WINONA HEALTH SERVICES: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
WINONA HEALTH SERVICES (EIN 41-0713914)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-14
IRS object ID
201312269349301746
Schema version
2011v1.5
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

FieldValueIRS element (for citing)
Timestamp2013-08-14T12:39:48-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN411765929EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1800 NICOLLET MALL STE 1300AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code554027033ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN410713914EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1WINONA HEALTH SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWINONameControl
Phone5074543650Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1855 MANKATO AVENUEAddressLine1
CityWINONACity
StateMNState
ZIP Code55987ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMICHAEL ALLENName
TitleCFOTitle
Phone5074543650Phone
Date Signed2013-08-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKIM HUNWARDSEN CPAName
PTINP00484560PTIN
Phone6122536500Phone
Date Prepared2013-08-12DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRACHELLE HEISING-SCHULTZNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1855 MANKATO AVENUEAddressLine1
CityWINONACity
StateMNState
ZIP Code55987ZIPCode
FieldValueIRS element (for citing)
Gross Receipts124636458GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.WINONAHEALTH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1894YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionHOSPITAL SERVICESActivityOrMissionDescription
Nbr Voting Members Governing Body17NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees1106TotalNbrEmployees
Total Nbr Volunteers414TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year530982ContributionsGrantsPriorYear
Contributions Grants Current Year781739ContributionsGrantsCurrentYear
Program Service Revenue Prior Year102395845ProgramServiceRevenuePriorYear
Program Service Revenue CY109670610ProgramServiceRevenueCY
Investment Income Prior Year410611InvestmentIncomePriorYear
Investment Income Current Year603359InvestmentIncomeCurrentYear
Other Revenue Prior Year-268OtherRevenuePriorYear
Other Revenue Current Year1348605OtherRevenueCurrentYear
Total Revenue Prior Year103337170TotalRevenuePriorYear
Total Revenue Current Year112404313TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year30871GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY37099GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year53776883SalariesEtcPriorYear
Salaries Etc Current Year57585719SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year46082451OtherExpensePriorYear
Other Expenses Current Year49374749OtherExpensesCurrentYear
Total Expenses Prior Year99890205TotalExpensesPriorYear
Total Expenses Current Year106997567TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3446965RevenuesLessExpensesPriorYear
Revenues Less Expenses CY5406746RevenuesLessExpensesCY
Total Assets BOY92070031TotalAssetsBOY
Total Assets EOY103453716TotalAssetsEOY
Total Liabilities BOY41248582TotalLiabilitiesBOY
Total Liabilities EOY46575471TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY50821449NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY56878245NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionDEVOTED TO IMPROVING THE HEALTH AND WELL-BEING OF OUR FAMILY, FRIENDS AND NEIGHBORS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense96942963Expense
Grants37099Grants
Revenue111019215Revenue
DescriptionWINONA HEALTH SERVICES (WHS), A 99-BED HOSPITAL, HAS A 118-YEAR HISTORY OF PROVIDING CARE TO ITS COMMUNITY AND SERVICES FROM BIRTH TO DEATH. IT IS THE SOLE COMMUNITY PROVIDER IN THE WINONA, MINNESOTA AREA. IN FISCAL YEAR 2012, WHS HAD 2,783 ADMISSIONS; 347 BIRTHS; 3,151 INPATIENT AND OUTPATIENT SURGERIES; AND 17,709 VISITS TO THE EMERGENCY ROOM.TO FULFILL ITS MISSION OF COMMUNITY SERVICE, THE CORPORATION PROVIDES CARE TO PATIENTS AND RESIDENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE AND COMMUNITY BENEFIT POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE CORPORATION DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS PATIENT AND RESIDENT SERVICE REVENUE.CHARITY CARE: WHS PROVIDES MEDICAL CARE TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. TOTAL CHARITY CARE COST WAS $548,267 FOR FY 2012. IN FURTHERANCE OF ITS CHARITABLE PURPOSE, THE CORPORATION PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY. THESE SERVICES AND DONATIONS ACCOUNT FOR A MEASURABLE PORTION OF THE CORPORATION'S COSTS AND SERVE TO PROMOTE HEALTHY LIFE STYLES, COMMUNITY DEVELOPMENT, HEALTH EDUCATION, AND AFFORDABLE ACCESS TO CARE.THE CORPORATION MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF COMMUNITY BENEFIT SERVICES IT PROVIDES. THOSE RECORDS INCLUDE MANAGEMENT'S ESTIMATE OF THE COST TO PROVIDE CHARITY CARE, THE COST OF SERVICES AND SUPPLIES FURNISHED FOR COMMUNITY BENEFIT PROGRAMS AND COSTS IN EXCESS OF PROGRAM PAYMENTS FOR TREATING MEDICAL ASSISTANCE PATIENTS.IN ADDITION TO COMMUNITY BENEFIT COSTS, THE CORPORATION PROVIDES ADDITIONAL COMMUNITY CONTRIBUTIONS SUCH AS SERVICES TO MEDICARE AND MEDICAID PATIENTS BELOW THE COSTS FOR TREATMENT, OTHER UNCOMPENSATED CARE, DISCOUNTED PRICING TO THE UNINSURED, AND PAYS TAXES AND FEES.Description
Total Program Service Expense96942963TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109682NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1106NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members17NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1MICHAEL ALLENBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5074543650TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1855 MANKATO AVENUEAddressLine1
CityWINONACity
StateMNState
ZIP Code55987ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
GARY EVANS
CHAIR5.00XX000
JAN BROSNHAN
DIRECTOR5.00X000
SCOTT BIESANZ
DIRECTOR5.00X000
SCOTT BIRDSALL MD
DIRECTOR45.00X332815052228
MATTHEW BROGHAMMER MD
DIRECTOR45.00X347069062309
VICKI DECKER
DIRECTOR5.00X000
RICHARD FERRIS MD
DIRECTOR45.00X224969058855
JIM KILLIAN
DIRECTOR5.00X000
HERB HIGHUM
DIRECTOR5.00X000
RICK IGLESIAS
DIRECTOR5.00X000
KEN MOGREN
DIRECTOR6.00X000
HUGH MILLER
DIRECTOR5.00X000
KIM SCHWAB
DIRECTOR5.00X000
DANIEL PARKER MD
DIRECTOR/CHIEF OF STAFF45.00X225707043606
MARK WAGNER
DIRECTOR5.00X000
STEVE BLUE
DIRECTOR6.00X000
RACHELLE HEISING-SCHULTZ
CEO/PRESIDENT42.00XX411144066873
MICHAEL ALLEN
CFO/TREASURER42.00X231857046214
SARA GABRICK
CNO40.00164060036789X
TIMOTHY GABRIELSON MD
ORTHOPEDIC SURGEON40.00489225081790X
LEROY TROMBETTA MD
GENERAL SURGEON40.00421578085193X
AMARJIT VIRDI MD
ANESTHESIOLOGIST40.00384714085382X
GARY HAYES MD
ORAL SURGEON40.00392109077976X
BRETT WHYTE MD
EMERGENCY PHYSICIAN40.00378721056284X
FieldValueIRS element (for citing)
Total Reportable Comp From Org4003968TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation753499TotalOtherCompensation
Number Individuals GT100 K68NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
RADIOLOGY CONSULTANTS OF WINONA LLC
23273 BLACKBERRY RDWINONAMN55987RADIOLOGIST1198664
SARNIA REALTY
PO BOX 1096WINONAMN55987PROPERTY LEASE1163907
SODEXO INC & AFFILIATES
4880 PAYSPHERE CIRCLECHICAGOIL60674HOSPITALITY/ENVIRONMENTAL SERVICES1026178
LOCUMTENENSCOM
PO BOX 405547ATLANTAGA30387CONTRACTED PHYSICIANS632642
REMEDY MEDICAL SERVICES
2809 E HAMILTON AVEEAU CLAIREWI54701CONTRACTED PHYSICIANS628810
FieldValueIRS element (for citing)
Number Of Contractors GT100 K16NumberOfContractorsGT100K
Related Organizations347100RelatedOrganizations
All Other Contributions434639AllOtherContributions
Noncash Contributions3050NoncashContributions
Total Contributions781739TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE REVENU6221109505467195054671
PURCHASED SERVICE REVE9000991032038310320383
SUPPORTING REVENUE90009942955564295556
FieldValueIRS element (for citing)
Total Program Service Revenue109670610TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column453376TotalRevenueColumn
Exclusion$453,376ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities6598820Securities
Other36634Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities6485471Securities
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities113349Securities
Other36634Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column149983TotalRevenueColumn
Exclusion$149,983ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory7095279GrossSalesOfInventory
Cost Of Goods Sold5746674CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column1348605TotalRevenueColumn
Related Or Exempt Function Income1348605RelatedOrExemptFunctionIncome

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column112404313TotalRevenueColumn
Related Or Exempt Function Income111019215RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$603,359ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total37099Total
Program Services37099ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2390313Total
Program Services1212022ProgramServices
Management And General1178291ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total43099185Total
Program Services40586339ProgramServices
Management And General2512846ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1434964Total
Program Services1408054ProgramServices
Management And General26910ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total7744025Total
Program Services6499728ProgramServices
Management And General1244297ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2917232Total
Program Services2689546ProgramServices
Management And General227686ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total96589Total
Management And General96589ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total120301Total
Management And General120301ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total20781Total
Management And General20781ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total15584589Total
Program Services14851767ProgramServices
Management And General732822ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total386165Total
Program Services193253ProgramServices
Management And General192912ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total4317025Total
Program Services3592251ProgramServices
Management And General724774ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total139560Total
Management And General139560ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total9598786Total
Program Services9588928ProgramServices
Management And General9858ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total558677Total
Program Services442553ProgramServices
Management And General116124ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total26250Total
Program Services26250ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total1792985Total
Management And General1792985ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total4418394Total
Program Services4158849ProgramServices
Management And General259545ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total822620Total
Program Services822620ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES66942546694254
BAD DEBT EXPENSE27764382776438
MN CARE TAX13072831307283
LOSS ON REFINANCING658323658323

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total55729Total
Program Services55729ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total106997567Total
Program Services96942963ProgramServices
Management And General10054604ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY13407607BOY
EOY16523772EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY11425369BOY
EOY14465169EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1836482BOY
EOY2122472EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY505539BOY
EOY713647EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis90139800LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec47879473LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY43745543BOY
EOY42260327EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY13378287BOY
EOY19028743EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY480786BOY
EOY600586EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY554007BOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY2049076BOY
EOY2014538EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY4687335BOY
EOY5724462EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY92070031BOY
EOY103453716EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY8701586BOY
EOY10673194EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY31032613BOY
EOY31410310EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1514383BOY
EOY4491967EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY41248582BOY
EOY46575471EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY50821449BOY
EOY56878245EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY50821449BOY
EOY56878245EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY92070031BOY
EOY103453716EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses5406746ReconcilationRevenueExpenses
Reconcilation Other Changes650050ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis4141674OtherCostOrOtherBasis
Book Value4141674BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis51674253OtherCostOrOtherBasis
Depreciation24090561Depreciation
Book Value27583692BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis32236646OtherCostOrOtherBasis
Depreciation23069369Depreciation
Book Value9167277BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2087227OtherCostOrOtherBasis
Depreciation719543Depreciation
Book Value1367684BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings42260327TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
RECEIVABLE FROM AFFILIATED ORGANIZATIONS2782966
DEFERRED BOND ISSUE COSTS, NET436496
MALPRACTICE INSURANCE RECEIVABLE2505000
FieldValueIRS element (for citing)
Total Book Value Other Assets5724462TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
ESTIMATED THIRD PARTY PAYOR SETTLEMENTS$833,477
DUE TO AFFILIATED ORGANIZATIONS$1,153,490
DEFERRED LIABILITY$2,505,000
FieldValueIRS element (for citing)
Total Of Amounts4491967TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE CORPORATION AND ITS CONSOLIDATED ENTITIES ARE ORGANIZED AS MINNESOTA NONPROFIT ENTITIES, EXCEPT FOR THE PHARMACY, AND ARE ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, ALL ENTITIES ARE SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO THEIR EXEMPT PURPOSE. THE CORPORATION FILES AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS TO REPORT ITS UNRELATED BUSINESS TAXABLE INCOME. THE CORPORATION BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND, AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE CORPORATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE, IF SUCH INTEREST AND PENALTIES ARE INCURRED. THE CORPORATION'S FEDERAL FORM 990T FILING FOR THE YEAR ENDING SEPTEMBER 30, 2011 IS SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent0FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served435PersonsServed
Total Community Benefit Expense548535TotalCommunityBenefitExpense
Net Community Benefit Expense548535NetCommunityBenefitExpense
Percent Of Total Expense0.00530PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense14334079TotalCommunityBenefitExpense
Direct Offsetting Revenue10309336DirectOffsettingRevenue
Net Community Benefit Expense4024743NetCommunityBenefitExpense
Percent Of Total Expense0.03860PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served435PersonsServed
Total Community Benefit Expense14882614TotalCommunityBenefitExpense
Direct Offsetting Revenue10309336DirectOffsettingRevenue
Net Community Benefit Expense4573278NetCommunityBenefitExpense
Percent Of Total Expense0.04390PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs16NumberOfActivitiesOrPrograms
Persons Served4244PersonsServed
Total Community Benefit Expense60186TotalCommunityBenefitExpense
Direct Offsetting Revenue7953DirectOffsettingRevenue
Net Community Benefit Expense52233NetCommunityBenefitExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Persons Served1163PersonsServed
Total Community Benefit Expense433415TotalCommunityBenefitExpense
Net Community Benefit Expense433415NetCommunityBenefitExpense
Percent Of Total Expense0.00420PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served35PersonsServed
Total Community Benefit Expense20166430TotalCommunityBenefitExpense
Direct Offsetting Revenue19099464DirectOffsettingRevenue
Net Community Benefit Expense1066966NetCommunityBenefitExpense
Percent Of Total Expense0.01020PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Persons Served6469PersonsServed
Total Community Benefit Expense177361TotalCommunityBenefitExpense
Net Community Benefit Expense177361NetCommunityBenefitExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs29NumberOfActivitiesOrPrograms
Persons Served11911PersonsServed
Total Community Benefit Expense20837392TotalCommunityBenefitExpense
Direct Offsetting Revenue19107417DirectOffsettingRevenue
Net Community Benefit Expense1729975NetCommunityBenefitExpense
Percent Of Total Expense0.01660PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs29NumberOfActivitiesOrPrograms
Persons Served12346PersonsServed
Total Community Benefit Expense35720006TotalCommunityBenefitExpense
Direct Offsetting Revenue29416753DirectOffsettingRevenue
Net Community Benefit Expense6303253NetCommunityBenefitExpense
Percent Of Total Expense0.06050PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served582PersonsServed
Total Community Building Expense38191TotalCommunityBuildingExpense
Net Community Building Expense38191NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served22PersonsServed
Total Community Building Expense55TotalCommunityBuildingExpense
Net Community Building Expense55NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served1280PersonsServed
Total Community Building Expense25110TotalCommunityBuildingExpense
Net Community Building Expense25110NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served55PersonsServed
Total Community Building Expense416TotalCommunityBuildingExpense
Net Community Building Expense416NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Persons Served1939PersonsServed
Total Community Building Expense63772TotalCommunityBuildingExpense
Net Community Building Expense63772NetCommunityBuildingExpense
Percent Of Total Expense0.00060PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$1,679,745BadDebtExpenseAmount
Amount Attributable To671898AmountAttributableTo
Amount Reimbursed By Medicare17932563AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare18689081CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-756518MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line11 WINONA AREA AMBULANCE SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityAMBULANCE SERVICESDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.50000OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership0.50000OfficersEtcProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1WINONA HEALTH SERVICESBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1855 MANKATO AVENUEAddressLine1
CityWINONACity
StateMNState
ZIP Code55987ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
OtherURGENT CARE & 2 PROVIDER BASED CLINICSOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1WINONA HEALTH SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted0CHNAConducted
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent300.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Lowest Negotiated RatesXLowestNegotiatedRates
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities1NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

FieldValueIRS element (for citing)
Business Name Line1WATKINS MANORBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1175 E WABASHA STREETAddressLine1
CityWINONACity
StateMNState
ZIP Code55987ZIPCode
FieldValueIRS element (for citing)
Facility TypeASSISTED LIVINGFacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS INCLUDED IN THE ANNUAL REPORT AND SENT TO 28,000 HOUSEHOLDS. COMMUNITY BENEFIT INFORMATION IS LISTED IN QUARTERLY NEWSLETTERS AND ON THE WEBSITE. INFORMATION IS ALSO INCLUDED IN THE WAITING ROOMS.
PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, HEALTH PROFESSIONS EDUCATION, LINE 7F, AND CASH AND IN-KIND DONATIONS, LINE 7K WERE ACTUAL EXPENSES COMPILED USING THE CBISA SOFTWARE. THE COST FOR SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT.
PART I, LINE 7G: THE AMOUNT OF COST ATTRIBUTABLE TO A PHYSICIAN CLINIC IS $2,510,511.
PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES TO DETERMINE THE PERCENTAGE WAS $2,776,438.
PART II: COMMUNITY BUILDING ACTIVITIES ALLOW WINONA HEALTH SERVICES TO BETTER ASSIST THE COMMUNITY IT SERVES THROUGH BETTER PATIENT ACCESS, IMPROVING QUALITY OF CARE, AND ASSISTING THOSE VULNERABLE POPULATIONS IN A WAY THAT MAKES THEIR LIVELIHOOD A LITTLE EASIER AMONG OTHER THINGS. THESE ACTIVITIES ALSO ALLOW THE COMMUNITY AND STAFF TO BE BETTER PREPARED IF A DISASTER OR EMERGENCY WERE TO STRIKE. THESE ACTIVITIES ALLOW WINONA HEALTH SERVICES TO BE AS PREPARED AS POSSIBLE TO BEST ASSIST THE COMMUNITY WE SERVE.PROGRAMS LIKE HEALTHY KIDS CLUB INVOLVE SEVERAL COMMUNITY PARTNERS TO ADDRESS THIS HEALTH ISSUE IN OUR COMMUNITY, WITHOUT PUTTING THE FOCUS SPECIFICALLY ON WEIGHT LOSS. HEALTHY KIDS CLUB IS A FREE, FUN, COMMUNITY-WIDE PROGRAM DESIGNED TO ENCOURAGE CHILDREN AGES 6 TO 11 TO LIVE HEALTHY - FROM MAKING HEALTHFUL FOOD CHOICES TO MAINTAINING ACTIVE LIFESTYLES. AREA SCHOOLS AND NINE AREA NONPROFIT ORGANIZATIONS SUCH AS THE FAMILY YMCA, WINONA COUNTY PARKS AND RECREATION AND UNITED WAY OF THE GREATER WINONA AREA ARE STRONG COMMUNITY PARTNERS. STAFF INVOLVEMENT IN BUILDING A HOME FOR HABITAT FOR HUMANITY COMPLIMENTS OUR MISSION TO TAKE CARE OF THOSE IN OUR COMMUNITY AND PROMOTES TEAM BUILDING WITHIN THE ORGANIZATION. INVOLVEMENT WITH LOCAL SCHOOLS THROUGH CAREER EXPLORATION AND TOURS OF OUR ORGANIZATION PROMOTES THE IMPORTANCE OF HEALTHCARE AND SERVING OUR COMMUNITY. WE EXIST TO CARE FOR THOSE WHO NEED US AND SHARE THIS MESSAGE WITH STUDENTS THINKING OF ENTERING THE HEALTHCARE FIELD. OUR STAFF WORKED CLOSELY WITH WINONA WORKFORCE CENTER TO HELP TRAIN THEIR CLIENTS AND SUPERVISE THEM IN VARIOUS JOBS. STAFF ALSO SPENT TIME AT THE SE REGIONAL HOSPITAL CONSORTIUM AT MAYO LEARNING HOW TO PREPARE FOR COMMUNITY EMERGENCIES. COMMUNITY OUTREACH IS SOMETHING ENCOURAGED FOR ALL STAFF BECAUSE IT'S NOT ONLY THE RIGHT THING TO DO, BUT IT IS PART OF OUR MISSION AS WELL.
PART III, LINE 4: BAD DEBT EXPENSE IS REPORTED AT CHARGES AS RECORDED BY THE ORGANIZATION.WHS DETERMINES BAD DEBT EXPENSE BY ESTIMATING WHAT MAY NOT BE COLLECTIBLE FROM PATIENT BALANCES AFTER TAKING INTO ACCOUNT APPROPRIATE DISCOUNTS AND PAYMENTS (UNINSURED DISCOUNT, ELIGIBLE CHARITY CARE DISCOUNTS/ADJUSTMENTS, AND PAYMENTS RECEIVED AND EXPECTED TO BE RECEIVED.) PAYMENTS ON ACCOUNTS THAT WERE WRITTEN OFF AS BAD DEBT REDUCES BAD DEBT EXPENSE IN THE CURRENT YEAR.WHS IS ESTIMATING THAT 40% OF BAD DEBT ACCOUNTS WOULD LIKELY QUALIFY FOR THE ORGANIZATION'S CHARITY CARE GUIDELINES IF THE PATIENT WOULD HAVE BEEN IDENTIFIED AND FOLLOWED THROUGH ON THE APPLICATION PROCESS. THIS PERCENTAGE IS BASED ON HISTORICAL KNOWLEDGE ON THOSE BEING PROVIDED APPLICATIONS AND THOSE ACTUALLY COMPLETING THE APPLICATIONS TO QUALIFY.THE CARRYING AMOUNT OF PATIENT AND RESIDENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS, RESIDENTS, AND THIRD-PARTY PAYORS. MANAGEMENT REVIEWS PATIENT AND RESIDENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS AND RESIDENTS DUE TO BAD DEBTS. MANAGEMENT CONSIDERS HISTORICAL WRITE OFF AND RECOVER INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION.
PART III, LINE 8: WHS PROVIDES SERVICES TO PATIENTS UNDER THE MEDICARE PROGRAM KNOWING THEY WILL NOT RECOVER ALL THE COSTS ASSOCIATED WITH PROVIDING THESE SERVICES. PROVIDING THESE SERVICES IS ESSENTIAL TO THESE PATIENTS AND THE COMMUNITY AND INCREASES THEIR ACCESS TO HEALTHCARE SERVICES. THEREFORE, THE ENTIRE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. THE ORGANIZATION REPORTED ONLY THOSE ALLOWABLE COSTS AND MEDICARE REIMBURSEMENTS REPORTED IN THE MEDICARE COST REPORT FOR THE YEAR.TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CMS.
PART III, LINE 9B: IN KEEPING WITH THE MISSION, VISION AND VALUES OF WINONA HEALTH SERVICES, OUR ORGANIZATION IS COMMITTED TO GIVING A PATIENT EVERY OPPORTUNITY TO PAY THEIR MEDICAL DEBT IN FULL OR TO MAKE ARRANGEMENTS BASED ON ORGANIZATIONAL POLICY. WHEN A PATIENT IS IN THE PROCESS OF APPLYING FOR FINANCIAL ASSISTANCE, WHETHER CHARITY CARE OR AN INTEREST FREE PAYMENT PLAN, THERE WILL BE NO COLLECTION EFFORTS. COLLECTION EFFORTS INCLUDE PHONE CONTACTS, LETTERS, PATIENT INTERVIEWS AND FILING A JUDGEMENT AGAINST THE PATIENT AND POTENTIAL GARNISHMENT OF WAGES. AFTER A DETERMINATION OF FINANCIAL ASSISTANCE, ANY PERSONAL PORTION DUE FOLLOWS THE SAME COLLECTION PROCEDURES AS OTHER ACCOUNTS.
PART VI, LINE 2: WINONA HEALTH SERVICES (WHS) USES A VARIETY OF METHODS TO LISTEN TO ITS CUSTOMERS, AND THE METHODOLOGIES VARY BY CUSTOMER GROUPS. THE DEVELOPMENT OF MOST MAJOR SERVICES INCLUDES THE MEETING OF A COMMUNITY ADVISORY GROUP TO ASSESS OPERATIONS AND PLANS AND PROVIDE RECOMMENDATIONS TO THE LEADERSHIP TEAM. WHS ALSO USES POINT OF CARE FEEDBACK COMMENT CARDS, FOCUS GROUPS, ADVISORY COMMITTEES COMPRISED OF COMMUNITY INDIVIDUALS, AND WEB AND CONSUMER NEWSLETTER SURVEYS TO CAPTURE FEEDBACK FROM PATIENTS/RESIDENTS AND COMMUNITY. IMMEDIATE FEEDBACK IS OBTAINED FROM PATIENTS/RESIDENTS AND COMMUNITY THROUGH PRE- AND POST-SERVICE CALLS, ROUNDING, AND INFORMAL SURVEYS. WHS ALSO WORKS WITH LOCAL NON-PROFIT ORGANIZATIONS GATHERING FEEDBACK FROM LOCAL AGENCIES AND THEIR BOARDS TO ENSURE COMMUNITY NEEDS ARE BEING MET. AS A RESULT OF FEEDBACK AND THE ECONOMY, WINONA HEALTH SERVICES, WINONA COUNTY AND WINONA STATE UNIVERSITY RECENTLY OPENED A FREE COMMUNITY HEALTH CLINIC ON OUR CAMPUS FOR THOSE WITHOUT INSURANCE. THIS FREE CLINIC IS OPEN QUARTERLY, BUT IF THE DEMAND INCREASES, MAY BE OPEN MORE FREQUENTLY. IN 2010, WINONA HEALTH SERVICES, UNITED WAY OF THE GREATER WINONA AREA AND WINONA AREA COMMUNITY FOUNDATION WORKED TOGETHER GATHERING INFORMATION FOR A COMMUNITY NEEDS ASSESSMENT. WHS AND WINONA COUNTY PUBLIC HEALTH BEGAN WORKING ON THE COMMUNITY HEALTH NEEDS ASSESSMENT IN LATE FY 2012 WITH THE REPORT EXPECTED TO BE PUBLISHED DURING FY 2013.
PART VI, LINE 3: WHS PLACES PAMPHLETS THAT CONTAIN INFORMATION ABOUT OUR CHARITY CARE PROGRAMS AND POLICIES THROUGHOUT THE ORGANIZATION, INCLUDING ALL PATIENT ACCESS AREAS. IN ADDITION, INFORMATION CAN BE FOUND ON OUR WEBSITE OR BY CALLING THE WHS BUSINESS OFFICE EITHER LOCALLY OR TOLL-FREE. WHS ALSO SENDS OUT A COVER LETTER WITH ALL FIRST TIME SELF-PAY STATEMENTS WHICH EXPLAINS OPTIONS FOR CHARITY CARE, GOVERNMENT PROGRAM ASSISTANCE, AND OUR UNINSURED DISCOUNT PROGRAM. IN ADDITION, THE WHS SOCIAL SERVICES DEPARTMENT AND/OR A CONTRACTED PATIENT ADVOCATE MAY MEET WITH IN-HOUSE OR RECENTLY DISCHARGED PATIENTS TO GO OVER ALL THE PAYMENT OPTIONS WHICH INCLUDE CHARITY CARE, GOVERNMENTAL PROGRAMS, OR OTHER ALTERNATIVE PAYMENT OPTIONS. FINALLY, WHS WORKS WITH THE COUNTY TO HELP INITIATE A SCREENING PROCESS FOR APPLYING FOR GOVERNMENTAL PROGRAMS BY OFFERING THE PATIENTS AN OPPORTUNITY TO LOCK IN AN EFFECTIVE DATE FOR THOSE PROGRAMS IF SUBSEQUENTLY FOUND ELIGIBLE.
PART VI, LINE 4: WHS DEFINES ITS PRIMARY SERVICE AREA AS THE ZIP CODE OF WINONA AND THE IMMEDIATE SURROUNDING AREA WITH A POPULATION BASE OF APPROXIMATELY 35,000 RESIDENTS. ITS SECONDARY SERVICE AREA ENCOMPASSES A 20-MILE RADIUS FROM WINONA REPRESENTING ANOTHER 12,000 RESIDENTS. WHS IS LOCATED BETWEEN TWO LARGE, WELL-KNOWN TERTIARY HEALTH CARE CENTERS, MAYO AND GUNDERSEN LUTHERAN. WHS HAS FOCUSED ON FULFILLING ITS COMMUNITY NEED: A FULL PRIMARY CARE FACILITY. WHS DEFINES ITSELF AS A PRIMARY CARE HEALTH SYSTEM AND PROVIDES ITS PATIENTS AND RESIDENTS CONNECTIONS TO TERTIARY LEVEL SERVICES TO MEET THEIR NEEDS REGIONALLY OR NATIONALLY, AS THE PATIENT CHOOSES. IN 2010, WINONA HAD A MEDIAN HOUSEHOLD INCOME OF $36,296 AND 22.3% OF PERSONS WERE BELOW THE POVERTY LEVEL. THE MAJORITY OF OUR PATIENTS LIVE IN WINONA WHICH HAS A POPULATION OF OVER 27,000 PEOPLE. APPROXIMATELY 20% OF OUR PATIENTS ARE UNINSURED AND/OR MEDICAID RECIPIENTS.
PART VI, LINE 5: WHS OFFERS EMERGENCY AND URGENT CARE, PRIMARY CARE FOR ALL AGES, SURGICAL AND SPECIALTY CARE, INPATIENT CARE, AND SENIOR SERVICES. OUR BOARD IS COMPRISED OF PHYSICIANS AND PRIMARILY COMMUNITY MEMBERS. THE BOARD AND MEDICAL STAFF ARE INVOLVED IN OUR STRATEGIC PLANNING WHICH FOCUSES ON THE HEALTH OF OUR COMMUNITY MEMBERS. TO MEET THE NEEDS OF OUR COMMUNITY, THE HOSPITAL EXTENDS PRIVILEGES TO MEDICAL STAFF THAT ARE QUALIFIED THROUGH LICENSURE IN THE STATE OF MINNESOTA. WE ARE INVOLVED IN SEVERAL ON-SITE AND OFF-SITE HEALTH FAIRS OFFERING FREE BLOOD PRESSURE CHECKS, GLUCOSE SCREENINGS AND STAFF EXPERTISE ON HEALTH QUESTIONS. WE ALSO PROVIDE FREE COMMUNITY HEALTH TALKS FOR COMMUNITY MEMBERS ON CERTAIN HEALTH TOPICS. EXCESS FUNDS ARE REINVESTED AND USED FOR PATIENT CARE AND FACILITY UPGRADES.ADDITIONAL PROGRAMS THAT BENEFIT THE COMMUNITY INCLUDE:HEALTH PROFESSIONAL TRAINING: WINONA HEALTH SERVICES WORKS CLOSELY WITH NURSE AND HEALTH PROFESSIONAL EDUCATION PROGRAMS AT WINONA STATE UNIVERSITY, ST. MARY'S UNIVERSITY AND SOUTHEAST TECHNICAL COLLEGE. ALONG WITH TRAINING LPNS AND RNS ON SITE, OTHER STUDENTS GOING INTO FIELDS OF ATHLETIC TRAINING, SOCIAL WORK, NUTRITION, LAB, RADIOLOGY, PHYSICAL THERAPY AND BIO MED ARE ALSO EDUCATED AND MENTORED ON SITE. APPROXIMATELY 536 STUDENTS WORK WITH STAFF IN THE FOLLOWING DEPARTMENTS: MEDICAL/SURGICAL/PEDIATRIC UNIT, FAMILY BIRTH CENTER, INTENSIVE CARE UNIT, EMERGENCY DEPARTMENT, LAB, RADIOLOGY, SOCIAL WORKERS, PHYSICAL AND OCCUPATIONAL THERAPY AND BIO MED.PREVENTIVE CARE: WHS ENCOURAGES PREVENTIVE CARE THROUGH A NUMBER OF RESOURCES. WINONA HEALTH ONLINE IS A FREE WEB-TOOL THAT ALLOWS PATIENTS TO HAVE ACCESS TO THEIR WINONA HEALTH SERVICES RECORDS ANYTIME, ANYWHERE WITH AN INTERNET CONNECTION. PATIENTS CAN DOCUMENT THEIR HEALTH HISTORY, ACCESS DIABETES AND ASTHMA MANAGEMENT PROGRAMS, RECEIVE LAB TEST RESULTS, AND TRACK WELLNESS ACTIVITIES. WINONA HEALTH SERVICES OFFERS A NUMBER OF EDUCATIONAL OPPORTUNITIES FOR THE COMMUNITY, FROM CPR CLASSES TO FREE OR LOW-COST SCREENINGS INCLUDING PROSTATE CANCER, CHOLESTEROL, DEPRESSION, AND MAMMOGRAMS. WHS IS THE MAIN SPONSOR FOR A COMMUNITY-WIDE DIABETES EXPO. COMMUNITY HEALTH TALKS PROVIDE INDIVIDUALS WITH EDUCATIONAL INFORMATION ON A VARIETY OF HEALTH TOPICS AND ARE FREE THROUGHOUT THE YEAR. THE WINONA HEALTH SERVICES OCCUPATIONAL HEALTH DEPARTMENT PRESENTS VARIOUS PREVENTIVE PROGRAMS GEARED TOWARD BUSINESS LEADERS AND HR PROFESSIONALS. THE DEPARTMENT TEAMS UP WITH PHYSICIANS AND LOCAL EXPERTS TO PROVIDE INFORMATION ON A WIDE VARIETY OF BUSINESS-RELATED TOPICS SUCH AS DRUG USE IN THE WORK PLACE, ERGONOMICS, WORKER'S COMPENSATION AND MORE. THESE ARE FREE AND WELL-ATTENDED. THE STAFF ALSO PARTICIPATES IN MANY COMMUNITY COLLABORATIVE HEALTHCARE EVENTS.EMPLOYEE HEALTH: THE HEALTHY U PROGRAM IS A HEALTH MANAGEMENT INCENTIVE INITIATIVE DESIGNED TO SUPPORT AND ENCOURAGE HEALTHY ACTIVITIES FOR OUR EMPLOYEES AND FAMILIES. THE PROGRAM REINFORCES THE EMPHASIS ON PREVENTION, AIMING TO IMPROVE THEIR HEALTH AND WELL-BEING. WELLNESS EVALUATIONS BY A CERTIFIED HEALTH ADVISOR ARE OFFERED FREE TO STAFF. EMPLOYEES CAN EARN CREDITS TIED TO COMPLETION OF PREDETERMINED ACTIVITIES SPECIFIC TO THEIR HEALTH GOALS WHICH COULD RESULT IN AN UP TO $600 SAVINGS IN HEALTH PLAN PREMIUMS. IN ITS FIFTH YEAR, HEALTHY KIDS CLUB IS A COMMUNITY-WIDE PROGRAM FOR CHILDREN 6-11 AND FOCUSES ON TEACHING CHILDREN THE IMPORTANCE OF HEALTH AND WELLNESS AT AN EARLY AGE. COLLABORATING WITH OTHER ORGANIZATIONS IN THE COMMUNITY, THE PROGRAM IS FREE AND HAS SERVICED OVER 3,500 CHILDREN AND FAMILIES, PROVIDED OVER 4,000 HEALTHY SNACKS SINCE ITS OFFICIAL INCEPTION IN 2007. WHS HAS SPENT OVER $95,000 ON THIS ACTIVITY SINCE 1996. AREA SCHOOLS AND NINE AREA NONPROFIT ORGANIZATIONS SUCH AS THE FAMILY YMCA, WINONA COUNTY PARKS AND RECREATION AND UNITED WAY OF THE GREATER WINONA AREA ARE STRONG COMMUNITY PARTNERS. EMERGENCY CARE: WHS PROVIDES 24-HOUR-A-DAY, 365-DAYS-PER-YEAR EMERGENCY CARE TO THE COMMUNITY. IT EMPLOYS FOUR FULL-TIME PHYSICIANS AND SEVERAL MID-LEVEL PROVIDERS AS THE SERVICE CONTINUES TO GROW. WINONA HEALTH SERVICES HAS EXCELLENT RELATIONS WITH NEIGHBORING TERTIARY FACILITIES AND TRANSPORTS PATIENTS AS NEEDED TO LA CROSSE AND ROCHESTER.COMMUNITY RELATIONS: WHS WORKS WITH AREA NONPROFIT ORGANIZATIONS TO SUPPORT HEALTH AND YOUTH-RELATED ACTIVITIES. ITS INVOLVEMENT INCLUDES SENDING PROFESSIONALS TO SPEAK TO CIVIC AND SCHOOL GROUPS. IN FY 2012, STAFF SPOKE TO 705 INDIVIDUALS THROUGH OUR OUTREACH SPEAKER'S BUREAU. WINONA HEALTH SERVICES VACCINATED OVER 705 INDIVIDUALS AT SPECIALLY-SCHEDULED FLU SHOT CLINICS. IN ADDITION, WHS STAFF DELIVERED MEALS-ON-WHEELS TO COMMUNITY MEMBERS THROUGH A LOCAL MEAL DELIVERY PROGRAM AND DONATE THE USE OF THEIR LAND TO A LOCAL GARDEN GROUP WHICH ALLOWED FOR 40 GARDEN PLOTS FOR COMMUNITY MEMBERS TO GROW THEIR OWN FOOD. STAFF MEMBERS ARE ALSO INVOLVED IN SEVERAL NON-PROFIT COMMITTEES, DONATING THEIR TIME TO HELP OUR COMMUNITY. COMMUNITY EDUCATION: WHS'S COMMUNITY EDUCATION PROGRAMMING INCLUDES FREE OR REDUCED-FEE CLASSES ON CHILDBIRTH AND PARENTING, SUPPORT GROUPS FOR BREASTFEEDING, CARDIO-PULMONARY RESUSCITATION, HEALTH CARE DIRECTIVES DIABETES PREVENTION, FIRST AID, AND SMOKING CESSATION. IN FY 2012, WHS SERVED 274 INDIVIDUALS THROUGH THESE CLASSES. STAFF AT LOCAL HEALTH FAIRS SERVED 945 INDIVIDUALS, OFTEN OFFERING FREE BLOOD SUGAR AND BLOOD PRESSURE SCREENINGS. VOLUNTEERS FROM THE WH AUXILIARY OFFER FREE HEALTHCARE DIRECTIVES EDUCATIONAL SESSIONS THROUGHOUT THE YEAR.
MNREPORTS FILED WITH STATESPART VI, LINE 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
WINONA STATE UNIVERSITY FOUNDATION
PO BOX 5838WINONAMN55987237079002501(C)(3)10000WELLNESS CENTER
WINONA HEALTH FOUNDATION
855 MANKATO AVENUEWINONAMN55987411879744501(C)(3)8182GENERAL SUPPORT
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: WINONA HEALTH SERVICES WILL REVIEW SOLICITATIONS FROM OTHER LEGALLY RECOGNIZED, TAX-EXEMPT NONPROFIT ORGANIZATIONS WHOSE WORK BENEFITS THE COMMUNITY BASED ON THE FOLLOWING: A. THE REQUEST ADDRESSES A COMMUNITY HEALTH OR WELLNESS ISSUE. B. THE REQUEST BENEFITS AREA YOUTH IN THE AREAS OF HEALTH AND WELLNESS. C. THE REQUEST SUPPORTS A PROJECT DIRECTLY BENEFITING THE COMMUNITY AND ALIGNED WITH WINONA HEALTH SERVICES' MISSIONS/VISION/VALUES. D. THE REQUEST SUPPORTS KEY WINONA HEALTH SERVICES BUSINESS AND MARKETING STRATEGIES. E. PRIORITY WILL BE GIVEN TO LOCAL NONPROFIT ORGANIZATIONS. F. TYPICALLY, ONLY ONE REQUEST WILL BE AWARDED TO A NONPROFIT IN A GIVEN YEAR. ALL DONATION REQUESTS WILL BE DIRECTED TO THE MARKETING COMMUNICATIONS DEPARTMENT FOR PROCESSING. A. STAFF WILL REVIEW THE REQUEST BASED ON THE ABOVE CRITERIA AND BUDGET PARAMETERS, WITH KEY DONATION DETERMINED YEARLY DURING THE BUDGETING PROCESS. B. THE FOLLOWING PROCESSES WILL BE USED TO REVIEW DONATION REQUESTS: 1. STAFF MAY PROCESS ALL DONATIONS APPROVED DURING THE BUDGETING PROCESS AND THOSE THAT MEET THE CRITERIA AND ARE LESS THAN $500 WITHOUT ADDITIONAL APPROVAL. 2. REQUESTS MEETING THE CRITERIA AND BETWEEN $500-$1,000 OR THOSE REQUESTS THAT REQUIRE FURTHER REVIEW SHOULD BE DISCUSSED WITH THE PRESIDENT/CEO BEFORE RECEIVING APPROVAL. 3. DONATION REQUESTS ABOVE $1,000 OR REQUESTS FOR MULTI-YEAR FUNDING SHOULD GO TO THE BOARD OF DIRECTOR'S PR/MARKETING COMMITTEE FOR REVIEW AND APPROVAL.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
SCOTT BIRDSALL MD
32506507750000301200272410390176000
MATTHEW BROGHAMMER MD
33931907750000402020231420410413000
RICHARD FERRIS MD
21721907750000367470231420284858000
DANIEL PARKER MD
21648009227000203140243260270347000
RACHELLE HEISING-SCHULTZ
348746052678097200411690297400482053000
MICHAEL ALLEN
207101020580041760209360273080280101000
SARA GABRICK
14868001493004500144120234110201883000
TIMOTHY GABRIELSON MD
4872250200000081790010340572049000
LEROY TROMBETTA MD
339379082199000634070228190507804000
AMARJIT VIRDI MD
38271402000000632740231420471130000
GARY HAYES MD
363321077500210380620370169730471119000
BRETT WHYTE MD
3303540378370105300344990228190436039000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 4BTHE FOLLOWING INDIVIDUALS RECEIVED EMPLOYER CONTRIBUTIONS TO A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: MATTHEW BROGHAMMER $8,627 SCOTT BIRDSALL $ 421 THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IS AVAILABLE TO EXECUTIVES, PHYSICIANS, AND MID-LEVEL PROVIDERS AS DETERMINED BY THE BOARD OF DIRECTORS. IT IS FUNDED BY EMPLOYER CONTRIBUTIONS, AND EMPLOYEES ARE VESTED WITHIN FIVE YEARS. AN ALTERNATIVE PLAN IS AVAILABLE WHICH IS FUNDED BY EMPLOYEE CONTRIBUTIONS AND NOT SUBJECT TO FORFEITURE.
PART I, LINE 7SCOTT BIRDSALL, MD, MATTHEW BROGHAMMER, MD, RICHARD FERRIS, MD, DANIEL PARKER, MD, AND GARY HAYES, MD RECEIVED RETENTION BONUSES FOR THE PURCHASE OF WINONA CLINIC LTD. LEROY TROMBETTA RECEIVED A PRODUCTION BONUS OF $80,199.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
CITY OF WINONA
416005651975232CE72012-05-0419887849REFUND REVENUE BONDS ISSUED 7/16/2004000
CITY OF WINONA
416005651975232BQ12007-07-3112779904SEE BELOW FOR COMPLETE DESCRIPTION000

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount RetiredAmountRetiredOther Spent ProceedsOtherSpentProceeds
1988784915556833567811797538520121000
1277990492784316703053400002007101116198006344845

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00000.000000.000000.000001
00000.000000.000000.000001

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
000000
000000

Form990 Schedule K Part VI Form990ScheduleKPartVI (3 entries)

IdentifierIdentifierExplanationExplanation
PART I, LINE B:SCHEDULE K INCLUDES THE ALLOCABLE SHARE OF THE SERIES 2007 TAX-EXEMPT BOND. THE REMAINING SHARE IS REPORTED ON RELATED ORGANIZATION SCHEDULE K, WINONA SENIOR SERVICES, EIN - 41-1936536.
PART I, LINE B, COLUMN (F):REFUNDING OF PRIOR REVENUE BONDS ORIGINALLY ISSUED 8/1/2000 AND 7/1/2004 AND RENOVATION AND ACQUISITION OF PROPERTY ON SARNIA STREET AND PARKS AVENUE.
PART II, LINE 11(A):THE AMOUNT REPORTED ON LINE 11 REPRESENTS THE AMOUNT OF PROCEEDS USED TO REFUND PRIOR BONDS ISSUED IN 2004.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
HIAWATHA BROADBAND COMMUNICATIONS INC
ONE BOARD MEMBER IS OWNER & ONE BOARD MEMBER IS ON THE BOARD OF HBC, INC.243171PURCHASE OF TELEPHONE AND CABLE SERVICES0
WINONA AGENCY
OWNED BY BOARD MEMBER245209PURCHASE OF INSURANCE0
MARIE OLSEN WAGNER
SPOUSE OF BOARD MEMBER70807COMPENSATION AND BENEFITS AS AN EMPLOYEE0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 11. THE EXECUTIVE COMMITTEE SHALL BE RESPONSIBLE FOR TRANSACTING THE BUSINESS OF THE BOARD OF DIRECTORS IN THE INTERIM BETWEEN MEETINGS OF THE FULL BOARD SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD. 2. THE COMMITTEE SHALL ACT ON MATTERS WHICH CANNOT REASONABLY AWAIT ACTION BY THE FULL BOARD OF DIRECTORS. 3. OTHER MATTERS MAY BE DELEGATED TO THE EXECUTIVE COMMITTEE BY THE BOARD OF DIRECTORS, FOR EXAMPLE: - RECRUITMENT, SELECTION, AND EVALUATION OF THE CEO; - REVIEW AND APPROVAL OF A SENIOR EXECUTIVE DEVELOPMENT PLAN AND A CEO SUCCESSION PLAN; - REVIEW AND APPROVAL OF THE INCENTIVE EXPECTATIONS FOR THE EXECUTIVE STAFF; - REVIEW AND APPROVAL OF THE EXECUTIVE COMPENSATION COMMITTEE'S RECOMMENDATIONS; 4. CONDUCT OTHER ACTIVITIES WITHIN THE SCOPE OF THE COMMITTEE'S PURPOSE AND AUTHORITY AS THE BOARD MAY FROM TIME TO TIME DETERMINE; 5. PERIODICALLY REVIEW THE COMMITTEE CHARTER AND MAKE RECOMMENDATIONS TO THE BOARD WITH REGARD TO ANY CHANGES TO THE CHARTER THAT THE COMMITTEE BELIEVES WOULD BE DESIRABLE.
FORM 990, PART VI, SECTION A, LINE 2THE FOLLOWING INDIVIDUALS HAVE BUSINESS RELATIONSHIPS: SCOTT BIESANZ WITH KEN MOGREN GARY EVANS WITH HUGH MILLER SCOTT BIRDSALL WITH RACHELLE HEISING-SCHULTZ AND STEVE BLUE HUGH MILLER WITH ANDY BLOMSNESS RACHELLE SCHULTZ WITH GARY EVANS SCOTT BIRDSALL, MD, MATTHEW BROGHAMMER, MD, RICHARD FERRIS, MD, AND DAN PARKER, MD HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER.
FORM 990, PART VI, SECTION B, LINE 11THE RETURN IS REVIEWED INITIALLY BY THE CFO AND DIRECTOR OF FINANCIAL OPERATIONS. IT IS THEN REVIEWED BY THE EXECUTIVE COMMITTEE BEFORE IT IS FILED.
FORM 990, PART VI, SECTION B, LINE 12CTHE CONFLICT OF INTEREST POLICY COVERS SENIOR LEADERS, DIRECTORS, OFFICERS AND BOARD COMMITTEE MEMBERS. THE POLICY IS SIGNED ANNUALLY AND REVIEWED BY THE CEO FOR CONFLICTS. ANY CONFLICTS ARE BROUGHT TO THE BOARD FOR DISCUSSION. IF A BOARD MEMBER HAS A POTENTIAL CONFLICT, THEY MUST ABSTAIN FROM VOTING.
FORM 990, PART VI, SECTION B, LINE 15THE EXECUTIVE COMMITTEE HAS A PROCESS IN PLACE FOR DETERMINING COMPENSATION FOR THE CEO AND CFO BASED ON RESULTS OF A COMPENSATION STUDY, APPROVAL AND DOCUMENTATION BY THE BOARD/COMMITTEE MEMBERS AND THE USE OF INDEPENDENT CONSULTING EVERY 3 YEARS. THE BOARD REVIEWS COMPENSATION FOR THESE INDIVIDUALS ANNUALLY.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THE FORM 990.
FORM 990, PART VII, SECTION A:THE FOLLOWING INDIVIDUALS DEVOTED TIME PROVIDING SERVICES TO RELATED ORGANIZATIONS. GARY EVANS 2 HOURS PER WEEK JAN BROSNHAN 2 HOURS PER WEEK SCOTT BIESANZ 2 HOURS PER WEEK SCOTT BIRDSALL, MD 2 HOURS PER WEEK MATTHEW BROGHAMMER, MD 2 HOURS PER WEEK VICKI DECKER 2 HOURS PER WEEK RICHARD FERRIS, MD 2 HOURS PER WEEK JIM KILLIAN 2 HOURS PER WEEK HERB HIGHUM 2 HOURS PER WEEK RICK IGLESIAS 2 HOURS PER WEEK KEN MOGREN 3 HOURS PER WEEK HUGH MILLER 2 HOURS PER WEEK KIM SCHWAB 2 HOURS PER WEEK DANIEL PARKER, MD 2 HOURS PER WEEK MARK WAGNER 2 HOURS PER WEEK STEVE BLUE 3 HOURS PER WEEK RACHELLE HEISING-SCHULTZ 6 HOURS PER WEEK MICHAEL ALLEN 6 HOURS PER WEEK
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 650,050.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
WINONA SENIOR SERVICES INC
855 MANKATO AVENUEWINONAMN55987411936536LONG-TERM CAREMN501(C)(3)LINE 3WINONA HEALTH SERVICES1
WINONA HEALTH FOUNDATION
855 MANKATO AVENUEWINONAMN55987411879744FUNDRAISINGMN501(C)(3)LINE 7WINONA HEALTH SERVICES1
WINONA HEALTH PHYSICIAN CLINICS
420 E SARNIAWINONAMN55987411767741HEALTH CARE SERVICESMN501(C)(3)LINE 90N/A

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1PARKVIEW PHARMACYBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1825 MANKATO AVENUEAddressLine1
CityWINONACity
StateMNState
ZIP Code55987ZIPCode
FieldValueIRS element (for citing)
EIN411552964EIN
Primary ActivityPHARMACYPrimaryActivity
Legal Domicile StateMNLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1WINONA HEALTH SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Share Of Total Income6026ShareOfTotalIncome
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (7 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
WINONA SENIOR SERVICES INC
N100072DUE TO/FROM NET CHANGE IN BALANCE
WINONA SENIOR SERVICES INC
R9787278DUE TO/FROM NET CHANGE IN BALANCE
WINONA SENIOR SERVICES INC
Q9765488DUE TO/FROM NET CHANGE IN BALANCE
WINONA HEALTH FOUNDATION
C347100DUE TO/FROM NET CHANGE IN BALANCE
WINONA HEALTH FOUNDATION
N153711DUE TO/FROM NET CHANGE IN BALANCE
WINONA HEALTH FOUNDATION
Q747028DUE TO/FROM NET CHANGE IN BALANCE
WINONA HEALTH FOUNDATION
R1218596DUE TO/FROM NET CHANGE IN BALANCE

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