WAGNER COMMUNITY MEMORIAL HOSPITAL: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- WAGNER COMMUNITY MEMORIAL HOSPITAL (EIN 46-0226283)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-03-21
- IRS object ID
- 201740809349300429
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-03-21T13:58:27-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 EAST 10TH ST PO BOX 5125 | AddressLine1Txt |
| City | SIOUX FALLS | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 571175125 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 460226283 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wagner Community Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WAGN | BusinessNameControlTxt |
| Phone | 6053843611 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 513 Third Street SW | AddressLine1Txt |
| City | Wagner | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 573800280 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Bryan Slaba | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6053843611 | PhoneNum |
| Signature | 2017-03-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Laurie Hanson | PreparerPersonNm |
| PTIN | P00851848 | PTIN |
| Phone | 6053391999 | PhoneNum |
| Preparation | 2017-03-15 | PreparationDt |
| 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 | Bryan Slaba | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 513 Third Street SW | AddressLine1Txt |
| City | Wagner | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 573800280 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $8,817,707 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.avera.org/wagnerhospital/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1947 | FormationYr |
| Legal Domicile State | SD | LegalDomicileStateCd |
| Activity Or Mission | To provide healthcare services. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 92 | TotalEmployeeCnt |
| Total Volunteers | 12 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $13,375 | PYContributionsGrantsAmt |
| CY Contributions Grants | $21,210 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $8,137,710 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,735,953 | CYProgramServiceRevenueAmt |
| PY Investment Income | $488,974 | PYInvestmentIncomeAmt |
| CY Investment Income | $41,742 | CYInvestmentIncomeAmt |
| PY Other Revenue | $18,802 | PYOtherRevenueAmt |
| CY Other Revenue | $18,802 | CYOtherRevenueAmt |
| PY Total Revenue | $8,658,861 | PYTotalRevenueAmt |
| CY Total Revenue | $8,817,707 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $6,040 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $6,891 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $3,900,348 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,306,429 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,339,505 | PYOtherExpensesAmt |
| CY Other Expenses | $4,284,888 | CYOtherExpensesAmt |
| PY Total Expenses | $8,245,893 | PYTotalExpensesAmt |
| CY Total Expenses | $8,598,208 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $412,968 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $219,499 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $11,136,888 | TotalAssetsBOYAmt |
| Total Assets EOY | $11,157,754 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,574,959 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,394,146 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,561,929 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,763,608 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Wagner Community Memorial Hospital's mission is to provide care and treatment of the sick; provide care and support of the aged, disabled, and indigent; and to provide for those in need of hospitalization regardless of race, color, creed, or ability to pay. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $7,467,315 | ExpenseAmt |
| Grant | $6,891 | GrantAmt |
| Revenue | $8,754,755 | RevenueAmt |
| Desc | WCMH is a 20 bed critical access hospital equipped with extensive advanced services, including areas for Medical/Surgical, Pediatric, Intensive/Coronary Care, and Swing Bed/Long Term Care. The clinic is adjacent to the hospital making it convenient to see hospital patients, and share laboratory services and other diagnostic equipment. Outreach services include OB/GYN, Pediatrics, Orthopedic Surgery, General Surgery, Urology, Podiatry, ENT & Audiology. The people of the community truly believe in having access to care and support their local medical providers. The facility serves as the inpatient unit for the local Indian Health Services clinic and works collaboratively with the IHS physicians and leaders to care for the Native American population. WCMH experienced 395 Inpatient days, 387 Swing Bed days, 2013 Emergency Department visits, and 2840 clinic visits. | Desc |
| Total Program Service Expenses | $7,467,315 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 26 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 92 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Lisa Weisser | PersonNm |
| Phone | 6053843611 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 513 3rd Street SW | AddressLine1Txt |
| City | Wagner | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 573800280 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| David Kotab | |||||||
| Board President | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Bill Frei | |||||||
| Board Vice President | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Chad Peters | |||||||
| Board Secretary/Treasurer | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Jean Pirner | |||||||
| Board Treasurer (left Sept 2015) | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Mitch Breen | |||||||
| Director | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Jan Coleman | |||||||
| Director | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Steve Cotton | |||||||
| Director | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Ann Freier-Metzger | |||||||
| Director | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Karen Soulek | |||||||
| Director | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Merle Bartunek | |||||||
| Director (left Sept 2015) | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Bryan Slaba | |||||||
| CEO/Administrator | 40.00 | Yes (X) | $163,500 | $0 | $8,881 | ||
| Dr Abdul S Qazi | |||||||
| Family Practice | 40.00 | $280,460 | $0 | $8,417 | Yes (X) | ||
| Lindsey A Barthel | |||||||
| Nurse Practitioner | 40.00 | $100,529 | $0 | $8,218 | Yes (X) | ||
| Melody Otte | |||||||
| Nurse Practitioner | 40.00 | $114,779 | $0 | $10,918 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $659,268 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $36,434 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Avera Sacred Heart Hospital | |||||
| 501 S Summit Street | Yankton | SD | 57078 | Management, IT & Bio Med Services | $575,307 |
| Dr Jeffery Pinter | |||||
| 27952 323rd Avenue | Winner | SD | 57580 | Physician Labor | $394,463 |
| Coast to Coast Health Care Inc | |||||
| 5145 Hampstead Village Ctr | New Albany | OH | 43054 | Physician Labor | $188,266 |
| Avera McKennan Hospital | |||||
| 1301 S Cliff Ave | Sioux Falls | SD | 57117 | Outreach Services | $154,650 |
| Avera Health | |||||
| 3900 W Avera Dr | Sioux Falls | SD | 57108 | Electronic Emergency Services | $144,108 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $20,296 | GovernmentGrantsAmt |
| All Other Contributions | $914 | AllOtherContributionsAmt |
| Total Contributions | $21,210 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Fees | 621110 | $8,536,220 | $8,536,220 |
| Other Revenue | 900099 | $199,321 | $199,321 |
| Change in int-Avera He | 900099 | $412 | $412 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,735,953 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,144 | TotalRevenueColumnAmt |
| Exclusion | $8,144 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $18,802 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $18,802 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,802 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,802 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $33,598 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $33,598 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $33,598 | TotalRevenueColumnAmt |
| Exclusion | $33,598 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,817,707 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,754,755 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $41,742 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,741 | TotalAmt |
| Program Services | $3,741 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,150 | TotalAmt |
| Program Services | $3,150 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $194,610 | TotalAmt |
| Management And General | $194,610 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,668 | TotalAmt |
| Program Services | $15,668 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,519,219 | TotalAmt |
| Program Services | $3,119,879 | ProgramServicesAmt |
| Management And General | $399,340 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,856 | TotalAmt |
| Program Services | $59,727 | ProgramServicesAmt |
| Management And General | $3,129 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $272,747 | TotalAmt |
| Program Services | $246,178 | ProgramServicesAmt |
| Management And General | $26,569 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $241,329 | TotalAmt |
| Program Services | $204,305 | ProgramServicesAmt |
| Management And General | $37,024 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,639 | TotalAmt |
| Management And General | $105,639 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,875 | TotalAmt |
| Management And General | $43,875 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,124,967 | TotalAmt |
| Program Services | $980,020 | ProgramServicesAmt |
| Management And General | $144,947 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,090 | TotalAmt |
| Management And General | $37,090 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $319,498 | TotalAmt |
| Program Services | $265,055 | ProgramServicesAmt |
| Management And General | $54,443 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,494 | TotalAmt |
| Program Services | $54,494 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $128,737 | TotalAmt |
| Program Services | $128,737 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,166 | TotalAmt |
| Program Services | $39,166 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,175 | TotalAmt |
| Program Services | $29,086 | ProgramServicesAmt |
| Management And General | $7,089 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $225,050 | TotalAmt |
| Program Services | $225,050 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $720,818 | TotalAmt |
| Program Services | $720,818 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,513 | TotalAmt |
| Program Services | $59,475 | ProgramServicesAmt |
| Management And General | $38 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $727,572 | $727,572 | |
| Repairs and Maintenance | $350,937 | $342,187 | $8,750 |
| Bad Debt | $217,513 | $217,513 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,844 | TotalAmt |
| Program Services | $25,494 | ProgramServicesAmt |
| Management And General | $68,350 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,598,208 | TotalAmt |
| Program Services | $7,467,315 | ProgramServicesAmt |
| Management And General | $1,130,893 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $685,816 | BOYAmt |
| EOY | $596,166 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,658 | BOYAmt |
| EOY | $19,567 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,768,931 | BOYAmt |
| EOY | $2,164,137 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $196,707 | BOYAmt |
| EOY | $163,146 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,909 | BOYAmt |
| EOY | $78,370 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $12,161,412 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,290,901 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,436,001 | BOYAmt |
| EOY | $5,870,511 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,957,622 | BOYAmt |
| EOY | $2,223,857 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,244 | BOYAmt |
| EOY | $42,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,136,888 | BOYAmt |
| EOY | $11,157,754 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $562,944 | BOYAmt |
| EOY | $434,416 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,108 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,005,907 | BOYAmt |
| EOY | $4,959,730 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,574,959 | BOYAmt |
| EOY | $5,394,146 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,561,929 | BOYAmt |
| EOY | $5,763,608 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,561,929 | BOYAmt |
| EOY | $5,763,608 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,136,888 | BOYAmt |
| EOY | $11,157,754 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $219,499 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$17,820 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,247 | OtherCostOrOtherBasisAmt |
| Book Value | $4,247 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,824,277 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,786,734 | DepreciationAmt |
| Book Value | $5,037,543 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,991,923 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,401,829 | DepreciationAmt |
| Book Value | $590,094 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $340,965 | OtherCostOrOtherBasisAmt |
| Depreciation | $102,338 | DepreciationAmt |
| Book Value | $238,627 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,870,511 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| Interest in Net Assets of Avera Health Foundation | $591 | F |
| Assets Limited as to Use - Avera Pooled Investments | $2,223,265 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $2,223,857 | TotalBookValueSecuritiesAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $8,582,374 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$17,820 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$217,513 | OtherRevenueAmt |
| Revenue Not Reported | -$235,333 | RevenueNotReportedAmt |
| Revenue Subtotal | $8,817,707 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $8,817,707 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $8,380,695 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $8,380,695 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $217,513 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $217,513 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $8,598,208 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The Hospital is organized as a South Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Hospital has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Bad Debt Expense -217,513. |
| Part XII, Line 4b - Other Adjustments: | Bad Debt Expense 217,513. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 466 | PersonsServedCnt |
| Total Community Benefit Expns | $264,600 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $264,600 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03160 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2204 | PersonsServedCnt |
| Total Community Benefit Expns | $1,530,625 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,332,826 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $197,799 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02360 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2670 | PersonsServedCnt |
| Total Community Benefit Expns | $1,795,225 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,332,826 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $462,399 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05520 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 6 | ActivitiesOrProgramsCnt |
| Persons Served | 555 | PersonsServedCnt |
| Total Community Benefit Expns | $3,045 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,045 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 5 | PersonsServedCnt |
| Total Community Benefit Expns | $7,046 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,125 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,921 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 2 | PersonsServedCnt |
| Total Community Benefit Expns | $2,033,291 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $647,565 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,385,726 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.16530 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 5 | PersonsServedCnt |
| Total Community Benefit Expns | $2,166 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,166 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 12 | ActivitiesOrProgramsCnt |
| Persons Served | 567 | PersonsServedCnt |
| Total Community Benefit Expns | $2,045,548 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $649,690 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,395,858 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.16660 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 12 | ActivitiesOrProgramsCnt |
| Persons Served | 3237 | PersonsServedCnt |
| Total Community Benefit Expns | $3,840,773 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,982,516 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,858,257 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.22180 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 1 | PersonsServedCnt |
| Total Community Benefit Expns | $4,720 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,720 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 4 | PersonsServedCnt |
| Total Community Benefit Expns | $64,528 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $64,528 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00770 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 119 | PersonsServedCnt |
| Total Community Benefit Expns | $616 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $616 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 524 | PersonsServedCnt |
| Total Community Benefit Expns | $2,500 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,500 | DirectOffsettingRevenueAmt |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 6 | ActivitiesOrProgramsCnt |
| Persons Served | 648 | PersonsServedCnt |
| Total Community Benefit Expns | $72,364 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,500 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $69,864 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00840 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $217,513 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $2,872,323 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,886,299 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$13,976 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wagner Community Memorial Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 280 | AddressLine1Txt |
| City | Wagner | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57380 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.avera.org/wagnerhospital/ | WebsiteAddressTxt |
| State License | 10571 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wagner Community Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See Line 7d narrative | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Line 7d narrative | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See 16i narrative | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See 16i narrative | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See 16i narrative | 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 |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Wagner Community Memorial Hospital | Part V, Section B, Line 5: A variety of organizations were consulted in conducting the most recent needs assessment. The organizations included Indian Health Services, Lake Andes Healthcare Center, Wagner Good Samaritan Center, Charles Mix County Health Nurses, Yankton Sioux Tribe, SD Department of Health, and Avera Sacred Heart Hospital. |
| Wagner Community Memorial Hospital | Part V, Section B, Line 7d: The CHNA report and implementation strategy are available at http://www.avera.org/locations/wagner-community-memorial-hospital-avera/. |
| Wagner Community Memorial Hospital | Part V, Section B, Line 11: Pursuant to the implementation strategy adopted by Wagner Community Memorial Hospital, mental health services, diabetic education, dialysis, teen pregnancy prevention, and exercise were identified as community needs. The facility has adopted the following plan to address each of these issues:1. Mental Health Services - WCMH providers will utilize eEmergency for behavioral health referrals. WCMH will provide counselors at no cost, as needed for cirtical incident debriefing for hospital staff. WCMH will collaborate with behavioral health services to facilitate contract for psychiatric providers. 2. Diabetic Education - WCMH will provide diabetic education in group settings. WCMH providers will refer patients who qualify for IHS benefits to IHS diabetic education program. WCMH nurses will inform patients that glucose meters are available in town at James Drug for purchase or at IHS, to those who qualify for benefits. 3. Dialysis - WCMH staff will educate the public about the New Hope Dialysis Center in the form of clinic, outpatient, and inpatient education, when appropriate. WCMH will assist with an advertisement in the local newspaper advertising for the New Hope Dialysis Center. 4. Teen Pregnancy Prevention - WCMH will provide resources for education materials to the community health nurse for educational purposes. WCMH will also provide volunteers to assist the community health nurse with sexual health education. Additionally WCMH will educate patients about resources available for pregnancy prevention. 5. Exercise - WCMH will produce and have available a flyer of the exercise options in the community. WCMH staff will also provide or contract an exercise class to be provided monthly at Park View Villa. |
| Wagner Community Memorial Hospital | Part V, Section B, Line 16i: Part V, line 16a, FAP Website:http://www.avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/Part V, line 16b, FAP Application Website:http://www.avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/Part V, line 16c, FAP Plain Language Summary Website:http://www.avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/Part V, Line 16i: The reference to the policy and its location is sent with all statements. |
| Wagner Community Memorial Hospital | Part V, Section B, Line 22d: Lookback method based on actual past claims paid to WCMH by Medicare fee-for-service together with private insurers. |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | In addition to utilizing FPG to determine eligibility for financial assistance, the hospital uses the factors as marked on Part V, line 13. |
| Part I, Line 6a: | Wagner Community Memorial Hospital is included in the community benefit report that is submitted to Avera Health by Avera Sacred Heart. It is available through the website and requested mailing, and is filed with the Catholic Health Association.Part I, Line 6b:The community benefit report is available on the organization's website, through requested mailing, and is also filed with the Catholic Health Association. |
| Part I, Line 7: | Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Lines 7e, 7f and 7i were obtained utilizing the actual general ledger system. Line 7b was calculated based on the allocation of expenses per payer mix percentages. Line 7g was obtained from the Medicare cost report. |
| Part I, Ln 7 Col(f): | Bad debt expense of $217,513 was subtracted from total operating expense. |
| Part II, Community Building Activities: | Part II Line 7 includes:1-Participation on a board to look at housing rehabilitation for low income and elderly community members.2-Participation in community economic groups, including Wagner Area Growth (WAG), Rotary, and Chamber of Commerce.6-Participation in the Wagner Area Health and Wellness Consortium and Wagner VA Stand Down. 8-Hosted an eigth grade career fair for the region schools; held healthcare career events; and worked with Charles Mix County schools through the Health Occupations for Today and Tomorrow (HOTT) program. |
| Part III, Line 2: | Bad debt recoveries and discounts applied during the collection process are rare, but when they do occur they are posted against the bad debt account. |
| Part III, Line 3: | Under our financial assistance policy, presumptive charity care is given to those who are believed to qualify based on facts and circumstances known to the organization. Amounts that qualify as presumptive charity care are not recorded to bad debt. As such, the hospital does not believe any amount recorded as bad debt would qualify as charity care. |
| Part III, Line 4: | The footnote to the organization's financial statements that describes bad debt expense is on pages 6 and 7 of the attached audited financial statements. |
| Part III, Line 8: | Medicare allowable cost of care was calculated from the medicare cost report for the fiscal year ending 6/30/2016.Many patients in our service area qualify for Medicare. The facility provides services to these patients even though Medicare reimbursement is not sufficient to cover the cost of providing this care. Providing services to this population promotes access to healthcare services which are needed in our community, thereby providing a benefit to our community.Total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicaid and Medicare Services. |
| Part III, Line 9b: | The collection practices as set forth in the policy requires that if a patient qualifies for charity care, no bill will be sent. Instead, a letter indicating that the patient's bill has been completely forgiven will be sent. When sending a bill to any patient, the organization shall include on the bill a statement that indicates that if the patient meets certain income requirements the patient may be eligible for a government-sponsored program or for financial assistance from the organization for help in paying for the services that were provided, and a statement that provides the patient with an organization contact resource from which the patient may obtain information about the organization's financial assistance policy for low-income uninsured patients and how to apply for such assistance for the payment of services that were provided.If the patient qualifies for the organization's financial assistance policy for low-income, uninsured patients and is cooperating with the organization with regard to efforts to settle an outstanding bill within a reasonable time period, the organization or its agent shall not send, nor intimate that it will send, the unpaid bill to any outside collection agency. At such time as the organization sends the uncollected account to an outside collection agency, the amount referred to the agency shall reflect the reduced-payment level for which the paitent was eligible under the organization's financial assistance policy for low-income uninsured patients. WCMH does not report any data to any of the credit agencies, however, the collection agencies WCMH utilizes may report to the credit agencies. |
| Part VI, Line 2: | In addition to preparing a community health needs assessment during the fiscal year ended June 30, 2016, WCMH determines patient needs through constant communication with patients, primary and specialty providers, and state and federal governmental health agencies. WCMH strives to consistently investigate, analyze, and determine the greatest needs of our community. |
| Part VI, Line 3: | WCMH has a written charity care policy. First reference to the policy is given to the patient upon admission. A second reference is attached to the third request for payment along with contact information. If neither notice is acted upon and the account continues to be unpaid a patient advocate will try to contact the patient if we have reasonable assumption that they may qualify for financial assistance. If the patient expresses interest in financial assistance, the patient advocate determines if any other opportunities are available for the patient. If the only option available is WCMH's charity care, the proper documentation is completed. The amount of reduction a patient may receive is based on a sliding scale point system. |
| Part VI, Line 4: | Wagner is a rural community located in southern Charles Mix County of South Dakota which has many health disparities with unmet needs. If one looks at the county as a whole, the average individual income is $17,403 with the median family income at $29,444. Inhabitants below the poverty level total 21.5%. County education demographics include 72.3% of residents having a high school degree and 14.2% holding a Bachelor's Degree in comparison to the national average of 80.4% and 24.4%. According to the US Census Bureau Fact Finder most recent data, 46.8% of residents in the county are of American Indian descent as compared to the national average of 0.9%. All of Charles Mix County is considered medically underserved by HRSA and the SD Department of Health. The service area is also considered a health professional shortage area with few providers and many miles in between these rural communities. Wagner provides the only local hospital facility since Indian Health Services (IHS) closed their facility in 1992. In 2008, the IHS emergency room closed putting a burden on the Wagner facility until a new clinic was built by the Wagner Hospital. There are only a few rural health clinics available in addition to the IHS clinic and the VA facility. Many clinics provide only primary care services and are often staffed by Physician Assistants. If more specialized care is needed, patients must travel to either Yankton, South Dakota, which is about 115 miles round trip or they drive the 280 round trip miles to Sioux Falls, which is the area's tertiary care hub with all types of specialty care available. In addition to the shortage of quality health care services, residents of Southern Charles Mix County also suffer from many chronic health conditions. The percent of the population over 65 years of age is almost double the national average in more than half of the county. The disability status of the county's inhabitants is consistent with, if not higher than, the national average of 21.3% in a majority of the communities. Gaps exist among socioeconomic groups in the rate of diabetes and its associated complications in South Dakota as well as throughout the United States. Certain racial and ethnic communities including American Indians, as well as economically disadvantaged or older people, suffer disproportionately compared to other populations. Diabetes prevalence for adults located in Central SD surpasses South Dakota and U.S. percentages. |
| Part VI, Line 5: | WCMH provides Community Health Improvement Services which include: Community CPR classes, sponsorship to the Dakota Smiles Mobile Dental Program, Blood Pressure screenings at area events, assisting with community disasters and award scholarships to the local high school graduates. Fourteen different healthcare career fairs were sponsored and presented by WCMH throughout southern Charles Mix County. |
| Part VI, Line 6: | WCMH is a managed facility of Avera Health. Avera Health and the Hospital work cooperatively to enhance healthcare throughout the community served by the Hospital. As a managed facility, WCMH is able to participate in Avera e-CARE services. These services include Avera e-ICU, e-Emergency, e-Pharmacy and e-Consult. These services allow rural patients to be cared for at their local hospitals, provide rural hospitals access to immediate specialty care and support, and help reduce health care costs and travel.WCMH also has access to "back office" support services, such as legal consultation, quality benchmarking, coding, computer services, contract negotiations, administrative consultation, group purchasing, human resource assistance and many other services. Avera Health is able to provide these services to WCMH at a cost below that which the Hospital could otherwise achieve. In turn, local caregivers are able to devote more resources to patient and resident care. Avera Health and WCMH dedicate resources to endeavors that make a positive difference to improve the health of the communities they serve. These activities include leadership development and training for community members, economic development, physical improvements in the community, contributions to nonprofit community organizations, nonprofit event sponsorships, donated medical supplies, community health education and support groups, health screenings, flu-shot clinics, community health education and various other activities. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bryan Slaba | ||||||||||||||
| CEO/Administrator | $162,754 | $0 | $0 | $0 | $746 | $0 | $7,537 | $0 | $1,344 | $0 | $172,381 | $0 | $0 | $0 |
| Dr Abdul S Qazi | ||||||||||||||
| Family Practice | $280,460 | $0 | $0 | $0 | $0 | $0 | $8,417 | $0 | $0 | $0 | $288,877 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule J, Part II: | FormAndLineReferenceDesc |
| Explanation | Bryan Slaba, CEO/Administrator, is compensated through an arrangement with Avera Sacred Heart Hospital, 501 Summit Street, Yankton, SD 57078. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jessica Peters | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Family relationship with Chad Peters, board member | RelationshipDescriptionTxt |
| Transaction | $15,668 | TransactionAmt |
| Transaction | Employee Compensation | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | There is only one class of member. Any individual, partnership, corporation or association having legal entity, who has contributed $25 or more to the Corporation with request of membership at the time of donation, shall be a member thereof and each member shall have one vote at all meetings of the members of the corporation. Membership of any individual who shall become deceased shall revert by request to that individual's next of kin or according to his will. Any member who has contributed $50 or more shall have the right to transfer such membership to his or her spouse. Said transfer to be approved by the Board of Directors. The basis for membership is on non-refundable contributions. |
| Form 990, Part VI, Section A, line 7a | Only one class of member exists. At the annual meeting, members approve the minutes of the last annual meeting, elect board members of the Wagner Community Memorial Hospital, and vote on other business that may be properly brought before the members. |
| Form 990, Part VI, Section A, line 7b | Amendments to the Articles of Incorporation and Bylaws require member approval. |
| Form 990, Part VI, Section A, line 8b | Wagner Community Memorial Hospital does not have committees. |
| Form 990, Part VI, Section B, line 11 | The CEO will review the 990. After the form 990 has been reviewed, it will be forwarded to the members of the Governing Body for their review. |
| Form 990, Part VI, Section B, line 12c | Directors and Management Officials are required to complete annual conflict of interest questionnaires which are monitored and tracked. The questionnaires are reviewed by the Board for any possible conflicts with any noted conflicts being brought to management's attention. Inquiries of conflicts are also reviewed at the monthly Board meetings. After a conflict is deemed to exist, the Board determines the level of participation of the potential conflicting member. |
| Form 990, Part VI, Section B, line 15a | Avera Sacred Heart Health Services and Wagner Community Memorial Hospital Compensation Committee use comparability data to determine appropriate compensation of the CEO based on experience and performance. The compensation amount is approved annually by the Board of Directors. |
| Form 990, Part VI, Section C, line 19 | Documents are made available upon request. |
| Form 990, Part IX, line 11g | Contracted Fees : Program service expenses 557,298. Management and general expenses 0. Fundraising expenses 0. Total expenses 557,298. Other Purchased Services : Program service expenses 422,722. Management and general expenses 0. Fundraising expenses 0. Total expenses 422,722. Info Technology Consulting Fees : Program service expenses 0. Management and general expenses 144,131. Fundraising expenses 0. Total expenses 144,131. Administration Consulting Fees : Program service expenses 0. Management and general expenses 816. Fundraising expenses 0. Total expenses 816. |