MEDICAL SERVICES INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- MEDICAL SERVICES INC (EIN 39-1536207)
- Tax period
- 2013-04-01 to 2014-03-31
- Filed
- 2014-11-05
- IRS object ID
- 201403099349301395
- Schema version
- 2013v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-05T15:43:19-06:00 | ReturnTs |
| Tax Period End | 2014-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGLADREY LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 227 W FIRST ST STE 700 | AddressLine1 |
| City | DULUTH | City |
| State | MN | State |
| ZIP Code | 558021919 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391536207 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEDICAL SERVICES INC | BusinessNameLine1 |
| Business Name Line2 | D/B/A HAYWARD AREA MEMORIAL HOSPITAL | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MEDI | BusinessNameControlTxt |
| Phone | 7156348911 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11040 N STATE ROAD 77 | AddressLine1 |
| City | HAYWARD | City |
| State | WI | State |
| ZIP Code | 548436391 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIM GULLINGSRUD | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Phone | 7156348911 | PhoneNum |
| Signature | 2014-10-31 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARY BETH SANTORI | PreparerPersonNm |
| PTIN | P00023783 | PTIN |
| Phone | 2187275025 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TIM GULLINGSRUD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11040 N STATE ROAD 77 | AddressLine1 |
| City | HAYWARD | City |
| State | WI | State |
| ZIP Code | 548436391 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $38,326,798 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTP://HAYWARDMEMORIALHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1986 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY HEALTH CARE TO THE PEOPLE OF HAYWARD, WI AND THE SURROUNDING AREAS | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 335 | TotalEmployeeCnt |
| Total Volunteers | 135 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $102,502 | PYContributionsGrantsAmt |
| CY Contributions Grants | $64,575 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $37,928,982 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $37,490,305 | CYProgramServiceRevenueAmt |
| PY Investment Income | $307,237 | PYInvestmentIncomeAmt |
| CY Investment Income | $433,602 | CYInvestmentIncomeAmt |
| PY Other Revenue | $260,894 | PYOtherRevenueAmt |
| CY Other Revenue | $257,213 | CYOtherRevenueAmt |
| PY Total Revenue | $38,599,615 | PYTotalRevenueAmt |
| CY Total Revenue | $38,245,695 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $16,576,253 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $17,162,223 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $16,880,632 | PYOtherExpensesAmt |
| CY Other Expenses | $18,029,972 | CYOtherExpensesAmt |
| PY Total Expenses | $33,456,885 | PYTotalExpensesAmt |
| CY Total Expenses | $35,192,195 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,142,730 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,053,500 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $52,903,245 | TotalAssetsBOYAmt |
| Total Assets EOY | $54,721,543 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $18,912,400 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $17,677,198 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $33,990,845 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $37,044,345 | NetAssetsOrFundBalancesEOYAmt |
| Mission | CONTINUOUSLY IMPROVE THE HEALTH STATUS OF THE PEOPLE OF THE HAYWARD AREA | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $29,028,437 | ExpenseAmt |
| Revenue | $37,582,001 | RevenueAmt |
| Desc | OUR 25 BED CRITICAL ACCESS HOSPITAL IS FLANKED BY MEDICAL CLINICS AND A LONG TERM CARE CENTER. THERE ARE 18 FULL-TIME PHYSICIANS ON THE MEDICAL STAFF AND THE HOSPITAL AND NURSING HOME EMPLOY CLOSE TO 300 INDIVIDUALS. OUR STAFF HAS IMMEDIATE CONTACT WITH SPECIAISTS IN LARGE HOSPITALS FOR CONSULTATION.THE EMERGENCY DEPARTMENT IS STAFFED BY PHYSICIANS AND NURSES 24 HOURS-A-DAY WITH ADDITIONAL PERSONNEL AT DESIGNATED TIMES. AIR AND GROUND AMBULANCES ARE AVAILABLE FOR THOSE REQUIRING A HIGHER LEVEL OF TRAUMA CARE. HIGHLY SKILLED PHYSICIANS AND MEDICAL PROFESSIONALS FROM LARGER HOSPITALS ACROSS THE NATION ARE ATTRACTED TO THIS POPULAR RECREATIONAL AREA BY THE QUALITY OF LIFE THEY FIND HERE. | Desc |
| Total Program Service Expenses | $29,028,437 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | 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 | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 25 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 335 | 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 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 | 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 | BRAD ZELLER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7159344245 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11040 N STATE ROAD 77 | AddressLine1 |
| City | HAYWARD | City |
| State | WI | State |
| ZIP Code | 54843 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| STEVE GILLIS | ||||||||
| VICE CHAIR | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KAREN GUSTAFSON | ||||||||
| TREASURER | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| HEIDI HABEL | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BRENT KELLEY DO | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BARBARA KOERPEL-DUFFY | ||||||||
| CHAIR | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| HARRY MALCOLM MD | ||||||||
| SECRETARY | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| TIM GULLINGSRUD | ||||||||
| CEO - MSI | 38.00 | 2.00 | Yes (X) | Yes (X) | $184,403 | $0 | $39,997 | |
| JULIE KAHL MD | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| GARY NATHAN | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JASON DOUGLAS | ||||||||
| DIRECTOR/PRESIDENT - REI | 1.00 | 39.00 | Yes (X) | $0 | $92,144 | $7,372 | ||
| JAMES MILLER | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DANIEL HYMANS | ||||||||
| DIRECTOR/PRESIDENT - REI | 1.00 | 39.00 | Yes (X) | Yes (X) | $0 | $248,478 | $30,652 | |
| LES WHITEAKER | ||||||||
| CFO - MMC | 1.00 | 39.00 | Yes (X) | $0 | $225,735 | $22,919 | ||
| BRAD ZELLER | ||||||||
| VICE PRESIDENT - MSI | 39.00 | 1.00 | Yes (X) | $130,685 | $0 | $34,054 | ||
| KENT DUMONSEAU | ||||||||
| CFO - REI | 14.00 | 26.00 | Yes (X) | $0 | $66,938 | $7,306 | ||
| JANET MCKICHAN | ||||||||
| VICE PRESIDENT - MSI | 40.00 | 0.00 | Yes (X) | $133,698 | $0 | $18,274 | ||
| HEATHER SHEEHAN | ||||||||
| VICE PRESIDENT - MSI | 40.00 | 0.00 | Yes (X) | $135,298 | $0 | $35,057 | ||
| SUSAN BAUER | ||||||||
| CRNA | 40.00 | 0.00 | $178,457 | $0 | $31,992 | Yes (X) | ||
| SUZANNE ULMER | ||||||||
| CRNA | 40.00 | 0.00 | $180,347 | $0 | $26,893 | Yes (X) | ||
| ROBERT TERRY | ||||||||
| CRNA | 40.00 | 0.00 | $180,325 | $0 | $33,977 | Yes (X) | ||
| ALLISON FARLEY | ||||||||
| PHARMACIST/DEPT HEAD | 40.00 | 0.00 | $135,312 | $0 | $30,775 | Yes (X) | ||
| STEVEN KRASEAN | ||||||||
| PHYSICAL THERAPIST/DEPT HE | 40.00 | 0.00 | $133,681 | $0 | $30,918 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,392,206 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $633,295 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $350,186 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 11 | 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/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| REGIONAL ENTERPRISES INC | |||||
| 1615 MAPLE LANE | ASHLAND | WI | 54806 | PROFESSIONAL FEES/RENT | $2,223,522 |
| WAPITI MEDICAL GROUP | |||||
| 107 FLYNN DRIVE SUITE 600 | MILBANK | SD | 57252 | ER SERVICES | $1,239,046 |
| MARKET & JOHNSON | |||||
| 2350 GALLOWAY STREET | EAU CLAIRE | WI | 54702 | CONSTRUCTION | $314,697 |
| ESSENTIA-HAYWARD | |||||
| 11134 N STATE RD 77 | HAYWARD | WI | 54843 | ER ON-CALL SERVICES | $145,349 |
| IMTIAZ MOHAMED | |||||
| 2732 LONDON ROAD | DULUTH | MN | 55804 | ER SERVICES | $134,593 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $64,575 | AllOtherContributionsAmt |
| Total Contributions | $64,575 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| HOSPITAL | 621500 | $33,537,323 | $33,537,323 |
| NURSING HOME | 621500 | $2,799,111 | $2,799,111 |
| ASSISTED LIVING | 621500 | $777,747 | $777,747 |
| ELECTRONIC HEALTH RECORD INCENTIV | 621500 | $325,659 | $325,659 |
| DIABETES | 621500 | $50,465 | $50,465 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $37,490,305 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $433,565 | TotalRevenueColumnAmt |
| Exclusion | $433,565 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $246,620 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $81,103 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $165,517 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $165,517 | TotalRevenueColumnAmt |
| Exclusion | $165,517 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $37 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $37 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $37 | TotalRevenueColumnAmt |
| Exclusion | $37 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| CAFETERIA | 900099 | $63,860 | $63,860 |
| MISCELLANEOUS | 900099 | $27,836 | $27,836 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $91,696 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $38,245,695 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $37,582,001 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $599,119 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $717,473 | TotalAmt |
| Management And General | $717,473 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,145,601 | TotalAmt |
| Program Services | $11,218,325 | ProgramServicesAmt |
| Management And General | $927,276 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $454,493 | TotalAmt |
| Program Services | $423,167 | ProgramServicesAmt |
| Management And General | $31,326 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,953,535 | TotalAmt |
| Program Services | $2,681,115 | ProgramServicesAmt |
| Management And General | $272,420 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $891,121 | TotalAmt |
| Program Services | $782,335 | ProgramServicesAmt |
| Management And General | $108,786 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,441 | TotalAmt |
| Management And General | $86,441 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $122,089 | TotalAmt |
| Management And General | $122,089 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,932 | TotalAmt |
| Management And General | $55,932 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $800,106 | TotalAmt |
| Management And General | $800,106 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,278,932 | TotalAmt |
| Management And General | $2,278,932 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $546,701 | TotalAmt |
| Program Services | $437,326 | ProgramServicesAmt |
| Management And General | $109,375 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,700,204 | TotalAmt |
| Program Services | $2,159,990 | ProgramServicesAmt |
| Management And General | $540,214 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,890 | TotalAmt |
| Management And General | $89,890 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| HOSPITAL SUPPLIES & OTH | $4,932,687 | $4,932,687 |
| PROVISION FOR DOUBTFUL | $3,338,380 | $3,338,380 |
| NURSING SUPPLIES & OTHE | $1,543,773 | $1,543,773 |
| OTHER GENERAL SERVICE S | $1,511,339 | $1,511,339 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,498 | TotalAmt |
| Management And General | $23,498 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,192,195 | TotalAmt |
| Program Services | $29,028,437 | ProgramServicesAmt |
| Management And General | $6,163,758 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,104,295 | BOYAmt |
| EOY | $21,336,839 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,570,136 | BOYAmt |
| EOY | $5,058,137 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $851,047 | BOYAmt |
| EOY | $874,930 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $269,979 | BOYAmt |
| EOY | $339,794 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $45,144,803 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $21,120,909 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,051,967 | BOYAmt |
| EOY | $24,023,894 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,877,312 | BOYAmt |
| EOY | $2,579,361 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $178,509 | BOYAmt |
| EOY | $508,588 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,903,245 | BOYAmt |
| EOY | $54,721,543 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,869,025 | BOYAmt |
| EOY | $3,895,044 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,043,375 | BOYAmt |
| EOY | $13,782,154 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,912,400 | BOYAmt |
| EOY | $17,677,198 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,990,845 | BOYAmt |
| EOY | $37,044,345 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,990,845 | BOYAmt |
| EOY | $37,044,345 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,903,245 | BOYAmt |
| EOY | $54,721,543 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $3,053,500 | ReconcilationRevenueExpnssAmt |
| 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 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 | $1,209 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,209 | 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 | HAYWARD AREA MEMORIAL HOSPITAL AND WATER'S EDGE PAY DUES TO CERTAIN ORGANIZATIONS RELATED TO THE INDUSTRY WHICH HAVE LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $45,799 | OtherCostOrOtherBasisAmt |
| Book Value | $45,799 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $32,893,156 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,216,191 | DepreciationAmt |
| Book Value | $19,676,965 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,020,452 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,847,406 | DepreciationAmt |
| Book Value | $3,173,046 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,185,396 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,057,312 | DepreciationAmt |
| Book Value | $1,128,084 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $24,023,894 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $34,988,381 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $81,103 | OtherRevenueAmt |
| Revenue Not Reported | $81,103 | RevenueNotReportedAmt |
| Revenue Subtotal | $34,907,278 | RevenueSubtotalAmt |
| Other Revenues Not Included | $3,338,417 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $3,338,417 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $38,245,695 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $31,934,881 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $81,066 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $81,066 | ExpensesNotReportedAmt |
| Expenses Subtotal | $31,853,815 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $3,338,380 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $3,338,380 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $35,192,195 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE COMPANY IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES. NOT-FOR-PROFIT ORGANIZATIONS MAY BECOME SUBJECT TO INCOME TAXES IF QUALIFICATION AS A TAX-EXEMPT ENTITY CHANGES, IF UNRELATED BUSINESS INCOME IS GENERATED AND IN CERTAIN OTHER INSTANCES. NOT-FOR-PROFIT ORGANIZATIONS ARE REQUIRED TO ASSESS THE CERTAINTY OF THEIR TAX POSITIONS RELATED TO THESE MATTERS AND, IN SOME CASES, RECORD LIABILITIES FOR POTENTIAL TAXES, INTEREST AND PENALTIES ACCOMPANIED BY FOOTNOTE DISCLOSURES. THE COMPANY HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE THE ACCRUAL OF AN INCOME TAX PROVISION. GENERALLY, THE COMPANY IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE OR LOCAL TAX AUTHORITIES FOR YEARS BEFORE 2011. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 81,103. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR DOUBTFUL RECEIVABLES 3,338,380. GAIN ON SALE OF EQUIPMENT 37. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 81,103. GAIN ON SALE OF EQUIPMENT -37. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR DOUBTFUL RECEIVABLES 3,338,380. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 150.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | $278,976 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $278,976 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00880 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,835,075 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,135,158 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $699,917 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02200 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,114,051 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,135,158 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $978,893 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03080 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $217,033 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,825 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $204,208 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00640 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,662,763 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,422,210 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,240,553 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13310 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,800 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $18,800 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,898,596 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,435,035 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,463,561 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14010 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,012,647 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,570,193 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,442,454 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.17090 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,338,380 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $10,816,676 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,001,188 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$184,512 | 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 |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 NONE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | HAYWARD AREA MEMORIAL HOSPITAL | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11040 N STATE ROAD 77 | AddressLine1 |
| City | HAYWARD | City |
| State | WI | State |
| ZIP Code | 54843 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HAYWARD AREA MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| 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 | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://HAYWARDMEMORIALHOSPITAL.COM | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| All Needs Addressed | Yes (1) | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 150.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | HAYWARD AREA MEMORIAL HOSPITAL | FormAndLineReferenceDesc |
| Explanation | PART V, SECTION B, LINE 3: THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC) WORKED WITH COMMUNITY MEMBERS WITH KNOWLEDGE OF AND/OR REPRESENTING VARIOUS SEGMENTS OF THE COMMUNITY INCLUDING SAWYER COUNTY PUBLIC HEALTH, NORTHWOODS COMMUNITY HEALTH CENTER, ESSENTIA CLINIC, THE SENIOR RESOURCE CENTER, THE NORTHWEST CONNECTION FAMILY RESOURCES CENTER, LCO TRIBAL CLINIC, AND THE HAYWARD SCHOOL DISTRICT. THE CHNAC IDENTIFIED COMMUNITY HEALTH NEEDS BY UNDERGOING AN ASSESSMENT PROCESS. THIS ASSESSMENT PROCESS CONSISTED OF A COMPREHENSIVE REVIEW OF COMMUNITY DEMOGRAPHIC INFORMATION INCLUDING INFORMATION AVAILABLE ON THE COUNTY HEALTH RANKING AND ROADMAPS REPORT. QUALITATIVE DATA WAS ALSO REVIEWED INCLUDING A SURVEY OF 800 HOUSEHOLDS IN THE HAMH&WE SERVICE AREA BY THE NATIONAL RURAL HEALTH RESOURCE CENTER AND INFORMATION COLLECTED BY SAWYER COUNTY PUBLIC HEALTH THROUGH A SERIES OF 14 COMMUNITY FOCUS GROUP SESSIONS.UPON COMPLETION OF THE HEALTH NEEDS ASSESSMENT, THE CHNAC COMPARED THE PRIORITIES IT HAD IDENTIFIED WITH THOSE INDEPENDENTLY IDENTIFIED BY SAWYER COUNTY PUBLIC HEALTH. | ExplanationTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| WATER'S EDGE | ||||
| 11040 N STATE ROAD 77 | HAYWARD | WI | 54843 | NURSING HOME |
| WATER'S EDGE | ||||
| 11040 N STATE ROAD 77 | HAYWARD | WI | 54843 | ASSISTED LIVING FACILITY |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED MEDICARE COST REPORT. |
| PART I, LINE 7G: | SUBSIDIZED HEALTH SERVICES INCLUDE PHYSICAL THERAPY, SPEECH PATHOLOGY, DIABETES EDUCATION, EMERGENCY, OBSERVATION BEDS, NURSING HOME, AND ASSISTED LIVING. |
| PART I, LN 7 COL(F): | BAD DEBT EXPENSE FROM FINANCIAL STATEMENTS IS $3,338,380. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | MANY PROGRAMS HAVE BEEN DESIGNED TO HELP PATIENTS OF THE COMMUNITY SUCH AS BREASTFEEDING EDUCATION, BLOOD DRIVES, CHILD BIRTH CLASSES, DISASTER READINESS, DIABETES EDUCATION, HEALTH FAIRS, HABITAT FOR HUMANITY, MORE ENERGY, IN KIND DONATIONS AND CASH DONATIONS AS EXAMPLES OF THE COMMUNITY ACTIVITIES HAYWARD HOSPITAL IS CURRENTLY INVOLVED IN. THE ACTIVITIES HAVE BEEN REPORTED ON SCHEDULE H, PART I, LINE 7E. |
| PART III, LINE 4: | ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE COMPANY ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE COMPANY ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE COMPANY RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE COSTING METHOD IS A COST TO CHARGE RATIO. |
| PART III, LINE 8: | HAYWARD AREA MEMORIAL HOSPITAL IS A CRITICAL ACCESS HOSPITAL THAT IS REIMBURSED AT 101% OF COST, LESS 2% SEQUESTRATION. THE MEDICARE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $677,356 AND ALLOWABLE COSTS OF $1,144,849 RESULTING IN A SHORTFALL OF $467,493. THE SHORTFALL IS THE RESULT OF UNREIMBURSED PROFESSIONAL CARE.THE HOSPITAL FOLLOWED MEDICARE'S PRESCRIBED METHODS OF DETERMINING COSTS PAYABLE UNDER TITLE XVIII (MEDICARE) IN COMPLETING ITS ANNUAL MEDICARE COST REPORT (COST REPORT) USING DATA AVAILABLE FROM THE INSTITUTION'S BASIC ACCOUNTS, AS USUALLY MAINTAINED, TO ARRIVE AT EQUITABLE AND PROPER PAYMENT FOR SERVICES. THE COST REPORT WAS COMPLETED USING THE HOSPITAL'S TRIAL BALANCE OF EXPENSES, AS WELL AS OTHER STATISTICAL AND FINANCIAL RECORDS MAINTAINED BY THE HOSPITAL. AS REQUIRED BY MEDICARE REGULATIONS, CERTAIN RECLASSIFICATIONS AND ADJUSTMENTS TO COSTS WERE INCLUDED IN THE COST REPORT TO DETERMINE MEDICARE ALLOWABLE COSTS.AFTER MEDICARE ALLOWABLE COSTS ARE DETERMINED, THE COST REPORT PROVIDES FOR THE STEP DOWN METHOD OF COST FINDING. THIS METHOD PROVIDES FOR ALLOCATING THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS, WHICH UTILIZE THE SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. AFTER ALL COSTS OF THE GENERAL SERVICE COST CENTERS HAVE BEEN ALLOCATED TO THE REMAINING COST CENTERS, THE TOTAL COSTS OF THESE REMAINING COST CENTERS ARE FURTHER DISTRIBUTED TO THE DEPARTMENTAL CLASSIFICATION TO WHICH THEY PERTAIN, E.G., HOSPITAL GENERAL INPATIENT ROUTINE, SUBPROVIDER, ANCILLARY, ETC.AFTER THE STEP-DOWN PROCESS, THE COST REPORT PROVIDES FOR THE APPORTIONMENT OF COSTS TO THE MEDICARE PROGRAM BASED ON A NUMBER OF DIFFERENT METHODOLOGIES INCLUDING PER PATIENT DAY, PER VISIT, AND PERCENTAGE OF CHARGES, AS MOST PREVALENT. MEDICARE COSTS AS DETERMINED BY THE COST REPORT METHODOLOGIES DESCRIBED PREVIOUSLY WERE UTILIZED TO COMPLETE THE APPLICABLE MEDICARE ALLOWABLE COSTS OF CARE FOR SCHEDULE H (FORM 990) PART III SECTION B LINE 6. |
| PART III, LINE 9B: | PATIENTS REQUEST ASSISTANCE AND AT THAT POINT RECEIVE THE DOCUMENTS TO APPLY FOR CHARITY CARE. MEDICAL SERVICES, INC DOES POST A LARGE SIGN IN THE LOBBY THAT STATES "THIS HEALTH CARE FACILITY IS REQUIRED TO GIVE A REASONABLE AMOUNT OF ITS SERVICES FREE OR AT A REDUCED CHARGE TO PERSONS WHO CANNOT AFFORD TO PAY FOR MEDICAL CARE. IF YOU ARE NOT ABLE TO PAY FOR ALL OR PART OF THE CARE YOU NEED, PLEASE CONTACT THE ADMISSIONS OR BUSINESS OFFICE OF THIS FACILITY AND ASK ABOUT THE AVAILABILITY OF SUCH CARE". THIS SIGN IS PLACED IN A LOCATION THAT ALL PATIENTS CAN SEE AND ASK FOR DOCUMENTS TO COMPLETE TO START THE CHARITY CARE APPLICATION PROCESS. COMMUNITY CARE INFORMATION IS ALSO INCLUDED IN ALL ADMISSION FOLDERS AND ALL ROOMS HAVE INFORMATIONAL BINDERS WITH CHARITY CARE INFORMATION. |
| FORM 990, SCHEDULE H, PART III, LINE 3 | AT HARYWARD AREA MEMORIAL HOSPITAL BAD DEBT IS CONSIDERED THE UNWILLINGNESS TO PAY, WHILE CHARITY CARE AND FREE CARE ARE INABILITY TO PAY. |
| PART VI, LINE 2: | FACILITY STAFF PARTICIPATE IN THE COMMUNITY NEEDS ASSESSMENT PROCESS WITH THE SAWYER COUNTY HEALTH DEPARTMENT, COMMUNITY HEALTH CLINICS, ASSISTED LIVING FACILITY, AND PHYSICIANS FROM THE COMMUNITY. FOLLOWING THE COMPLETION OF THE ASSESSMENT, VARIOUS WORK GROUPS ARE CONVENED. APPROPRIATE STAFF MEMBERS FROM THE FACILITY THEN WORK WITH COMMUNITY MEMBERS TO DEVELOP PROGRAMS AND APPROACHES TO ADDRESS THE IDENTIFIED HEALTH ISSUES. SOME EXAMPLES INCLUDE ABUSE OF PRESCRIPTION DRUGS, SEXUAL ABUSE PREVENTION PROGRAMS, UNDERAGE ALCOHOL USE, TRANSPORT ISSUES, TELEHEALTH, PATIENT ADVOCACY PROGRAM, AND REDUCED COST CLINIC. |
| PART VI, LINE 3: | ALL PATIENTS ARE BILLED THE SAME, HOWEVER, IF A PATIENT BECOMES DELINQUENT ON A BILL, A LETTER IS SENT TO THE PATIENT ASKING THAT THE PATIENT CONTACT THE BUSINESS FOR ASSISTANCE WITH THE OVERDUE BILL. PATIENTS HAVE THE OPTION TO DISCUSS PAYMENT OPTIONS WITH THE BILLING OFFICE AND POSSIBLE ELIGIBILITY FOR CHARITY CARE. |
| PART VI, LINE 4: | HAYWARD WISCONSIN IS LOCATED IN NORTHERN WISCONSIN AND CONSISTS OF A HIGH MEDICAID POPULATION. HAYWARD SERVES A HIGH MEDICAID AND HIGH MEDICARE POPULATION WITH THE TWO ACCOUNTING FOR 68% OF GROSS REVENUES AND 55% OF NET PATIENT SERVICES REVENUES. HAYWARD IS CONSIDERED A SUMMER VACATION DESTINATION THAT BRINGS LARGE CROWDS DURING THE SUMMER MONTHS. THE EMERGENCY DEPARTMENT SERVES A LARGE NUMBER OF PATIENTS THAT RANGE FROM COMMERCIAL INSURANCE, MEDICARE, MEDICAID, IHS (INDIAN HEALTH SERVICES), ETC. HAYWARD HOSPITAL IS FOCUSED ON PROVIDING HIGH QUALITY HEALTHCARE IN A RURAL LOCATION. MANY SERVICES ARE PROVIDED BY HAYWARD HOSPITAL, ALLOWING LESS PATIENT TRAVEL AT A TIME WHEN THE PATIENT IS LIKELY NOT FEELING WELL. THE HAYWARD COMMUNITY IS AN AGING POPULATION AND WE RECOGNIZE THAT NEED AND HAVE COMMITTED MILLIONS OF DOLLARS INTO SERVICES FOR THE OLDER POPULATION. WE BELIEVE HAYWARD HOSPITAL PROVIDES EXCEPTIONAL CARE IN A RURAL LOCATION. |
| PART VI, LINE 5: | OPEN MEDICAL STAFF. COMMUNITY CALL PROGRAM FOR MEDICAL STAFF. LOCAL COMMUNITY BOARD WITH 11 VOTING MEMBERS. NONPROFIT STATUS WITH PROFITS (IF ANY) USED FOR ADDITIONAL SERVICES, CAPITAL PURCHASES SUCH AS A CT SCANNER, LAB EQUIPMENT, ELECTRONIC HEALTH RECORD, IMPROVED INPATIENT SERVICES, OB PROGRAM, CONTINUED EDUCATION FOR ALL STAFF, GROWING SENIOR SERVICES PROGRAM AND A FOCUS ON THE NEEDS OF THE COMMUNITY. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
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 (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TIM GULLINGSRUD | ||||||||||||||
| CEO - MSI | $184,403 | $0 | $0 | $0 | $0 | $0 | $8,751 | $0 | $31,246 | $0 | $224,400 | $0 | $0 | $0 |
| DANIEL HYMANS | ||||||||||||||
| DIRECTOR/PRESIDENT - REI | $0 | $233,753 | $0 | $14,725 | $0 | $0 | $0 | $9,586 | $0 | $21,066 | $0 | $279,130 | $0 | $0 |
| LES WHITEAKER | ||||||||||||||
| CFO - MMC | $0 | $193,162 | $0 | $32,573 | $0 | $0 | $0 | $6,097 | $0 | $16,822 | $0 | $248,654 | $0 | $0 |
| BRAD ZELLER | ||||||||||||||
| VICE PRESIDENT - MSI | $118,800 | $0 | $11,885 | $0 | $0 | $0 | $5,986 | $0 | $28,068 | $0 | $164,739 | $0 | $0 | $0 |
| JANET MCKICHAN | ||||||||||||||
| VICE PRESIDENT - MSI | $133,698 | $0 | $0 | $0 | $0 | $0 | $6,407 | $0 | $11,867 | $0 | $151,972 | $0 | $0 | $0 |
| HEATHER SHEEHAN | ||||||||||||||
| VICE PRESIDENT - MSI | $123,298 | $0 | $12,000 | $0 | $0 | $0 | $6,156 | $0 | $28,901 | $0 | $170,355 | $0 | $0 | $0 |
| SUSAN BAUER | ||||||||||||||
| CRNA | $178,457 | $0 | $0 | $0 | $0 | $0 | $8,908 | $0 | $23,084 | $0 | $210,449 | $0 | $0 | $0 |
| SUZANNE ULMER | ||||||||||||||
| CRNA | $180,347 | $0 | $0 | $0 | $0 | $0 | $8,930 | $0 | $17,963 | $0 | $207,240 | $0 | $0 | $0 |
| ROBERT TERRY | ||||||||||||||
| CRNA | $180,325 | $0 | $0 | $0 | $0 | $0 | $9,397 | $0 | $24,580 | $0 | $214,302 | $0 | $0 | $0 |
| ALLISON FARLEY | ||||||||||||||
| PHARMACIST/DEPT HEAD | $135,312 | $0 | $0 | $0 | $0 | $0 | $7,109 | $0 | $23,666 | $0 | $166,087 | $0 | $0 | $0 |
| STEVEN KRASEAN | ||||||||||||||
| PHYSICAL THERAPIST/DEPT HE | $133,681 | $0 | $0 | $0 | $0 | $0 | $6,947 | $0 | $23,971 | $0 | $164,599 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | REGIONAL ENTERPRISES, INC. IS THE SOLE CORPORATE MEMBER OF MEDICAL SERVICES, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE PRESIDENT OF REI SHALL BE AN EX OFFICIO MEMBER OF THE MSI BOARD WITH FULL VOTING PRIVILEGES. |
| FORM 990, PART VI, SECTION A, LINE 7B | AS THE SOLE MEMBER OF MEDICAL SERVICES, INC., REGIONAL ENTERPRISES, INC. HAS THE FOLLOWING RESERVE POWERS: A. TO MAKE, AMEND, OR REPEAL MSI'S BYLAWS AND ARTICLES OF INCORPORATION. B. TO APPROVE ANY CHANGE IN MSI'S PHILOSOPHY, MISSION OR VISION STATEMENTS, AND APPROVE THE LONG-RANGE GOALS AND STRATEGIC PLAN FOR MSI. C. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGET. D. TO APPROVE ALL BUILDING PROGRAMS THAT EXCEED $500,000 IN VALUE. E. TO SELECT AND RETAIN AN INDEPENDENT AUDITING FIRM. F. TO APPOVE THE PURCHASE, SALE, LEASE, DISPOSITION, OR ALIENATION OF ANY REAL PROPERTY OWNED BY MSI. ANY SUCH ACTION SHALL BE JOINTLY APPROVED BY THE BOARD OF DIRECTORS OF MEMORIAL MEDICAL CENTER OF ASHLAND, WISCONSIN. G. TO APPROVE ANY PLAN OF DISSOLUTION OR MERGER, CONSOLIDATION, ACQUISITION OR DISPOSITION OF REAL PROPERTY OR RELOCATION OF THE FACILITIES OF MSI. ANY SUCH ACTION SHALL BE JOINTLY APPROVED BY THE BOARD OF DIRECTORS OF MEMORIAL MEDICAL CENTER OF ASHLAND, WISCONSIN. H. TO AUTHORIZE THE PRESIDENT OF REI TO RECOMMEND TO THE BOARD OF MSI, THE INDIVIDUAL WHO WILL SERVE AS THE CHIEF ADMINISTRATIVE OFFICER FOR MSI, SUBJECT TO RATIFICATION BY THE MSI BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FINANCE AND ACCOUNTING TEAM REVIEW THE 990 PRIOR TO FILING TO CONFIRM ACCURACY OF INFORMATION. THE 990 IS REVIEWED BY THE BOARD OF DIRECTORS BEFORE IT IS FILED. IF ANY CHANGES ARE MADE, A FINAL COPY OF THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH DIRECTOR AND OFFICER SHALL DISCLOSE TO THE BOARD OF DIRECTORS, OR TO THE OTHER MEMBERS OF ANY COMMITTEE CONSIDERING A PROPOSED BUSINESS TRANSACTION OR ARRANGEMENT, THE EXISTENCE AND NATURE OF ANY FINANCIAL INTEREST SUCH PERSON OR A MEMBER OF SUCH PERSON'S FAMILY MAY HAVE WITH RESPECT TO SUCH PROPOSED TRANSACTION OR ARRANGEMENT. EACH DIRECTOR AND PRINCIPAL OFFICER SHALL PROMPTLY MAKE DISCLOSURES AS MAY BE NECESSARY TO KEEP THE BOARD OR COMMITTEE FULLY APPRISED OF SUCH PERSON'S FINANCIAL INTERESTS. DISCLOSURE SHALL ALSO BE ACCOMPLISHED ON AN ANNUAL BASIS BY HAVING EACH DIRECTOR AND PRINCIPAL OFFICER EXECUTE AND DELIVER TO MSI A CERTIFICATE REGARDING CONFLICTS OF INTEREST. IF ANY DIRECTOR OR PRINCIPAL OFFICER DISCLOSES A POTENTIAL FINANCIAL INTEREST TO THE BOARD OF DIRECTORS OR ANY COMMITTEE REGARDING A PROPOSED TRANSACTION OR ARRANGEMENT, THE BOARD OR COMMITTEE SHALL FIRST DETERMINE WHETHER THE PROPOSED TRANSACTION OR ARRANGEMENT COULD BE CONSIDERED AN INSIDER TRANSACTION. IF THE BOARD OR COMMITTEE IS CERTAIN THAT THE TRANSACTION OR ARRANGEMENT WILL NOT INVOLVE AN INSIDER, THE INTERESTED PERSON SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE FINANCIAL INTEREST IS DISCUSSED. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. IF IT IS DETERMINED NO CONFLICT EXISTS, THE INTERESTED PERSON MAY REJOIN THE MEETING AND PARTICIPATE IN THE DISCUSSIONS AND ACTIONS REGARDING THIS AGENDA ITEM. THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER MSI CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN MSI'S BEST INTEREST AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO MSI. IF THE BOARD OR COMMITTEE BELIEVES AN ALTERNATE TRANSACTION COULD BE CONSIDERED THAT WOULD BE MORE ADVANTAGEOUS TO MSI, THE CHAIRPERSON OF THE BOARD OR COMMITTEE SHALL APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION. FURTHER ACTION BY THE BOARD OR COMMITTEE SHALL BE TABLED UNTIL SUCH TIME AS THE DISINTERESTED PERSON HAS BEEN ABLE TO REPORT HIS OR HER FINDINGS TO THE APPROPRIATE GOVERNING BODY. THE BOARD OR COMMITTEE SHALL NOT APPROVE ANY TRANSACTION OR ARRANGEMENT THAT IS NOT IN THE BEST INTERESTS OF MSI AND THAT IS NOT FAIR AND REASONABLE TO MSI. ONCE DISCUSSION AND/OR ACTION REGARDING THE AGENDA ITEM RELATING TO THE DIRECTOR'S FINANCIAL INTEREST HAS BEEN COMPLETED, THE INTERESTED PERSON MAY REJOIN THE BOARD OR COMMITTEE MEETING. IF THE TRANSACTION OR ARRANGEMENT INVOLVES OR MAY INVOLVE AN INSIDER, THE BOARD OR COMMITTEE SHALL FOLLOW THE PROCEDURES ABOVE AND THE INSIDER SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE INSIDER TRANSACTION IS DISCUSSED. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE WHETHER THE TRANSACTION OR ARRANGEMENT UNDER CONSIDERATION COULD CONSTITUTE AN INSIDER TRANSACTION. AS PART OF THIS CONSIDERATION, THE BOARD OR COMMITTEE SHALL ALSO CONSIDER WHETHER THEIR ACTION COULD BE CONSTRUED TO BE AN EXCESS BENEFIT TRANSACTION SUBJECT TO INTERMEDIATE SANCTIONS. IN DETERMINING WHETHER A TRANSACTION OR ARRANGEMENT IS AN EXCESS BENEFIT TRANSACTION, THE BOARD OR COMMITTEE CONSIDERING THE TRANSACTION OR ARRANGEMENT SHOULD REVIEW APPROPRIATE DATA AS TO COMPARABILITY (SUCH AS COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS IN THE REGION, NATIONAL COMPENSATION STUDIES, COMPETING OFFERS RECEIVED BY THE INSIDER, ASSET APPRAISALS OR RENTAL ANALYSES BY QUALIFIED APPRAISERS AND OTHER INFORMATION THAT MAY BE OBTAINED ABOUT COMPARABLE AGREEMENTS, PURCHASES, SALES AND LEASES). THE BOARD OR COMMITTEE MAY RELY ON SUCH INFORMATION OR DATA PROVIDED BY MSI'S MANAGEMENT. THE BOARD OR COMMITTEE SHALL NOT APPROVE ANY TRANSACTION OR ARRANGEMENT THAT IS AN EXCESS BENEFIT TRANSACTION. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A DIRECTOR OR PRINCIPAL OFFICER HAS FAILED TO DISCLOSE A FINANCIAL INTEREST, IT SHALL INFORM THE DIRECTOR OR PRINCIPAL OFFICER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE DIRECTOR OR PRINCIPAL OFFICER AN OPPORTUNITY TO EXPLAIN WHY DISCLOSURE WAS NOT MADE. IF, AFTER HEARING THE RESPONSE OF THE DIRECTOR OR PRINCIPAL OFFICER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE DIRECTOR HAS IN FACT FAILED TO DISCLOSE A FINANCIAL INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND/OR CORRECTIVE ACTION, WHICH MAY INCLUDE, BUT NOT BE LIMITED TO: SUSPENSION OF VOTING RIGHTS, RECISION OF ANY AGREEMENTS, AND TERMINATION OF DIRECTOR OR OFFICER STATUS. |
| FORM 990, PART VI, SECTION B, LINE 15 | HR WILL RESEARCH SALARY DATA FOR OUR REGION AND PROVIDE ADMINISTRATION WITH A TYPICAL COMPENSATION RANGE. DIFFICULT POSITIONS TO FILL, DEMANDS OF THE POSITION, EXPERIENCE, EDUCATION, PAST WORK HISTORY, AND REFERENCES ARE ALL TAKEN INTO CONSIDERATION WHEN DETERMINING COMPENSATION. UPDATES TO THE RANGES ARE PUT INTO PLACE AROUND APRIL OR MAY EACH YEAR, IF CHANGES OCCURRED. |
| FORM 990, PART VI, SECTION C, LINE 18 | A PUBLIC DISCLOSURE COPY OF THE TAX RETURN IS AVAILABLE BY REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE BY REQUEST FROM THE PUBLIC RELATIONS DIRECTOR FOR THE SAME PERIOD OF DISCLOSURE SET FORTH IN SECTION 6104(D). THE GOVERNING DOCUMENTS THAT ARE CONFIDENTIAL AND NOT AVAILABLE TO THE PUBLIC. |
| FORM 990, PART VII | TIM GULLINGSRUD: TIME ALLOCATION: EMPLOYMENT AS CEO - MSI: 37 HOURS PER WEEK BOARD OF DIRECTORS - MSI: 1 HOUR PER WEEK BOARD OF DIRECTORS - REI: 1 HOUR PER WEEK BOARD OF DIRECTORS - REIMC: 1 HOUR PER WEEK MEDICAL SERVICES, INC COMPENSATION: CEO - MSI REPORTABLE COMPENSATION: $184,406 CEO - MSI OTHER COMPENSATION: $39,997 BOARD REPORTABLE COMPENSATION: $ 0 BOARD OTHER COMPENSATION: $ 0 JASON DOUGLAS: TIME ALLOCATION: EMPLOYMENT AS PRESIDENT - REI: 36 HOURS PER WEEK BOARD OF DIRECTORS - MSI: 1 HOUR PER WEEK BOARD OF DIRECTORS - REI: 1 HOUR PER WEEK BOARD OF DIRECTORS - REIMC: 1 HOUR PER WEEK BOARD OF DIRECTORS - MMC: 1 HOUR PER WEEK MEMORIAL MEDICAL CENTER COMPENSATION: PRESIDENT - REI REPORTABLE COMPENSATION: $92,144 PRESIDENT - REI OTHER COMPENSATION: $7,372 BOARD REPORTABLE COMPENSATION: $ 0 BOARD OTHER COMPENSATION: $ 0 DANIEL HYMANS: TIME ALLOCATION: EMPLOYMENT AS PRESIDENT - REI: 36 HOURS PER WEEK BOARD OF DIRECTORS - MSI: 1 HOUR PER WEEK BOARD OF DIRECTORS - REI: 1 HOUR PER WEEK BOARD OF DIRECTORS - REIMC: 1 HOUR PER WEEK BOARD OF DIRECTORS - MMC: 1 HOUR PER WEEK MEMORIAL MEDICAL CENTER COMPENSATION: PRESIDENT - REI REPORTABLE COMPENSATION: $248,478 PRESIDENT - REI OTHER COMPENSATION: $30,652 BOARD REPORTABLE COMPENSATION: $ 0 BOARD OTHER COMPENSATION: $ 0 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MEMORIAL MEDICAL CENTER INC | |||||||||||
| 1615 MAPLE LANE | ASHLAND | WI | 54806 | 237013497 | MEDICAL SERVICES | WI | 501(C)(3) | LINE 3 | REGIONAL ENTERPRISES INC | Yes (1) | |
| REGIONAL ENTERPRISES INC | |||||||||||
| 1615 MAPLE LANE | ASHLAND | WI | 54806 | 391555837 | SUPPORT | WI | 501(C)(3) | LINE 11B, II | 0 | N/A | |
| REI MEDICAL CLINICS INC | |||||||||||
| 1615 MAPLE LANE | ASHLAND | WI | 54806 | 391701306 | SUPPORT | WI | 501(C)(3) | LINE 11B, II | REGIONAL ENTERPRISES INC | Yes (1) | |
| 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 | 0 | 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 | Yes (1) | 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 | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments