 MILES AWAY, AND FLAMBEAU HOSPITAL IS DESIGNATED AS UNDERSERVED. THE HOSPITAL PROVIDES A SIGNIFICANT PORTION OF ITS PATIENT CARE SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS ESPECIALLY THOSE BENEFICIARIES WHO RECEIVE HOME HEALTH SERVICES FROM THE ORGANIZATION. IN THE SHORT PERIOD ENDING JUNE 30, 2015, THESE MEDICARE AND MEDICAID PATIENTS ACCOUNTED FOR APPROXIMATELY 73 PERCENT OF THE PATIENT SERVICES PROVIDED BY THE ORGANIZATION DURING THE YEAR.
PART VI, LINE 5:FLAMBEAU HOSPITAL PROVIDES EDUCATION, NEEDED SUBSIDIZED SERVICES AND SUPPORT TO THE COMMUNITY THROUGH SERVICES IT PROVIDES AND COLLABORATION WITH OTHER GROUPS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY.
PART VI, LINE 7, REPORTS FILED WITH STATESWI

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyYes (X)CompensationSurveyInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
JAMES BRAUN
CHIEF ADMINISTRATIVE OFFICER/CFO$194,536$0$0$0$0$0$7,993$0$30,697$0$233,226$0$0$0
DAVE GRUNDSTROM
CAO RETIRED 2016$0$215,753$0$4,872$0$13,522$0$0$0$6,701$0$240,848$0$0
SARA B HILGART
PHARMACIST$140,563$0$0$0$0$0$5,704$0$10,809$0$157,076$0$0$0
JANE EATON-NYMAN
DIR. OF ORGANIZATIONAL INTEGRITY$130,321$0$0$0$0$0$5,440$0$29,257$0$165,018$0$0$0

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF PARK FALLS WISCONSINBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN396005566BondIssuerEIN
Bond Issued2012-02-10BondIssuedDt
Issue Price$4,523,750IssuePriceAmt
PurposeREFINANCE 1994, 1997, 2007, AND 2009 LOAN AND FINANCE ER DEPARTMENT REMODELPurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$1,703,139RetiredAmt
Total Proceeds$4,523,750TotalProceedsAmt
Credit Enhancement$90,475CreditEnhancementAmt
Capital Expenditures$3,475,615CapitalExpendituresAmt
Other Spent Proceeds$957,660OtherSpentProceedsAmt
Substantial Completion2012SubstantialCompletionYr
Current Refunding0CurrentRefundingInd
Advance Refunding0AdvanceRefundingInd
Final Allocation MadeYes (1)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (1)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedPropertyInd
Any Lease Arrangements0AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop0MgmtContractBondFincdPropInd
Any Research Agreements0AnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt Test0BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop0ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd0ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiledInd
Rebate Not Due Yet0RebateNotDueYetInd
Exception To Rebate0ExceptionToRebateInd
No Rebate Due0NoRebateDueInd
Variable Rate Issue0VariableRateIssueInd
Hedge Identified In Bks And Rec0HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGICInd
Written Proc To Monitor Reqs0WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective Action0ProceduresCorrectiveActionInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6MARSHFIELD CLINIC AND MINISTRY HEALTH CARE, INC. ("MINISTRY"), BOTH WISCONSIN TAX-EXEMPT CORPORATIONS, ARE JOINT CORPORATE MEMBERS OF THE HOSPITAL. MINISTRY ALSO, VIA CONTRACT, SHARES CERTAIN GOVERNANCE AUTHORITIES WITH MARSHFIELD CLINIC WITH RESPECT TO THE PARK FALLS AND PHILLIPS ("PRICE COUNTY CLINICS") CLINIC OPERATIONS OF MARSHFIELD CLINIC, WITH MARSHFIELD CLINIC RETAINING THE REMAINING AUTHORITIES. MARSHFIELD CLINIC HAS CONTRACTED TO PROVIDE OPERATING MANAGEMENT TO THE HOSPITAL AND PRICE COUNTY CLINICS. THE GOAL OF THE MEMBERSHIP ARRANGEMENTS IS TO PROVIDE FOR THE EFFECTIVE, ECONOMICAL, AND COORDINATED MANAGEMENT AND OPERATION OF HEALTH CARE SERVICES IN PRICE COUNTY. COLLECTIVELY, THE PARTIES HAVE ESTABLISHED AN INTEGRATED HEALTH CARE DELIVERY SYSTEM FOR PRICE COUNTY.
FORM 990, PART VI, SECTION A, LINE 7ACORPORATE MEMBERS HAVE APPROVED RIGHT FOR DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7BAPPROVAL OF BUDGET, ADMINISTRATOR, PROPERTY PURCHASED, AND DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 8BNOT APPLICABLE AS THERE ARE NO SUB-COMMITTEES.
FORM 990, PART VI, SECTION B, LINE 11A COPY OF THE FORM 990 WAS PROVIDED TO ALL MEMBERS OF THE BOARD PRIOR TO FILING. IF THE BOARD MEMBERS WOULD LIKE ANY EXPLANATION OR CHANGES, THEY WOULD HAVE AN OPPORTUNITY TO COMMENT ON THE RETURN BEFORE ITS FILING.
FORM 990, PART VI, SECTION B, LINE 12CTHE BOARD OF DIRECTORS AND KEY EMPLOYEES OF THE HOSPITAL ANNUALLY SIGN TO ADHERE TO THE CONFLICT OF INTEREST POLICY AT FLAMBEAU HOSPITAL, INC. IT IS ASSUMED THAT THE BOARD OF DIRECTORS AND KEY EMPLOYEES WILL RECOGNIZE CONFLICTS OF INTEREST WITH ANY PERSONS OR FIRMS MENTIONED IN THE POLICY. IT IS THE POLICY OF THE BOARD THAT THE EXISTENCE OF ANY INTEREST DESCRIBED IN THE POLICY SHALL BE DISCLOSED BEFORE ANY TRANSACTION IS CONSUMMATED. IT IS THE BOARD OF DIRECTORS AND KEY EMPLOYEES RESPONSIBILITY TO REVIEW POTENTIAL CONFLICTS OF INTEREST AND IF A CONFLICT EXISTS THE INDIVIDUAL IS PROHIBITED TO VOTE ON TRANSACTIONS WHERE THE POTENTIAL CONFLICT EXISTS.
FORM 990, PART VI, SECTION B, LINE 15THE MARSHFIELD CLINIC PREPARES A COMPENSATION SCHEDULE THAT IS USED TO DETERMINE TOP MANAGEMENT AND KEY EMPLOYEE COMPENSATION. COMPENSATION STUDIES ARE ALSO USED TO PROVIDE COMPARABILITY DATA. THIS DATA IS REVIEWED AND APPROVED BY INDEPENDENT PERSONS AND ALL DECISIONS ARE SUBSTANTIATED.
FORM 990, PART VI, SECTION C, LINE 19THE HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
FORM 990, PART XI, LINE 9:ADMINISTRATION NON-OP OTHER 572,845.
FORM 990, PART XI, LINE 2CTHE PROCESS IS CONSISTENT WITH PRIOR YEARS.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1FLAMBEAU HOSPITAL FOUNDATION INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 310AddressLine1Txt
CityPARK FALLSCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54552ZIPCd
FieldValueIRS element (for citing)
EIN205957150EIN
Primary ActivitiesSUPPORT OF FLAMBEAU HOSPITALPrimaryActivitiesTxt
Legal Domicile StateWILegalDomicileStateCd
Exempt Code Section501 (C) 3ExemptCodeSectionTxt
Public Charity Status11, IPublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1FLAMBEAU HOSPITAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationYes (1)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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