ST CROIX REGIONAL MEDICAL CENTER: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- ST CROIX REGIONAL MEDICAL CENTER (EIN 39-0890676)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-02-01
- IRS object ID
- 201320329349300977
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-02-01T15:29:39-06:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390890676 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CROIX REGIONAL MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | STCR | NameControl |
| Phone | 7154830556 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1 |
| City | ST CROIX FALLS | City |
| State | WI | State |
| ZIP Code | 54024 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN TREMBLE | Name |
| Title | CFO & VP | Title |
| Phone | 7154830556 | Phone |
| Date Signed | 2013-01-28 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KOREY BOELTER | Name |
| PTIN | P00775161 | PTIN |
| Phone | 6123764500 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVE DOBOSENSKI | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1 |
| City | ST CROIX FALLS | City |
| State | WI | State |
| ZIP Code | 54024 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 72054291 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SCRMC.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1954 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE QUALITY HEALTHCARE SERVICES TO ALL RESIDENTS OF THE SERVICE AREA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 555 | TotalNbrEmployees |
| Total Nbr Volunteers | 139 | TotalNbrVolunteers |
| Total Gross UBI | 143 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 96022 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 55060 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 60408797 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 65202932 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 57660 | InvestmentIncomePriorYear |
| Investment Income Current Year | 172182 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 267021 | OtherRevenuePriorYear |
| Other Revenue Current Year | 851058 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 60829500 | TotalRevenuePriorYear |
| Total Revenue Current Year | 66281232 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 24000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 20000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 23744186 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 24030427 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 35650284 | OtherExpensePriorYear |
| Other Expenses Current Year | 39246411 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 59418470 | TotalExpensesPriorYear |
| Total Expenses Current Year | 63296838 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1411030 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2984394 | RevenuesLessExpensesCY |
| Total Assets BOY | 42744679 | TotalAssetsBOY |
| Total Assets EOY | 48531694 | TotalAssetsEOY |
| Total Liabilities BOY | 25094130 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 27596751 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 17650549 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 20934943 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE MISSION OF SCRMC IS TO PROVIDE THE HIGHEST QUALITY, ACCESSIBLE, INTEGRATED, COST EFFECTIVE CARE FOR INDIVIDUALS AND FAMILIES SERVED. | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 43387226 | Expense |
| Grants | 0 | Grants |
| Revenue | 48775783 | Revenue |
| Description | OUTPATIENT SERVICES - SURGICAL, LABORATORY, BASIC, AND ADVANCED RADIOLOGY PROCEDURES. PRIMARY AND SPECIALITY CARE FOR AMBULATORY PATIENTS AT FOUR SERVICE SITES. DURING FISCAL YEAR 2012, THERE WERE 98,837 OUTPATIENT VISITS, 7,428 EMERGENCY ROOM VISITS RECORDED, 1,689 OUTPATIENT SURGERIES, AND 212,992 LAB TESTS COMPLETED. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 13386384 | Expense |
| Grants | 20000 | Grants |
| Revenue | 15012061 | Revenue |
| Description | INPATIENT SERVICES - OBSTETRIC, MEDICAL-SURGICAL, INTENSIVE CARE, AND SHORT STAY INPATIENT CARE. DURING FISCAL YEAR 2012, THERE WERE 268 BIRTHS, 1,623 INPATIENT ADMISSIONS, AND A TOTAL OF 4,535 INPATIENT DAYS FOR AN AVERAGE LENGTH OF STAY OF 2.79 DAYS. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1078197 | Expense |
| Grants | 0 | Grants |
| Revenue | 1415088 | Revenue |
| Description | CONTRACT PHARMACY - ST. CROIX REGIONAL MEDICAL CENTER BECAME ELIGIBLE TO PARTICIPATE IN THE 340B DRUG PRICING PROGRAM, WHICH IS MANAGED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OFFICE OF PHARMACY AFFAIRS (OPA), RESULTING IN THE REALIZATION OF A CONTRACT PHARMACY SERVICE. PARTICIPATION IN THE 340B DRUG PRICING PROGRAM RESULTS IN SIGNIFICANT SAVINGS, ESTIMATED TO BE 20-50%, ON THE COST OF PHARMACEUTICALS FOR USE BY OUTPATIENTS OF THE FACILITY. THROUGH THIS PROGRAM, ST. CROIX REGIONAL MEDICAL CENTER IS ABLE TO REACH MORE ELIGIBLE PATIENTS AND PROVIDE MORE COMPREHENSIVE SERVICES. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 57851807 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 1 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 43 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 555 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Own Website | X | OwnWebsite |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JOHN TREMBLE CFO VP | NamePerson |
| Telephone Number | 7154830317 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1 |
| City | ST CROIX FALLS | City |
| State | WI | State |
| ZIP Code | 54024 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| HARLEN HEGDAL | ||||||||
| CHAIR | 4.00 | X | X | 550 | 0 | 0 | ||
| MARSHA BEYER MD | ||||||||
| VICE CHAIR/CONTRACTED RVMC PROVIDER | 2.00 | X | X | 0 | 0 | 0 | ||
| LARRY COLLINS | ||||||||
| TREASURER | 3.00 | X | X | 650 | 0 | 0 | ||
| CLYDE VAN OORT | ||||||||
| SECRETARY | 2.00 | X | X | 275 | 0 | 0 | ||
| STEVE TESCH | ||||||||
| TRUSTEE | 2.00 | X | 250 | 0 | 0 | |||
| JEFF HALL MD | ||||||||
| TRUSTEE/CONTRACTED RVMC PROVIDER | 2.00 | X | 0 | 0 | 0 | |||
| JEANINE BRUNCLIK MD | ||||||||
| TRUSTEE/CONTRACTED RVMC PROVIDER | 2.00 | X | 0 | 0 | 0 | |||
| WILLIAM SCHULTZ MD | ||||||||
| TRUSTEE/CONTRACTED RVMC PROVIDER | 2.00 | X | 0 | 0 | 0 | |||
| CARLA GOETZ | ||||||||
| TRUSTEE | 2.00 | X | 175 | 0 | 0 | |||
| JOHN TREMBLE | ||||||||
| CFO & VP | 40.00 | X | 171397 | 0 | 14248 | |||
| DAVE DOBOSENSKI | ||||||||
| CEO | 40.00 | X | 220106 | 0 | 16293 | |||
| CLAUDIO NUNES | ||||||||
| PHYSICIAN | 40.00 | 369360 | 0 | 31031 | X | |||
| GURDESH BEDI | ||||||||
| PHYSICIAN | 40.00 | 413486 | 0 | 22390 | X | |||
| JOHN INGALLS | ||||||||
| PHYSICIAN | 40.00 | 251431 | 0 | 14249 | X | |||
| GEOFFERY GORES | ||||||||
| PHYSICIAN | 40.00 | 231145 | 0 | 2165 | X | |||
| THOMAS HINCK | ||||||||
| PHYSICIAN | 40.00 | 230518 | 0 | 14764 | X | |||
| LENNY LIBIS | ||||||||
| RETIRED CEO | 0.00 | 101548 | 0 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1990891 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 115140 | TotalOtherCompensation |
| Number Individuals GT100 K | 8 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| RIVER VALLEY MEDICAL CENTER | |||||
| 208 SOUTH ADAMS STREET | ST CROIX FALLS | WI | 54024 | PHYSICIAN SERVICES | 9008203 |
| HEALTH PARTNERSREGIONS | |||||
| PO BOX 64059 | ST PAUL | MN | 55164 | PHYSICIAN SERVICES | 1040847 |
| ST CROIX VALLEY ANESTHESIA | |||||
| 2196 84TH AVENUE | OSCEOLA | WI | 54020 | CRNA SERVICES | 988136 |
| VOYAGEUR RADIOLOGY LLC | |||||
| 9975 DELLWOOD ROAD | STILLWATER | MN | 55082 | RADIOLOGIST SERVICES | 980251 |
| MARKET & JOHNSON INC | |||||
| 2350 GALLOWAY STREET | EAU CLAIRE | WI | 54703 | GENERAL CONSTRUCTION CONTRACTOR | 507310 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 26 | NumberOfContractorsGT100K |
| All Other Contributions | 55060 | AllOtherContributions |
| Total Contributions | 55060 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| PATIENT SERVICES | 624100 | 63567507 | 63567507 | |
| CONTRACT PHARMACY | 624100 | 1415088 | 1415088 | |
| CAFETERIA MEAL SALES | 722210 | 220337 | $220,337 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 65202932 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 162897 | TotalRevenueColumn |
| Exclusion | $162,897 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 22178 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 7412 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 14766 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14766 | TotalRevenueColumn |
| Exclusion | $14,766 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 5774932 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 5765647 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 9285 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9285 | TotalRevenueColumn |
| Exclusion | $9,285 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| MISCELLANEOUS | 900099 | 445120 | $445,120 |
| JOINT VENTURE REVENUE | 900099 | 208448 | $208,448 |
| EHR PAYMENT | 900099 | 128165 | $128,165 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 54559 | TotalRevenueColumn |
| Unrelated Business Revenue | 143 | UnrelatedBusinessRevenue |
| Exclusion | $54,416 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 836292 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 66281232 | TotalRevenueColumn |
| Related Or Exempt Function Income | 64982595 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 143 | UnrelatedBusinessRevenue |
| Exclusion | $1,243,434 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20000 | Total |
| Program Services | 20000 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 402075 | Total |
| Management And General | 402075 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17591620 | Total |
| Program Services | 15147709 | ProgramServices |
| Management And General | 2443911 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 965731 | Total |
| Program Services | 849531 | ProgramServices |
| Management And General | 116200 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3706019 | Total |
| Program Services | 3260099 | ProgramServices |
| Management And General | 445920 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1364982 | Total |
| Program Services | 1200743 | ProgramServices |
| Management And General | 164239 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 201596 | Total |
| Management And General | 201596 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 57403 | Total |
| Management And General | 57403 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19460426 | Total |
| Program Services | 18900455 | ProgramServices |
| Management And General | 559971 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12100 | Total |
| Program Services | 4217 | ProgramServices |
| Management And General | 7883 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8488736 | Total |
| Program Services | 8438555 | ProgramServices |
| Management And General | 50181 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 815152 | Total |
| Program Services | 741875 | ProgramServices |
| Management And General | 73277 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1842045 | Total |
| Program Services | 1692253 | ProgramServices |
| Management And General | 149792 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 121381 | Total |
| Program Services | 105960 | ProgramServices |
| Management And General | 15421 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 111635 | Total |
| Program Services | 82986 | ProgramServices |
| Management And General | 28649 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 472436 | Total |
| Program Services | 432279 | ProgramServices |
| Management And General | 40157 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3274944 | Total |
| Program Services | 2996574 | ProgramServices |
| Management And General | 278370 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 186630 | Total |
| Program Services | 185048 | ProgramServices |
| Management And General | 1582 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBTS | 1943000 | 1943000 | |
| OTHER EXPENSES | 1897700 | 1717521 | 180179 |
| DUES AND FEES | 125123 | 80703 | 44420 |
| EQUIP RENTAL AND MAINT | 124379 | 52299 | 72080 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 111725 | Total |
| Management And General | 111725 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63296838 | Total |
| Program Services | 57851807 | ProgramServices |
| Management And General | 5445031 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2594019 | BOY |
| EOY | 5803309 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2077468 | BOY |
| EOY | 1698119 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8674927 | BOY |
| EOY | 9164690 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 105000 | BOY |
| EOY | 174084 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1108768 | BOY |
| EOY | 1140192 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 208356 | BOY |
| EOY | 221040 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 48725557 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 23370898 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23653502 | BOY |
| EOY | 25354659 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3116138 | BOY |
| EOY | 3001739 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 460072 | BOY |
| EOY | 1200815 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 746429 | BOY |
| EOY | 594881 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 178166 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42744679 | BOY |
| EOY | 48531694 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12344112 | BOY |
| EOY | 15803330 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12084579 | BOY |
| EOY | 10807239 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 665439 | BOY |
| EOY | 986182 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25094130 | BOY |
| EOY | 27596751 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17650549 | BOY |
| EOY | 20934943 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17650549 | BOY |
| EOY | 20934943 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42744679 | BOY |
| EOY | 48531694 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2984394 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 300000 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 1 | AgentTrusteeEtc |
| Beginning Balance | 9292 | BeginningBalance |
| Additions During Year | 54011 | AdditionsDuringYear |
| Distributions During Year | 43053 | DistributionsDuringYear |
| Ending Balance | 20250 | EndingBalance |
| Included On FS | 0 | IncludedOnFS |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 900672 | OtherCostOrOtherBasis |
| Book Value | 900672 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 25293626 | OtherCostOrOtherBasis |
| Depreciation | 10650988 | Depreciation |
| Book Value | 14642638 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 779778 | OtherCostOrOtherBasis |
| Depreciation | 489561 | Depreciation |
| Book Value | 290217 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19126229 | OtherCostOrOtherBasis |
| Depreciation | 12230349 | Depreciation |
| Book Value | 6895880 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2625252 | OtherCostOrOtherBasis |
| Book Value | 2625252 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 25354659 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEFERRED COMPENSATION PLAN | $756,782 |
| ASSET RETIREMENT OBLIGATION | $229,400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 986182 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART IV, LINE 1B: | ST. CROIX REGIONAL MEDICAL CENTER IS AN AGENT FOR A CHECKING ACCOUNT THAT HOUSES FUNDS FOR THE WEST CENTER REGIONAL TRAUMA ADVISORY COUNCIL. THE MONIES ARE USED TO FUND TRAUMA TRAINING FOR THOSE PARTICIPATING HOSPITALS WITHIN THE COUNCIL. | |
| PART X: | THE MEDICAL CENTER IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE MEDICAL CENTER IS ALSO EXEMPT FROM STATE INCOME TAXES. THE MEDICAL CENTER'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. THE MEDICAL CENTER IS NOT AWARE OF ANY ADDITIONAL ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES THAN ARE CURRENTLY FILED IN THE TAX RETURN. THE TAX RETURNS FOR THE YEARS 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL AND STATE AUTHORITIES. THE MEDICAL CENTER HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE MEDICAL CENTER FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1086538 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1086538 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01770 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8623321 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5972306 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2651015 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04320 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9709859 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5972306 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3737553 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06090 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 54225 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 54225 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 54225 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 54225 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9764084 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5972306 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3791778 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06180 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 44 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 7512 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7512 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 14341 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 14341 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 209462 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 209462 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00340 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 47657 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 47657 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 47 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 278972 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 278972 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00450 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,943,000 | BadDebtExpenseAmount |
| Amount Attributable To | 1046645 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 16603432 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 16446689 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 156743 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CROIX REGIONAL MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 STATE STREET | AddressLine1 |
| City | ST CROIX FALLS | City |
| State | WI | State |
| ZIP Code | 54024 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CROIX REGIONAL MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 250.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 4 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (4 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| FREDERIC CLINIC | ||||
| 107 OAK STREET E | FREDERIC | WI | 54837 | PROVIDER BASED CLINIC |
| INGALLS CLINIC | ||||
| 7456 MAIN STREET | WEBSTER | WI | 54893 | PROVIDER BASED CLINIC |
| UNITY CLINIC | ||||
| 1482 190TH AVE | BALSAM LAKE | WI | 54024 | FREE STANDING CLINIC |
| ST CROIX FALLS CLINIC | ||||
| 235 STATE STREET | ST CROIX FALLS | WI | 54024 | PROVIDER BASED CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: ST CROIX REGIONAL MEDICAL CENTER, THROUGH ITS PATIENT ADVOCATES, EVALUATES EACH APPLICANT'S SITUATION IN ACCORDANCE WITH CRITERIA ESTABLISHED ANNUALLY BY THE BOARD OF DIRECTORS. THE CRITERIA INCLUDES:1. INDIVIDUAL OR FAMILY INCOME2. FAMILY SIZE3. OTHER SOURCES OF PAYMENT FOR SERVICES4. INDIVIDUAL OR FAMILY ASSETSQUALIFICATION IS BASED ON ASSET LEVELS ESTABLISHED BY MEDICAL ASSISTANCE, FAMILY SIZE, AND INCOME LEVELS BASED ON 150% OF FEDERALPOVERTY GUIDELINES AS PUBLISHED ANNUALLY BY THE FEDERAL GOVERNMENT.GRANTING OF COMMUNITY CARE - AMOUNT:PATIENTS THAT QUALIFY FOR ST CROIX REGINAL MEDICAL CENTER'S CHARITY CARE PROGRAM WILL RECEIVE 100% OF THEIR ACCOUNT BALANCE APPLIED TO THE FUND.GRANTING OF COMMUNITY CARE - TERM:PATIENTS THAT QUALIFY FOR ST CROIX REGINAL MEDICAL CENTER'S CHARITY CARE PROGRAM WILL RECEIVE COMMUNITY CARE FOR A SPECIFIC HOSPITALIZATION OR FOR A SPECIFIED COURSE OF TREATMENT.ALL PATIENTS RECEIVEING CHARITY CARE MUST RE-APPLY IF THEIR STATUS CHANGES OR THE TREATMENT DURATION HAS ENDED. | ||
| PART I, LINE 6A: ST. CROIX REGIONAL MEDICAL CENTER PARTICIPATES IN AN ANNUAL COMMUNITY BENEFIT REPORT PRODUCED BY THE WISCONSIN HOSPITAL ASSOCIATION. | ||
| PART I, L7 COL(F): BAD DEBT EXPENSES OF $1,943,000 WERE SUBTRACTED FROM THE TOTAL EXPENSES OF $63,296,838 IN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F. | ||
| PART II: THE ORGANIZATION PROVIDES DIRECT SUPPORT TO OVER 48 COMMUNITY ACTIVITIES, PROVIDES OVER 18,000 HOURS OF VOLUNTEER TIME IN INDIRECT PATIENT CARE ACTIVITIES, AND OVER 400 HOURS OF EDUCATION FOR HEALTHCARE PROFESSIONALS. | ||
| PART III, LINE 4: FROM THE PATIENT ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS PARAGRAPH IN NOTE 1 TO THE AUDITED FINANCIAL STATEMENTS:"PATIENTS ARE NOT REQUIRED TO PROVIDE COLLATERAL FOR SERVICES RENDERED. PAYMENT FOR SERVICES IS REQUIRED UPON RECEIPT OF AN INVOICE, AFTER PAYMENT OF INSURANCE, IF ANY. SELF-PAY ACCOUNTS ARE ANALYZED FOR COLLECTIBILITY BASED ON THE MONTHS PAST DUE AND PAYMENT HISTORY. AN ALLOWANCE IS ESTIMATED FOR THESE ACCOUNTS BASED ON THE HISTORICAL EXPERIENCE OF THE MEDICAL CENTER. ACCOUNTS THAT ARE DETERMINED TO BE UNCOLLECTIBLE ARE SENT TO A COLLECTION AGENCY AND WRITTEN OFF AT THAT TIME." | ||
| PART III, LINE 8: THE MEDICAL CENTER PROVIDES CARE TO INDIVIDUALS WHERE GOVERNMENT DEPARTMENTS DETERMINE THE AMOUNT OF REIMBURSEMENT OF SERVICE REGARDLESS OF THE COST TO PROVIDE THE SERVICE. AMOUNTS REIMBURSED BY GOVERNMENT PAYORS ARE ESTIMATED TO BE LESS THAN THE COSTS TO PROVIDE THE SERVICES AS FOLLOWS:MEDICAID- WISCONSIN $2,482,800MEDICAID- MINNESOTA $225,800CHAMPUS AND VA $35,400MEDICARE - PHYSICIAN $3,846,200MEDICARE - HOSPITAL $33,300MEDICARE ADVANTAGE $435,200ALL GOVERNMENT PAYORS $7,058,700 TOTAL CHARITY CARE, UNCOMPENSATED CARE AND UNDER COMPENSATED CARE BY GOVERNMENT PAYORS WAS $7,512,00. THIS REPRESENTS 12.0% OF NET OPERATING REVENUES OF THE MEDICAL CENTER.ALL AMOUNTS IN LINE 6 WERE DERIVED FROM THE FILED 2012 MEDICARE COST REPORT. | ||
| PART III, LINE 9B: THE MEDICAL CENTER HAS ESTABLISHED GUIDELINES FOR THE PROVISION OF HEALTH SERVICES AT REDUCED COSTS FOR INDIVIDUALS BASED UPON THEIR INCOME AND OTHER CIRCUMSTANCES. THE MEDICAL CENTER HAS A POLICY TO PROVIDE AN IMMEDIATE DISCOUNT TO ALL UNINSURED PATIENTS OF 10% OF CHARGES. | ||
| PART V, SECTION B, LINE 17E: THE PATIENT WILL FIRST RECEIVE 2 BILLS FROM ST. CROIX REGIONAL MEDICAL CENTER. IF NO PAYMENT IS MADE AFTER 60 DAYS, THEN OUR PATIENT ADVOCATES CALL THE PATIENT LOOKING FOR PAYMENT. TWO PHONE CALLS ARE MADE BEFORE FURTHER COLLECTION EFFORTS ARE INITIATED. | ST. CROIX REGIONAL MEDICAL CENTER | |
| PART V, SECTION B, LINE 19D: ST. CROIX REGIONAL MEDICAL CENTER USED THE AVERAGE PPO NEGOTIATED RATE AS THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. | ST. CROIX REGIONAL MEDICAL CENTER | |
| PART VI, LINE 2: OVERALL MARKETPLACE DEMOGRAPHICS AND COMPETITIVE ANALYSIS IS CONDUCTED ON A REGULAR BASIS. WHEN DEMAND FOR NEW SERVICE LINES IS INTENSIFIED, THEY ARE ADDED SLOWLY UNTIL DEMAND CAPACITY REACH CRITICAL LEVELS. | ||
| PART VI, LINE 3: ALL PATIENTS HAVE ACCESS TO WRITTEN MATERIALS AND PAMPHLETS AT OR NEAR THE POINT OF REGISTRATION. IN ADDITION, PATENTS HAVE ACCESS TO PATIENT ADVOCATES WITH FULL KNOWLEDGE OF RESOURSES AVAILABLE. | ||
| PART VI, LINE 4: THE ORGANIZATION SERVES A GEOGRAPHIC AREA OF APPROXIMATELY 300 SQUARE MILES IN WESTERN WISCONSIN THAT INCLUDES THE TOWNS OF ST CROIX FALLS, BALSAM LAKE, LUCK, MILLTOWN, FREDERIC, AND GRANTSBERG IN WISCONSIN AND TAYLORS FALLS AND LINDSTROM IN EASTERN MINNESOTA. | ||
| PART VI, LINE 6: THE CENTER IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. | ||
| WI | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | SCHOLARSHIPS | TypeOfGrant |
| Number Of Recipients | 20 | NumberOfRecipients |
| Amount Of Cash Grant | 20000 | AmountOfCashGrant |
| Amount Of Non Cash Assistance | 0 | AmountOfNonCashAssistance |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: THE ORGANIZATION'S PROCEDURES INCLUDE SUBSTANTIATION OF EXPENSES, GRADES, TRANSCRIPTS AND RECEIPTS, AS WELL AS FOLLOW UP WITH COMMUNITY ORGANIZATIONS AND LEADERS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN TREMBLE | |||||||||||||
| 151360 | 0 | 20037 | 0 | 0 | 0 | 9357 | 0 | 4891 | 0 | 185645 | 0 | 0 | 0 |
| DAVE DOBOSENSKI | |||||||||||||
| 220106 | 0 | 0 | 0 | 0 | 0 | 13695 | 0 | 2598 | 0 | 236399 | 0 | 0 | 0 |
| CLAUDIO NUNES | |||||||||||||
| 369360 | 0 | 0 | 0 | 0 | 0 | 16500 | 0 | 14531 | 0 | 400391 | 0 | 0 | 0 |
| GURDESH BEDI | |||||||||||||
| 413486 | 0 | 0 | 0 | 0 | 0 | 16500 | 0 | 5890 | 0 | 435876 | 0 | 0 | 0 |
| JOHN INGALLS | |||||||||||||
| 251431 | 0 | 0 | 0 | 0 | 0 | 13748 | 0 | 501 | 0 | 265680 | 0 | 0 | 0 |
| GEOFFERY GORES | |||||||||||||
| 231145 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2165 | 0 | 233310 | 0 | 0 | 0 |
| THOMAS HINCK | |||||||||||||
| 230518 | 0 | 0 | 0 | 0 | 0 | 12816 | 0 | 1948 | 0 | 245282 | 0 | 0 | 0 |
| LENNY LIBIS | |||||||||||||
| 0 | 0 | 0 | 0 | 101548 | 0 | 0 | 0 | 0 | 0 | 101548 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 4B | CONTRIBUTIONS TO A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: JOHN TREMBLE $20,037 CINDY LUNDMARK $14,758 LAURA JENSEN $17,487 | |
| PART I, LINE 6 | ANNUAL EMPLOYER CONTRIBUTIONS TO THE 457F PLAN ARE CONDITIONED UPON ATTAINING CERTAIN PRE-SET GOALS AND ARE CONTINGENT ON APPROVAL BY THE BOARD OF DIRECTORS. THE AWARD IS BASED ON TWO COMPONENTS - LONGEVITY AND PERFORMANCE. PERFORMANCE IS BASED ON MEETING 3 GOALS - NET REVENUE, NET MARGIN AND NET ASSETS. | |
| PART III | COMPENSATION REPORTED TO LENNY LEBIS IS THE RESULT OF THE PRIOR EMPLOYEE CHOOSING TO HAVE THE DISTRIBUTION FROM THEIR 457 SAVINGS PLAN BE DISTRIBUTED FROM THE AGENT HOLDING THEIR FUNDS TO SCRMC. SCRMC DEPOSITS THE DISTRIBUTION AND THEN PAYS THE PRIOR EMPLOYEE THROUGH THE PAYROLL PROCESS, WITHHOLDING FEDERAL AND STATE INCOME TAXES ON THE DISTRIBUTION. THESE TRANSACTION DO NOT RESULT IN SCRMC HAVING ANY ADDITIONAL EXPENSE. THIS DISTRIBUTION IS THE RESULT OF SAVINGS THE FORMER EMPLOYEE DID WHILE AN EMPLOYEE OF SCRMC. AT THE TIME SAVINGS WERE SET ASIDE, THEY WERE REPORTED ON THE 990 TAX RETURN. | SUPPLEMENTAL INFORMATION |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|
| POLK COUNTY | ||||||
| 396005730 | 2006-05-11 | 13000000 | REFUND SERIES 2000 BONDS, FACILITY CONSTRUCTION AND EQUIPMENT PURCHASES | 0 | 0 | 0 |
| POLK COUNTY | ||||||
| 396005730 | 2006-12-27 | 3683432 | FACILITY CONSTRUCTION | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|
| 5081575 | 13000000 | 13000000 | 2008 | 0 | 0 | 1 | 1 |
| 1154590 | 3683432 | 3683432 | 2008 | 0 | 0 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|
| 1 | 1 | 0 | 0 | 1 |
| 0 | 0 | 0 | 0 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 1 |
| 0 | 0 | 0 | 0 | 0 | 1 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIVER VALLEY MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | FOUR OWNER SERVE ON THE BOARD OF DIRECTORS OF SCRMC | Relationship |
| Amount Of Transaction | 9008203 | AmountOfTransaction |
| Description Of Transaction | PHYSICIAN SERVICES | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | FORM 990, PART IV | Identifier |
| Return Reference | FOUR OWNERS OF RVMC | ReturnReference |
| Explanation | THE FOUR OWNERS OF RVMC INCLUDE MARSHA BEYER, JEFF HALL, JEANINE BRUNCLIK, WILLIAM SCHULTZ. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| NEW PROGRAM SERVICES | FORM 990, PART III, LINE 2 | ST. CROIX VALLEY EMERGENCY MEDICAL SERVICES, INC. (SCV EMS) WAS FORMED THROUGH A PARTNERSHIP WITH WESTERN WISCONSIN EMS AND LAKES REGION EMS IN AUGUST, 2011. SCV EMS PROVIDES EFFICIENT AMBULANCE SERVICE TO THE LOCAL COMMUNITIES WITHIN WESTERN WISCONSIN BETTER SERVING THE PATIENT POPULATION. |
| FORM 990, PART VI, SECTION A, LINE 1 | ST. CROIX REGIONAL MEDICAL CENTER HAS AN EXECUTIVE COMMITTEE WITH BROAD AUTHORITY TO ACT ON BEHALF OF ITS BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE INCLUDES THE CHAIR, VICE CHAIR, SECRETARY, TREASURER AND ONE OTHER DIRECTOR FROM THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE HAS POWER TO TRANSACT ALL REGULAR BUSINESS OF THE ORGANIZATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PERIOD LIMITATION IMPOSED BY THE BOARD OF DIRECTORS AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION A, LINE 6 | ST. CROIX REGIONAL MEDICAL CENTER HAS TWO CLASSES OF MEMBERS - SPONSORING MEMBERS, WHICH INCLUDES BOTH INDIVIDUALS AND CORPORATIONS, AND PROVIDER ELECTORS. INDIVIDUALS AND CORPORATIONS MAY BECOME SPONSORING MEMBERS THROUGH DONATIONS OF A SPECIFIED AMOUNT TO THE MEDICAL CENTER. INDIVIDUALS MAY BECOME PROVIDER ELECTORS BY PROVIDING SERVICES AT ST. CROIX REGIONAL MEDICAL CENTER THROUGH SPECIFIED EMPLOYMENT CONDITIONS. | |
| FORM 990, PART VI, SECTION A, LINE 7A | PROVIDER ELECTORS VOTE IN THE ELECTION OF FOUR PROVIDER DIRECTORS. SPONSORING MEMBERS, INCLUDING INDIVIDUALS AND CORPORATIONS, VOTE IN THE ELECTION OF FIVE COMMUNITY DIRECTORS. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBERS VOTE ON THE AUDITORS EMPLOYED TO AUDIT THE BOOKS OF THE MEDICAL CENTER AND TO PREPARE AN ANNUAL REPORT. AN OPS COUNCIL, CONSISTING OF FIVE INDIVIDUALS APPOINTED BY RIVER VALLEY MEDICAL CENTER, A RELATED ORGANIZATION, HAS SIGNIFICANT OVERSIGHT AUTHORITY AT THE MEDICAL CENTER. THE OPS COUNCIL'S AUTHORITY INCLUDES, BUT IS NOT LIMITED TO, REVIEW AND APPROVE OF ALL POLICIES AND PROCEDURES AS THEY RELATE TO MEDICAL OPERATIONS AND RECCOMMENDATION OF THE ANNUAL CAPITAL AND OPERATING BUDGETS TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WENT THROUGH THE FOLLOWING REVIEW PROCESS BEFORE FILING WITH THE IRS: (A) A DETAILED REVIEW WAS CONDUCTED BY THE ORGANIZATION'S CFO, (B) THE FORM 990 WAS PRESENTED FOR REVIEW AND APPROVAL TO THE ORGANIZATION'S FINANCE COMMITTEE IN NOVEMBER 2012, AND (C) THE ORGANIZATION'S BOARD OF DIRECTORS REVIEWED AND APPROVED THE FORM 990. | |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERSHIP IS CONTINGENT UPON ANNUAL DISCOSURE OF POTENTIAL AND ACTUAL CONFLICTS OF INTEREST. THE DERTERMINATION IS MADE AT THE BOARD LEVEL AND ALL BOARD MEMBERS MUST CERTIFY ANNUALLY. IF A BOARD MEMBER HAS A CONFLICT, THEY REFRAIN FROM VOTING OR PARTICIPATING IN DISCUSSIONS CONCERNING THAT TOPIC. | |
| FORM 990, PART VI, SECTION B, LINE 15A | CEO - ANNUAL PERFORMANCE AND SALARY REVIEW IS CONDUCTED BY THE BOARD OF DIRECTORS USING SUCH OUTSIDE INFORMATION AS DEEMED NECESSARY. REVIEWS ARE CONDUCTED EACH JUNE. THE PROCESS LAST INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2012. OTHER OFFICERS - THE HUMAN RESOURCE DEPARTMENT CONDUCTS OUTSIDE RESEARCH TO DETERMINE REASONABLE COMPENSATION. THE CEO THEN DETERMINES THE COMPENSATION OF THESE INDIVIDUALS. REVIEWS ARE CONDUCTED EACH JUNE. THIS PROCESS LAST OCCURED IN FISCAL YEAR 2012. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE MEDICAL CENTER'S GOVERING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 5: | UNITY PHARMACY NET ASSETS 300,000. TOTAL TO FORM 990, PART XI, LINE 5: 300,000. |
| REIMBURSEMENTS FOR PHYSICIAN SERVICES | SCHEDULE L, PART IV AND SCHEDULE R, PART V, LINE 1O | ST. CROIX REGIONAL MEDICAL CENTER REIMBURSES RIVER VALLEY MEDICAL CENTER (RVMC), FOR PHYSICIAN SERVICES PROVIDED BY EMPLOYEES OF RVMC. ALL PAYMENTS ARE "GROSS", MEANING THAT THEY INCLUDE UNIDENTIFIED AMOUNTS FOR BENEFITS AND MALPRACTICE INSURANCE, AS WELL AS W-2 COMPENSATION. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UNITY PHARMACY LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1504 190TH AVENUE SUITE 100 | AddressLine1 |
| City | BALSAM LAKE | City |
| State | WI | State |
| ZIP Code | 54810 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 454471131 | EIN |
| Primary Activities | PHARMACEUTICALS | PrimaryActivities |
| Legal Domicile State | WI | LegalDomicileState |
| Total Income | 0 | TotalIncome |
| EOY Assets | 343425 | EOYAssets |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CROIX REGIONAL MEDICAL CENTER | BusinessNameLine1 |
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| ST CROIX VALLEY EMERGENCY MEDICAL SERVICES INC | ||||||||||
| 235 EAST STATE STREET | ST CROIX FALLS | WI | 54024 | 452872803 | TO LEASE, MAINTAIN, AND OPERATE AN EMERGENCY AMBULANCE SERVICE. | WI | 501(C)(3) | LINE 9 | ST CROIX REGIONAL MEDICAL CENTER | 1 |
| CANCER CENTER OF WESTERN WISCONSIN | ||||||||||
| 501 HOSPITAL ROAD | NEW RICHMOND | WI | 54017 | 273238660 | TO PROVIDE CARE TO CANCER PATIENTS. | WI | 501(C)(3) | LINE 9 | ST CROIX REGIONAL MEDICAL CENTER | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CROIX VALLEY EMS INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | Q | TransactionType |
| Amount Involved | 150200 | AmountInvolved |
| Method Of Amt Determination | MEMBERSHIP AGREEMENT | MethodOfAmtDetermination |
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