SARTORI MEMORIAL HOSPITAL INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- SARTORI MEMORIAL HOSPITAL INC (EIN 42-0758901)
- Tax period
- 2014-07-01 to 2015-06-30
- Filed
- 2016-05-13
- IRS object ID
- 201611349349307706
- Schema version
- 2014v6.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-05-13T16:50:54-05:00 | ReturnTs |
| Tax Period End | 2015-06-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420758901 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sartori Memorial Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % TIMOTHY HUBER | InCareOfNm |
| Business Name Control | SART | BusinessNameControlTxt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 515 College Street | AddressLine1Txt |
| City | Cedar Falls | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50613 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHELE M PANICUCCI | PersonNm |
| Person Title | Senior VP and CFO | PersonTitleTxt |
| Phone | 3192727300 | PhoneNum |
| Signature | 2016-05-16 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-12-15 16:53:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Jack Dusenbery | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3421 West Ninth Street | AddressLine1Txt |
| City | Waterloo | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 507025499 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $38,852,913 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.wheatoniowa.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1954 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | General inpatient and outpatient acute health care services. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 324 | TotalEmployeeCnt |
| Total Volunteers | 6 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $188,040 | PYContributionsGrantsAmt |
| CY Contributions Grants | $572,574 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $38,328,277 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $37,494,356 | CYProgramServiceRevenueAmt |
| PY Investment Income | $24,183 | PYInvestmentIncomeAmt |
| CY Investment Income | $15,412 | CYInvestmentIncomeAmt |
| PY Other Revenue | $944,386 | PYOtherRevenueAmt |
| CY Other Revenue | $720,894 | CYOtherRevenueAmt |
| PY Total Revenue | $39,484,886 | PYTotalRevenueAmt |
| CY Total Revenue | $38,803,236 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $433,404 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $400,557 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $13,379,004 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,544,220 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $19,155,229 | PYOtherExpensesAmt |
| CY Other Expenses | $19,395,282 | CYOtherExpensesAmt |
| PY Total Expenses | $32,967,637 | PYTotalExpensesAmt |
| CY Total Expenses | $33,340,059 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,517,249 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,463,177 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $14,722,932 | TotalAssetsBOYAmt |
| Total Assets EOY | $15,345,292 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,935,797 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,725,007 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,787,135 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,620,285 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | AS A MEMBER OF WHEATON FRANCISCAN HEALTHCARE, OUR AFFILIATES STRIVE TO LIVE OUT THE HEALING MINISTRY OF THE JUDEO-CHRISTIAN TRADITION WHILE PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTHCARE SERVICES THAT PROMOTE THE DIGNITY AND WELL BEING OF THE PATIENTS AND COMMUNITIES WE SERVE. OUR VISION IS TO BE RECOGNIZED FOR SUPERIOR HEALTHCARE SERVICE, CLINICAL EXCELLENCE, AS THE HEALTHCARE EMPLOYER OF CHOICE, AND THE PREFERRED PARTNER OF PHYSICIANS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $29,555,611 | ExpenseAmt |
| Grant | $400,557 | GrantAmt |
| Revenue | $37,953,153 | RevenueAmt |
| Desc | WHEATON FRANCISCAN SERVICES, INC. (WFSI) is a Catholic, not-for-profit health care and housing organization serving at sites in Wisconsin, Iowa, Illinois, and Colorado. The System includes 14 hospital sites, three transitional and extended-care facilities, two home health agencies, more than 2,500 physicians, more than 70 clinic sites with 511 employed physicians, and 2,620 units of assisted living and other housing, and the corporate services offices in Wheaton, Illinois, and Glendale, Wisconsin. Started more than 130 years ago and formally incorporated in 1983, WFSI is committed to living out the Mission and Values of its Sponsors, the Wheaton Franciscan Sisters, by providing excellent and compassionate health care and housing services to all, regardless of their ability to pay. WFSI was incorporated in 1983 to preserve and strengthen Judeo-Christian values, provide a framework for lay expertise and involvement, respond to an increasingly complex environment, ensure continuity of Franciscan sponsorship, and assure viability and excellence throughout the organization. As a not-for-profit organization, WFSI reinvests all net income into the communities it serves. Its multiple entities are dedicated to delivering quality health care to patients and residents through highly-trained staff, advanced technology, and superior and compassionate service; caring for each person's body, mind, and spirit with respect and dignity; working to improve the health of the communities; and ensuring health care access for everyone. WFSI is organized into market-based regional holding companies organized in the Southeast, Wisconsin region, as well as other regional holding companies conducting services in Illinois, Iowa, and Colorado. The System's housing and spiritual development services are organized under the holding company name of Franciscan Ministries, Inc. Since 2006, the "doing business as" name for WFSI's health care ministry has been Wheaton Franciscan Healthcare (WFH). In 2014, Wheaton Franciscan Healthcare donated more than 47,000 pounds of equipment and medical supplies with an estimated value of $109,414.59 to Hospital Sisters Mission Outreach. These supplies help to promote wellness and healing in medical ministries throughout the world, and keep unused and overstock equipment and supplies out of local landfills. 2013 marked the 12th consecutive year Wheaton Franciscan Healthcare in Southeast Wisconsin was named one of the top 100 most efficient, best performing health care networks in the nation, according to IMS (formerly SDI), the nation's premier integrated health network (IHN) evaluation system. The top 100 ranking is based on integration in areas such as managed care, information systems, and physician affiliations. Wheaton Franciscan Healthcare scored above the nation's top 100 integrated health networks' average score in the areas of hospital utilization, physician participation, services and access, outpatient utilization, integration, and integrated technology. Wheaton Franciscan Healthcare has been recognized for its dedication to patient privacy and is a FairWarning Ready Certified Care Provider. Wheaton received the certification for taking cutting-edge measures to ensure sensitive patient information is protected at all times, and patient privacy monitoring is one of the essentials. Wheaton Franciscan Healthcare is also a recipient of the ECRI Institute's Healthcare Supply Chain Achievement Award. The award honors organizations that demonstrate excellence in overall cost management and in adopting best practice solutions in supply chain processes. Wheaton is one of five health care organizations nationwide to be honored. Please see our full 2015 Annual Report online at: www.WheatonAnnualReport.org CORPORATE STRUCTURE: Parent Company: Wheaton Franciscan Services, Inc. DBA Wheaton Franciscan Healthcare Health care ministry: Wheaton Franciscan Healthcare Housing ministry: Franciscan Ministries, Inc. Health Care Mission: Wheaton Franciscan Healthcare is committed to living out the healing ministry of Jesus by providing exceptional and compassionate health care service that promotes the dignity and well being of the people we serve. Health Care Vision: Our health ministries will be recognized in each community we serve for superior and compassionate patient service, clinical excellence, as the health care employer of choice, and the preferred partner of physicians. Housing Mission: Franciscan Ministries is committed to providing quality and affordable housing in a compassionate environment that promotes wholeness of life within ourselves and the communities we serve. Housing Vision: Our housing ministries will be recognized for excellence in property management and a well-integrated network of support services that provide hope, growth, and opportunity. Values: Our common Values, which flow from our Mission and Catholic tradition, must have meaning for every one of us. Through them we put the healing ministry of Jesus into practice throughout the Wheaton Franciscan System. Respect: We value each person as sacred, created in the image and likeness of God, which gives worth and meaning to each person's life. Integrity: We value honesty and words and actions that build trust. Development: We value personal and professional growth that combines the physical, emotional, spiritual and relational aspects of life and work. Excellence: We value superior performance in our work and service. Stewardship: We value our responsibility to use human, financial, and natural resources entrusted to us for the common good, with special concern for those who are poor. WHEATON FRANCISCAN HEALTHCARE Wheaton Franciscan Services, Inc.'s health care division, doing business as Wheaton Franciscan Healthcare (WFH), consists of facilities in Illinois, Iowa, and Wisconsin. SYSTEM STATISTICS Hospital Sites: 14 Staffed Hospital beds: 1,525 Long-term Care Facilities: 3 Home Health Agencies: 2 Units of Housing: 2,620 Associates: 17,378 Affiliated Physicians: 2,530 Employed Physicians: 511 Emergency Room Visits: 348,200 Newborns: 8,217 Hospital Admissions: 61,602 Hospital Patient Days: 298,791 Skilled Nursing Unit Patient Days: 21,525 Long-term Care Facility Patient Days: 88,718 Hospital Outpatient Visits: 1,606,876 Hospice Days: 29,303 Home Health Visits: 136,884 Medical Group Physician Visits: 1,511,538 WFH ORGANIZATIONS Iowa Wheaton Franciscan Healthcare - Iowa Covenant Medical Center Covenant Clinic Covenant Home Health Mercy Hospital of Franciscan Sisters Sartori Memorial Hospital Covenant Foundation Sartori Health Care Foundation N.E. Iowa Real Estate Investments, LTD Schoitz Health Resources Schoitz Medical Group Illinois Marianjoy, Inc. Marianjoy Rehabilitation Hospital and Clinics Marianjoy Medical Group Marianjoy Foundation Marianjoy Auxiliary OSF Services Canticle Ministries Upendo Village Wisconsin Wheaton Franciscan, Inc. (Elmbrook Memorial, Midwest Spine and Orthopedic Hospital and Wisconsin Heart Hospital, and St. Joseph Campuses) All Saints Hospital (Spring Street and Wisconsin Ave Campuses) St. Francis Hospital Franklin Hospital Franciscan Woods The Terrace at St. Francis Lakeshore Manor Wheaton Franciscan Home Health Wheaton Franciscan Hospice Wheaton Franciscan Laboratories Wheaton Franciscan Medical Group All Saints Foundation Volunteers in Partnership with Wheaton Franciscan Healthcare-All Saints St. Joseph Foundation Elmbrook Memorial Foundation Elmbrook Memorial Auxiliary Circle of Life Foundation The Foundation for St. Francis and Franklin AFFILIATIONS INCLUDE: Midwest Orthopedic Specialty Hospital - Franklin, WI United Hospital System - Kenosha, Wisconsin St. Catherine's Medical Center and Kenosha Medical Center Campuses WHEATON FRANCISCAN HEALTHCARE COMMUNITY IMPACT FOR SYSTEM / 2015 Charity Care: $34,472,456. Charity Care is defined as free or discounted health services provided to those who cannot afford to pay and who meet all criteria for financial assistance. Charity care is based on actual costs, not charges, and does not include bad debt. Unreimbursed Cost of Public Programs: $115,878,726. Unreimbursed cost of public programs is defined as the shortfall experienced when payments received are below the cost of treating public beneficiaries through Medicaid and other local public programs. Community Health Improvement Services: $3,545,491. Community Health Improvement Services are defined as clinical and non-clinical services designed to improve community health, which are provided to the community for free or for fees that did not cover costs. Financial Contributions: $2,501,914. Financial contributions are defined as contributions, including cash, non-cash items such as food, furniture, equipment, supplies, and loaned staff for volunteer and charitable purposes, made to individuals, community groups, or nonprofit organizations for charitable purposes. Health Professions Education: $8,043,187. Health professions education is d | Desc |
| Total Program Service Expenses | $29,555,611 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | false | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 324 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (true) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | Yes (true) | LocalChaptersInd |
| Policies Reference Chapters | Yes (true) | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIMOTHY HUBER | PersonNm |
| Phone | 3192727607 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3421 WEST NINTH STREET | AddressLine1Txt |
| City | WATERLOO | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 507025499 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Jack Dusenbery | ||||||||||
| President - Director | 1.0 | 40.0 | Yes (X) | Yes (X) | $0 | $658,432 | $85,854 | |||
| Nick Evens | ||||||||||
| Chair - Director | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| John Fuller | ||||||||||
| Treasurer - Director | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| James Hartel MD | ||||||||||
| Director | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||||
| Noreen Hermansen | ||||||||||
| Director | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||||
| Sue Roberts | ||||||||||
| Director | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||||
| Tom Strub DDS | ||||||||||
| Director | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||||
| Michele Panicucci | ||||||||||
| Asst. Treas. | 1.0 | 40.0 | Yes (X) | $0 | $418,160 | $106,333 | ||||
| Phyllis Doulaveris | ||||||||||
| Sr VP and Chief Nursing Office | 1.0 | 40.0 | $0 | $279,057 | $52,979 | Yes (X) | ||||
| Rose Fowler | ||||||||||
| Admin. VP Operations Site Ad | 40.0 | 1.0 | $266,400 | $0 | $45,224 | Yes (X) | ||||
| James Lehman MD | ||||||||||
| VP Medical Affairs | 1.0 | 40.0 | $0 | $420,597 | $39,032 | Yes (X) | ||||
| Kelly Wolf | ||||||||||
| Pharmacist Ii | 40.0 | 1.0 | $126,061 | $0 | $9,925 | Yes (X) | ||||
| Diane Heindl MD | ||||||||||
| Physician | 1.0 | 40.0 | $0 | $204,129 | $18,008 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $392,461 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,980,375 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $357,355 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Emergency Practice Associates Inc | |||||
| PO Box 1260 | WATERLOO | IA | 507041260 | Physician Services | $1,373,358 |
| Xygent Inc | |||||
| 9961 Valley View Road | EDEN PRAIRIE | MN | 55344 | Surgical Services | $442,648 |
| Graham Construction | |||||
| 421 Grand Avenue | DES MOINES | IA | 50309 | Construction | $392,229 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $58,681 | FundraisingAmt |
| Related Organizations | $448,167 | RelatedOrganizationsAmt |
| Government Grants | $14,708 | GovernmentGrantsAmt |
| All Other Contributions | $51,018 | AllOtherContributionsAmt |
| Noncash Contributions | $16,085 | NoncashContributionsAmt |
| Total Contributions | $572,574 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PROGRAM SERVICE REVENUE | 900099 | $15,757,971 | $15,757,971 |
| MEDICARE/MEDICAID PAYMENTS | 900099 | $21,378,250 | $21,378,250 |
| RENT REVENUE | 900002 | $358,135 | $358,135 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $37,494,356 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,412 | TotalRevenueColumnAmt |
| Exclusion | $15,412 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $68,977 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $68,977 | TotalRevenueColumnAmt |
| Exclusion | $68,977 | ExclusionAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $44,478 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $58,681 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $49,677 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$5,199 | TotalRevenueColumnAmt |
| Exclusion | -$5,199 | ExclusionAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| ELECTRONIC HEALTH RECORD | 900099 | $458,797 | $458,797 | |
| GIFT SHOP | 453220 | $53,477 | $53,477 | |
| CAFETERIA | 722514 | $102,249 | $102,249 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $42,593 | TotalRevenueColumnAmt |
| Exclusion | $42,593 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $657,116 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $38,803,236 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $37,953,153 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $277,509 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $400,557 | TotalAmt |
| Program Services | $400,557 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $311,624 | TotalAmt |
| Management And General | $311,624 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,489,157 | TotalAmt |
| Program Services | $10,338,963 | ProgramServicesAmt |
| Management And General | $150,194 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $240,146 | TotalAmt |
| Program Services | $236,935 | ProgramServicesAmt |
| Management And General | $3,211 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,717,368 | TotalAmt |
| Program Services | $1,689,814 | ProgramServicesAmt |
| Management And General | $27,554 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $785,925 | TotalAmt |
| Program Services | $777,684 | ProgramServicesAmt |
| Management And General | $8,241 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,277 | TotalAmt |
| Program Services | $4,277 | ProgramServicesAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,471,050 | TotalAmt |
| Program Services | $1,471,050 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,048 | TotalAmt |
| Program Services | $6,048 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,567,500 | TotalAmt |
| Program Services | $1,530,587 | ProgramServicesAmt |
| Management And General | $36,913 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $856,161 | TotalAmt |
| Program Services | $856,161 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,433 | TotalAmt |
| Program Services | $17,600 | ProgramServicesAmt |
| Management And General | $833 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,105 | TotalAmt |
| Program Services | $14,105 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,980 | TotalAmt |
| Management And General | $22,980 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,436,989 | TotalAmt |
| Program Services | $1,436,812 | ProgramServicesAmt |
| Management And General | $177 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PURCHASED SERVICES | $1,523,934 | $1,523,934 | |
| MEDICAL SUPPLIES | $5,823,594 | $5,823,594 | |
| BAD DEBT EXPENSE | $749,301 | $749,301 | |
| CORPORATE SERVICES ALLOCATION | $3,777,052 | $554,331 | $3,222,721 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,123,858 | TotalAmt |
| Program Services | $2,123,858 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,340,059 | TotalAmt |
| Program Services | $29,555,611 | ProgramServicesAmt |
| Management And General | $3,784,448 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,903,931 | BOYAmt |
| EOY | $4,993,985 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $338,437 | BOYAmt |
| EOY | $361,835 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $29,450,966 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $19,480,205 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,452,263 | BOYAmt |
| EOY | $9,970,761 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,301 | BOYAmt |
| EOY | $18,711 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,722,932 | BOYAmt |
| EOY | $15,345,292 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,681,102 | BOYAmt |
| EOY | $1,588,306 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,254,695 | BOYAmt |
| EOY | $1,136,701 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,935,797 | BOYAmt |
| EOY | $2,725,007 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,787,135 | BOYAmt |
| EOY | $12,620,285 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,787,135 | BOYAmt |
| EOY | $12,620,285 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,722,932 | BOYAmt |
| EOY | $15,345,292 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $5,463,177 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$4,630,027 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $4,277 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $0 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,277 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule C Disclosures | FormAndLineReferenceDesc |
| Explanation | Schedule C Part II-B Line 1i: Wheaton Franciscan Healthcare and Franciscan Ministries are part of a controlled group of healthcare and housing organizations that are related through a common parent organization. Certain entities within this controlled group engage in limited lobbying activities that benefit each organization collectively. Wheaton Franciscan Healthcare employs two individuals whose responsibilities include the oversight and management of lobbying activities for the organization - the Senior Vice President of Strategic Initiatives and the Director of Government Relations and Advocacy . The Senior Vice President provides strategic oversight for the department and participates in visits with key elected officials when appropriate. The Director provides on the ground support; serves as the first point of contact for elected officials and executes on legislative lobbying activities that support the strategic interests of the organization. These lobbying activities approximate 50% of total annual salary for the Director and less than 20% for the Senior Vice President. A benefits factor of 25% is added, and the total is allocated amongst the organizations receiving the benefit of these services. The lobbying activities include advocacy efforts related to public policy proposals such as: changes to Medicare and Medicaid funding; federal or state legislation that may impact the organization; participating in and coordinating visits with elected officials at all levels of government (local, state and federal); mobilizing grassroots efforts on behalf of the organization on issues of interest; coordinating advocacy activities in conjunction with relevant trade associations; and providing internal awareness on specific state related legislative issues when the need arises. The portion of direct expenses related to annual employee business travel to Washington DC or other locations, in order to lobby for issues important to healthcare providers and patients, have been included if applicable. Finally, any trade association dues containing a percentage portion allocable to lobbying activities, has been added or estimated, as appropriate. Sartori Hospital, Inc. #42-0758901 $4,277 | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp | |
| Land | LandGrp |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,392,075 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,351,556 | DepreciationAmt |
| Book Value | $5,040,519 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,974,262 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,236,746 | DepreciationAmt |
| Book Value | $3,737,516 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,084,629 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,891,903 | DepreciationAmt |
| Book Value | $1,192,726 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,970,761 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO/FROM THIRD PARTY PAYORS | $13,039 |
| OTHER LIABILITIES | $1,123,662 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,136,701 | TotalLiabilityAmt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | fstvl of trees | Event1Nm |
| Gross Receipts Event1 | $94,356 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $55,848 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $38,508 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $5,025 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $9,516 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $350 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $33,258 | OtherDirectExpensesEvent1Amt |
| Event2 | May Breakfast | Event2Nm |
| Gross Receipts Event2 | $8,803 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $2,833 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $5,970 | GrossRevenueEvent2Amt |
| Rent Facility Costs Event2 | $418 | RentFacilityCostsEvent2Amt |
| Other Direct Expenses Event2 | $1,110 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 0 | OtherEventsTotalCnt |
| Gross Receipts Total | $103,159 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $58,681 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $44,478 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $5,443 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $9,516 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $350 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $34,368 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $49,677 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$5,199 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $360,772 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $360,772 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01110 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,598,755 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,490,273 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $108,482 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00330 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,959,527 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,490,273 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $469,254 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01440 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $27,140 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $27,140 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $454,916 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $31,432 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $423,484 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01300 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,881,209 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $864,542 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,016,667 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03120 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $45,875 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $45,875 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,413,140 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $895,974 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,517,166 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04650 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,372,667 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,386,247 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,986,420 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06090 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,604 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,911 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $23,693 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,604 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,911 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $23,693 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $749,301 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $8,653,099 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $10,543,785 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,890,686 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sartori Memorial Hospital Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 515 College Street | AddressLine1Txt |
| City | Cedar Falls | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50613 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | http://www.wheatoniowa.org | WebsiteAddressTxt |
| State License | 0700059H (IA) | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Facility Reporting Group | 1 | FacilityReportingGroupCd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sartori Memorial Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | wheatoniowa.org | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 12 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | wheatoniowa.org | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | wheatoniowa.org | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule H Supplemental Information | FormAndLineReferenceDesc |
| Explanation | Schedule H Part V Section B Line 3j, 5, 6a-6b, 7a, and 10a: Wheaton Franciscan Healthcare's Community Health Needs Reports provide additional detailed information in response to many of the Schedule H questions on our Community Health Needs Assessments and Implementation Plans. These reports can be directly accessed at the following websites: Please go to www.wheatoniowa.org and select "About Us", then "Community Benefit Report", then "Community Outreach and Benefit" then "Community Health Needs Assessment". One fully summarized report is accessible for each of the three Iowa Hospital Facilities that contains detailed information on the Community Health Needs Assessment, Implementation Plan, and all supporting data. Schedule H Part V Section B Line 5, 6a-6b and 7d: Iowa hospital facilities collaborated with both hospital and non hospital facilities in the preparation of their most recent Community Health Needs Assessment (2012). At Mercy Hospital, located in Fayette County, an assessment was conducted in cooperation with the city of Oelwein, and the Iowa State University Extension and Outreach Office. In Black Hawk County where Covenant Medical Center and Sartori Memorial Hospital are located, collaboration occurred with several Unity Point Hospitals including Allen, Grundy County Memorial, Community Memorial, as well as Waverly Health Center. Other local agencies involved included Black Hawk County Public Health Department, United Way and other local organizations. Although we have not independently verified this, certain reports in conjunction with this work may be available on these organizations websites. Additionally, in Black Hawk County, the Iowa hospital facilities and their partners collaborated to interview 52 organizations, including but not limited to Hawkeye Community College, University of Northern Iowa, other university and public school systems; the YWCA, Big Brothers Big Sisters of Northeast Iowa, several religious organizations, the Northeast Iowa Food Bank, and many more in order to obtain information on the various community needs that were being addressed by these organizations, and how they were being addressed. In response to providing this information publically, in addition to Wheaton Iowa's website information provided above, condensed versions of the Community Health Needs Assessment have been placed throughout the health system for viewing by visitors and patients. Schedule H Part V Section B Line 11: Sartori: Leaders within Wheaton Franciscan Healthcare-Iowa (Wheaton Iowa) analyzed data, determined resources available within each facility, and identified the needs that would be addressed. Several meaningful meetings were held with sub-committees in each of the top areas identified prior to setting the priority needs to address in our initial plan. Through our assessment and review of all our research findings, a summary of the top community needs were compiled: -Access and Education -Health Behaviors & Community Wellness (Obesity, Physical Activity, Substance Abuse, etc.) -Mental Health -Geriatric Related Illnesses (Dementia, Alzheimer's, etc.) -Cardiovascular Disease -Cancer -Maternal, Infant and Child Health -Sexually Transmitted Infections -Dental Care -Family Planning -Violence -Environmental Health (Lead Poising, Radon, etc.) -Health Care for Veterans In nearly every focus group/interview these areas were identified as topics where the health care industry could possibly affect change in our community. Not only are there gaps in these areas for Black Hawk County, but also within the eight county region we serve, and throughout the state of Iowa as represented in the Understanding the Community Health Needs in Iowa from the Iowa Department of Public Health (IDPH). It is in these areas that we feel Sartori Memorial Hospital, as well as Covenant Medical Center, could have the greatest impact. Listed below are key findings and examples of the work done over the past three years. Sartori shares these focus areas with Covenant, also located in Black Hawk County serving much of the same geographic area, and under the same leadership and sponsorship of Wheaton Iowa. -Access and Education o The MOCHA Project - collaboration with community churches and two area barbershops providing nearly 200 African American men & women on disparities specific to this demographic (i.e. Prostate and lung cancer, diabetes and other diet related diseases, etc.) o Participation in community events to promote access and health education (i.e. Northend Music & Arts Festival; Living Young, Annual dinner at Catholic Worker House, YWCA Know Your Numbers, First Aid tent/education at Sturgis Falls celebration in Cedar Falls, etc.) o Teach-back training for all Wheaton Iowa associates to ensure patient understanding of health information -Health Behaviors & Community Wellness (Obesity, Physical Activity, Substance Abuse, etc.) o Kids Caf at Northeast Iowa Food Bank (NEIFB) - Nutrition education and BMI tracking o Bikes for Kids - Partnership w/Variety of Iowa to provide kids with bikes, safety education, and the importance of physical activity o Free Flu Shot Clinics to underserved at Boys & Girls Club, Ethnic Minorities of Burma Advocacy and Resource Center (EMBARC), and NEIFB o EMBARC - Community Navigator Program to teach leaders in the refugee community about health care and how to navigate services so navigators can conduct learning circles with other refugees o Girls Circle - Providing health education to aid in guiding young teenage girls at Boys & Girls Club (FY 2015), and Club Les Dames (FY 2016) -Mental Health o Improvements in equipment to reduce falls in the Senior Behavioral Health unit at Sartori o Participation with Cedar Valley United Way's (CVUW) Community Impact Team for Health to facilitate community wide partnership in enhancing mental health services, and fostering better communication. -Cardiovascular Disease o Education and public service announcements throughout the county, including participation in American Heart Association Walk, etc. o Close the Gap - Heart health education to minority groups and blood pressure screenings at Tyson Foods, etc.) o Participation and support of the American Heart Association Walk, Go Red For Women, etc. While every area in which we had findings is of concern, the call to show focused, measureable results as a long term outcome of this plan, along with our organizational value of stewardship, means not every identified disparity/need will be part of this plan. Although the issues below are considered exclusions we often support other organizations working on these issues through a financial or human resource investment: -Violence - outside the scope of our provider mission. However we have supported other organizations working on this issue (i.e. YWCA's Week Without Violence annual workshop; University of Northern Iowa's Center for Violence Prevention) -Geriatric-Related Illnesses - Senior Behavioral Health services at Sartori; Alzheimer's Walk and Luncheon, etc.) -Sexually Transmitted Infections (Covenant representative quality improvement committee with Black Hawk County Health Department to help establish a campaign to address the growing rate of sexually transmitted infections in Black Hawk County and promote testing locations). -Dental Care - outside the scope of our provider mission (Major sponsor of the Iowa Dental Association's Mission of Mercy held in Waterloo every three years). -Family Planning - Sartori follows the Social Responsibilities of Catholic Healthcare Services -Environmental Health (Lead Poisoning, Radon, etc.) - outside the scope of our provider mission. -Declining High School Graduation Rates (Associates volunteer for Junior Achievement; School at Work program for associates so they could obtain their GED). -Health Care for Veterans - Veterans are required to obtain service in Iowa City, Iowa 1.5 hours south of Waterloo or at a local veterans clinic An in depth analysis can be found within our Community Health Needs Assessment Report and Implementation Plan at http://www.wheatoniowa.org/about-us/community-outreach-benefit/community-h ealth-needs-assessment.aspx. Schedule H Part V Section B Line 16d, 16g, and 16i: Wheaton Franciscan Healthcare takes several proactive approaches to make our patients aware of our financial assistance policy. In addition to our policy being posted on our website and available to anyone who requests one, there is abundant signage throughout all of our facilities explaining our financial assistance policy and how to obtain the actual policy, if desired. Notices regarding the availability of financial assistance are displayed in highly visible locations where there is a significant volume of inpatient or outpatient traffic such as in patient admitting and registration areas (both inpatient and outpatient settings), physician offices, and emergency departments. Brochures describing the policy are available in the same location | ExplanationTxt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule H Supplemental Information | FormAndLineReferenceDesc |
| Explanation | Schedule H Part 1 Line 6a The Annual Report that outlines the Hospital's community benefit information is contained in a report prepared by the system, Wheaton Franciscan Services, Inc. (FEIN #36-3262111) which is the ultimate parent organization of an integrated health care system operated in Wisconsin, Illinois, Iowa, and Colorado. For more information, please see our annual report at www.mywheaton.org. It is available under "About Wheaton" by selecting "Community Impact," and scrolling down to "View Our Annual Report". Schedule H Part 1 Line 7 Community Benefit amounts are reported using total actual costs per the hospital's managerial accounting system in use, which includes all patient segments including inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, Medicare HMO, uninsured, and self-pay patients. Medicare is reported using the most recently filed cost report at the time the Annual Report and related community benefit information is published. Amounts are compiled using a software application recommended by the Catholic Health Association because it has the ability to provide the information in a format suitable for Schedule H presentation. After the data is entered by the Site Finance Directors, its accuracy is verified by employees who are trained in community benefit reporting, and then approved by the Chief Financial Officer and the President/CEO of the organization. After amounts are verified and approved, community benefit amounts become finalized. Wheaton Franciscan Healthcare complies with Illinois state law which requires reporting to the Attorney General's Office. Additionally, Wheaton Franciscan Healthcare voluntarily reports community benefit information in Wisconsin and Iowa by making the information readily available on certain websites. Finally, the information is compiled with the assistance of the software, for presentation in IRS Forms 990 Schedule H and Statement of Program Service Accomplishments Part III. Schedule H Part 1 Line 7 Column f Wheaton Franciscan Healthcare organizations follow guidelines established by the Catholic Health Association, who recommends that bad debt expense not be included in community benefit amounts. As a result of this applied methodology, a total amount of $749,301 has not been included in the denominator of the calculation that determines the percentages reported on Schedule H Line 7 Column f. Schedule H Part 1 Line 7g In the Southeast Wisconsin and Marianjoy regions, physician clinics are operated by a separate legal entity and are therefore not included in Community Benefit amounts on hospital 990's. In the Iowa region, clinic operations are included as a department of the hospital, Covenant Medical Center, Inc. Clinic operations for the Iowa clinics are included only in the community benefit reporting of charity care, government sponsored health care, and Medicare shortfall. Therefore, for all entities, including Covenant Medical Center, Inc., costs related to physician clinics are not included in subsidized health services reported on Schedule H Part I Line 7g. Schedule H Part III Section A Lines 1-4 As part of an annual process, affiliates of Wheaton Franciscan Healthcare complete a consolidated audit each year, which for June 30, 2014, contained a footnote on Bad Debt which appeared under item (4) "Net Patient Service Revenue" on page 15-16 of the attached audited financial statements. Note that while FASB ASU 2011-07 requires certain organizations present bad debt as a reduction from patient service revenue for financial statement presentation, for IRS Form 990 presentation, these amounts are classified as bad debt expense. It is the practice of Wheaton Franciscan Healthcare to record actual bad debt expense for each organization at the time the amount due is determined to be uncollectible, and thus written off. With the onset of presumptive care effective July 1, 2011, practices are now in place to retroactively determine a patient's eligibility under Wheaton's Charity Care Policy, and remove those amounts from bad debt expense in order to correctly show these patients as charity care. Wheaton Franciscan Healthcare's position is therefore that none of the patients resulting in uncollectible accounts would have qualified as charity care patients as this determination is made at the time of admission, and corrective action is taken based on presumptive care. Bad debt expense is only determined after many months of collection efforts, and for this reason Part III Section A Line 3 is reported at zero. Additionally, since the organization follows guidelines established by the Catholic Health Association and the related state counterpart in Wisconsin, Iowa, or Illinois as appropriate, Wheaton Franciscan Healthcare does not include any form of bad debt expense in its annual reporting of community benefit amounts. Schedule H Part III Section B Line 6-8 Schedule H Part III Section B Line 6 reports "allowable costs of care" as taken from the most recently filed Medicare cost report available at the time the Community Benefit Report is published. The Medicare cost report calculates its allowable total costs based on applicable Medicare regulations. Medicare and Medicaid cost is determined using individual cost center cost-to-charge ratios. This cost to charge ratio is determined using all payer cost and all payer charges. The cost to charge ratio is applied to the actual Medicare and Medicaid charges to determine the Medicare and Medicaid cost. This organization has adopted the cost and charge practices as recommended by the Catholic Health Association and the Wisconsin, Iowa, or Illinois Hospital Association as applicable, and therefore, does not count any Medicare shortfall numbers in its annual reporting of Community Benefit amounts. While we are not allowed to report Medicare HMO shortfalls as a component of the total Medicare shortfall reported on Schedule H Part III Section B Line 7 based on currently written IRS instructions, it is noteworthy to mention that had we been allowed to include Medicare HMO, our shortfall would have increased by $255,371, for a total adjusted Medicare Shortfall (including Medicare HMO) of $2,146,057. Schedule H Part III Section C Line 9b Wheaton Franciscan Healthcare has a policy that outlines all collection practices for patients who are known to qualify for government programs and for our charity care program. We make every attempt to assist the patient in enrolling in government insurance plans or our own charity care program allowing for free or discounted care. If the patient does not qualify for any type of aid or charity care, declines to establish a reasonable payment plan or pay the liability, the patient will be moved into a bad debt status, and the account is sent to a collection agency. This does not occur before the patient has received several notices and a final written warning. Schedule H Part V Section A and Section C Affiliates of Wheaton Franciscan Healthcare have defined and reported "hospital facilities" to include only those bricks and mortar buildings that actually have inpatient beds, in addition to meeting all other criteria under Wisconsin, Iowa, or Illinois state laws, as applicable, required for hospital licensing. Although there are other facilities within our system built to hospital standards, performing hospital-based billing, and conforming to other "hospital" standards under state law, until there is further guidance from the IRS, these facilities have been reported in Section C, due to their lack of having state certified inpatient beds. Schedule H Part VI Line 2 Wheaton Franciscan Healthcare assesses the needs of the communities it serves by reviewing admission and discharge data, analyzing information from the community health departments and other community leaders, and by aligning our services with the Healthy People 2020 and other current year initiatives. Wheaton Franciscan Healthcare has also completed its first Community Health Needs Assessments and Implementation Plans for all its hospital facilities, so please reference Schedule H Part V Section B Lines 1-8 for additional information. Schedule H Part VI Line 3 Wheaton Franciscan Healthcare provides its patients with several opportunities to gain knowledge and awareness of its Community Care (Charity Care/Financial Assistance) program. Notices regarding the availability of financial assistance are displayed in highly visible locations where there is a significant volume of inpatient or outpatient traffic such as: patient admitting and registration areas in both inpatient and outpatient settings, physician offices, and emergency departments. Additionally, brochures describing the policy are available upon request in the same locations and on Wheaton Franciscan Healthcare's website. The policy is also discussed at the time of registration or pre-registration for all inpatient procedures. Schedule H Part VI Line 4 Please | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Valuation Method UsedValuationMethodUsedDesc | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| Sartori Healthcare Foundation Inc | ||||||||
| 3421 West 9th St | Waterloo | IA | 507025499 | 421240996 | 501(c)(3) | $72,282 | Book | Support |
| OSF Services Inc | ||||||||
| PO Box 667 | Wheaton | IL | 601870667 | 391471463 | 501(c)(3) | $328,275 | Book | Provide support |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule I Disclosures | FormAndLineReferenceDesc |
| Explanation | Wheaton Franciscan Healthcare and Franciscan Ministries maintain files and reYords to manage the decision-making and award process for organizations that it provides community sponsorship dollars to. Decisions are made by a Community Sponsorship Committee with leaders who hold positions in Diversity, Strategic Planning, Mission Services, Marketing and Philanthropy. The Committee generally strives to sponsor organizations that have missions that align with the mission, vision and values of Wheaton Franciscan Healthcare and/or Franciscan Ministries. The committee also looks for certain other criteria when deciding which organizations will receive contributions, including but not limited to supporting healthcare or housing related activities within the Southeast Wisconsin, Iowa, and Illinois markets, supporting programming that work to further diversity and cultural competency, aligning with other WFH business relationships or service lines, supporting student academic achievement or workforce development initiatives, and finally, supporting environmental "green" initiatives. Leaders periodically meet with representatives of sponsored organizations to discuss objectives including how dollars will be spent. Additionally, Wheaton Franciscan Healthcare may, at a later date, ask for documentation in order to monitor that funds were spent for their intended purpose. Currently, confirmation letters are sent to sponsored organizations when award dollars are given, that confirm the dollar amount awarded and the intended purpose, with a request that the recipient acknowledge receipt of the funds in written correspondence. Files are maintained in the Organizational Change and Leadership Performance Department to include copies of letters of request, award and denial letters, additional documentation if requested, along with acknowledgement receipts from sponsored organizations. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Phyllis Doulaveris | ||||||||||||||
| Sr VP and Chief Nursing Office | $0 | $197,073 | $0 | $81,300 | $0 | $684 | $0 | $13,853 | $0 | $39,126 | $0 | $332,036 | $0 | $0 |
| Jack Dusenbery | ||||||||||||||
| President - Director | $0 | $410,813 | $0 | $237,000 | $0 | $10,619 | $0 | $59,315 | $0 | $26,539 | $0 | $744,286 | $0 | $0 |
| Rose Fowler | ||||||||||||||
| Admin. VP Operations Site Ad | $186,270 | $0 | $79,800 | $0 | $330 | $0 | $27,129 | $0 | $18,095 | $0 | $311,624 | $0 | $0 | $0 |
| Diane Heindl MD | ||||||||||||||
| Physician | $0 | $201,735 | $0 | $1,800 | $0 | $594 | $0 | $16,658 | $0 | $1,350 | $0 | $222,137 | $0 | $0 |
| James Lehman MD | ||||||||||||||
| VP Medical Affairs | $0 | $312,630 | $0 | $103,400 | $0 | $4,567 | $0 | $13,853 | $0 | $25,179 | $0 | $459,629 | $0 | $0 |
| Michele Panicucci | ||||||||||||||
| Asst. Treas. | $0 | $268,853 | $0 | $135,300 | $0 | $14,007 | $0 | $82,446 | $0 | $23,887 | $0 | $524,493 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule J Disclosure | FormAndLineReferenceDesc |
| Explanation | Schedule J Part I Line 4b: Wheaton Franciscan Services, Inc., established the Wheaton Franciscan Services, Inc. Non-Qualified Benefit Restoration Plan to provide selected employees with certain benefits which they are unable to receive under the qualified plan because of limitations on such qualified plans under Sections 401(a)(17) and 415(b) of the Internal Revenue Code. This Plan is intended to satisfy the short-term deferral exception under Code Section 409(a). Accordingly, the Participant's Plan accruals are calculated as of the last day of each Plan Year and paid as a taxable distribution to the Participant in that Plan Year. At this time, there are two long-term senior officials who are eligible for benefits under the plan, John Oliverio, Chief Executive Officer, and Greg Smith, Chief Information Officer. Under this plan, John Oliverio received a 2014 taxable payout of $628,324. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule O Disclosures | IRS Form 990 Part I Line 6 Sartori Memorial Hospital, Inc. received donated services through volunteers assisting in such areas as surgical waiting area, information desk, ambulatory surgery, medical records, engineering, occupational health, dietary, community screenings, materials, laundry, surgery, administration, human resources, public relations, wellness, and medical runner. Part V Line 1a and Part VII Section B Line 1-2 Wheaton Franciscan Healthcare streamlined their reporting of IRS Forms 1099-MISC so that most 1099-MISC are now reported using the FEIN number of the parent organization or of a related organization. The actual expense continues to be either paid by, or transferred to, the individual entity, which is normally a subsidiary or related organization to the organization(s) issuing the 1099. For this reason, the reader may notice on some 990's that there are top 5 independent contractors reported, but no 1099s are reported. Likewise on the 990's of the organization(s) reporting number of 1099's, there may be a disproportionate share of 1099's reported as compared with the actual expenses of the organization. IRS Form 990 Part VI Section A Lines 6-7b Sartori Memorial Hospital, Inc. has one member which holds several reserved powers over Sartori Memorial Hospital, Inc. These reserved powers include, but are not limited to, the election of members of the governing body and election of officers, approval of certain financial expenditures in accordance with policy, and approval of budgets and strategic plans; these approvals are based on recommendations from the governing body. IRS Form 990 Part VI Section B Line 10 Wheaton Franciscan Healthcare and Franciscan Ministries are part of a controlled group of health care and housing providers, controlled under a common parent organization Wheaton Franciscan Services, Inc. Some of these organizations are exempt through the Catholic Group Ruling and other organizations have a stand-alone exemption (IRS determination) letter. As such, these related affiliates have certain policies and procedures that were adopted at the parent level, but are applicable to the entire controlled group of organizations. All policy and procedure matters are handled in a manner to ensure that all activities are consistent with the organization's overall exempt purposes. Please see Schedule R for a full listing of all related affiliate organizations. IRS Form 990 Part VI Section B Line 11 Affiliates of Wheaton Franciscan Healthcare use a multiple-level review process on all Federal and State information and tax returns to ensure accurate and timely filing for all organizations. Under the direction of the Tax Manager, the Accounting Department prepares Forms 990, 990-T, and associated state filings. When complete, the return is first reviewed by the Controller, who focuses on the income statement and balance sheet items, and all schedules where transactions of this type might be reported. If discrepancies are found, the item will be corrected prior to the next step in the review process. Once cleared through Accounting, the return is provided to the Tax Department, where the Tax Manager and Vice President of Accounting focus their review on consistency of reporting between all returns, accuracy of tax related information, and explanation and understanding of any outliers. Again, any problems or questions are investigated and corrected. Depending on the level of complexity of the year in question, as well as the individual issues specific to that filing, certain returns may be selected for outside review by a public accounting firm. This decision will vary from year to year based on many factors, and sometimes outside review is not utilized at all. Also, certain schedules, such as Schedule K, Schedule H, and Schedule J, may be selected for review by outside bond counsel, a community benefit associate, and/or the compensation committee respectfully and as needed. This decision will vary from year to year, again based on many factors. The Accounting Department, upon completion of all levels of review, will schedule an appointment with the Senior Vice President and CFO, who will perform a review prior to signing the return. Once signed, the return is cleared to provide to members of the Board of Directors. The parent organization, Wheaton Franciscan Services, Inc. has designated that the Audit Committee review the parent return in certain years, where the 990 is explained at a high level by management representatives, and any questions or concerns that the Committee has can be addressed. At a later date and prior to efiling, the full board is provided access to all 990's throughout their assigned region via an online portal. A similar process exists at the regional holding company levels - a 990 is selected for review in certain years by the Finance and Operations Committee. Similarly, the 990 is explained at a high level, and Committee questions or concerns are addressed. Members of the full board are provided access to all 990's within that region via an online portal prior to efiling. IRS Form 990 Part VI Section B Line 12 The organization has a Conflict of Interest policy. Under that policy, if at any time, an officer or director becomes aware that the board may discuss or act upon any transaction or arrangement which may have any bearing of any kind upon, or may relate in any manner to, a financial interest of the individual , the financial interest must be disclosed. All associates of the organization must disclose a potential conflict of interest at the time it arises (or beforehand if not in existence at the time of hire). The disclosures are reviewed and a determination is made as to whether a conflict of interest exists and how it might be managed. Additionally, as part of an annual process, conflict of interest questions are sent out to all Officers, Directors, and other individuals in key positions using software designed to capture this information. The responses are analyzed in order to determine information on potential conflicts, as well as information on business and family relationships for purposes of answering certain questions on IRS Form 990. Responses to these questions are reviewed by the Vice President of Compliance and the Manager of Tax Compliance, and follow up action, if any, are documented within the software. After an approximate 3 and again at 6 weeks, names of all non responders are compiled, and these individuals receive either an email or letter reminding them to complete the information. Responses to questions continue to be reviewed and documented throughout this time period. Approximately 1 month prior to the filing deadline of IRS Form 990, responses to date are compiled. Any response requiring disclosure is entered into the information return. The remaining non responder names are determined, and a letter, along with the actual Conflict of Interest Policy, is sent to the Chairperson of each board. The letter outlines the current non responders, as well as any Officer or Board member that has disclosed a financial interest that might pose a potential conflict of interest. Depending upon the nature of the financial interest and work done by the board, several actions may be considered - the board member with a financial interest would need to voluntarily excuse him or herself from the deliberations and/or voting on such a matter; or, if necessary, the board would determine that the subject's financial interest was an actual conflict of interest, in which case the board member would be informed by the board Chairperson that he or she would not be allowed to vote in any such matters due to this real or perceived conflict of interest. Minutes of the board meeting would document this decision process, and reflect whatever action(s) are ultimately taken. The board chairperson is also required to discuss with non responders the repercussions of not responding, and require the board member to complete the annual conflict of interest disclosure questions before being allowed to continue in any board matters. If the board member refuses, the Chairperson has the authority to determine the appropriate action, including, but not limited to prohibiting them from participating in deliberations, preventing them from voting, and/or removing them as a board member. |
| Schedule O Disclosures (cont'd) | IRS Form 990 Part VI Section B Line 15b The filing organization has paid individuals who served as either Officers or Key Employees during the reporting period. These individuals have the following compensation structure: The compensation for the organization's officers and key employees who are paid by the filing organization is reviewed and approved on an annual basis, as part of the WFSI Executive Compensation Plan, by the Executive Committee of the Wheaton Franciscan Services, Inc. Board of Directors (the "Executive Committee of the WFSI Board"), an independent board, acting in a manner consistent with its conflicts of interest policy. The WFSI Board's decision is informed by an opinion on market comparable compensation data provided to the WFSI Board by an independent compensation expert. The WFSI Board maintains contemporaneous documentation of the substantiation of the deliberation and decisions it makes. IRS Form 990 Part VI Section C Line 19 Affiliates of Wheaton Franciscan Healthcare and Franciscan Ministries provide upon request certain documents including our financial statements, conflict of interest policy, and governing documents that support our tax exempt status, including, but not limited to, articles of incorporation and bylaws. Requests for information are considered on a case-by-case basis, and this process is outlined in our Public Disclosure Policy. As part of the requirements for tax exempt bond financing, the consolidated financial statements of Wheaton Franciscan Services, Inc. (#36-3262111) are required to be provided each quarter to the Municipal Securities Rule Making Board (MSRB). The vehicle used to accomplish this is through an external website (http://emma.msrb.org/) referred to as "EMMA" (Electronic Municipal Market Access System). The financial statements are uploaded each quarter to the website, and along with other information provided at the bond's inception, are available for viewing by the general public. IRS Form 990 Part VII Column B Wheaton Franciscan Healthcare and Franciscan Ministries are a controlled group of related healthcare and housing organizations. As such, many employees who are at the Director level or above, or who are Officers and/or Directors of organizations where Wheaton has common boards and other overlaps, spend significant time devoted to tasks not only for the filing organization, but also for related organizations. While there is no official time study tracking that is done, it is estimated that for each employee, tasks devoted to related organizations could approximate up to 80% or more of total hours. IRS Form 990 Part XI Line 9 Certain related organizations utilize receivable/payable accounts throughout the year. These intercompany balances are settled through the equity account at the end of each fiscal year to bring the receivable/payable balances to zero. Disclosure Statement Related to Forms 5471 Information return of US persons with respect to certain Foreign corporations filed on behalf of the taxpayer Under the constructive ownership rules of Internal Revenue Code Sections 958(a) and (b), the taxpayer is required to file Forms 5471, Information Return of US persons with respect to certain foreign corporations, as a category 4 and/or 5 filer with respect to Wheaton Franciscan Insurance Company, FEIN #98-0691609. These filing requirements are or will be satisfied through the filing of Forms 5471 with respect to the foreign corporation on the taxpayer's behalf by the US taxpayers identified below who have the same filing requirement. Taxpayer name: Wheaton Franciscan Services, Inc. Address: 26 w171 Roosevelt Road, Wheaton IL 60187 FEIN number of US Tax return with which form 5471 was filed: 36-3262111 IRS Service Center where US Tax return was or will be filed: e-filed |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (63 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| WHEATON FRANCISCAN SERVICES INC | ||||||||||
| 26 W 171 ROOSEVELT RD | WHEATON | IL | 60187 | 363262111 | PARENT CORP | IL | 501(c)(3) | 11 - III-FI | NA | false |
| WFH - SOUTHEAST WISCONSIN INC | ||||||||||
| 400 WEST RIVER WOODS PARKWAY | GLENDALE | WI | 53212 | 391568865 | HOLDING CO | IL | 501(c)(3) | 11 - III-FI | WFSI | false |
| WFH - ALL SAINTS INC | ||||||||||
| 3801 SPRING STREET | RACINE | WI | 53405 | 391264986 | HOSPITAL | WI | 501(c)(3) | 3 | WFH-SE WI | false |
| WFH - ALL SAINTS FOUNDATION INC | ||||||||||
| 3805B SPRING STREET | RACINE | WI | 53405 | 391570877 | FOUNDATION | WI | 501(c)(3) | 11 - I | WFH-AS INC | false |
| VOLUNTEERS IN PTNRSHIP WITH WFH-AS INC | ||||||||||
| 3807 SPRING STREET | RACINE | WI | 53405 | 930838390 | FOUNDATION | WI | 501(c)(3) | 11 - III-NF | WFH-AS INC | false |
| WFH - CIRCLE OF LIFE FOUNDATION INC | ||||||||||
| 4300 WEST BROWN DEER RD STE 250 | BROWN DEER | WI | 53223 | 562426294 | FOUNDATION | WI | 501(c)(3) | 11 - I | WFH-PE | false |
| WHEATON FRAN HOME HEALTH & HOSPICE INC | ||||||||||
| 3070 NORTH 51ST STREET STE 406 | MILWAUKEE | WI | 53210 | 391559428 | HOME HLTH | WI | 501(c)(3) | 3 | WFH-SE WI | false |
| WHEATON FRANCISCAN MEDICAL GROUP INC | ||||||||||
| 400 WEST RIVER WOODS PARKWAY | GLENDALE | WI | 53212 | 391791586 | MED GROUP | WI | 501(c)(3) | 3 | WFH-SE WI | false |
| WHEATON FRANCISCAN -ELMBROOK FNDN | ||||||||||
| 19333 WEST NORTH AVENUE | BROOKFIELD | WI | 53045 | 392028808 | FOUNDATION | WI | 501(c)(3) | 11 - I | WF INC | false |
| WHEATON FRANCISCAN LABORATORIES INC | ||||||||||
| 3237 SOUTH 16TH STREET | MILWAUKEE | WI | 53215 | 391701402 | LABORATORY | WI | 501(c)(3) | 9 | WFH-SE WI | false |
| WFH PHARMACY ENT AND FRAN WOODS INC | ||||||||||
| 19525 WEST NORTH AVENUE | BROOKFIELD | WI | 53005 | 391613624 | PHARMACY | WI | 501(c)(3) | 9 | WFH-SE WI | false |
| WFH - ST FRANCIS INC | ||||||||||
| 3237 SOUTH 16TH STREET | MILWAUKEE | WI | 53215 | 390907740 | HOSPITAL | WI | 501(c)(3) | 3 | WFH-SE WI | false |
| WF - ST JOSEPH FOUNDATION INC | ||||||||||
| 5000 WEST CHAMBERS STREET | MILWAUKEE | WI | 53210 | 391636804 | FOUNDATION | WI | 501(c)(3) | 11 - I | WF INC | false |
| WHEATON FRANCISCAN INC | ||||||||||
| 5000 WEST CHAMBERS STREET | MILWAUKEE | WI | 53210 | 390816857 | HOSPITAL | WI | 501(c)(3) | 3 | WFH-SE WI | false |
| WFH-FNDN FOR ST FRANCIS AND FRANKLIN INC | ||||||||||
| 3237 SOUTH 16TH STREET | MILWAUKEE | WI | 53215 | 320135258 | FOUNDATION | WI | 501(c)(3) | 11 - I | WFH-SFH | false |
| ELMBROOK AUXILIARY | ||||||||||
| 19333 WEST NORTH AVENUE | BROOKFIELD | WI | 53045 | 396068950 | AUXILIARY | WI | 501(c)(3) | 11 - III-FI | WF INC | false |
| WFH - TERRACE AT ST FRANCIS INC | ||||||||||
| 3200 SOUTH 20TH STREET | MILWAUKEE | WI | 53215 | 391486775 | NURSING HOME | WI | 501(c)(3) | 9 | WFH-SE WI | false |
| WFH - FRANKLIN INC | ||||||||||
| 10101 SOUTH 27TH STREET | FRANKLIN | WI | 53132 | 562592868 | HOSPITAL | WI | 501(c)(3) | 3 | WFH-SE WI | false |
| WHEATON WAY CONDO OWNERS ASSCN INC | ||||||||||
| 10101 SOUTH 27TH STREET | FRANKLIN | WI | 53132 | 300659830 | CONDO ASSCN | WI | N/A | N/A | WFH-FRKLN | false |
| METRO PHYSICIANS INC | ||||||||||
| 400 WEST RIVER WOODS PARKWAY | GLENDALE | WI | 53212 | 943436893 | MED GROUP | WI | 501(c)(3) | 3 | WFMG | false |
| MARIANJOY INC | ||||||||||
| 26 W 171 ROOSEVELT RD | WHEATON | IL | 60187 | 363483589 | HOLDING CO | IL | 501(c)(3) | 11 - III-FI | WFSI | false |
| MARIANJOY FOUNDATION INC | ||||||||||
| 26 W 171 ROOSEVELT RD | WHEATON | IL | 60187 | 352165613 | FOUNDATION | IL | 501(c)(3) | 7 | MJ HOSP | false |
| MARIANJOY REHAB CENTER AUXILIARY INC | ||||||||||
| 26 W 171 ROOSEVELT RD | WHEATON | IL | 60187 | 363896976 | AUXILIARY | IL | 501(c)(3) | 11 - I | MJ HOSP | false |
| MARIANJOY REHAB HOSPITAL & CLINICS INC | ||||||||||
| 26 W 171 ROOSEVELT RD | WHEATON | IL | 60187 | 362680776 | REHAB HOSPITA | IL | 501(c)(3) | 3 | MARIANJOY | false |
| REHABILITATION MEDICINE CLINIC INC | ||||||||||
| 26 W 171 ROOSEVELT RD | WHEATON | IL | 60187 | 363236791 | MEDICAL GRP | IL | 501(c)(3) | 3 | MARIANJOY | false |
| OSF SERVICES INC | ||||||||||
| PO Box 667 | WHEATON | IL | 601870667 | 391471463 | HOLDING CO | WI | 501(c)(3) | 11 - III-FI | WFSI | false |
| CANTICLE MINISTRIES INC | ||||||||||
| PO Box 667 | WHEATON | IL | 601870667 | 364091836 | HOUSING/ADVCY | IL | 501(c)(3) | 7 | OSF SVCS INC | false |
| FRANCISCAN SISTERS CHARITABLE FUND OF CO | ||||||||||
| 2626 OSCEOLA STREET | DENVER | CO | 80212 | 840733072 | AUXILIARY | CO | 501(c)(3) | 7 | OSF SVCS INC | false |
| SET MINISTRY INC | ||||||||||
| 2977 NORTH 50TH STREET | MILWAUKEE | WI | 53210 | 391618277 | SOCIAL WORK | WI | 501(c)(3) | 9 | OSF SVCS INC | false |
| ST CATHERINE'S HOSPITAL INC | ||||||||||
| 9555 76TH STREET | PLEASANT PRAIRIE | WI | 53158 | 390855075 | HOSPITAL | WI | 501(c)(3) | 3 | OSF SVCS INC | false |
| UHS INC (1) | ||||||||||
| 6308 EIGHTH AVENUE | KENOSHA | WI | 53143 | 391956749 | HOSPITAL | WI | 501(c)(3) | 3 | NONE | false |
| UPENDO VILLAGE NFP | ||||||||||
| PO Box 667 | WHEATON | IL | 601870667 | 331007368 | HIV SUPPORT | IL | 501(c)(3) | 9 | OSF SVCS INC | false |
| WFH - IOWA INC | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421177001 | HOLDING CO | IA | 501(c)(3) | 11 - III-FI | WFSI | false |
| COVENANT FOUNDATION INC | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421295784 | FOUNDATION | IA | 501(c)(3) | 9 | COV MED CTR | false |
| COVENANT MEDICAL CENTER INC | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421264647 | HOSPITAL | IA | 501(c)(3) | 3 | WFH-IOWA | false |
| MERCY HOSPITAL OF FRANCISCAN SISTERS INC | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421178403 | HOSPITAL | IA | 501(c)(3) | 3 | WFH-IOWA | false |
| NE IOWA REAL ESTATE INVESTMENTS LTD | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421207432 | HOLDING CO | IA | 501(c)(2) | N/A | WFH-IOWA | false |
| SCHOITZ HEALTH RESOURCES INC (4) | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421232935 | PROMOTE HLTH | IA | 501(c)(3) | 11 - II | NA | false |
| SCHOITZ MEDICAL CENTER INC (5) | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 420718472 | OP ROOM SVCS | IA | 501(c)(3) | 3 | SCHOITZ HR | false |
| SARTORI HEALTH CARE FOUNDATION INC | ||||||||||
| 3421 WEST NINTH STREET | WATERLOO | IA | 50702 | 421240996 | FOUNDATION | IA | 501(c)(3) | 11 - I | SARTORI HOSP | Yes (true) |
| FRANCISCAN MINISTRIES INC | ||||||||||
| 26W171 ROOSEVELT ROAD | WHEATON | IL | 601870667 | 363259684 | HOLDING CO | IL | 501(c)(3) | 11 - III-FI | WFSI | false |
| ASSISI HOMES - BATAVIA APARTMENTS INC | ||||||||||
| 1259 EAST WILSON STREET | BATAVIA | IL | 60510 | 363914084 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| ASSISI HOMES - COLONY PARK INC | ||||||||||
| 550 EAST THORNHILL DRIVE | CAROL STREAM | IL | 60188 | 364039278 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| ASSISI HOMES - CONSTITUTION HOUSE INC | ||||||||||
| 401 NORTH CONSTITUTION DRIVE | AURORA | IL | 60506 | 364049150 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| ASSISI HOMES - JEFFERSON COURT INC | ||||||||||
| 415 EAST KNAPP STREET | MILWAUKEE | WI | 53202 | 391771526 | HOUSING | WI | 501(c)(3) | 9 | FMI | false |
| ASSISI HOMES - KENOSHA INC | ||||||||||
| 1860 27TH AVENUE | KENOSHA | WI | 53140 | 391814815 | HOUSING | WI | 501(c)(3) | 9 | FMI | false |
| ASSISI HOMES - SAXONY INC | ||||||||||
| 1876 22ND AVENUE | KENOSHA | WI | 53140 | 391790498 | HOUSING | WI | 501(c)(3) | 9 | FMI | false |
| ASSISI HOMES OF GURNEE INC | ||||||||||
| 3495 WEST GRAND AVENUE | GURNEE | IL | 60031 | 363942336 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| ASSISI HOMES OF ILLINOIS INC | ||||||||||
| 2126 WEST ROOSEVELT ROAD | WHEATON | IL | 60187 | 363803443 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| Assisi HOMES OF NEENAH INC | ||||||||||
| 210 BYRD AVENUE | NEENAH | WI | 54946 | 363767250 | HOUSING | WI | 501(c)(3) | 9 | FMI | false |
| CANTICLE PLACE INC | ||||||||||
| 26W171 ROOSEVELT ROAD | WHEATON | IL | 601870667 | 363957850 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| CATHERINE MARIAN HOUSING INC | ||||||||||
| 806 SOUTH WISCONSIN AVENUE | RACINE | WI | 53403 | 391657098 | HOUSING | WI | 501(c)(3) | 9 | FMI | false |
| CLARE GARDENS INC | ||||||||||
| 2626 OSCEOLA STREET | DENVER | CO | 80212 | 237200039 | HOUSING | CO | 501(c)(3) | 9 | FMI | false |
| CLARE OF ASSISI HOMES-WESTMINSTER INC | ||||||||||
| 2451 WEST 82ND PLACE | WESTMINSTER | CO | 80031 | 742740978 | HOUSING | CO | 501(c)(3) | 9 | FMI | false |
| DAYSPRING VILLA INC | ||||||||||
| 3777 WEST 26TH AVENUE | DENVER | CO | 80211 | 363933908 | HOUSING | CO | 501(c)(3) | 9 | FMI | false |
| FRANCIS HEIGHTS INC | ||||||||||
| 2626 OSCEOLA STREET | DENVER | CO | 80212 | 840626174 | HOUSING | CO | 501(c)(3) | 9 | FMI | false |
| FRANCISCAN MINISTRIES COMMUNITY FNDN INC | ||||||||||
| 26W171 ROOSEVELT ROAD | WHEATON | IL | 601870667 | 364456204 | FOUNDATION | IL | 501(c)(3) | 11 - I | FMI | false |
| MARIAN HOUSING CENTER INC | ||||||||||
| 4105 SPRING STREET | RACINE | WI | 53405 | 391515867 | HOUSING | WI | 501(c)(3) | 9 | FMI | false |
| MARIAN PARK INC | ||||||||||
| 2126 WEST ROOSEVELT ROAD | WHEATON | IL | 60187 | 362750105 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
| RIDGEWAY PLACE INC | ||||||||||
| 155 EAST RIDGEWAY AVENUE | WATERLOO | IA | 50702 | 421416064 | HOUSING | IA | 501(c)(3) | 9 | FMI | false |
| VILLA MARIA INC | ||||||||||
| 2461 WEST 82ND PLACE | WESTMINSTER | CO | 80031 | 841347868 | HOUSING | CO | 501(c)(3) | 9 | FMI | false |
| VILLA ST CLARE INC | ||||||||||
| 130 BYRD AVENUE | NEENAH | WI | 54946 | 391769395 | HOUSING | WI | 501(c)(3) | 9 | FMI | false |
| ASSISI HOMES LASALLE MANOR INC | ||||||||||
| 26W171 ROOSEVELT ROAD | WHEATON | IL | 601890795 | 800623447 | HOUSING | IL | 501(c)(3) | 9 | FMI | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|
| WHEATON FRANCISCAN ENTERPRISES INC | ||||||||||
| 400 WEST RIVER WOODS PARKWAY | GLENDALE | WI | 53212 | 391985204 | HOLDING CO | WI | WF HOLDINGS INC | C CORP | false | |
| WHEATON FRANCISCAN HOLDINGS INC | ||||||||||
| 400 WEST RIVER WOODS PARKWAY | GLENDALE | WI | 53212 | 391836357 | HOLDING CO | WI | WFH-SE WI | C CORP | false | |
| WHEATON FRANCISCAN MED GRP-SUSSEX INC | ||||||||||
| 400 WEST RIVER WOODS PARKWAY | GLENDALE | WI | 53212 | 391361100 | MED GROUP | WI | WF HOLDINGS INC | C CORP | false | |
| WHEATON FRANCISCAN PROVIDER NETWORK INC | ||||||||||
| 400 WEST RIVER WOODS PARKWAY | GLENDALE | WI | 53212 | 391952140 | PROVIDER CONTRACT | WI | WFH-SE WI | C CORP | false | |
| FMOB CONDOMINIUM ASSCN (3) | ||||||||||
| 400 WEST RIVER WOODS PARKWAY | GLENDALE | WI | 53212 | 341983857 | CONDO MGMT | WI | FMOB LLC | C CORP | false | |
| WHEATON FRANCISCAN INSURANCE COMPANY | ||||||||||
| 980691609 | FINANCIAL | WFSI | false | UK | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (true) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Schoitz Health Resources | ||
| B | $72,282 | Book value |
| Schoitz Health Resources | ||
| C | $448,167 | Book value |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule R Disclosures | FormAndLineReferenceDesc |
| Explanation | (1) UHS, Inc. is listed without a direct controlling entity because of the two organizations with an interest, KHMC Community Board and OSF Services Inc, neither can appoint a majority of the board, and since KHMC is not an entity (it is a community board), neither body "controls". (3) Franklin Medical Office Building Condominium Association, Inc. is owned approximately 81% by Franklin Medical Office Building LLC, and since the LLC went from being 20% to 100% Wheaton owned effective 01/27/2015, is being added as a related organization. | ExplanationTxt |
Comments