AMERY REGIONAL MEDICAL CENTER INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization: AMERY REGIONAL MEDICAL CENTER INC (EIN 39-0908320)
Tax period: 2014-01-01 to 2014-12-31
Filed: 2015-11-16
IRS object ID: 201503209349307680
Schema version: 2014v5.0
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 H
Schedule I
Schedule J
Schedule K
Schedule K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2015-11-16T12:57:28-06:00	ReturnTs
Tax Period End	2014-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	135665207	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	KPMG LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	4200 WELLS FARGO CTR 90 S 7TH	AddressLine1Txt
Address Line2	STREET	AddressLine2Txt
City	MINNEAPOLIS	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	55402	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2014-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	390908320	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	AMERY REGIONAL MEDICAL CENTER INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	AMER	BusinessNameControlTxt
Phone	7152688000	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	8170 33RD AVENUE SOUTH PO BOX 1309	AddressLine1Txt
City	MINNEAPOLIS	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	554401309	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	DEBRA RUDQUIST	PersonNm
Person Title	PRESIDENT & CEO	PersonTitleTxt
Phone	7152688000	PhoneNum
Signature	2015-11-16	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	ANN LAMOUREUX	PreparerPersonNm
PTIN	P00691316	PTIN
Phone	6123055000	PhoneNum

Field	Value	IRS element (for citing)
Tax	2014	TaxYr
Build TS	2016-02-25 16:41:14Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Address Change	Yes (X)	AddressChangeInd
Principal Officer	DEBRA RUDQUIST	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	8170 33RD AVENUE SOUTH PO BOX 1309	AddressLine1Txt
City	MINNEAPOLIS	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	554401309	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$52,649,688	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.AMERYMEDICALCENTER.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1954	FormationYr
Legal Domicile State	WI	LegalDomicileStateCd
Activity Or Mission	SEE PART III, LINE 1 - "ORGANIZATION'S MISSION"	ActivityOrMissionDesc
Voting Members Governing Body	13	VotingMembersGoverningBodyCnt
Voting Members Independent	6	VotingMembersIndependentCnt
Total Employee	504	TotalEmployeeCnt
Total Volunteers	46	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$1,218,419	PYContributionsGrantsAmt
CY Contributions Grants	$79,333	CYContributionsGrantsAmt
PY Program Service Revenue	$33,484,207	PYProgramServiceRevenueAmt
CY Program Service Revenue	$50,935,728	CYProgramServiceRevenueAmt
PY Investment Income	$24,371	PYInvestmentIncomeAmt
CY Investment Income	$90,732	CYInvestmentIncomeAmt
PY Other Revenue	$700,380	PYOtherRevenueAmt
CY Other Revenue	$1,413,667	CYOtherRevenueAmt
PY Total Revenue	$35,427,377	PYTotalRevenueAmt
CY Total Revenue	$52,519,460	CYTotalRevenueAmt
PY Grants And Similar Paid	$43,574	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$23,373	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$14,262,126	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$30,803,652	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$22,127,508	PYOtherExpensesAmt
CY Other Expenses	$20,765,682	CYOtherExpensesAmt
PY Total Expenses	$36,433,208	PYTotalExpensesAmt
CY Total Expenses	$51,592,707	CYTotalExpensesAmt
PY Revenues Less Expenses	-$1,005,831	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$926,753	CYRevenuesLessExpensesAmt
Total Assets BOY	$60,296,588	TotalAssetsBOYAmt
Total Assets EOY	$62,494,933	TotalAssetsEOYAmt
Total Liabilities BOY	$41,739,669	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$42,425,170	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$18,556,919	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$20,069,763	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	AMERY REGIONAL MEDICAL CENTER IS COMMITTED TO PROVIDEACCESSIBLE, COMPREHENSIVE, QUALITY HEALTHCARE AND TO PROMOTE THEHEALTH AND WELLNESS OF ITS COMMUNITY.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$45,079,685	ExpenseAmt
Grant	$23,373	GrantAmt
Revenue	$52,061,777	RevenueAmt
Desc	SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS	Desc
Total Program Service Expenses	$45,079,685	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	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	0	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	0	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	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	37	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	504	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	13	GoverningBodyVotingMembersCnt
Independent Voting Member	6	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	Yes (1)	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	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	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	Yes (1)	WrittenPolicyOrProcedureInd
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	JASON LUHRS - CFO	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	7152688000	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	265 GRIFFIN STREET EAST	AddressLine1Txt
City	AMERY	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54001	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd
DANIEL LIEN
DIRECTOR & CHAIR	2.00	1.00	Yes (X)	$1,200	$0	$0
JAMES A LEADHOLM JR
DIRECTOR & VICE CHAIR	1.50	1.00	Yes (X)	$1,200	$0	$0
DAN DRAXLER
DIRECTOR	1.50	0.50	Yes (X)	$1,200	$0	$0
ROSS R BULLARD
DIRECTOR & TREASURER	1.50	43.50	Yes (X)	$0	$199,103	$60,564
J DANIEL NELSON MD
DIRECTOR	1.00	49.00	Yes (X)	$0	$554,102	$112,665
JEFFREY J ROBERTSON
DIRECTOR	1.50	48.50	Yes (X)	$0	$761,012	$39,693
HEIDI ERSPAMER
DIRECTOR	1.00	0.50	Yes (X)	$1,200	$0	$0
JOAN BYRNES
DIRECTOR & SECRETARY	1.00	0.50	Yes (X)	$1,200	$0	$0
KATHRYN ISAKSON
DIRECTOR	24.00	0.50	Yes (X)	$27,903	$0	$232
RANAE NYGAARD
DIRECTOR	1.00	0.50	Yes (X)	$1,200	$0	$0
ANN SEAGREN MD
DIRECTOR	1.00	39.00	Yes (X)	$0	$206,459	$37,093
NANCY MAGNINE PAC
DIRECTOR	1.00	39.00	Yes (X)	$0	$109,872	$24,555
DYLAN COE MD
DIRECTOR	1.00	39.00	Yes (X)	$0	$225,283	$29,396
DEBRA RUDQUIST
PRESIDENT & CHIEF EXECUTIVE OFFICER	49.50	0.50		$0	$92,591	$10,284	Yes (X)
JAMES QUENAN MD
CHIEF MEDICAL OFFICER	0.50	39.50		$0	$258,811	$81,260	Yes (X)
JOYCE SCHAEFER
ADMINISTRATOR-PATIENT CARE	40.00			$135,908	$0	$30,871		Yes (X)
SANDRA REED
ADMINISTRATOR-CLINICAL SERVICES	45.00			$125,145	$0	$30,681		Yes (X)
JOANNE JACKSON
DIRECTOR-HR,PR & MKTG	40.00			$113,455	$0	$18,650		Yes (X)
MARK MOIOFFER
PHARMACIST	40.00			$119,697	$0	$8,531		Yes (X)
MARK TRYGGESTAD
DIRECTOR OF PHARMACY	40.00			$156,015	$0	$9,747		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$685,323	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$2,407,233	TotReportableCompRltdOrgAmt
Total Other Compensation	$494,222	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	8	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
GROUP HEALTH PLAN INC
PO BOX 64059	ST PAUL	MN	551640059	PHYSICIAN SERVICES	$4,666,964
QUORUM HEALTH RESOURCES
105 CONTINENTAL PLACE	BRENTWOOD	TN	370271018	MANAGEMENT SERVICES	$852,784
ANESTHETISTS INC
130 S KNOWLES AVE PO BOX 376	NEW RICHMOND	WI	54017	NURSE ANESTHITISTS	$808,494
HEALOGICS WOUND CARE
3087 MOMENTUM PLACE	CHICAGO	IL	606895330	WOUND HEALING MANAGEMENT	$429,431
DIAMOND HEALTHCARE CORP
PO BOX 85050	RICHMOND	VA	23285	BEHAVIORAL HEALTH MANAGEMENT	$420,302

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	12	CntrctRcvdGreaterThan100KCnt
Related Organizations	$5,017	RelatedOrganizationsAmt
Government Grants	$9,365	GovernmentGrantsAmt
All Other Contributions	$64,951	AllOtherContributionsAmt
Total Contributions	$79,333	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE RE	621110	$49,640,058	$49,640,058
OTHER OPERATING REVENU	900099	$598,639	$598,639
SUBSIDIARY REVENUE	900099	$346,051	$346,051
CONTRACT SERVICE REVEN	900099	$183,594	$183,594
FITNESS CENTER REVENUE	624110	$167,386	$167,386

Field	Value	IRS element (for citing)
Total Program Service Revenue	$50,935,728	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$217,914	TotalRevenueColumnAmt
Exclusion	$217,914	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$92,595	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$0	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$92,595	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$92,595	TotalRevenueColumnAmt
Exclusion	$92,595	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Other	$3,046	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$130,228	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Other	-$127,182	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$127,182	TotalRevenueColumnAmt
Exclusion	-$127,182	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	ExclusionExclusionAmt
EHR INCENTIVE REVENUE	900099	$1,126,049	$1,126,049
CAFETERIA AND OTHER SE	900099	$195,023		$195,023

Field	Value	IRS element (for citing)
Other Revenue Total	$1,321,072	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$52,519,460	TotalRevenueColumnAmt
Related Or Exempt Func Income	$52,061,777	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$378,350	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$23,373	TotalAmt
Program Services	$23,373	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$22,800	TotalAmt
Management And General	$22,800	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$26,865,085	TotalAmt
Program Services	$23,910,741	ProgramServicesAmt
Management And General	$2,954,344	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$441,526	TotalAmt
Program Services	$371,553	ProgramServicesAmt
Management And General	$69,973	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$2,188,035	TotalAmt
Program Services	$1,841,277	ProgramServicesAmt
Management And General	$346,758	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$1,286,206	TotalAmt
Program Services	$1,082,369	ProgramServicesAmt
Management And General	$203,837	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$32,921	TotalAmt
Management And General	$32,921	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$67,693	TotalAmt
Management And General	$67,693	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$4,636,836	TotalAmt
Program Services	$3,058,117	ProgramServicesAmt
Management And General	$1,578,719	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$311,492	TotalAmt
Program Services	$39,294	ProgramServicesAmt
Management And General	$272,198	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$593,356	TotalAmt
Program Services	$472,607	ProgramServicesAmt
Management And General	$120,749	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$958,447	TotalAmt
Program Services	$948,226	ProgramServicesAmt
Management And General	$10,221	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,012,464	TotalAmt
Program Services	$965,260	ProgramServicesAmt
Management And General	$47,204	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$180,124	TotalAmt
Program Services	$121,036	ProgramServicesAmt
Management And General	$59,088	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$6,632	TotalAmt
Program Services	$1,556	ProgramServicesAmt
Management And General	$5,076	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$1,344,147	TotalAmt
Program Services	$1,344,147	ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$4,266,964	TotalAmt
Program Services	$4,161,197	ProgramServicesAmt
Management And General	$105,767	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$155,443	TotalAmt
Management And General	$155,443	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLY & EQUIPM	$2,837,899	$2,835,824	$2,075
DRUG EXPENSE	$2,225,350	$2,225,350
EQUIPMENT RENT, REPAIR	$1,150,612	$1,144,128	$6,484
OTHER MISCELLANEOUS EXP	$608,632	$412,244	$196,388

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$376,670	TotalAmt
Program Services	$121,386	ProgramServicesAmt
Management And General	$255,284	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$51,592,707	TotalAmt
Program Services	$45,079,685	ProgramServicesAmt
Management And General	$6,513,022	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$47,900	BOYAmt
EOY	$27,014	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$12,930,302	BOYAmt
EOY	$15,059,580	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$7,097,727	BOYAmt
EOY	$7,267,788	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$671,808	BOYAmt
EOY	$711,373	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$15,255	BOYAmt
EOY	$544,341	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$53,925,392	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$25,259,624	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$31,374,354	BOYAmt
EOY	$28,665,768	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$5,662,905	BOYAmt
EOY	$8,176,152	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$1,967,746	BOYAmt
EOY	$2,025,673	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$28,142	BOYAmt
EOY	$17,244	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$500,449	BOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$60,296,588	BOYAmt
EOY	$62,494,933	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$5,048,954	BOYAmt
EOY	$8,046,688	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$1,299,935	BOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$35,390,780	BOYAmt
EOY	$34,378,482	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$41,739,669	BOYAmt
EOY	$42,425,170	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$17,580,403	BOYAmt
EOY	$18,969,763	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$976,516	BOYAmt
EOY	$1,100,000	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$18,556,919	BOYAmt
EOY	$20,069,763	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$60,296,588	BOYAmt
EOY	$62,494,933	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$926,753	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	$586,091	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)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

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 C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$0	OtherActivitiesAmt
Total Lobbying Expenditures	$0	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART II-B, LINE 1:	FormAndLineReferenceDesc
Explanation	AMERY REGIONAL MEDICAL CENTER, INC. PAYS FOR CERTAIN CORPORATE AND EMPLOYEE PROFESSIONAL ASSOCIATION MEMBERSHIPS. A PORTION OF SUCH MEMBERSHIP DUES POTENTIALLY COULD BE USED BY THE PROFESSIONAL ASSOCIATIONS FOR LOBBYING ACTIVITIES.	ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,072,735	OtherCostOrOtherBasisAmt
Book Value	$1,072,735	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$26,369,041	OtherCostOrOtherBasisAmt
Depreciation	$9,952,217	DepreciationAmt
Book Value	$16,416,824	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$20,591,882	OtherCostOrOtherBasisAmt
Depreciation	$11,104,457	DepreciationAmt
Book Value	$9,487,425	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$5,891,734	OtherCostOrOtherBasisAmt
Depreciation	$4,202,950	DepreciationAmt
Book Value	$1,688,784	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$28,665,768	TotalBookValueLandBuildingsAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$52,649,688	TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported	$0	RevenueNotReportedAmt
Revenue Subtotal	$52,649,688	RevenueSubtotalAmt
Other Revenues Not Included	-$130,228	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	-$130,228	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$52,519,460	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$51,722,935	TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included	$130,228	OtherExpensesIncludedAmt
Expenses Not Reported	$130,228	ExpensesNotReportedAmt
Expenses Subtotal	$51,592,707	ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt	$0	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$51,592,707	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART X, LINE 2:	AMERY REGIONAL MEDICAL CENTER, INC. IS INCLUDED IN THE HEALTHPARTNERS, INC. (HP) CONSOLIDATED AUDITED FINANCIAL STATEMENT. HP'S ACCOUNTING POLICY PROVIDES THAT A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. HP RECORDED NO LIABILITIES AT DECEMBER 31, 2014 OR 2013 FOR UNRECOGNIZED TAX BENEFITS.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	LOSS ON DISPOSAL OF ASSETS -130,228.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	LOSS ON DISPOSAL OF ASSETS 130,228.

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
Percent250	Yes (X)	Percent250Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
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	$424,820	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$424,820	NetCommunityBenefitExpnsAmt
Total Expense	0.00820	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,345,712	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,684,705	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$661,007	NetCommunityBenefitExpnsAmt
Total Expense	0.01280	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,770,532	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,684,705	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,085,827	NetCommunityBenefitExpnsAmt
Total Expense	0.02100	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$468,389	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$198,661	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$269,728	NetCommunityBenefitExpnsAmt
Total Expense	0.00520	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$15,672	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$15,672	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$136,116	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$136,116	NetCommunityBenefitExpnsAmt
Total Expense	0.00260	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$620,177	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$198,661	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$421,516	NetCommunityBenefitExpnsAmt
Total Expense	0.00810	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$7,390,709	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,883,366	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,507,343	NetCommunityBenefitExpnsAmt
Total Expense	0.02910	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReportedInd
Bad Debt Expense	$1,079,899	BadDebtExpenseAmt
Bad Debt Expense Attributable	$809,924	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$16,725,345	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$16,985,527	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$260,182	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	2	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp (2 entries)

FacilityFacilityNum	Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Licensed HospitalLicensedHospitalInd	General Medical And SurgicalGeneralMedicalAndSurgicalInd	Critical Access HospitalCriticalAccessHospitalInd	Emergency Room24 HrsEmergencyRoom24HrsInd	Facility Reporting GroupFacilityReportingGroupCd	OtherOtherDesc
AMERY REGIONAL MEDICAL CENTER
1	265 GRIFFIN STREET EAST	AMERY	WI	54001	Yes (X)	Yes (X)	Yes (X)	Yes (X)	A
AMERY REGIONAL MEDICAL CENTER WEST
2	230 DERONDA STREET	AMERY	WI	54001	Yes (X)	Yes (X)	Yes (X)		A	10 BED INPATIENT BEHAVIORAL HEALTH DPU OF AMERY REGIONAL MEDICAL CENTER CAH

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	FACILITY REPORTING GROUP - A	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
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	13	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (1)	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.AMERYMEDICALCENTER.ORG/	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	HTTP://HEALTHYPOLKCOUNTY.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/	OtherWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	13	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	HTTP://WWW.AMERYMEDICALCENTER.ORG/COMMUNITY_HEALTH_NEEDS_ASSESSMENT.ASPX	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	250.000000000000	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
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
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
Average Negotiated Rates	Yes (X)	AverageNegotiatedRatesInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (10 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART V, SECTION B	FACILITY REPORTING GROUP A
FACILITY REPORTING GROUP A CONSISTS OF:	- FACILITY 1: AMERY REGIONAL MEDICAL CENTER, - FACILITY 2: AMERY REGIONAL MEDICAL CENTER WEST
GROUP A-FACILITY 1 -- AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 5:	THE CHNA USED A COMBINATION OF SURVEY'S TO DETERMINE THE LIFESTYLE AND PERCEIVED HEALTH OF THE COMMUNITY. THE ASSESSMENT INCLUDED PHONE SURVEYS, PAPER SURVEYS KEPT AT MEDICAL CENTERS, THROUGH THE MEDICAL CENTERS WEB SITES, AND SURVEYS MAILED DIRECT TO COMMUNITY MEMBERS. IN TOTAL, THE ASSESSMENT RECEIVED INPUT FROM 1,770 COMMUNITY MEMBERS TO DEVELOP 10 AREAS OF FOCUS.THERE WERE FOUR COMMUNITY FORUMS IN WHICH COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE 10 AREAS OF FOCUS. AT THE COMMENCEMENT OF EACH DISCUSSION, THOSE IN ATTENDANCE PLACED VOTES ON THE TOP 5 AREAS.FOLLOWING THESE OUTREACH ACTIVITIES, A GROUP OF APPROXIMATELY 20 COMMUNITY PARTNERS PARTICIPATED IN A PROCESS FOCUSING ON REVIEW AND DISCUSSION OF COMPILED DATA ON THE CURRENT HEALTH STATUS OF COMMUNITY MEMBERS, AS WELL AS VOTING RESULTS FROM THE FORUMS. DURING THE MEETING, THIS GROUP COMPLETED A PAPER SURVEY TO CAST THEIR VOTES TO DETERMINE THE TOP THREE HEALTH FOCUS AREAS FOR THE COMMUNITY. THESE THREE AREAS DETERMINED WERE: 1. MENTAL HEALTH 2. OBESITY 3. ALCOHOL USE
GROUP A-FACILITY 1 -- AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 6A:	THE FOLLOWING HOSPITALS PARTICIPATED IN COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA): - AMERY REGIONAL MEDICAL CENTER - OSCEOLA MEDICAL CENTER - ST. CROIX REGIONAL MEDICAL CENTER
GROUP A-FACILITY 1 -- AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 6B:	THE POLK COUNTY HEALTH DEPARTMENT PARTICIPATED IN COMMUNITY HEALTH NEEDS ASSESSMENT.
GROUP A-FACILITY 1 -- AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 11:	AMERY REGIONAL MEDICAL CENTER (ARMC) COULD NOT ADDRESS ALL OF THE NEEDS AS THE ALLOCATION OF ARMC'S RESOURCES ALONE WOULD NOT BE ENOUGH TO PROPERLY ADDRESS ALL OF THEM. IN COLLABORATION WITH THE POLK COUNTY HEALTH DEPARTMENT AND PARTNER HOSPITALS IN POLK COUNTY (OSCEOLA MEDICAL CENTER AND ST. CROIX REGIONAL MEDICAL CENTER), ARMC HAS IDENTIFIED THREE TOP PRIORITY AREAS BASED UPON THE CHNA. AN EXTENSIVE COMMUNITY HEALTHIMPROVEMENT PLAN (CHIP) IS IN PLACE AND ARMC HAS COMMITTED TO WORKING TO IMPROVE THE TOP THREE HEALTH FOCUS AREAS OF OBESITY, MENTAL HEALTH, AND UNHEALTHY ALCOHOL USE. ARMC HAS SET GOALS ALONG WITH WORK PLANS TO ACHIEVE THE GOALS; ACTIVE COMMITTEES ARE WORKING TOWARD ACHIEVING THE COMMUNITY INITIATIVES IN ALL THREE FOCUS AREAS.
GROUP A-FACILITY 2 -- AMERY REGIONAL MEDICAL CENTER WEST CAMPU PART V, SECTION B, LINE 5:	THE CHNA USED A COMBINATION OF SURVEY'S TO DETERMINE THE LIFESTYLE AND PERCEIVED HEALTH OF THE COMMUNITY. THE ASSESSMENT INCLUDED PHONE SURVEYS, PAPER SURVEYS KEPT AT MEDICAL CENTERS, THROUGH THE MEDICAL CENTERS WEB SITES, AND SURVEYS MAILED DIRECT TO COMMUNITY MEMBERS. IN TOTAL, THE ASSESSMENT RECEIVED INPUT FROM 1,770 COMMUNITY MEMBERS TO DEVELOP 10 AREAS OF FOCUS.THERE WERE FOUR COMMUNITY FORUMS IN WHICH COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE 10 AREAS OF FOCUS. AT THE COMMENCEMENT OF EACH DISCUSSION, THOSE IN ATTENDANCE PLACED VOTES ON THE TOP 5 AREAS.FOLLOWING THESE OUTREACH ACTIVITIES, A GROUP OF APPROXIMATELY 20 COMMUNITY PARTNERS PARTICIPATED IN A PROCESS FOCUSING ON REVIEW AND DISCUSSION OF COMPILED DATA ON THE CURRENT HEALTH STATUS OF COMMUNITY MEMBERS, AS WELL AS VOTING RESULTS FROM THE FORUMS. DURING THE MEETING, THIS GROUP COMPLETED A PAPER SURVEY TO CAST THEIR VOTES TO DETERMINE THE TOP THREE HEALTH FOCUS AREAS FOR THE COMMUNITY. THESE THREE AREAS DETERMINED WERE: 1. MENTAL HEALTH 2. OBESITY 3. ALCOHOL USE
GROUP A-FACILITY 2 -- AMERY REGIONAL MEDICAL CENTER WEST CAMPU PART V, SECTION B, LINE 6A:	THE FOLLOWING HOSPITALS PARTICIPATED IN COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA): - AMERY REGIONAL MEDICAL CENTER - OSCEOLA MEDICAL CENTER - ST. CROIX REGIONAL MEDICAL CENTER
GROUP A-FACILITY 2 -- AMERY REGIONAL MEDICAL CENTER WEST CAMPU PART V, SECTION B, LINE 6B:	THE POLK COUNTY HEALTH DEPARTMENT PARTICIPATED IN COMMUNITY HEALTH NEEDS ASSESSMENT.
GROUP A-FACILITY 2 -- AMERY REGIONAL MEDICAL CENTER WEST CAMPU PART V, SECTION B, LINE 11:	AMERY REGIONAL MEDICAL CENTER (ARMC) COULD NOT ADDRESS ALL OF THE NEEDS AS THE ALLOCATION OF ARMC'S RESOURCES ALONE WOULD NOT BE ENOUGH TO PROPERLY ADDRESS ALL OF THEM. IN COLLABORATION WITH THE POLK COUNTY HEALTH DEPARTMENT AND PARTNER HOSPITALS IN POLK COUNTY (OSCEOLA MEDICAL CENTER AND ST. CROIX REGIONAL MEDICAL CENTER), ARMC HAS IDENTIFIED THREE TOP PRIORITY AREAS BASED UPON THE CHNA. AN EXTENSIVE COMMUNITY HEALTHIMPROVEMENT PLAN (CHIP) IS IN PLACE AND ARMC HAS COMMITTED TO WORKING TO IMPROVE THE TOP THREE HEALTH FOCUS AREAS OF OBESITY, MENTAL HEALTH, AND UNHEALTHY ALCOHOL USE. ARMC HAS SET GOALS ALONG WITH WORK PLANS TO ACHIEVE THE GOALS; ACTIVE COMMITTEES ARE WORKING TOWARD ACHIEVING THE COMMUNITY INITIATIVES IN ALL THREE FOCUS AREAS.

Field	Value	IRS element (for citing)
Facility	5	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
ARMC REHAB SERVICES
220 N KELLER AVENUE	AMERY	WI	54001	REHABILITATION
LUCK MEDICAL CLINIC
137 FIRST AVENUE	LUCK	WI	54853	RURAL HEALTH CLINIC
TURTLE LAKE MEDICAL CLINIC
550 MARTIN AVENUE	TURTLE LAKE	WI	54889	RURAL HEALTH CLINIC
CLEAR LAKE CLINIC
357 THIRD AVENUE	CLEAR LAKE	WI	54005	RURAL HEALTH CLINIC
LUCK PT & FITNESS
2547 STATE ROAD 35 SUITE 5	LUCK	WI	54853	PHYSICAL THERAPY

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART III, LINE 2:	AMERY REGIONAL MEDICAL CENTER, INC. (ARMC) USES A COST TO CHARGE METHODOLOGY.
PART III, LINE 3:	ARMC USES THE COST TO CHARGE COST METHODOLOGY TO DETERMINE AMOUNT REPORTED AS BAD DEBT. ARMC BELIEVES THAT MANY OF THE ACCOUNTS IN BAD DEBT WOULD HAVE QUALIFIED FOR CHARITY CARE IF THE GUARANTORS WOULD HAVE COMPLETED THE FINANCIAL ASSISTANCE PAPERWORK. ARMC IS PROVIDING SERVICES TO INDIVIDUALS/FAMILIES IN ITS SERVICE AREA WHO ARE UNABLE/UNWILLING TO PAY FOR THESE SERVICES. THIS IS COMPARABLE TO PROVIDING CHARITY CARE WHICH ARMC ALSO INCLUDES AS A COMMUNITY BENEFIT.
PART III, LINE 4:	ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CHARITY CARE:THE FINANCIAL STATEMENTS DO NOT HAVE A SEPARATE BAD DEBT FOOTNOTE. THE FOLLOWING IS PART OF THE ARMC'S PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS OR CHARITY CARE, BASED ON ESTABLISHED GUIDELINES FOR IDENTIFYING UNCOLLECTIBLE PATIENT ACCOUNTS AND CLASSIFYING THESE ACCOUNTS AS EITHER DOUBTFUL ACCOUNTS OR CHARITY CARE. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, ARMC'S MANAGEMENT PERIODICALLY ASSESSES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CHARITY CARE BY TAKING INTO CONSIDERATION, BY PAYER CATEGORY, THE EXPECTED NET COLLECTIONS, ACCOUNTS RECEIVABLE AGING, HISTORICAL COLLECTIONS EXPERIENCE, ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THE PRIMARY SOURCE OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS THE PATIENT RESPONSIBILITY PORTION OF COMMERCIAL ACCOUNTS. THE PRIMARY SOURCE OF THE ALLOWANCE FOR CHARITY CARE IS CHARGES FOR UNINSURED PATIENTS. PATIENTS WHO ARE INSURED ARE ASSESSED SEPARATELY FOR COLLECTABILITY FROM UNINSURED PATIENTS. THE RESULTS OF THESE ASSESSMENTS ARE USED TO ESTABLISH THE NET REALIZABLE VALUE OF PATIENT ACCOUNTS RECEIVABLE AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CHARITY CARE.ARMC PROVIDED MEDICAL CARE WITHOUT CHARGE OR AT REDUCED COST TO PATIENTS WHO WERE DETERMINED TO BE UNABLE TO PAY (CHARITY CARE) OF $778,638 AND $1,153,581 FOR THE YEARS ENDED DECEMBER 31, 2014 AND 2013, RESPECTIVELY, AND PROVIDED MEDICAL CARE TO PATIENTS WHO WERE DETERMINED TO BE ABLE, BUT UNWILLING, TO PAY (DOUBTFUL ACCOUNTS) OF $2,289,688 AND $2,315,465 FOR THE YEARS ENDED DECEMBER 31, 2014 AND 2013, RESPECTIVELY. ACCORDINGLY, ARMC DOES NOT SEPARATE ALLOWANCE ACCOUNTS FOR DOUBTFUL ACCOUNTS AND CHARITY CARE.
PART III, LINE 8:	THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO AS REQUIRED BY MEDICARE. THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE ARMC IS INCURRING THE COST OF PROVIDING SERVICES TO MEDICARE PATIENTS AND NOT GETTING PAID COMPLETELY BY MEDICARE FOR THE COST OF PROVIDING THESE SERVICES.
PART III, LINE 9B:	ARMC IS COMMITTED TO MEETING THE HEALTHCARE NEEDS OF THE COMMUNITY. AS PART OF THIS MISSION, ARMC ADMINISTERS A FINANCIAL ASSISTANCE PROGRAM TO HELP PATIENTS WHO NEED MEDICAL CARE BUT HAVE DIFFICULTY WITH RELATED MEDICAL EXPENSES. IN ARMC FACILITIES, NON-ELECTIVE PROFESSIONAL MEDICAL SERVICES WILL BE PROVIDED WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY AND FINANCIAL ASSISTANCE WILL BE MADE AVAILABLE. PROGRAM ELIGIBILITY IS BASED ON INCOME, ASSETS, LIABILITIES AND FAMILY SIZE UTILIZING A SLIDING DISCOUNT BASED ON THE LATEST HEALTH AND HUMAN/SERVICES (HHS) FEDERAL POVERTY GUIDELINES. PATIENTS IN NEED OF FINANCIAL ASSISTANCE ARE SENT AN APPLICATION AND FOLLOWED UP IN COORDINATION WITH THE HEALTH BENEFITS COUNSELOR. ARMC BELIEVES THAT MANY OF THE ACCOUNTS IN BAD DEBT WOULD HAVE QUALIFIED FOR CHARITY CARE IF THE GUARANTORS WOULD HAVE COMPLETED THE FINANCIAL ASSISTANCE PAPERWORK.
PART VI, LINE 7, REPORTS FILED WITH STATES	WI
PART VI, LINE 2	ARMC COMPLETED A CHNA IN COORDINATION WITH THE POLK COUNTY HEALTH DEPARTMENT, OSCEOLA MEDICAL CENTER, AND ST. CROIX REGIONAL MEDICAL CENTER IN FISCAL YEAR 2013.THIS CHNA IDENTIFIED THE TOP TEN COMMUNITY NEEDS AND PROVIDES DETAILED STATISTICS BREAKING DOWN THOSE NEEDS AND THEIR EFFECT ON THE COMMUNITY IN RELATION WITH THE ARMC'S ROLE IN ADDRESSING THOSE NEEDS.
PART VI, LINE 3	ARMC'S PATIENT FINANCIAL SERVICES DEPARTMENT WORKS WITH EACH PATIENT REGARDING ACCOUNT BALANCES LEFT TO PATIENT RESPONSIBILITY. PATIENTS WHO ARE NOT ALREADY ON GOVERNMENT ASSISTANCE OR HAVE LIMITED ASSISTANCE, ARE REFERRED TO ARMC'S HEALTH BENEFITS COUNSELOR, WHO WORKS WITH THEM TO EVALUATE ASSISTANCE OPTIONS AND ASSISTS IN GETTING APPLICATIONS OR CONTACTS WITH THE APPROPRIATE PROGRAMS. IF ADDITIONAL ASSISTANCE IS NEEDED, THE COUNSELOR WILL WORK WITH THE PATIENT TO APPLY FOR FINANCIAL ASSISTANCE WITH ARMC AND HELPS THEM THROUGH THE PROCESS. THE FINANCIAL ASSISTANCE PROGRAM AND APPLICATION ARE LOCATED ON THE ARMC'S INTERNET SITE TO ALLOW PATIENTS DIRECT ACCESS TO THIS INFORMATION.
PART VI, LINE 4	ARMC'S SERVICE AREA INCLUDES FIFTEEN DIFFERENT ZIP CODES IN NORTHWEST WISCONSIN THAT PRIMARILY REPRESENT POLK COUNTY. IT INCLUDES THREE RURAL HEALTH CLINICS IN LUCK, TURTLE LAKE, & CLEAR LAKE WHICH ARE ALL MEDICALLY UNDERSERVED AREAS. THE ARMC COMMUNITY IS ALSO CONSIDERED A MENTAL HEALTH MEDICALLY UNDERSERVED AREA. THE WOUND CENTER & INPATIENT PSYCH SERVICE DRAWS PATIENTS FROM OUTSIDE ARMC'S NORMAL SERVICE AREA.
PART VI, LINE 5	TEN OF ARMC'S THIRTEEN BOARD MEMBERS LIVE IN ARMC'S SERVICE AREA. ARMC HAS AN OPEN MEDICAL STAFF WHICH INCLUDES PROVIDERS FROM THE COMMUNITY, AND OTHER COMMUNITIES AS WELL AS THE TWIN CITIES. ANY SURPLUS FUNDS GENERATED ARE USED TO PURCHASE EQUIPMENT, BUILD NEW FACILITIES, AND EXPAND SERVICES AVAILABLE IN ARMC'S COMMUNITY.
PART VI, LINE 6	HEALTHPARTNERS AND ARMC HAVE HAD A LONG-STANDING RELATIONSHIP, WITH HEALTHPARTNERS EMPLOYING AND SOURCING PHYSICIANS AND MID-LEVEL PRACTITIONERS TO ARMC FOR ARMC'S PRIMARY CARE CLINICS. AS OF 2014, ARMC BECAME PART OF THE HEALTHPARTNERS FAMILY OF MISSION-DRIVEN NON-PROFIT ORGANIZATIONS. AS PART OF THE HEALTHPARTNERS FAMILY, ARMC USES HEALTHPARTNERS' INTEGRATED ELECTRONIC HEALTH RECORD SYSTEM, PARTICIPATES IN COORDINATED CHNA PROCESSES AND IMPLEMENTATION STRATEGIES, ACCESSES CENTRALIZED SUPPORT SERVICES IN FINANCE, LEGAL, IS AND T, AND QUALITY. THE FOUR HEALTHPARTNERS HOSPITALS IN THE ST. CROIX VALLEY - STILLWATER MN AND HUDSON, NEW RICHMOND, AND AMERY WI - WORK TOGETHER TO ESTABLISH ACCESSIBLE AND COORDINATED SPECIALTY SERVICES IN THE VALLEY FOR THE BENEFIT OF VALLEY RESIDENTS. EXAMPLES OF THESE SERVICES INCLUDE RADIATION THERAPY ON THE NEW RICHMOND CAMPUS, BREAST DIAGNOSTICS ON THE LAKEVIEW CAMPUS, AND GERIATRIC BEHAVIORAL HEALTH SERVICES ON THE AMERY CAMPUS. HEALTHPARTNERS INCLUDES INSURANCE AND HMO (HEALTH MAINTENANCE ORGANIZATION) ENTITIES THAT PROVIDE CARE COORDINATION, DISEASE MANAGEMENT, ON-LINE CARE FOR BASIC CONDITIONS, A 24 HOUR/7 DAY PER WEEK NURSE LINE, AND OTHER SERVICES THAT ENHANCE CARE FOR MEMBERS, PATIENTS AND THE COMMUNITY.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	WISCONSIN MEDICAL SOCIETY INC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	330 E LAKESIDE ST PO BOX 1109	AddressLine1Txt
City	MADISON	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	537011109	ZIPCd

Field	Value	IRS element (for citing)
Cash Grant	$8,000	CashGrantAmt
Purpose Of Grant	PROGRAM SUPPORT	PurposeOfGrantTxt

Field	Value	IRS element (for citing)
Total501c3 Org	1	Total501c3OrgCnt
Total Other Org	0	TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 2:	FormAndLineReferenceDesc
Explanation	AMERY REGIONAL MEDICAL CENTER, INC. (ARMC) MANAGEMENT STAFF REVIEW THE MISSION AND PURPOSE OF POTENTIAL GRANTEE ORGANIZATIONS TO ASSURE CONSISTENCY WITH ARMC'S MISSION AND PURPOSE. AMOUNTS SUBSEQUENTLY GRANTED ARE SUBJECT TO ARMC'S FORMAL SPENDING APPROVAL AND DOCUMENTATION PROCESS BASED ON AMOUNT OF THE EXPENDITURE.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
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 (9 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
ROSS R BULLARD
DIRECTOR & TREASURER	$0	$173,194	$0	$25,909	$0	$0	$0	$27,860	$0	$32,704	$0	$259,667	$0	$0
J DANIEL NELSON MD
DIRECTOR	$0	$473,107	$0	$80,000	$0	$995	$0	$70,120	$0	$42,545	$0	$666,767	$0	$995
JEFFREY J ROBERTSON
DIRECTOR	$0	$416,986	$0	$299,000	$0	$45,026	$0	$5,100	$0	$34,593	$0	$800,705	$0	$0
ANN SEAGREN MD
DIRECTOR	$0	$206,459	$0	$0	$0	$0	$0	$19,208	$0	$17,885	$0	$243,552	$0	$0
DYLAN COE MD
DIRECTOR	$0	$225,283	$0	$0	$0	$0	$0	$21,890	$0	$7,506	$0	$254,679	$0	$0
JAMES QUENAN MD
CHIEF MEDICAL OFFICER	$0	$242,405	$0	$10,640	$0	$5,766	$0	$46,288	$0	$34,972	$0	$340,071	$0	$999
JOYCE SCHAEFER
ADMINISTRATOR-PATIENT CARE	$135,908	$0	$0	$0	$0	$0	$4,319	$0	$26,552	$0	$166,779	$0	$0	$0
SANDRA REED
ADMINISTRATOR-CLINICAL SERVICES	$125,145	$0	$0	$0	$0	$0	$3,954	$0	$26,727	$0	$155,826	$0	$0	$0
MARK TRYGGESTAD
DIRECTOR OF PHARMACY	$155,381	$0	$0	$0	$634	$0	$4,486	$0	$5,261	$0	$165,762	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE J, PART II - PRIOR REPORTED COMPENSATION	FormAndLineReferenceDesc
Explanation	COLUMN (F) INCLUDES AMOUNTS PAID TO PARTICIPANTS IN THE CURRENT YEAR, WHICH WERE PREVIOUSLY REPORTED IN COLUMN (C) OF PRIOR YEARS' 990'S, AS RETIREMENT AND DEFERRED COMPENSATION, FOR THE FOLLOWING DIRECTORS AND OFFICERS: J. DANIEL NELSON, MD $ 995 JAMES QUENAN, MD $ 999 ANY ANALYSIS OF EARNINGS FOR THE CURRENT YEAR, FOR THESE PARTICIPANTS OF THE PLAN, SHOULD EXCLUDE THE AMOUNT IN COLUMN F AS PART OF THE ANALYSIS SINCE THOSE EARNINGS WERE ALREADY REPORTED IN COLUMN (C) OF PREVIOUS YEARS' 990'S.	ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
VILLAGE OF LUCK WISCONSIN
A	396006307	2011-04-28	$8,500,000	REFINANCE EXISTING DEBT	0	0	0
CITY OF AMERY WISCONSIN
B	396005378	2011-04-13	$8,500,000	REFINANCE EXISTING DEBT	0	0	0
VILLAGE OF CLEAR LAKE WISCONSIN
C	396006238	2011-03-29	$8,500,000	REFINANCE EXISTING DEBT	0	0	0
TOWN OF BLACK BROOK POLK COUNTY WISCONSIN
D	391169876	2011-05-13	$6,150,000	REFINANCE EXISTING DEBT	0	0	0

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Total ProceedsTotalProceedsAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Other Spent ProceedsOtherSpentProceedsAmt	Substantial CompletionSubstantialCompletionYr	Current RefundingCurrentRefundingInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd
A	$769,121	$8,500,000	$170,000	$8,330,000	2007	Yes (1)	Yes (1)	Yes (1)
B	$769,121	$8,500,000	$170,000	$8,330,000	2007	Yes (1)	Yes (1)	Yes (1)
C	$769,121	$8,500,000	$170,000	$8,330,000	2007	Yes (1)	Yes (1)	Yes (1)
D	$557,077	$6,150,000	$123,000	$6,027,000	2007	Yes (1)	Yes (1)	Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCd	Owning Bond Financed PropertyOwningBondFinancedPropertyInd	Any Lease ArrangementsAnyLeaseArrangementsInd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Any Research AgreementsAnyResearchAgreementsInd	Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd	Change In Use Bond Financed PropChangeInUseBondFinancedPropInd	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A	0	0	0	0	Yes (1)	0	0
B	0	0	0	0	Yes (1)	0	0
C	0	0	0	0	Yes (1)	0	0
D	0	0	0	0	Yes (1)	0	0

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCd	Rebate Not Due YetRebateNotDueYetInd	Variable Rate IssueVariableRateIssueInd
A	Yes (1)	Yes (1)
B	Yes (1)	Yes (1)
C	Yes (1)	Yes (1)
D	Yes (1)	Yes (1)

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	FORM 990, SCHEDULE K, PART IV, LINE 2A THRU 2C	FormAndLineReferenceDesc
Explanation	REBATE CALCULATION IS NOT DUE BUT EVERY 5 YEARS. THERE IS NO REBATE CACLULATION DUE FOR ANY BONDS LISTED IN SCHEDULE K, PART I.	ExplanationTxt

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	TOWN OF LINCOLN POLK COUNTY WISCONSIN	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	391406159	BondIssuerEIN
Bond Issued	2011-05-31	BondIssuedDt
Issue Price	$6,150,000	IssuePriceAmt
Purpose	REFINANCE EXISTING DEBT	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
Retired	$557,077	RetiredAmt
Total Proceeds	$6,150,000	TotalProceedsAmt
Issuance Costs From Proceeds	$123,000	IssuanceCostsFromProceedsAmt
Capital Expenditures	$1,709,792	CapitalExpendituresAmt
Other Spent Proceeds	$4,317,208	OtherSpentProceedsAmt
Substantial Completion	2007	SubstantialCompletionYr
Current Refunding	Yes (1)	CurrentRefundingInd
Advance Refunding	0	AdvanceRefundingInd
Final Allocation Made	Yes (1)	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	Yes (1)	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	0	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	0	WrittenProcToMonitorReqsInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART III, LINE 4A - EXEMPT PURPOSE AND ACHIEVEMENTS	CORPORATE STRUCTURE, PURPOSE, GOVERNANCE AMERY REGIONAL MEDICAL CENTER (ARMC), A STATE LICENSED 25-BED, LEVEL IV CRITICAL ACCESS HOSPITAL (CAH), IS A WISCONSIN NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3) AND IS PART OF THE FAMILY OF HEALTHPARTNERS ORGANIZATIONS "HEALTHPARTNERS". FOUNDED IN 1957, HEALTHPARTNERS IS AN INTEGRATED SYSTEM OF HEALTH CARE DELIVERY AND HEALTH CARE FINANCING ORGANIZATIONS, AND IS ONE OF THE LARGEST CONSUMER-GOVERNED ORGANIZATIONS IN THE COUNTRY. HEALTHPARTNERS' MISSION IS TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS AND COMMUNITY. HEALTHPARTNERS SEEKS TO TRANSFORM HEALTHCARE THROUGH A RELENTLESS FOCUS ON THE TRIPLE AIM - PROVIDING EXCEPTIONAL EXPERIENCE FOR THE INDIVIDUAL, IMPROVING THE HEALTH OF THE POPULATION, AND MAINTAINING AFFORDABILITY, ALL AT THE SAME TIME. HEALTHPARTNERS INCLUDES AN ARRAY OF TAX-EXEMPT AND TAXABLE ORGANIZATIONS WITH HEALTH CARE ACTIVITIES PRIMARILY OPERATING IN MINNESOTA AND WESTERN WISCONSIN. HEALTHPARTNERS PROVIDES A FULL-RANGE OF HEALTH CARE DELIVERY AND HEALTH PLAN SERVICES INCLUDING INSURANCE, PATIENT CARE, ADMINISTRATION AND HEALTH AND WELL-BEING PROGRAMS. HEALTHPARTNERS HEALTH PLAN'S SERVE MORE THAN 1.5 MILLION MEDICAL AND DENTAL MEMBERS NATIONWIDE, AND IS THE TOP-RANKED COMMERCIAL PLAN IN MINNESOTA. HEALTHPARTNERS MEDICAL CARE SYSTEM INCLUDES MORE THAN 1,700 PHYSICIANS, SIX HOSPITALS, 55 PRIMARY CARE CLINICS, 22 URGENT CARE LOCATIONS AND NUMEROUS SPECIALTY PRACTICES IN MINNESOTA AND WESTERN WISCONSIN. IN ADDITION, HEALTHPARTNERS DENTAL CARE SYSTEM HAS MORE THAN 60 DENTISTS AND 22 DENTAL CLINICS. HEALTHPARTNERS ALSO PROVIDES MEDICAL EDUCATION AND TRAINING TO MEDICAL PROFESSIONALS AND CONDUCTS RESEARCH AND FUND RAISING ACTIVITIES THAT SUPPORT THE HEALTH CARE DELIVERY SYSTEM. A COMPLETE LISTING OF ALL ORGANIZATIONS WITHIN THE HEALTHPARTNERS FAMILY, AND THE RELATIONSHIP BETWEEN THEM, CAN BE FOUND ON SCHEDULE R WITHIN THIS 990 RETURN. DETAILED INFORMATION ABOUT THE COMMUNITY BENEFIT ACTIVITIES AND ACCOMPLISHMENTS OF EACH TAX-EXEMPT ORGANIZATION CAN BE FOUND IN THE INDIVIDUAL FORM 990 RETURN FOR THAT ORGANIZATION. HEALTHPARTNERS IS DRIVING CHANGE THAT HELPS OUR MEMBERS AND PATIENTS LIVE HEALTHIER LIVES. HEALTHPARTNERS COLLABORATE WITH OTHER PLANS, CARE PROVIDERS AND OTHER COMMUNITY AND BUSINESS ORGANIZATIONS IN THE REGION AND THROUGHOUT THE NATION TO INCREASE ACCESS, CREATE AND SHARE QUALITY MEASURES AND INITIATIVES, PARTICIPATE IN DEVELOPMENT OF PUBLIC POLICY, AND COLLABORATE IN IMPROVEMENTS THAT SUPPORT THE TRIPLE AIM. AMONG HEALTHPARTNERS' SIGNATURE INITIATIVES CONTINUING IN 2014 ARE TOTAL COST OF CARE MEASUREMENTS (DEVELOPMENT OF A NATIONALLY RECOGNIZED METRIC, ENDORSED BY THE NATIONAL QUALITY FORUM, ENABLING MEASUREMENT AND INCENTIVES BASED ON COORDINATION AND EVIDENCE-BASED PRACTICES), MENTAL HEALTH (REDUCING STIGMA, AND ASSURING ACCESS TO HIGH QUALITY CARE IN THE MOST APPROPRIATE SETTINGS), CHILDREN'S HEALTH (IMPROVING CHILD HEALTH BY PROMOTING EARLY BRAIN DEVELOPMENT, PROVIDING FAMILY CENTERED CARE, AND STRENGTHENING COMMUNITIES), AND SUSTAINABILITY (ENERGY EFFICIENCY, WASTE REDUCTION, AND RESOURCE MANAGEMENT). HEALTHPARTNERS, INC. (HPI) IS THE PARENT ENTITY OF HEALTHPARTNERS AND IS A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(4). HPI IS THE SOLE CORPORATE MEMBER OF HPI-RAMSEY, A MINNESOTA NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, HPI-RAMSEY IS THE SOLE CORPORATE MEMBER OF REGIONS HOSPITAL, REGIONS HOSPITAL FOUNDATION, CAPITOL VIEW TRANSITIONAL CARE CENTER, STILLWATER HEALTH SYSTEM (LAKEVIEW HEALTH), RAMSEY INTEGRATED HEALTH SERVICES AND RH-WISCONSIN, INC., ALL OF WHICH ARE NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). RH-WISCONSIN AND GROUP HEALTH PLAN, INC. (GHI) ARE CORPORATE MEMBERS OF ARMC. GHI IS A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, ARMC IS THE SOLE CORPORATE MEMBER OF THE AMERY REGIONAL MEDICAL CENTER FOUNDATION (FOUNDATION) A WISCONSIN NON-STOCK CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). BENEFIT TO THE COMMUNITY: 1. COMMUNITY HEALTH SERVICES: $269,728 - COMMUNITY HEALTH EDUCATION - ARMC HELPS EDUCATE THE LOCAL COMMUNITIES IN REGARDS TO HEALTH ISSUES BY PROVIDING THE FOLLOWING TYPES OF COMMUNITY EDUCATION: ASTHMA, BREASTFEEDING, CPR, CARDIAC SUPPORT, DIABETES, EXPECTANT PARENTS/PRE-NATAL, HEALTH FAIRS, NUTRITION COUNSELING, SMOKING CESSATION, AND SPORTS MEDICINE. THE FACILITY ALSO WORKS CLOSELY WITH LOCAL AND COUNTY REPRESENTATIVES TO INFORM THE COMMUNITY ABOUT GOVERNMENTAL BENEFITS AND PROGRAMS AVAILABLE. ARMC PROVIDES EDUCATION AT OUR SCHOOLS BY HOLDING A 3RD GRADE HEALTH FAIR REACHING 206 STUDENTS FROM AMERY, CLEAR LAKE, CLAYTON, AND TURTLE LAKE. THE FACILITY ALSO PROVIDED EDUCATION FOR EARLY CHILDHOOD DEVELOPMENT TARGETING PRE-K, ADOLESCENT SEXUALITY CLASSES AT AMERY SCHOOLS, SEX-EDUCATION CLASSES WERE OFFERED TO AMERY 8TH GRADE GIRLS AND MEDICAL PROFESSIONAL SPEAKERS AT CAREER DAY FOR HIGH SCHOOL STUDENTS. ARMC ALSO PARTICIPATED IN SHADOW TRAINING FOR HIGH SCHOOL STUDENTS WHO ARE INTERESTED IN PURSUING HEALTH CARE AS A CAREER. - COMMUNITY-BASED CLINICAL SERVICES - $2,911 ARMC HOSTED TWO BLOOD DRIVES COLLECTING A TOTAL OF 69 PINTS IN SUPPORT OF THE AMERICAN RED CROSS. BEHAVIORAL HEALTH SCREENED TEENS FOR DEPRESSION AT THE AMERY HIGH SCHOOL REACHING APPROXIMATELY 200 STUDENTS FROM THE 9TH AND 10TH GRADE. ARMC CONDUCTED FREE BLOOD PRESSURE CHECKS FOR 2014 AT A COST OF $379 (3 HEALTH FAIRS TOTALING 16 HRS OF STAFF TIME). INFLUENZA VACCINATIONS WERE ADMINISTERED TO STAFF MEMBERS AT VARIOUS EMPLOYER SITES AT A COST OF $1,165. - HEALTH CARE SUPPORT SERVICES - $255,423 ARMC'S PATIENT EMERGENCY FUND, SUPPORTED BY EMPLOYEES AND STAFF, DONATED $407 TO HELP 20 INDIVIDUALS RECEIVING CARE AT THE FACILITY IN 2014. FUNDS PROVIDED TO INDIVIDUALS WERE FOR EMERGENT NEEDS RELATED TO THEIR HEALTH INCLUDING EMERGENCY MEDICATIONS AND GAS CARDS. ARMC OPERATES A FITNESS CENTER IN AMERY AND LUCK TO MEET THE WELLNESS NEEDS OF THE COMMUNITIES. THIS SERVICE OPERATES AT A LOSS OF $96,386. SOCIAL WORKER, HEALTH BENEFIT COUNSELORS, AND PATIENT FINANCIAL SERVICES REPRESENTATIVES PROVIDE HEALTH CARE SUPPORT SERVICES TO INDIVIDUALS ON A ONE-ON-ONE BASIS. THESE STAFF MEMBERS HELP EDUCATE AND ASSIST INDIVIDUALS WITH ADVANCE DIRECTIVE SUPPORT, INFORMATION AND REFERRAL SERVICES, ENROLLMENT ASSISTANCE IN GOVERNMENT PROGRAMS, FINDING OTHER SOURCES OF PAYMENT, AND ACCESSING SERVICES BEYOND MEDICAL CARE. ARMC SPENT $99,848 IN STAFF TIME TO ASSIST 227 PATIENTS TO ENROLL IN PUBLIC MEDICAL PROGRAMS, REFER INDIVIDUALS TO COMMUNITY SERVICES/PUBLIC HEALTH ASSISTANCE AND HELP 165 PATIENTS WITH FINANCIAL ASSISTANCE. ARMC OPERATES A VAN TRANSPORTATION SERVICE FOR ITS RURAL PATIENT POPULATION. PATIENTS WHO ARE UNABLE TO ARRANGE THEIR OWN TRANSPORTATION TO ARMC FOR CARE AND TREATMENT MAY SCHEDULE A TRANSPORT. PERSONS WHO USE THE SERVICE ARE ASKED TO PAY $2.00 PER RIDE. OVER 1,200 PATIENTS USED THIS SERVICE IN 2014, WITH REVENUE JUST UNDER $4,000 AND OPERATING COST OF $62,000.
FORM 990, PART III, LINE 4A	2. HEALTH PROFESSIONAL EDUCATION: $15,672 STUDENTS IN NURSING, PHYSICIAN ASSISTANT PROGRAMS, PHYSICAL THERAPY, MEDICAL RECORDS, MEDICAL ASSISTANT, LAB TECHNICIAN, NURSE PRACTITIONERS, AND MEDICAL ADMINISTRATIVE ASSISTANTS STUDY AT ARMC. WEEKLY MEDICAL CONFERENCES ARE OFFERED BY ARMC MEDICAL STAFF PRESENTING CASES AND EDUCATIONAL TOPICS TO VARIOUS STAFF. ARMC ALSO HAS AN AGREEMENT WITH UW MADISON FOR 4TH YEAR MEDICAL STUDENTS AND UM-DULUTH FOR FIRST YEAR AND SECOND YEAR MEDICAL STUDENT ROTATIONS. IN ADDITION, ARMC ACTIVELY COLLABORATES WITH THE WISCONSIN INDIANHEAD TECHNICAL COLLEGE (WITC) TO HELP EDUCATE AND TRAIN YOUNG NURSES. FOR THE YEAR 2014, ARMC PROVIDED CLINICAL TRAINING FOR 39 NURSES, 9 MED STUDENTS, 2 LAB TECHNICIANS AND 2 DIAGNOSTIC TECHNICIANS TOTALING 4,362 HOURS. EACH YEAR ARMC AND THE FOUNDATION PROVIDE SEVEN $1,000 SCHOLARSHIPS TO LOCAL HIGH SCHOOL SENIORS PURSUING A CAREER IN A HEALTH-RELATED FIELD. 3. SUBSIDIZED HEALTH SERVICES: ARMC IS COMMITTED TO SERVING OUR COMMUNITIES AND PROVIDING NEEDED SERVICES EVEN IF A FINANCIAL LOSS IS REALIZED. 4. FINANCIAL CONTRIBUTIONS: $45,008 - CASH DONATIONS - ARMC HELPED VARIOUS NON-PROFIT ORGANIZATIONS, COMMUNITY GROUPS, AND SCHOOL PROGRAMS THROUGH CASH DONATIONS TOTALING $26,223. - IN-KIND DONATIONS - IN-KIND SERVICES DONATED INCLUDED STAFF HOURS (112 HOURS $7,704) SPENT IN SUPPORT OF LOCAL COMMUNITY BOARDS OR COMMITTEE WORK (UNITED WAY OF ST. CROIX VALLEY), WITC HEALTH INFORMATION TECHNOLOGY, NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI) AND MENTAL HEALTH TASK FORCE, AMERY COMMUNITY CLUB, POLK COUNTY CRIMINAL JUSTICE COLLABORATING COUNSEL , AMERY SCHOOL DISTRICT STRATEGIC PLANNING COMMITTEE, AMERY ECONOMIC DEVELOPMENT, LAKE WAPO/ BT SANITARY DISTRICT COMMISSIONER, AMERICAN CANCER SOCIETY, ST. CROIX VALLEY FAMILY RESOURCE CENTER, WITC PROGRAM REVIEW COMMITTEE AND ADVISORY COMMITTEE FOR MEDICAL ASSISTANTS). ARMC IS ALSO A STRONG ADVOCATE AND MEMBER OF THE ST. CROIX VALLEY SART (SEXUAL ASSAULT RESPONSE TEAM), WHICH FORMED IN ORDER TO HELP THOSE WHO HAVE EXPERIENCED ACUTE RAPE TRAUMA OR DOMESTIC ABUSE. MEDICAL EQUIPMENT AND PHARMACEUTICAL SUPPLIES TOTALING $66 WERE DONATED TO MEDICAL MISSION TRIPS IN HAITI. EXPENSES ABSORBED BY ARMC WHEN PROVIDING MEETING SPACE FOR NON-PROFIT AND COMMUNITY GROUPS LIKE THE AMERICAN CANCER SOCIETY-AMERY, CAREGIVERS SUPPORT GROUP OF POLK COUNTY, GIRL SCOUT LEADERSHIP, BABY & ME-FAMILY RESOURCE CENTER OF ST. CROIX VALLEY, AND CLAYTON AREA 4H CLUB TOTALED $1,015. - SPONSORSHIP ACTIVITIES/EVENTS - ARMC SPONSORS EVENTS SUCH AS THE AMERICAN CANCER SOCIETY WALK/RUN ($5000) IN AMERY, LUCK AND FREDERIC; ALZHEIMER'S GREAT WALK IN AMERY ($2500); AMERY FALL FESTIVAL ($2000) AND AMERY AREA COMMUNITY CENTER EVENTS ($500) TOTALING $10,000. 5. COMMUNITY BUILDING ACTIVITIES: $88,854 ARMC REACHES OUT TO PEOPLE AND COMMUNITIES THROUGHOUT POLK COUNTY, PARTS OF BARRON, BURNETT, AND ST. CROIX COUNTIES AND IS AN INVOLVED MEMBER IN LOCAL AND STATE COMMUNITIES. ARMC'S CONCERN FOR THE GROWTH AND DEVELOPMENT OF THE SURROUNDING COMMUNITIES AS WELL AS INDIVIDUAL WELFARE IS DEMONSTRATED BY PROVIDING EDUCATION AND RESOURCES TO ENCOURAGE POSITIVE COMMUNITY RELATIONS AND IMPROVE THE HEALTH OF ITS LOCAL COMMUNITIES. IMPLEMENTATION OF VARIOUS PROGRAMS IS SPECIFICALLY INTENDED TO IMPROVE THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE. ARMC PARTICIPATED IN COMMUNITY-BUILDING ACTIVITIES THAT SUPPORTED CHILDREN'S SAFETY, DRUG AWARENESS, ECONOMIC DEVELOPMENT, EMERGENCY PREPAREDNESS, WORK-FORCE DEVELOPMENT, LOCAL ARTISTS (COMMUNITY ART WALL/ART CASE), FITNESS AND HEALTH IN SCHOOLS, RADIO HEALTH EDUCATION PROGRAMS, HEALTH FAIRS, LOCAL FOOD SHELF, AND ADOPT-A-FAMILY PROGRAM FOR FAMILIES IN NEED. PARTNERSHIPS WITH SCHOOLS, CHURCHES AND OTHER ORGANIZATIONS MAKE MANY OF THESE PROGRAMS POSSIBLE. IN ORDER TO HELP COMBAT POVERTY, ARMC PROVIDES THE LOCAL FOOD SHELF, AMERY AREA FOOD SHELF, WITH FREE RENT, HEAT AND SHELVING FOR FOOD ITEMS. IN 2014, A TOTAL OF $26,919 WAS PROVIDED TO THIS LOCAL PROGRAM. ARMC CONTINUES TO BE ECO-FRIENDLY AND ENVIRONMENTALLY CONSCIOUS USING SUSTAINABLE INITIATIVES THAT ENSURE THE COMMUNITY'S HEALTH AND WELL-BEING. FROM RECYCLING PROGRAMS TO SUPPORT OF LOCAL GROWN ORGANIC PRODUCE TO THE DESIGN OF ARMC, ARMC EFFORTS ENCOURAGE HEALTHY LIFE CHOICES THROUGHOUT THE COMMUNITY. ENVIRONMENTAL-FRIENDLY ELEMENTS FOUND ON THE GROUNDS OF ARMC INCLUDE LANDSCAPING FOR WILDLIFE AND WATER QUALITY, RAIN GARDENS, GREEN ROOFS, PERVIOUS SURFACES, AND A COMMUNITY WALKING PATH WHICH ENHANCE THE VALUE OF THE NATURAL RESOURCES AND CONTRIBUTES TO THE HEALTH OF THE COMMUNITY. 6. COMMUNITY BENEFIT OPERATIONS: $2,253 ARMC HAS WORKED CLOSELY WITH POLK COUNTY AND OTHER AREA MEDICAL FACILITIES TO GATHER DATA AND COSTS ASSOCIATED WITH THE COMMUNITY HEALTH NEEDS ASSESSMENT, AS WELL AS OTHER COSTS ASSOCIATED WITH COMMUNITY BENEFIT STRATEGY AND OPERATIONS. DEDICATED STAFF TIME, RESOURCES, AND OTHER COSTS INVOLVED IN THE REPORTING OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR 2014 TOTAL $2,253. THE CHNA CONDUCTED IN 2013 INCLUDED AMRC, OSCEOLA MEDICAL CENTER, ST. CROIX REGIONAL MEDICAL CENTER AND POLK COUNTY HEALTH DEPARTMENT. THE CHNA USED A COMBINATION OF SURVEYS TO DETERMINE THE LIFESTYLE AND PERCEIVED HEALTH OF THE COMMUNITY WHICH INCLUDED PHONE SURVEYS, PAPER SURVEYS KEPT BY THE PARTICIPATING ORGANIZATIONS, THROUGH PARTICIPATING ORGANIZATION WEBSITES, AND SURVEYS MAILED DIRECTLY TO COMMUNITY MEMBERS. IN TOTAL, THE CHNA RECEIVED INPUT FROM 1,770 COMMUNITY MEMBERS TO DEVELOP TEN AREAS OF FOCUS. A FULL REPORT OF THE CHNA IS AVAILABLE AT WWW.POLKCOUNTYHEALTHDEPT.COM AND WWW.AMERYMEDICALCENTER.ORG. THERE WERE FOUR COMMUNITY FORUMS IN WHICH COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE TEN AREAS OF FOCUS. AT THE COMMENCEMENT OF EACH DISCUSSION, THOSE IN ATTENDANCE PLACED VOTES ON THE TOP FIVE AREAS. FOLLOWING THESE OUTREACH ACTIVITIES, A GROUP OF APPROXIMATELY 20 COMMUNITY PARTNERS PARTICIPATED IN A PROCESS FOCUSING ON REVIEW AND DISCUSSION OF COMPILED DATA ON THE CURRENT HEALTH STATUS OF COMMUNITY MEMBERS, AS WELL AS VOTING RESULTS FROM THE FORUMS. DURING THE MEETING, THIS GROUP COMPLETED A PAPER SURVEY TO CAST THEIR VOTES TO DETERMINE THE TOP THREE HEALTH FOCUS AREAS FOR THE COMMUNITY. THESE THREE AREAS DETERMINED WERE: 1. MENTAL HEALTH 2. OBESITY 3. ALCOHOL USE IMPLEMENTATION ACTIVITIES IN 2014 INCLUDED THE FOLLOWING: MENTAL HEALTH: - MENTAL HEALTH TASK FORCE COMPLETED FINAL YEAR OF A 3 YEAR SUICIDE PREVENTION GRANT TARGETING QUESTION, PERSUADE, REFER TRAININGS IN COUNTY SCHOOL DISTRICTS, COMMUNITY, AND OTHER SERVICE ORGANIZATIONS - MENTAL HEALTH TASK FORCE UPDATED BROCHURE OF LOCAL MENTAL HEALTH RESOURCES AND DISTRIBUTED WIDELY IN COMMUNITY - HEALTHY BEGINNINGS PROJECT OFFERED IN POLK COUNTY OFFERING STUDENT THERAPY SERVICES ONSITE IN OSCEOLA SCHOOL DISTRICT AS WELL AS HOME VISITS - MENTAL HEALTH TASK FORCE OBTAINED OTTO BREMER FOUNDATION GRAND FUNDING FOR DEPRESSION SCREENING PROGRAM TO BE IMPLEMENTED 2015-2016 - ARMC OFFERS MONTHLY SEMINARS FOR COMMUNITY AND STAFF SPONSORED BY BEHAVIORAL HEALTH AT AHC OBESITY PREVENTION: - ENVIRONMENTAL SCAN OF SCHOOL POLICIES AND OBESITY PREVENTION INITIATIVES CONDUCTED - RESOURCE BROCHURE DETAILING SCHOOL OBESITY PREVENTION PROGRAMS CREATED AND DISTRIBUTED - WORKSITE WELLNESS TOOLKIT TRAINING SCHEDULED IN 2015 FOR BUSINESSES IN POLK COUNTY - COMMUNITY HARVEST OF THE MONTH PROJECT DRAFTED AND APPLIED FOR GRANT FUNDING TO IMPLEMENT COUNTY WIDE - BABY BEHAVIOR VIDEO PRODUCED BY HEALTH DEPARTMENT TO PREVENT INFANT OVERFEEDING- UNDERSTANDING YOUR BABY'S CUES UNHEALTHY ALCOHOL USE: - ENVIRONMENTAL SCAN OF CITY/TOWN CLERKS CONDUCTED ON EXISTENCE OF LOCAL ALCOHOL POLICIES - DATA COLLECTION OF OPERATING WHILE INTOXICATED ON UNDERAGE DRINKING CITATIONS GATHERED FROM SHERIFF'S DEPARTMENT AND LOCAL MUNICIPALITIES. DATA WILL BE USED TO CREATE A PUBLIC INFORMATION CAMPAIGN - HEALTH DEPARTMENT SECURED WI RURAL HEALTH GRANT TO PLAN FOR AND CONDUCT UNDERAGE ALCOHOL COMPLIANCE CHECKS - POLK COUNTY GUIDE TO ALCOHOL COMPLIANCE CHECKS COMPLETED - HEALTH DEPARTMENT SECURED PARENTS WHO HOST CAMPAIGN GRANT - COMMUNITY HEALTH IN ACTION GRANT SECURED FOCUSING ON BEST PRACTICES FOR CHANGING UNHEALTHY ALCOHOL PRACTICES IN COMMUNITIES 7. ORGANIZATION AWARDS AND ACHIEVEMENTS $30,000 INFECTION PREVENTION COORDINATOR LYNN GAFFNEY, RN, WAS AWARDED A FELLOWSHIP FOR $30,000 IN PARTNERSHIP WITH THE ASSOCIATION FOR PROFESSIONALS IN INFECTION CONTROL AND EPIDEMIOLOGY, EMERGENCY NURSES ASSOCIATION, SOCIETY FOR HEALTHCARE EPIDEMIOLOGY OF AMERICA AND SOCIETY OF HOSPITAL MEDICINE. HEALTH RESEARCH AND EDUCATION TRUST (HRET) IS AN AMERICAN HOSPITAL ASSOCIATION (AHA) AFFILIATE. THIS FELLOWSHIP WAS GRANTED TO HELP REDUCE CATHETER ASSOCIATED URINARY TRACT INFECTION (CAUTI) AT FACILITY.
FORM 990, PART VI, SECTION A, LINE 4	THE ORGANIZATION'S NAME WAS CHANGED FROM APPLE RIVER HOSPITAL, INC., TO AMERY REGIONAL MEDICAL CENTER, INC. (ARMC), AND THE CORPORATE MEMBERS OF ARMC WERE DEFINED AS GROUP HEALTH PLAN, INC. (GHI) AND RH-WISCONSIN, INC., WHEN ARTICLES OF INCORPORATION AND BYLAWS OF ARMC WERE AMENDED 1/1/14.
FORM 990, PART VI, SECTION A, LINE 6	RH WISCONSIN, INC. IS THE CLASS A MEMBER AND GHI IS THE CLASS B MEMBER OF ARMC.
FORM 990, PART VI, SECTION A, LINE 7A	ARMC'S BOARD OF DIRECTORS IS COMPRISED OF NOT MORE THAN 13 PERSONS APPOINTED AS FOLLOWS: - 7 COMMUNITY REPRESENTATIVES APPOINTED BY THE CLASS A MEMBER (RH-WISCONSIN), FROM RECOMMENDATIONS BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. - 3 REPRESENTATIVES APPOINTED BY THE CLASS B MEMBER (GHI). - 3 HEALTH CARE PROVIDERS NOMINATED BY THE PHYSICIAN GROUP STAFFING ARMC'S PRIMARY CARE CLINIC, AND APPOINTED BY THE CLASS B MEMBER (GHI). - THE PRESIDENT AND CHIEF MEDICAL OFFICER OF ARMC SIT IN EX-OFFICIO CAPACITIES, WITHOUT THE RIGHT TO VOTE.
FORM 990, PART VI, SECTION A, LINE 7B	THE CLASS A AND CLASS B MEMBERS (RH WISCONSIN, INC. AND GHI RESPECTIVELY) BOTH MUST APPROVE THE DECISIONS OF THE BOARD OF DIRECTORS AS FOLLOWS: - AMENDMENT OF ARTICLES OR BYLAWS IMPACTING MEMBERSHIP - RESIGNATION OF A MEMBER - DISSOLUTION - ANY CHANGE IN THE FUNDAMENTAL NATURE OR PURPOSE - MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION - DISPOSITION OF SUBSTANTIALLY ALL ASSETS. ONLY THE CLASS A MEMBER MUST APPROVE THE DECISIONS OF THE BOARD OF DIRECTORS AS FOLLOWS: - AMENDMENT OF ARTICLES OR BYLAWS NOT IMPACTING MEMBERSHIP - ANNUAL OPERATING AND CAPITAL BUDGETS AND STRATEGIC PLANS - ESTABLISHMENT OF NEW ENTITIES OR SIGNIFICANT RELATIONSHIPS WITH OTHER ENTITIES - UNBUDGETED EXPENDITURES IN EXCESS OF AMOUNTS ESTABLISHED BY THE MEMBER - GUARANTEEING THE DEBT OF ANY OTHER PERSON OR ENTITY - A LOAN OR OTHER INDEBTEDNESS IN EXCESS OF AMOUNTS ESTABLISHED BY THE MEMBER - TRANSFER OF ASSETS TO ANOTHER ENTITY - APPOINTMENT OF THE PRESIDENT AND THE BOARD CHAIR.
FORM 990, PART VI, SECTION B, LINE 11	ARMC'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF ARMC. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF ARMC, GHI'S INTERNAL LEGAL DEPARTMENT AND ARMC'S OUTSIDE INDEPENDENT ACCOUNTANTS. EACH ONE OF THOSE AREAS HAS AN OPPORTUNITY TO REVIEW, ASK QUESTIONS AND MAKE COMMENTS BACK TO THE TAX DEPARTMENT OF GHI BEFORE THE FORM 990 IS COMPLETED AND PRESENTED TO THE GOVERNING BODY OF ARMC. ARMC MAKES AVAILABLE TO THE GOVERNING BODY (BOARD OF DIRECTORS) A COPY OF THE 990 FOR REVIEW AND COMMENT PRIOR TO THE FILING OF THE 990 RETURN. THIS COPY WILL BE PROVIDED IN A MAILING TO THE BOARD MEMBERS PRIOR TO THE FILING OF THE 990. EACH BOARD MEMBER WILL HAVE AN OPPORTUNITY TO COMMENT OR ASK QUESTIONS ABOUT THE 990 BEFORE IT IS FILED. THIS PROCESS WILL BE NOTED AND DOCUMENTED IN A WRITTEN MEMO IN THE FILES OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 12C	THE ARMC BOARD OF DIRECTORS MONITORS POTENTIAL CONFLICTS OF INTEREST OF ITS BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES, BY MAINTAINING A CONFLICT OF INTEREST POLICY. ANNUALLY, UNDER THE POLICY, ALL BOARD MEMBERS, PRINCIPAL OFFICERS, MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS AND KEY EMPLOYEES ARE PROVIDED WITH A COPY OF THE POLICY AND REQUESTED TO COMPLETE A QUESTIONNAIRE IDENTIFYING ANY POTENTIAL CONFLICTS OF INTERESTS. A REPORT OF THESE POTENTIAL CONFLICTS IS SHARED WITH THE CHAIR AND THE CEO. BOARD AGENDAS AND EXECUTIVE DECISIONS ARE DOCUMENTED IN RELATION TO THIS POLICY.
FORM 990, PART VI, SECTION B, LINE 15	ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES OF ARMC ARE PAID BY ARMC, GHI, LAKEVIEW HEALTH RHSC AND REGIONS, ALL RELATED ORGANIZATIONS WHICH HAVE AN ANNUAL PROCESS TO REVIEW THE MARKET COMPARABILITY OF THE TOTAL COMPENSATION OF THE FOUNDATION'S PRESIDENT AND ITS OTHER OFFICERS. EVERY THREE YEARS, UNDER THE DIRECTION OF THE GHI BOARD OF DIRECTORS' COMPENSATION COMMITTEE (COMPENSATION COMMITTEE), A TOTAL COMPENSATION MARKET REVIEW IS COMPLETED. THE REVIEW INCLUDES ALL COMPONENTS OF COMPENSATION; BASE SALARY, ANNUAL INCENTIVES, BENEFITS AND PERQUISITES. THE MARKET SURVEY RESULTS ARE PRESENTED TO, REVIEWED BY AND APPROVED BY THE INDEPENDENT COMPENSATION COMMITTEE. IN INTERIM YEARS, GHI'S HUMAN RESOURCES STAFF, UNDER THE DIRECTION OF THE COMPENSATION COMMITTEE, UPDATES CHANGES IN THE SALARY STRUCTURE BASED ON THE SAME INDEPENDENT STUDIES PERFORMED BY THE COMPENSATION COMMITTEE. FOR THE PRESIDENT AND CERTAIN OTHER POSITIONS FULL INDEPENDENT REVIEWS ARE PERFORMED. IN ALL CASES, COMMITTEE MEMBERS COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY TO ASSURE THE COMPENSATION COMMITTEE MEMBERS' INDEPENDENCE, STAFF IS NOT IN ROOM DURING DELIBERATIONS OR VOTE INCLUDING EXECUTIVE SESSIONS, AND CONTEMPORANEOUS MINUTES ARE KEPT. THE BOARD OF DIRECTORS HAS DELEGATED TO THE COMPENSATION COMMITTEE THE ACCOUNTABILITY TO CONDUCT AN ANNUAL PERFORMANCE EVALUATION AND TO DETERMINE THE COMPENSATION OF THE PRESIDENT BASED ON THE PERFORMANCE REVIEW AND THE MARKET COMPARABILITY DATA, APPROVED BY THE COMPENSATION COMMITTEE. THE BOARD HAD DELEGATED TO THE PRESIDENT (WITH AUTHORITY TO FURTHER DELEGATE) THE ACCOUNTABILITY TO CONDUCT ANNUAL PERFORMANCE REVIEWS AND DETERMINE THE COMPENSATION OF ALL OTHER OFFICERS WITHIN THE COMPENSATION RANGES DETERMINED BY THE COMPENSATION COMMITTEE. ANY EXCEPTIONS NEED TO BE APPROVED BY THE COMPENSATION COMMITTEE. TOTAL COMPENSATION IS APPROPRIATELY DOCUMENTED ON THE FORM 990 AND W2 STATEMENTS.
FORM 990, PART VI, SECTION C, LINE 18	ARMC 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM ARMC OR HEALTHPARTNERS, INC.
FORM 990, PART VI, SECTION C, LINE 19	ARMC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:	FIXED ASSET VALUATION ADJUSTMENT 584,020. OTHER BALANCE SHEET VALUATION ADJUSTMENTS 2,071.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (28 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Direct Controlling NADirectControllingNACd	Controlled OrganizationControlledOrganizationInd	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
HEALTHPARTNERS INC
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	411693838	HYBRID STAFF MODEL/NETWORK MODEL HEALTH MAINTENANCE ORGANIZATION	MN	501(C)(4)	N/A	Yes (1)
HPI - RAMSEY
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	411793333	CORPORATE PLANNING AND OVERSIGHT	MN	501(C)(3)		Yes (1)	509(A)(3) TYPE I	HEALTHPARTNERS INC
GROUP HEALTH PLAN INC
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	410797853	STAFF MODEL HEALTH MAINTENANCE ORGANIZATION	MN	501(C)(3)		Yes (1)	170(B)(1) (A)(III)	HEALTHPARTNERS INC
HEALTHPARTNERS INSTITUTE FOR EDUCATION AND RESEARCH
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	411670163	HEALTHCARE EDUCATION & RESEARCH	MN	501(C)(3)		Yes (1)	509(A)(3) TYPE I	GROUP HEALTH PLAN INC
CAPITOL VIEW TRANSITIONAL CARE CENTER
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	412011453	POST HOSPITALIZATION PATIENT CARE	MN	501(C)(3)		Yes (1)	170(B)(1) (A)(III)	HPI - RAMSEY
REGIONS HOSPITAL
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	410956618	HOSPITAL	MN	501(C)(3)		Yes (1)	170(B)(1) (A)(III)	HPI - RAMSEY
REGIONS HOSPITAL FOUNDATION
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	411888902	PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT	MN	501(C)(3)		Yes (1)	170(B)(1) (A)(VI)	HPI - RAMSEY
RHSC INC
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	411891928	HEALTHCARE STAFFING	MN	501(C)(3)		Yes (1)	509(A)(3) TYPE II	HEALTHPARTNERS INC
RH-WISCONSIN
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	202287016	CORPORATE PLANNING AND OVERSIGHT	WI	501(C)(3)		Yes (1)	509(A)(3) TYPE II	HPI - RAMSEY
PHYSICIANS NECK AND BACK CLINICS
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	270684883	SPECIALTY PATIENT CARE	MN	501(C)(3)		Yes (1)	509(A)(3) TYPE II	GROUP HEALTH PLAN INC
HUDSON HOSPITAL INC
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	390804125	HOSPITAL	WI	501(C)(3)		Yes (1)	170(B)(1) (A)(III)	RH-WISCONSIN & GROUP HEALTH PLAN INC
HUDSON HOSPITAL FOUNDATION INC
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	391279567	PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT	WI	501(C)(3)		Yes (1)	170(B)(1) (A)(VI)	HUDSON HOSPITAL INC
WESTERN WISCONSIN EMERGENCY MEDICAL SERVICES COMPANY
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	263616590	PROVIDE MEDICAL TRANSPORT SERVICES	WI	501(C)(3)		Yes (1)	509(A)(3) TYPE II	RH-WISCONSIN
LAKEVIEW MEMORIAL HOSPITAL FOUNDATION
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	411386635	PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT	MN	501(C)(3)		Yes (1)	509(A)(3) TYPE II	STILLWATER HEALTH SYSTEM
LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	410811697	HOSPITAL	MN	501(C)(3)		Yes (1)	170(B)(1) (A)(III)	STILLWATER HEALTH SYSTEM
STILLWATER MEDICAL GROUP
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	830379473	PHYSICIANS GROUP	MN	501(C)(3)		Yes (1)	509(A)(2)	STILLWATER HEALTH SYSTEM
STILLWATER HEALTH SYSTEM
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	300221189	CORPORATE PLANNING AND OVERSIGHT	MN	501(C)(3)		Yes (1)	509(A)(3) TYPE II	HPI - RAMSEY
WESTFIELDS HOSPITAL INC
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	390808442	HOSPITAL	WI	501(C)(3)		Yes (1)	170(B)(1) (A)(III)	RH-WISCONSIN & GROUP HEALTH PLAN INC
WESTFIELDS HOSPITAL FOUNDATION INC
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	391770913	PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT	WI	501(C)(3)		Yes (1)	509(A)(3) TYPE I	WESTFIELDS HOSPITAL INC
RAMSEY INTEGRATED HEALTH SERVICES
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	411503090	IN-HOME PATIENT CARE	MN	501(C)(3)		Yes (1)	509(A)(2)	HPI - RAMSEY
PARK NICOLLET HEALTH SERVICES
6500 EXCELSIOR BLVD	ST LOUIS PARK	MN	55426	363465840	CORPORATE PLANNING AND OVERSIGHT	MN	501(C)(3)		Yes (1)	509(A)(2) TYPE III	HEALTHPARTNERS INC
PARK NICOLLET FOUNDATION
6500 EXCELSIOR BLVD	ST LOUIS PARK	MN	55426	237346465	GRANTS TO SERVE THE COMMUNITY	MN	501(C)(3)		Yes (1)	170(B)(1) (A)(VI)	PARK NICOLLET HEALTH SERVICES
PARK NICOLLET METHODIST HOSPITAL
6500 EXCELSIOR BLVD	ST LOUIS PARK	MN	55426	410132080	HOSPITAL	MN	501(C)(3)		Yes (1)	170(B)(1) (A)(III)	PARK NICOLLET HEALTH SERVICES
PARK NICOLLET INSTITUTE
6500 EXCELSIOR BLVD	ST LOUIS PARK	MN	55426	410961862	HEALTHCARE RESEARCH	MN	501(C)(3)		Yes (1)	170(B)(1) (A)(III)	PARK NICOLLET HEALTH SERVICES
PARK NICOLLET HEALTH CARE PRODUCTS
6500 EXCELSIOR BLVD	ST LOUIS PARK	MN	55426	010638901	HEALTHCARE PRODUCTS	MN	501(C)(3)		Yes (1)	509(A)(3) TYPE II	PARK NICOLLET HEALTH SERVICES
PARK NICOLLET CLINIC
6500 EXCELSIOR BLVD	ST LOUIS PARK	MN	55426	410834920	HEALTHCARE	MN	501(C)(3)		Yes (1)	170(B)(1) (A)(III)	PARK NICOLLET HEALTH SERVICES
PNMC HOLDINGS
6500 EXCELSIOR BLVD	ST LOUIS PARK	MN	55426	411741792	HEALTHCARE REAL ESTATE	MN	501(C)(3)		Yes (1)	509(A)(3) TYPE I	PARK NICOLLET CLINIC
AMERY REGIONAL MEDICAL CENTER FOUNDATION INC
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	391726539	PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT	WI	501(C)(3)		Yes (1)	170(B)(1) (A)(VI)	AMERY REGIONAL MEDICAL CENTER INC

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	AMERY REGIONAL MEDICAL CENTER PHARMACY LLC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	265 GRIFFIN STREET E	AddressLine1Txt
City	AMERY	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54001	ZIPCd

Field	Value	IRS element (for citing)
EIN	390908320	EIN
Primary Activities	PHARMACEUTICAL	PrimaryActivitiesTxt
Legal Domicile State	WI	LegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	AMERY REGIONAL MEDICAL CENTER	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Share Of Total Income	-$2,253	ShareOfTotalIncomeAmt
Share Of EOY Assets	$83,092	ShareOfEOYAssetsAmt
Disproportionate Allocations	0	DisproportionateAllocationsInd
General Or Managing Partner	Yes (1)	GeneralOrManagingPartnerInd
Ownership	0.50000	OwnershipPct

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd
HEALTHPARTNERS ADMINISTRATORS INC
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	411629390	THIRD PARTY ADMINISTRATOR	MN	HEALTHPARTNERS INC	C	0
HEALTHPARTNERS ASSOCIATES INC
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	522365151	MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT	MN	HEALTHPARTNERS ADMINISTRATORS INC	C	0
HEALTHPARTNERS SERVICES INC
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	411683568	MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT	MN	HEALTHPARTNERS ADMINISTRATORS INC	C	0
HEALTHPARTNERS INSURANCE COMPANY
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	411683523	MEDICAL AND DENTAL INSURANCE	MN	HEALTHPARTNERS ADMINISTRATORS INC	C	0
DENTAL SPECIALTIES INC
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	451297583	PROFESSIONAL DENTAL SERVICES	MN	HEALTHPARTNERS ADMINISTRATORS INC	C	0
HEALTHPARTNERS CENTRAL MINNESOTA CLINICS INC
8170 33RD AVE S PO BOX 1309	MPLS	MN	554401309	411236798	MEDICAL CLINIC STAFFING	MN	HEALTHPARTNERS ADMINISTRATORS INC	C	0
PARK NICOLLET ENTERPRISES
6500 EXCELSIOR BLVD	ST LOUIS PARK	MN	55426	411656735	REAL ESTATE FOR RELATED ORGANIZATIONS	MN	PARK NICOLLET HEALTH SERVICES	C	0

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (1)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	0	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	0	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (1)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	0	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	0	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (4 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt
AMERY REGIONAL MEDICAL CENTER FOUNDATION
C	$0
AMERY REGIONAL MEDICAL CENTER FOUNDATION
N	$0
AMERY REGIONAL MEDICAL CENTER FOUNDATION
O	$0
HEALTHPARTNERS INC - CLAIMSHEALTHCARE SERVICES
L	$223,371