SPOONER HEALTH SYSTEM INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- SPOONER HEALTH SYSTEM INC (EIN 39-0892183)
- Tax period
- 2015-04-01 to 2016-03-31
- Filed
- 2017-02-13
- IRS object ID
- 201710449349300231
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-02-13T09:15:00-06:00 | ReturnTs |
| Tax Period End | 2016-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390892183 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SPOONER HEALTH SYSTEM INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SPOO | BusinessNameControlTxt |
| Phone | 7159391732 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1280 CHANDLER DRIVE | AddressLine1Txt |
| City | SPOONER | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54801 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL D SCHAFER | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Phone | 7159391732 | PhoneNum |
| Signature | 2017-02-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KOREY BOELTER | PreparerPersonNm |
| PTIN | P00775161 | PTIN |
| Phone | 6123764500 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | MICHAEL D SCHAFER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1280 CHANDLER DRIVE | AddressLine1Txt |
| City | SPOONER | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54801 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $21,257,302 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SPOONERHEALTH.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1955 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HIGH QUALITY HEALTHCARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 168 | TotalEmployeeCnt |
| Total Volunteers | 60 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $30,221 | PYContributionsGrantsAmt |
| CY Contributions Grants | $62,686 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $19,576,856 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $20,539,948 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,610,862 | PYInvestmentIncomeAmt |
| CY Investment Income | $405,127 | CYInvestmentIncomeAmt |
| PY Other Revenue | $66,030 | PYOtherRevenueAmt |
| CY Other Revenue | $61,094 | CYOtherRevenueAmt |
| PY Total Revenue | $21,283,969 | PYTotalRevenueAmt |
| CY Total Revenue | $21,068,855 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $5,796 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $11,675 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,099,524 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,276,141 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,068,489 | PYOtherExpensesAmt |
| CY Other Expenses | $9,857,398 | CYOtherExpensesAmt |
| PY Total Expenses | $18,173,809 | PYTotalExpensesAmt |
| CY Total Expenses | $19,145,214 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,110,160 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,923,641 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $47,691,063 | TotalAssetsBOYAmt |
| Total Assets EOY | $53,258,259 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $23,913,106 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $27,954,722 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $23,777,957 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $25,303,537 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE HIGH QUALITY HEALTHCARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $13,082,930 | ExpenseAmt |
| Grant | $11,675 | GrantAmt |
| Revenue | $20,142,590 | RevenueAmt |
| Desc | SPOONER HEALTH SYSTEM PLAYS A VITAL ROLE IN THE HEALTH AND WELL-BEING OF THE COMMUNITY BY OFFERING SERVICES TO PATIENTS SUCH AS 24-HOUR EMERGENCY CARE, ACUTE CARE, SURGICAL, REHABILITATION, DIAGNOSTIC, AND HOSPICE CARE. FOR THE FISCAL YEAR ENDING 3/31/16, THERE WERE 2,277 INPATIENT DAYS, 380 INPATIENT DISCHARGES, 6 NEWBORN DAYS, 13,691 OUTPATIENT VISITS, 6,949 EMERGENCY ROOM VISITS, AND 440 SURGERIES. SPOONER HEALTH SYSTEM PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS/RESIDENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. A FINANCIAL ASSISTANCE PROGRAM IS ALSO AVAILABLE FOR PATIENTS FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. THIS PROGRAM INCLUDES FEE DISCOUNTS, AS WELL AS 100% FREE CARE. SPOONER HEALTH SYSTEM ALSO PROVIDES NUMEROUS HEALTHCARE AND WELLNESS CLASSES, SUPPORT GROUPS, AND VARIOUS EDUCATIONAL/HEALTH SCREENING OPPORTUNITIES AS A COMMUNITY BENEFIT. THESE PROGRAMS ARE OFFERED TO ITS PATIENTS, THEIR FAMILIES, EMPLOYEES, COMMUNITY MEMBERS AND THE GENERAL PUBLIC. SPOONER HEALTH SYSTEM ALSO RECEIVES DONATED SERVICES FROM COMMUNITY VOLUNTEERS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $617,924 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $397,358 | RevenueAmt |
| Desc | THE HOME HEALTH AGENCY PROVIDES NURSING AND REHABILITATION SERVICES TO PATIENTS IN THEIR HOME. FOR THE FISCAL YEAR ENDING 3/31/16, THERE WERE 2,457 HOME HEALTH VISITS, 123 ADMITTED CASES, AND 120 DISCHARGED CASES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $13,700,854 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 21 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 168 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REBECCA BUSCH CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7159391732 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1280 CHANDLER DRIVE | AddressLine1Txt |
| City | SPOONER | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54801 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| JAMIE MORALES | |||||||
| BOARD PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MICHAEL KNOEPKE | |||||||
| BOARD VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ADAM LIEGL | |||||||
| BOARD TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARK VAN ETTEN MD | |||||||
| BOARD SECRETARY/MEDICAL DIRECTOR | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SHELDON JOHNSON | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| NANCY MARKGREN | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MAUREEN REVAK | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL SCHAFER | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| REBECCA BUSCH | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | Yes (X) | $113,552 | $0 | $18,829 | ||
| TIMOTHY BASSETT | |||||||
| PHARMACY DIRECTOR | 40.00 | $144,408 | $0 | $12,853 | Yes (X) | ||
| KEN ENGEL | |||||||
| PHARMACIST | 40.00 | $137,639 | $0 | $15,431 | Yes (X) | ||
| PATRICK MCCANN MD | |||||||
| ER MEDICAL DIRECTOR | 40.00 | $260,380 | $0 | $34,858 | Yes (X) | ||
| ANNE MENTELE CRNA | |||||||
| CERT. NURSE ANESTHETIST | 40.00 | $168,713 | $0 | $32,836 | Yes (X) | ||
| TIMOTHY SCHMIDT CRNA | |||||||
| CERT. NURSE ANESTHETIST | 40.00 | $174,394 | $0 | $33,422 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $999,086 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $148,229 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WAPITI MEDICAL GROUP-WOOD RIVER LLC | |||||
| 107 FLYNN DR STE 600 | MILBANK | SD | 57252 | ER PHYSICIAN COVERAGE | $958,941 |
| HEALTHTECH MANAGEMENT SERVICES | |||||
| 5110 MARYLAND WAY STE 200 | BRENTWOOD | TN | 37027 | MANAGEMENT FEES | $563,291 |
| SHARED MEDICAL TECHNOLOGY INC | |||||
| 202 W NEWTON ST | RICE LAKE | WI | 54868 | DIAGNOSTIC RADIOLOGY | $453,448 |
| CPSI | |||||
| PO BOX 850309 | MOBILE | AL | 36685 | COMPUTER SUPPORT | $320,173 |
| BWBR | |||||
| 380 ST PETER STREET SUITE 600 | ST PAUL | MN | 55102 | ARCHITECT DESIGN FEES | $200,396 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $8,897 | FundraisingAmt |
| Government Grants | $6,450 | GovernmentGrantsAmt |
| All Other Contributions | $47,339 | AllOtherContributionsAmt |
| Total Contributions | $62,686 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REV. | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $20,539,948 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $20,539,948 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $20,539,948 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $229,241 | TotalRevenueColumnAmt |
| Exclusion | $229,241 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $68,767 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $9,558 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $59,209 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $59,209 | TotalRevenueColumnAmt |
| Exclusion | $59,209 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $344,000 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $164,626 | SecuritiesAmt |
| Other | $3,488 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $179,374 | SecuritiesAmt |
| Other | -$3,488 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $175,886 | TotalRevenueColumnAmt |
| Exclusion | $175,886 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $8,576 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $8,897 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $10,775 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$2,199 | TotalRevenueColumnAmt |
| Exclusion | -$2,199 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $4,084 | TotalRevenueColumnAmt |
| Exclusion | $4,084 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $4,084 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,068,855 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $20,539,948 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $466,221 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,675 | TotalAmt |
| Program Services | $11,675 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,075 | TotalAmt |
| Management And General | $138,075 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,180,181 | TotalAmt |
| Program Services | $6,299,585 | ProgramServicesAmt |
| Management And General | $880,596 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $181,348 | TotalAmt |
| Program Services | $159,107 | ProgramServicesAmt |
| Management And General | $22,241 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,264,073 | TotalAmt |
| Program Services | $1,109,044 | ProgramServicesAmt |
| Management And General | $155,029 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $512,464 | TotalAmt |
| Program Services | $449,614 | ProgramServicesAmt |
| Management And General | $62,850 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $645,083 | TotalAmt |
| Management And General | $645,083 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $110,894 | TotalAmt |
| Management And General | $110,894 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,688 | TotalAmt |
| Management And General | $57,688 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,542,763 | TotalAmt |
| Program Services | $2,459,564 | ProgramServicesAmt |
| Management And General | $83,199 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $276,528 | TotalAmt |
| Management And General | $276,528 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $352,335 | TotalAmt |
| Program Services | $184,598 | ProgramServicesAmt |
| Management And General | $167,737 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $297,812 | TotalAmt |
| Program Services | $77,964 | ProgramServicesAmt |
| Management And General | $219,848 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $596,611 | TotalAmt |
| Program Services | $579,468 | ProgramServicesAmt |
| Management And General | $17,143 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,469 | TotalAmt |
| Program Services | $74,523 | ProgramServicesAmt |
| Management And General | $22,946 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,362 | TotalAmt |
| Program Services | $35,199 | ProgramServicesAmt |
| Management And General | $10,163 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,706,972 | TotalAmt |
| Management And General | $1,706,972 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,039 | TotalAmt |
| Management And General | $91,039 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DRUGS | $1,258,291 | $1,258,291 | |
| BAD DEBT EXPENSE | $874,511 | $243,014 | $631,497 |
| MEDICAL SUPPLIES | $771,174 | $730,824 | $40,350 |
| DUES/SUBSCRIPTIONS | $76,500 | $28,384 | $48,116 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,366 | TotalAmt |
| Management And General | $56,366 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,145,214 | TotalAmt |
| Program Services | $13,700,854 | ProgramServicesAmt |
| Management And General | $5,444,360 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $700 | BOYAmt |
| EOY | $700 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,802,135 | BOYAmt |
| EOY | $14,569,981 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,562,238 | BOYAmt |
| EOY | $2,665,090 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $219,312 | BOYAmt |
| EOY | $241,766 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $147,267 | BOYAmt |
| EOY | $155,735 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $40,112,171 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $16,300,125 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,848,483 | BOYAmt |
| EOY | $23,812,046 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,550,217 | BOYAmt |
| EOY | $11,275,695 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $560,711 | BOYAmt |
| EOY | $537,246 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,691,063 | BOYAmt |
| EOY | $53,258,259 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,621,106 | BOYAmt |
| EOY | $6,662,722 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,200,000 | BOYAmt |
| EOY | $21,200,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,000 | BOYAmt |
| EOY | $92,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,913,106 | BOYAmt |
| EOY | $27,954,722 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,764,332 | BOYAmt |
| EOY | $25,303,537 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,625 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,777,957 | BOYAmt |
| EOY | $25,303,537 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,691,063 | BOYAmt |
| EOY | $53,258,259 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,923,641 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$398,061 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule 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 D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $984,772 | OtherCostOrOtherBasisAmt |
| Book Value | $984,772 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,563,608 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,034,199 | DepreciationAmt |
| Book Value | $529,409 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,907,713 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,265,926 | DepreciationAmt |
| Book Value | $641,787 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,656,078 | OtherCostOrOtherBasisAmt |
| Book Value | $21,656,078 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $23,812,046 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ASSET RETIREMENT OBLIGATION | Desc |
| Amt | $92,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $92,000 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $20,207,969 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $13,625 | OtherRevenueAmt |
| Revenue Not Reported | $13,625 | RevenueNotReportedAmt |
| Revenue Subtotal | $20,194,344 | RevenueSubtotalAmt |
| Other Revenues Not Included | $874,511 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $874,511 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $21,068,855 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $18,270,703 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $18,270,703 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $874,511 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $874,511 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $19,145,214 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE ORGANIZATION IS CLASSIFIED BY THE INTERNAL REVENUE SERVICE AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS SUBJECTED TO FEDERAL INCOME TAX ONLY ON NET UNRELATED BUSINESS INCOME. THE ORGANIZATION FOLLOWS THE GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR INCOME TAXES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE APPLICATION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | NET ASSETS RELEASED FROM RESTRICTIONS 13,625. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS 874,511. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS 874,511. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | SHS GOLF OUTING | Event1Nm |
| Gross Receipts Event1 | $17,473 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $8,897 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $8,576 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $2,761 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $4,000 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $1,815 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $2,199 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $17,473 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $8,897 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $8,576 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $2,761 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $4,000 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $1,815 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $2,199 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $10,775 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$2,199 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $235,821 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $235,821 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01290 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,170,398 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,274,908 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,895,490 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10370 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,406,219 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,274,908 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,131,311 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11660 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 10 | ActivitiesOrProgramsCnt |
| Persons Served | 15325 | PersonsServedCnt |
| Total Community Benefit Expns | $85,290 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,198 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $76,092 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00420 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 77 | PersonsServedCnt |
| Total Community Benefit Expns | $27,772 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $27,772 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 318 | PersonsServedCnt |
| Total Community Benefit Expns | $545,440 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $353,576 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $191,864 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01050 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $56,327 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $56,327 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00310 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 15 | ActivitiesOrProgramsCnt |
| Persons Served | 15720 | PersonsServedCnt |
| Total Community Benefit Expns | $714,829 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $362,774 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $352,055 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01930 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 15 | ActivitiesOrProgramsCnt |
| Persons Served | 15720 | PersonsServedCnt |
| Total Community Benefit Expns | $4,121,048 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,637,682 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,483,366 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13590 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $588 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $588 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 61 | PersonsServedCnt |
| Total Community Benefit Expns | $17,280 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $17,280 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $515 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $515 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 20 | PersonsServedCnt |
| Total Community Benefit Expns | $2,468 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,468 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,530 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,530 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 207 | PersonsServedCnt |
| Total Community Benefit Expns | $16,294 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $16,294 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 288 | PersonsServedCnt |
| Total Community Benefit Expns | $38,675 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $38,675 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $874,511 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,836,778 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,004,518 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$167,740 | 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 (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SPOONER HEALTH SYSTEM INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1280 CHANDLER DRIVE | AddressLine1Txt |
| City | SPOONER | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54801 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SPOONERHEALTH.COM | WebsiteAddressTxt |
| State License | 1024 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | HOME HEALTH AGENCY | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SPOONER HEALTH SYSTEM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.SPOONERHEALTH.COM/ABOUT-US/COMM-HEALTH-ASSESSMENT/ | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | WWW.CO.WASHBURN.WI.US/DEPARTMENTS/HEALTH-HUMAN-SERVICES/PUBLIC-HEALTH | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.SPOONERHEALTH.COM/ABOUT-US/COMM-HEALTH-ASSESSMENT/ | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | 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 (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.SPOONERHEALTHSYSTEM.COM/PATIENTS-VISITORS/PATIENT-VISITOR-INFO/ | FAPAppAvailableOnWebsiteURLTxt |
| 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 |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Lowest Negotiated Rates | Yes (X) | LowestNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SPOONER HEALTH SYSTEM | PART V, SECTION B, LINE 5: SPOONER HEALTH SYSTEM WORKED IN PARTNERSHIP WITH WASHBURN COUNTY ON A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT. COMMUNITY INPUT WAS GATHERED THROUGH A STEERING COMMITTEE (INDIVIDUALS SELECTED FOR THEIR PROFESSIONAL INSIGHT REPRESENTING THE COMMUNITIES INTERESTS) AND A PUBLIC COMMUNITY SURVEY. A NEWS RELEASE WAS SENT TO THE LOCAL PAPERS TO INFORM AND INVITE THE PUBLIC TO BE PART OF THE PROCESS. THE SURVEY WAS DEVELOPED TO CAPTURE THE COMMUNITY PERCEPTION OF THE PRESENT AND FUTURE HEALTH NEEDS OF WASHBURN COUNTY. SPOONER HEALTH SYSTEM CONTRACTED WITH THE NATIONAL RURAL HEALTH RESOURCE CENTER TO DEVELOP, DISTRIBUTE, AND COLLATE THE SURVEY RESULTS.IN THE SUMMER OF 2015, SURVEYS WERE MAILED TO A RANDOM STRATIFIED SAMPLE OF 800 COMMUNITY RESIDENCES. ONE HUNDRED ADDITIONAL SURVEYS WERE MADE AVAILABLE FOR DISTRIBUTION AT THE HOSPITAL AND PUBLIC HEALTH. ADDITIONALLY, THE SURVEY WAS MADE AVAILABLE ELECTRONICALLY AND THE SURVEY LINK WAS PUBLICIZED AND AVAILABLE ON SPOONER HEALTH SYSTEM AND WASHBURN COUNTY WEBSITES. RESPONDENTS WERE ENCOURAGED TO COMPLETE THE ASSESSMENT USING ONE OF THE THREE MODALITIES. |
| SPOONER HEALTH SYSTEM | PART V, SECTION B, LINE 6B: SPOONER HEALTH SYSTEM COLLABORATED WITH WASHBURN COUNTY PUBLIC HEALTH AND THE NATIONAL RURAL HEALTH RESOURCE CENTER OF DULUTH, MN WHEN COMPLETING THEIR CHNA. |
| SPOONER HEALTH SYSTEM | PART V, SECTION B, LINE 11: DURING THE FISCAL YEAR, WE CONTINUED TO OPERATE THE HOME HEALTH AGENCY AT A LOSS BECAUSE OF THE COMMUNITY'S NEED. WE ALSO HELD SMOKING CESSATION CLASSES, REHAB SCREENING EVENTS, FLU SHOT CLINICS, AND PARTICIPATED IN COMMUNITY GROUPS SUCH AS TEAM WELLNESS, WASHBURN COUNTY DRUG TEAM, M-TEAM, ALZHEIMER'S ASSOCIATION, AND FAITH IN ACTION BOARD.AT THIS TIME, WE HAVE NOT IDENTIFIED NEEDS THAT CANNOT BE MET BECAUSE WE COLLABORATED WITH OTHER COMMUNITY ENTITIES. THEREFORE, THE PLAN INCLUDES ITEMS THAT MAY NOT BE ABLE TO BE ADDRESSED BY SPOONER HEALTH SYSTEM, BUT CAN BE ADDRESSED BY THOSE COMMUNITY PARTNERS. |
| SPOONER HEALTH SYSTEM | PART V, SECTION B, LINE 16I: ALTHOUGH THE ACTUAL POLICY AND PROCEDURE IS NOT ON THE WEBSITE, BASIC INFORMATION IS POSTED REGARDING THE FACT THAT FINANCIAL ASSISTANCE IS AVAILABLE. THE INFORMATION ON THE WEBSITE EXPLAINS EXACTLY WHAT TO DO IN ORDER TO APPLY FOR FINANCIAL ASSISTANCE. THE APPLICATION FORM IS ALSO AVAILABLE ON THE WEBSITE AND AT REGISTRATION. FINANCIAL ASSISTANCE APPLICATION AND LETTER IS SENT OUT TO PATIENTS WHO ARE NOT ABLE TO PAY THEIR BALANCES DUE. |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED PRIMARILY ON HOUSEHOLD INCOME COMPARED TO FEDERAL POVERTY GUIDELINES. HOWEVER, QUALIFIED HOUSEHOLD ASSETS ARE ALSO CONSIDERED WHEN DETERMINING AN INDIVIDUAL'S ABILITY TO PAY FOR HEALTHCARE SERVICES. FINALLY, INSURANCE STATUS CAN IMPACT A PERSON'S ELIGIBILITY IF THEY HAVE ACCESS TO HEALTH INSURANCE, THIRD-PARTY REIMBURSEMENT OR GOVERNMENTAL ASSISTANCE BUT FAIL TO TAKE ADVANGE OF IT OR FAIL TO MAINTAIN ELIGIBILITY. |
| PART I, LINE 7: | THE AMOUNTS REPORTED IN PART I, LINE 7A-C WERE COMPUTED USING THE COST TO CHARGE RATIO FROM WORKSHEET 2 OF THE SCHEDULE H, IRS INSTRUCTIONS. THE AMOUNTS REPORTED IN LINES 7E-I WERE REPORTED BASED ON DIRECT COSTS INCURRED BY SHS. |
| PART I, LINE 7G: | INCLUDED IN PART I, LINE 7G ARE THE MEMORY CLINIC, WHICH IS A PHYSICIAN CLINIC, AND THE HOME HEALTH AGENCY. BOTH SERVICES ARE LISTED AS SUBSIDIZED HEALTH SERVICES BECAUSE THEY ARE OPERATED BY SHS TO PROVIDE A SERVICE THAT IS NEEDED IN THE COMMUNITY BUT THAT CANNOT BE SUSTAINED ON THEIR OWN. THE TOTAL COMMUNITY BENEFIT EXPENSE FOR THE HOME HEALTH AGENCY WAS $460,919 WITH DIRECT OFFSETTING REVENUE OF $323,519, RESULTING IN A NET COMMUNITY BENEFIT EXPENSE OF $137,400. THE TOTAL COMMUNITY BENEFIT EXPENSE FOR THE MEMORY CLINIC WAS $84,521 WITH DIRECT OFFSETTING REVENUE OF $30,057, RESULTING IN A NET COMMUNITY BENEFIT EXPENSE OF $54,464. |
| PART I, LN 7 COL(F): | THE HOSPITAL IS REPORTING $874,511 OF BAD DEBT EXPENSE IN FORM 990, PART IX, LINE 24B. TOTAL EXPENSE, LESS THIS AMOUNT, ARE $18,270,703. THIS AMOUNT IS USED TO CALCULATE THE PERCENTAGE OF TOTAL EXPENSE IN SCHEDULE H, PART I, LINE 7, COLUMN F. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | SPOONER HEALTH SYSTEM (SHS) IS PARTNERED WITH WASHBURN COUNTY AND THE STATE OF WISCONSIN IN THEIR EMERGENCY PREPAREDNESS EFFORTS THROUGH INVOLVEMENT WITH THE NORTHWEST WISCONSIN HEALTH CARE COALITION AND REGIONAL TRAUMA ADVISORY COUNCIL. SHS IS ALSO PARTNERED WITH THE FOLLOWING ORGANIZATIONS THAT DIRECTLY PROMOTE HEALTH OF PERSONS LIVING IN WASHBURN AND BURNETT COUNTIES: DRUG ENDANGERED CHILDREN M TEAM, WASHBURN COUNTY SAFETY COALITION, ELDER ABUSE INTERDISCIPLINARY TEAM, WASHBURN COUNTY AND POLK BURNETT COUNTY CARE TRANSITION COALITION, FAITH IN ACTION, TIME OUT SHELTER, AND BURNETT CRISIS OVERSIGHT COMMITTEE. |
| PART III, LINE 2: | THE AMOUNT OF BAD DEBT EXPENSE REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENT INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. |
| PART III, LINE 3: | A PORTION OF THE BAD DEBT EXPENSE REPORTED IN LINE 2 WOULD BE CONSIDERED CHARITY CARE IF THE PROPER PAPERWORK WAS COMPLETED, HOWEVER THIS AMOUNT CANNOT BE QUANTIFIED. |
| PART III, LINE 4: | FOR INFORMATION ABOUT BAD DEBT EXPENSE, SEE THE "PATIENT AND RESIDENT RECEIVABLES, NET" SECTION OF NOTE 1 ON PAGE 9 OF THE ATTACHED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | FROM PART III, LINE 6, THE TOTAL ALLOWABLE COST REPORTED TO MEDICARE WAS BASED ON THE 2016 FILED MEDICARE COST REPORT.FROM PART III, LINE 7, SPOONER HEALTH SYSTEM BELIEVES THAT THE SHORTFALL OF $167,740 SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE THESE ARE THE COSTS OF PROVIDING MEDICALLY NECESSARY SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IF THE HOSPITAL DIDN'T PROVIDE THESE SERVICES, NO OTHER ORGANIZATION IN THE COMMUNITY WOULD. |
| PART III, LINE 9B: | AFTER FINANCIAL ASSISTANCE IS PROVIDED, SPOONER HEALTH SYSTEM WILL CONTINUE TO WORK WITH PATIENTS TO RESOLVE THE REMAINDER OF THEIR BALANCE AFTER FINANCIAL ASSISTANCE. SPOONER HEALTH SYSTEM MAKES ALL REASONABLE ATTEMPTS TO CONFIRM THAT PATIENTS ARE NOT ELIGIBLE FOR OTHER ASSISTANCE PROGRAMS PRIOR TO COLLECTION AGENCY ASSIGNMENT. PRIOR TO TRANSFER TO A COLLECTION AGENCY, SPOONER HEALTH SYSTEM WILL SEND STATEMENTS AND COLLECTION LETTERS TO THE PATIENT AT THE ADDRESS PROVIDED BY THE PATIENT. STATEMENTS AND COMMUNICATIONS WILL INFORM THE PATIENT OF THEIR FINANCIAL RESPONSIBILITY AFTER FINANCIAL ASSISTANCE. AFTER PAYMENT PLAN ARRANGEMENTS HAVE BEEN MADE AND BEFORE TRANSFER TO A COLLECTION AGENCY, SPOONER HEALTH SYSTEM WILL SEND A NOTICE TO PATIENTS WHO HAVE FAILED TO MAKE PAYMENT ARRANGEMENTS OR WHO DO NOT COMPLY WITH MUTUALLY AGREED UPON PAYMENT PLANS. THE NOTICE WILL ALERT THE PATIENT OF THEIR BALANCE AND THAT IF THEIR FINANCIAL SITUATION HAS CHANGED, THEY MAY HAVE THE OPPORTUNITY FOR A NEW PAYMENT PLAN. |
| PART VI, LINE 2: | THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT REPORTED IN PART V, SECTION B WAS THE ONLY ASSESSMENT OF THE COMMUNITY'S HEALTH NEEDS CONDUCTED DURING THE FISCAL YEAR. |
| PART VI, LINE 3: | PATIENTS WITHOUT INSURANCE ARE GIVEN THE FINANCIAL ASSISTANCE (FA) APPLICATION. OUR FINANCIAL COUNSELOR CALLS THEM AFTER DISCHARGE AND EXPLAINS WHAT ASSISTANCE (FROM THE GOVERNMENT OR SHS) MAY BE AVAILABLE TO THEM. SHE ASKS THEM TO FILL IT OUT AND MAKES AN APPOINTMENT WITH THEM IN THE OFFICE IF THEY NEED ASSISTANCE WITH THE FA APPLICATION OR GOING TO WWW.ACCESS.GOV TO APPLY FOR GOVERNMENTAL ASSISTANCE. WHEN THEY COME IN, SHE WILL ASSIST THEM WITH THE APPLICATION PROCESS AS MUCH AS SHE CAN. IF THEY NEED FURTHER ASSISTANCE, ARE OF RETIREMENT AGE, OR IF THERE IS A DISABILITY INVOLVED, SHE REFERS THEM TO THE WASHBURN COUNTY AGING AND DISABILITY RESOURCE CENTER WHERE THEY WILL HELP THE PATIENTS IN GETTING ADDITIONAL ASSISTANCE. OUR FINANCIAL COUNSELOR ALSO REFERS PATIENTS TO THE COUNTY'S PUBLIC HEALTH DEPARTMENT IF THEY NEED FAMILY OR WOMEN'S HEALTH ASSISTANCE. WE ALSO PUBLICIZE THE AVAILABILITY OF FA IN OUR ANNUAL REPORT TO THE COMMUNITY THAT IS SENT OUT TO EVERY ADDRESS IN OUR PRIMARY SERVICE AREA. |
| PART VI, LINE 4: | SPOONER HEALTH SYSTEM PRIMARILY SERVES THE COMMUNITIES WITHIN WASHBURN COUNTY IN NORTHWESTERN WISCONSIN. WASHBURN COUNTY IS THE 30TH LARGEST COUNTY BY LAND AREA IN WISCONSIN WITH AN ESTIMATED POPULATION OF 15,911 (PER JULY 2015 US CENSUS BUREAU). THE MEDIAN HOUSEHOLD INCOME IS $42,368 WITH 13.5% OF PERSONS BELOW POVERTY LEVEL (PER 2011-2015 DATA). WASHBURN COUNTY HAD A 4.4% UNEMPLOYMENT RATE IN APRIL 2016 PER DWD, BUREAU OF WORKFORCE TRAINING. |
| PART VI, LINE 6: | SPOONER HEALTH SYSTEM IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt |
|---|---|---|
| HIGH SCHOOL STUDENT SCHOLARSHIPS | 2 | $2,000 |
| EMPLOYEE TUITION ASSISTANCE | 2 | $9,675 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | SPOONER HEALTH SYSTEM AWARDS SCHOLARSHIPS TO HIGH SCHOOL SENIORS WHO ARE GOING ON TO COLLEGE IN A HEALTH CARE FIELD. THE FUNDS ARE PAID DIRECTLY TO THE COLLEGE TO ENSURE THEY ARE USED FOR THE PURPOSE OF TUITION. SPOONER HEALTH SYSTEM ALSO OFFERS TUITION ASSISTANCE FOR EMPLOYEES THAT ARE FURTHERING THEIR EDUCATION TO ENHANCE THEIR JOB RELATED SKILLS, KNOWLEDGE AND IMPROVE THEIR POTENTIAL FOR PROMOTION OR CAREER DEVELOPMENT OPPORTUNITIES. TO RECEIVE TUITION REIMBURSEMENT FROM THE HOSPITAL, AN EMPLOYEE MUST SUBMIT A TUITION ASSISTANCE IN EXCHANGE FOR SERVICE FROM THE HUMAN RESOURCES DEPARTMENT ALONG WITH THE APPROPRIATE DOCUMENTATION. THIS INCLUDES WRITTEN PROOF OF SUCCESSFUL COMPLETION OF THE COURSE PER THE COURSE REQUIREMENTS AND ITEMIZED BILLS, RECEIPTS OR STATEMENTS WITH PROOF OF PAYMENT FOR EXPENSES. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TIMOTHY BASSETT | ||||||||||||||
| PHARMACY DIRECTOR | $144,408 | $0 | $0 | $0 | $0 | $0 | $4,559 | $0 | $8,294 | $0 | $157,261 | $0 | $0 | $0 |
| KEN ENGEL | ||||||||||||||
| PHARMACIST | $137,639 | $0 | $0 | $0 | $0 | $0 | $4,192 | $0 | $11,239 | $0 | $153,070 | $0 | $0 | $0 |
| PATRICK MCCANN MD | ||||||||||||||
| ER MEDICAL DIRECTOR | $260,380 | $0 | $0 | $0 | $0 | $0 | $8,002 | $0 | $26,856 | $0 | $295,238 | $0 | $0 | $0 |
| ANNE MENTELE CRNA | ||||||||||||||
| CERT. NURSE ANESTHETIST | $168,713 | $0 | $0 | $0 | $0 | $0 | $4,883 | $0 | $27,953 | $0 | $201,549 | $0 | $0 | $0 |
| TIMOTHY SCHMIDT CRNA | ||||||||||||||
| CERT. NURSE ANESTHETIST | $174,394 | $0 | $0 | $0 | $0 | $0 | $5,430 | $0 | $27,992 | $0 | $207,816 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WI HEALTH AND EDUCATIONAL FACILITIES AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 391337855 | BondIssuerEIN |
| Bond Issued | 2014-10-23 | BondIssuedDt |
| Issue Price | $21,200,000 | IssuePriceAmt |
| Purpose | CONSTRUCTING REPLACEMENT HOSPITAL | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $21,200,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $619 | IssuanceCostsFromProceedsAmt |
| Working Capital Expenditures | $518,316 | WorkingCapitalExpendituresAmt |
| Capital Expenditures | $14,996,519 | CapitalExpendituresAmt |
| Unspent | $5,684,545 | UnspentAmt |
| Substantial Completion | 2016 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | 0 | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 3 | SPOONER HEALTH SYSTEM, INC. DISCONTINUED ITS OBSTETRICS, NURSERY, AND LABOR AND DELIVERY PROGRAMS DURING THE FISCAL YEAR ENDING MARCH 31, 2016. |
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE CONSISTS OF THE BOARD PRESIDENT, VICE-PRESIDENT, SECRETARY AND TREASURER. THE EXECUTIVE COMMITTEE HAS AND EXERCISES THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE ORGANIZATION DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 3 | SPOONER HEALTH SYSTEM CONTRACTS WITH HEALTHTECH MANAGEMENT SERVICES TO PROVIDE MANAGEMENT SERVICES. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN WAS REVIEWED BY MANAGEMENT BEFORE BEING FORWARDED TO THE BOARD OF DIRECTORS. AT THE BOARD OF DIRECTORS MEETING, THE 990 WAS REVIEWED WITH BOARD MEMBERS WHO APPROVED IT. THE 990 WAS THEN FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | IT IS THE POLICY OF SPOONER HEALTH SYSTEM THAT ALL POTENTIAL CONFLICTS OF INTEREST SHOULD BE IDENTIFIED BY ANY OFFICER, BOARD MEMBER, OR KEY EMPLOYEE OF THE ORGANIZATION ON AN ANNUAL BASIS. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE PERSON WITH THE CONFLICT SHALL LEAVE MEETINGS DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. |
| FORM 990, PART VI, SECTION B, LINE 15 | MICHAEL SCHAFER, CEO, IS AN EMPLOYEE OF THE UNRELATED MANAGEMENT COMPANY THAT PROVIDES SERVICES TO SPOONER HEALTH SYSTEM. SPOONER HEALTH SYSTEM PAYS THE MANAGEMENT COMPANY A MANAGEMENT FEE FOR MICHAEL SCHAFER'S SERVICES AS CEO. THE MANAGEMENT COMPANY PERFORMS A SALARY REVIEW OF THE CEO OF SPOONER HEALTH SYSTEM EACH YEAR AND PROVIDES THE APPROPRIATE INFORMATION, INCLUDING COMPENSATION SURVEYS, TO SPOONER HEALTH SYSTEM'S BOARD OF DIRECTORS EACH YEAR. THROUGH THIS REVIEW, THE BOARD OF DIRECTORS IS ABLE TO REVIEW THE COMPARABILITY DATA RELIED UPON IN DETERMINING THE CEO'S COMPENSATION. THE INFORMATION IS PRESENTED BY THE MANAGEMENT COMPANY TO THE BOARD OF DIRECTORS OF SPOONER HEALTH SYSTEM, ALONG WITH A PERFORMANCE EVALUATION AND A RECOMMENDATION OF A SALARY LEVEL, WHICH IS THEN APPROVED BY THE BOARD OF DIRECTORS OF SPOONER HEALTH SYSTEM. ALL OFFICERS AND KEY EMPLOYEES' COMPENSATION IS REVIEWED ON AN ANNUAL BASIS AND COMPARED TO MARKET DATA GATHERED BY THE HUMAN RESOURCES DEPARTMENT. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 2,024,151. MANAGEMENT AND GENERAL EXPENSES 14,021. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,038,172. SUPPORT SERVICES: PROGRAM SERVICE EXPENSES 367,723. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 367,723. ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 67,690. MANAGEMENT AND GENERAL EXPENSES 69,178. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 136,868. |